By: H.B. No. A BILL TO BE ENTITLED AN ACT Relating to the licensing and regulation of non-physician allied health professionals known as Neurodiagnostic Technologists and Practitioners; for patient protection, safety and welfare; requiring an occupational license; creating an offense; providing penalties and authorizing fees. BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: SECTION 1. 1 Occupations Code, Title, Subtitle K is amended by adding Chapter 0 to read as follows: 1 OCCUPATIONAL CODE 1 TITLE. HEALTH PROFESSIONS 1 1 SUBTITLE K. PROFESSIONS RELATED TO THE USE OF CERTAIN MEDICAL EQUIPMENT 1 CHAPTER 0. NEURODIAGNOSTIC TECHNOLOGY SUBCHAPTER A. GENERAL PROVISIONS. Sec. 0.001. SHORT TITLE. 0 This chapter may be cited as the Neurodiagnostic Technology Act. Page - 1 -
Sec. 0.00. DEFINITIONS. 1 1 1 1 1 1 0 1 For the purposes of this chapter, the following terms and definitions shall have the following meanings unless otherwise stated within the context of the chapter: (1) SCOPE OF PRACTICE for the field of Neurodiagnostic Technology (NDT) is the recording of physiologic data from the nervous system and reporting the results in a manner consistent with education and credentialing. The scope of practice for NDT includes but is not limited to the following eight () modalities: Electroencephalography (EEG); Magnetoencephalography (MEG); Evoked Potentials (EP); Intraoperative Neuromonitoring (IONM, aka NIOM or IOM); Long Term Monitoring (LTM); Nerve Conduction Studies (NCS); Polysomnography/Sleep Technology (PSG); and Autonomic Reflex Testing (ART). () BOARD means the Texas Medical Board (TMB). The BOARD will determine all recognized qualifications, domestic or international, for licensure. The BOARD reserves the authority to add new approved modalities for emerging technologies associated with NDT. () NATIONAL AND INTERNATIONAL CREDENTIALING ORGANIZATIONS means accrediting organizations recognized by TMB that administers examinations and awards credentials for the modalities of NDT. () CONTINUING EDUCATION UNITS (CEUs) means hours of Page - -
1 1 1 1 1 instruction in NDT courses approved by the BOARD. () EXECUTIVE DIRECTOR means the executive director or presiding officer of the TMB. () LICENSE. A license granted and issued by the BOARD under this Act to perform any of the ND modalities including but not limited to those listed in the scope of practice. () LICENSE HOLDER means a person who has been granted a license and is qualified in one or more modalities as a Neurodiagnostic (ND) Technologist or Practitioner under this act. () PHYSICIAN. A person licensed to practice medicine by the Texas State Board of Medical Examiners. () LICENSED ND PRACTITIONER. Designated as LNDP. A nonphysician, doctoral level person licensed and qualified under this Act to perform IONM with the additional delegated authority to supervise and interpret IONM under the general oversight of a PHYSICIAN. The acceptable doctoral fields of study will be approved 1 by the BOARD. LNDPs are not allowed the deferred licensure 0 1 requirements of section 0.. Doctoral level practitioners only may also use the title Surgical Neurophysiologist. () LICENSED ND TECHNOLOGIST. Designated as LNDT. A nonphysician, non-doctoral level person licensed under this Act and qualified to perform one or more ND modalities under appropriate Board-approved levels of oversight by a PHYSICIAN or a delegated Page - -
1 1 1 1 1 1 0 1 LICENSED ND PRACTITIONER. () LICENSED ND TECHNOLOGIST qualified for EEG. A license holder qualified to perform the EEG modality shall be designated as LNDT(EEG). A technologist licensed in accordance with section 0.1 and not holding the national EEG credential shall be designated as LNDT(EEG-NB). (1) LICENSED ND TECHNOLOGIST qualified for MEG. A license holder qualified to perform the MEG modality shall be designated as LNDT(MEG). A technologist licensed in accordance with section 0. and not holding the national MEG credential shall be designated as LNDT(MEG-NB). (1) LICENSED ND TECHNOLOGIST qualified for EP. A license holder qualified to perform the EP modality shall be designated as LNDT(EP). A technologist licensed in accordance with section 0.1 and not holding a national EP credential shall be designated as LNDT(EP-NB). (1) LICENSED ND TECHNOLOGIST qualified for IONM. A nondoctoral level license holder qualified to perform the IONM modality shall be designated as LNDT(IONM). A person licensed in accordance with section 0. and not holding a national IONM credential shall be designated as LNDT(IONM-NB). These technologists may also use the title IONM Clinician or other titles approved by the BOARD. Page - -
1 1 1 1 1 1 0 1 (1) LICENSED ND TECHNOLOGIST qualified for LTM. A license holder qualified to perform the LTM modality shall be designated as LNDT(LTM). A technologist licensed in accordance with section 0. and not holding a national LTM credential shall be designated as LNDT(LTM-NB). (1) LICENSED ND TECHNOLOGIST qualified for ART. A license holder qualified to perform the ART modality shall be designated as LNDT(ART). A technologist licensed in accordance with section 0.1 and not holding a national ART credential shall be designated as LNDT(ART-NB). (1) LICENSED ND TECHNOLOGIST qualified for NCS. A license holder qualified to perform the NCS modality shall be designated as LNDT(NCS). A technologist licensed in accordance with section 0.1 and not holding a national NCS credential shall be designated as LNDT(NCS-NB). () LICENSED ND TECHNOLOGIST qualified for PSG. A license holder qualified to perform the PSG modality shall be designated as LNDT(PSG). A technologist licensed in accordance with section 0.1 and not holding a national PSG credential shall be designated as LNDT(PSG-NB). () LICENSED ND TECHNOLOGIST qualified for more than one ND modality. A license holder qualified to perform multiple modalities shall be designated as LNDT with the qualified Page - -
1 1 1 1 1 1 0 modalities listed within parenthesis and separated by a forward slash. For example, LNDT(EEG/EP/IONM) designates a LICENSED ND TECHNOLOGIST qualified to perform EEG, EP and IONM. (0) ND TRAINEE. A license holder qualified in one or more ND modalities and is training to obtain a qualification in another modality and is under the personal supervision of a licensed physician, or licensed practitioner and/or licensed technologist qualified in the same modality in which they are being trained. A ND Trainee is not subject to the penalties described in Subchapter G. The position or title of ND Trainee is valid for a length of time to be determined by the BOARD or until the ND Trainee is Board-eligible or release of the passing results of a national certifying examination taken by the applicant. (1) ND STUDENT. An unlicensed person who is either enrolled in a ND educational program or is receiving on the job training may perform ND modalities under the personal supervision of a licensed physician, or licensed practitioner and/or licensed technologist qualified in the same modality in which they are being trained. Sec. 0.00. FULL AND PARTIAL EXEMPTIONS. 1 The following persons performing specific ND test modalities do not require licensure under this act: (1) Any Physician licensed to practice medicine in Texas. Page - -
1 1 1 1 1 1 0 1 () Any Audiology personnel licensed in the State of Texas who do not hold a recognized IONM credential are partially exempt under this act and able to perform the following modalities: Brainstem Auditory Evoked Responses, EMG associated with cranial nerves, Electronystagmography (ENG), and Video ENG. Audiology personnel licensed in the State of Texas who hold a recognized IONM credential qualify for licensure under this act to perform IONM. () Any Physical Therapists (PTs) licensed in the State of Texas who do not hold a recognized NDT credential are partially exempt under this act and able to perform the following modalities: clinical NCS, ENG, and Video ENG. PTs licensed in the State of Texas who hold recognized credentials qualify for licensure under this act to perform any of the ND modalities for they are qualified. () Any unlicensed person performing a ND test modality: (a) for academic research purposes provided the results are not used in treatment and diagnosis of a patient; (b) only under Personal Supervision either as: (i) a ND Student while enrolled in a ND educational program, (ii) or a Trainee or employee as part of the Page - -
1 1 1 1 1 1 employee s job training; or () A faculty member of an accredited medical school, university or any school with a ND, allied health, or health education program. SUBCHAPTER B. POWERS AND DUTIES OF BOARD Sec. 0.01. VERIFICATION OF NATIONAL CREDENTIALS. The BOARD shall administer the credential verification processes. Sec. 0.0. RULES REGARDING IMPLEMENTATION. The BOARD shall adopt rules necessary to implement this chapter. Sec. 0.0. BOARD REPRESENTATION FOR TECHNOLOGISTS AND PRACTITIONERS. The BOARD shall adopt rules to establish a NDT Advisory Committee composed of qualified technologists and practitioners to serve in an advisory and administrative capacity. The Advisory Committee will be responsible for developing a NDT Policy and Procedure Manual that will be used by the Board to properly administer the Texas NDT Act. SUBCHAPTER C. LICENSE REQUIREMENTS. 0 The following specific requirements apply to those seeking a license under this chapter: Sec. 0.1. LICENSE REQUIRED. 1 (1) A person may not act as a ND Technologist or Practitioner unless the person holds a license issued under this chapter. Page - -
() A person who is not licensed under this chapter, or whose license has been suspended or revoked, may not: (a) Use the title "Neurodiagnostic Technologist" or Neurodiagnostic Practitioner on a sign, business card, name tag, or any form of advertising; (b) Use in connection with the person's practice any abbreviations or credentials indicating or implying that the person is a ND technologist or practitioner; or (c) Directly or by implication represent in any way that the person is a ND technologist or practitioner. (d) Use potentially misleading initials after one s 1 1 1 1 name such as ENDT, EEGT, EPT, IOMT, NCST, PSGT or any other such designations not specified or approved by the BOARD. () A license: 1 (a) is not transferable or assignable and valid only 1 with respect to the person named on the license; and (b) authorizes the license holder to perform the ND modality for which the license holder is qualified. 0 Sec. 0.. LICENSING APPLICATION. 1 (1) An applicant for a license must: (a) apply to the Board on a form prescribed under rules adopted by the Board; Page - -
(b) submit with the application a nonrefundable application fee in an amount set by the Board; and (c) be of good moral character - no convictions of felony offenses or crimes of moral turpitude years prior to application. () The BOARD by rule shall specify the information that must be included on the application for licensure. Sec. 0.. LICENSE FEES. 1 1 1 1 1 1 (1) The BOARD by rule shall establish reasonable and necessary fees in amounts sufficient to cover the costs of administering and enforcing this chapter. () The BOARD may increase these fees as deemed necessary. () The BOARD will establish a fixed maximum allowable biennial fee. () The fee will be the same amount per applicant regardless of the number of modalities an individual is qualified to perform. Sec. 0.. QUALIFICATIONS FOR LICENSE. 0 1 (1) In addition to the application requirements in Sec. 0., the Board accepts verification of passing a national credentialing organization(s) examination and maintaining such credentials as a requirement for full licensure. The educational requirements for credentialing Page - -
in the individual ND modalities are the purview of the national board credentialing organizations. () The Board reserves the discretionary power to develop and administer any future examination(s) or prerequisites as determined by rule. () Commencing on July 1, 0, to be licensed as a ND technologist or practitioner, persons must meet the following criteria: (a) Any person maintaining current, unexpired national credentials recognized by the BOARD shall be qualified for a full license by the BOARD; 1 (b) Renewal of license is subject to taking continuing 1 1 education units as specified in Sec. 0.1 of this chapter. 1 1 1 Sec. 0.1. REDUCED LICENSE REQUIREMENT for individuals not holding a national credential but actively engaged in working in clinical EEG, clinical EP, ART, clinical NCS, or PSG at least one year prior to the enactment of the NDT Act. This section does not apply to the IONM, LTM or MEG modalities. 0 1 (1) A person who applies for a license in the modalities under this section not later than July 1, 0, is permanently exempt from the national board examination required under this chapter if the person presents satisfactory evidence to Page - -
1 1 the Board that the person has been actively performing ND procedures prior to January 1, 01. () Satisfactory evidence under Subsection 0.1(1) must be a completed form provided by the BOARD that is signed and submitted by the employer or supervising physician of the applicant. () A person who qualifies under this section for a permanent exemption from the requirement to take examinations required under this chapter must comply with all other requirements under this chapter for issuance of a license. () Renewal of license is subject to taking continuing education units as specified in Sec. 0.1 of this chapter. () This section does not expire. 1 1 1 1 Sec. 0.. DEFERRED LICENSE REQUIREMENT for persons not holding IONM, LTM or MEG credentials recognized by the BOARD, but who are actively engaged in working in IONM, LTM or MEG at least one year prior to the enactment of the NDT Act. 0 1 (1) A person who applies for a license in IONM, LTM or MEG under this section not later than July 1, 0, is deferred from the examination required for years if the person presents satisfactory evidence to the BOARD that the person has been actively performing IONM, LTM, or MEG procedures prior to January 1, 01. Page - 1 -
1 1 1 () Satisfactory evidence under Subsection 0.(1) must be a completed form provided by the BOARD that is signed and submitted by the employer or supervising physician of the applicant. () A person who qualifies under this section for a -year deferment of the requirement to take the applicable examination must comply with all other requirements under this chapter for issuance of a license. () Renewal of license is subject to taking continuing education units as specified in Sec. 0.1 of this chapter. () This Section, 0., expires on July 1, 00. () After July 1, 00, only Sec. 0. applies to obtaining full licensure for: LNDT(IONM), LNDT(LTM), and LNDT(MEG). 1 SUBCHAPTER D. LICENSE RENEWAL. 1 Sec. 0.. LICENSE RENEWAL. 1 0 1 (1) A license is valid for two years. () The BOARD by rule may adopt a system under which licenses expire on various dates during the year. () A person may renew an unexpired license by paying the renewal fee to the BOARD before the license expiration date. Page - 1 -
() To renew a license under this chapter, a person must submit proof satisfactory to the BOARD that the person has: (a) maintained the appropriate credentials with the exception of persons described in Sec. 0.1; and (b) complied with continuing education requirements. Sec. 0.1. CONTINUING EDUCATION. 1 1 1 (1) The BOARD shall establish for the renewal of a license continuing education requirements of not less than 0 units/hours for each renewal period commencing January 1, 0. () The BOARD reserves the authority to modify the required number of continuing education units/hours. () The BOARD shall adopt a procedure to assess a license holder's participation in continuing education programs. 1 SUBCHAPTER E. PROHIBITED PRACTICES AND ENFORCEMENT PROVISIONS 1 1 Sec. 0.01. RESTRICTED AND PROHIBITED PRACTICES FOR TECHNOLOGISTS AND PRACTITIONERS 0 1 (1) ND technologists and non-physician, doctorate level practitioners must adhere to health care laws and guidelines. They are prohibited from practicing medicine as defined by the BOARD. Page - 1 -
() A ND technologist may report any preliminary objective neurologic events in a clinical setting that have been preestablished to be critical values by a licensed physician or an institution when these values need to be reported in a timely manner to the designated care provider. () A ND technologist in IONM may recommend actions or interventions as a physician-approved standing order when objective neurologic events have been pre-established to be critical values by a licensed physician or an institution when these values need to be reported in a timely manner to the surgeon or anesthesia personnel. 1 Sec. 0.0. INVESTIGATION OF COMPLAINTS. 1 1 1 1 1 (1) The BOARD shall investigate any complaint alleging that a violation of this chapter or a rule or order adopted under this chapter has occurred. () A complaint must be filed in a manner prescribed by the BOARD. Sec. 0.0. SANCTIONS. 0 The BOARD may impose sanctions as provided by the Sections 1. and 1.. 1 SUBCHAPTER F. PENALITIES Sec. 0.01. ADMINISTRATIVE PENALTY. Page - 1 -
The BOARD or Executive Director may impose an administrative penalty on a person under Subchapter F, Chapter 1, regardless of whether the person holds a license under this chapter, if the person violates this chapter or a rule or order adopted under this chapter. Sec. 0.0. CRIMINAL PENALTY. (1) A person commits an offense if the person violates this chapter. () An offense under this section is a Class A misdemeanor. 1 1 SECTION. Not later than February 1, 0, the Texas Medical Board and the presiding officer of the Texas Medical Board, as appropriate, shall adopt rules and forms necessary to implement Chapter 0, Occupations Code, as added by the NDT Act. 1 1 1 SECTION. The Texas Medical Board shall issue a NDT license under Chapter 0, Occupations Code, as added by this Act, to an applicant who: 1 0 1 (1) applies for a license under this section not later than July 1, 0; () submits to the Board the information required by rule; () meets the requirements of Section 0., Section 0.1, and Section 0., Occupations Code, as added by this Act; and Page - 1 -
() pays the application fee established by the Board. SECTION. (1) Except as provided by Subsection () of this section, this Act takes effect September 1, 01. () Section 0.1 (License Required) and Subchapter F (Penalties), Chapter 0, Occupations Code, as added by this Act, take effect September 1, 0. Page - 1 -