85R13698 TSR-F

By: Zedler H.B. No. 4023

A BILL TO BE ENTITLED

AN ACT

relating to the licensing and regulation of neurodiagnostic practitioners and neurodiagnostic technologists; 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. Subtitle K, Title 3, Occupations Code, is amended by adding Chapter 606 to read as follows:

CHAPTER 606. NEURODIAGNOSTIC PRACTITIONERS AND NEURODIAGNOSTIC

TECHNOLOGISTS

SUBCHAPTER A. GENERAL PROVISIONS

Sec. 606.001. DEFINITIONS. In this chapter:

(1) "Autonomic reflex testing" means a test used to measure how autonomic nerves work in controlling involuntary body functions, including blood pressure, heart rate, and sweating, in response to different maneuvers, such as deep breathing, blowing into a mouthpiece, sweating, and lying for several minutes on a table that is tilted to a near standing position.

(2) "Board" means the Texas Medical Board.

(3) "Credentialing organization" means an accrediting organization that is recognized by the board and that administers and awards credentials in the modalities of neurodiagnostic technology.

(4) "Direct supervision" means supervision by a responsible physician or neurodiagnostic practitioner or neurodiagnostic technologist who is physically present and immediately available to provide assistance and direction while a neurodiagnostic procedure is being performed.

(5) "Electroencephalography" means the recording and analysis of the ongoing electrical activity of the brain using a digital or analog instrument with a minimum of 16 channels and 21 electrodes to assist in the diagnosis of epilepsy and other neurological symptoms.

(6) "Electromyography" means the recording and analysis of electrical activity generated by a needle insertion into a muscle.

(7) "Evoked potentials" means the recording of electrical activity from the brain, spinal nerves, or sensory receptors that occurs in direct response to auditory, visual, or electrical stimulation using surface electrodes and computer equipment to average the electrical potentials generated.

(8) "Intraoperative monitoring" means the use of a neurophysiological monitoring technique during surgery that ensures the safety of a patient by:

(A) providing information to the surgeon that relates to the integrity of the central and peripheral nervous systems; and

(B) using real-time electrographic information or stimulus evoked recordings of auditory, visual, somatosensory, or motor pathways via surface or subdermal needle electrodes.

(9) "License holder" means a person who holds a license as a neurodiagnostic practitioner or neurodiagnostic technologist under this chapter.

(10) "Long-term monitoring" means the prolonged recording, by video recording or digital analysis, of the ongoing electrical activity of the brain to evaluate and diagnose epilepsy and other intermittent or infrequent neurological disturbances.

(11) "Magnetoencephalography" means the use of a neuroimaging technique for mapping brain activity by recording magnetic fields, outside the head, that are produced by electrical currents that occur naturally in the brain.

(12) "Nerve conduction study" means a recording obtained from electrical stimulation of peripheral nerves using surface electrodes and standard equipment with oscilloscopes for waveform analysis to evaluate and diagnose a disorder of the peripheral nervous system.

(13) "Neurodiagnostic practitioner" means a person who holds a doctoral degree approved by the board and a license issued under this chapter to:

(A) perform the duties of a neurodiagnostic technologist;

(B) perform intraoperative monitoring under the general supervision of a physician; and

(C) supervise the performance of intraoperative monitoring and interpret intraoperative monitoring data under the delegated authority and general supervision of a physician.

(14) "Neurodiagnostic student" means a person who is enrolled in a neurodiagnostics program.

(15) "Neurodiagnostic technologist" means a person who holds a license issued under this chapter to:

(A) use specialized equipment to record and analyze physiological data and electrical activity from the central and peripheral nervous systems; and

(B) perform one or more of the following neurodiagnostic procedures under the appropriate level of supervision by a physician or a neurodiagnostic practitioner:

(i) electroencephalography;

(ii) evoked potentials;

(iii) continuous electroencephalography monitoring;

(iv) intraoperative neuromonitoring;

(v) long-term monitoring;

(vi) magnetoencephalography;

(vii) nerve conduction studies;

(viii) polysomnography; or

(ix) autonomic reflex testing.

(16) "Neurodiagnostic trainee" means a license holder who performs a neurodiagnostic procedure that the person does not have a credential to perform while under the direct supervision of a physician or neurodiagnostic practitioner or neurodiagnostic technologist who does have a credential to perform the procedure.

(17) "Polysomnography" means the recording of the biophysiological changes that occur during sleep by monitoring the ongoing electrical activity of the brain, eye movements, muscle activity, heart rhythm, and respiratory effort to diagnose and treat sleep disorders.

Sec. 606.002. EXEMPTIONS. This chapter does not apply to:

(1) a physician licensed in this state;

(2) a person performing a neurodiagnostic procedure:

(A) for research if the results of the procedure are not used to diagnose or treat a patient;

(B) as a neurodiagnostic student or neurodiagnostic trainee under the direct supervision of a physician or a neurodiagnostic practitioner or neurodiagnostic technologist;

(C) as an employee under the direct supervision of a physician as part of the employee's job training; or

(D) as an audiologist or physical therapist licensed in this state while performing only a procedure that the audiologist or physical therapist is authorized to perform as determined by board rule; or

(3) a faculty member of an accredited school or university with a neurodiagnostics, allied health, or health education program.

SUBCHAPTER B. POWERS AND DUTIES OF BOARD

Sec. 606.051. GENERAL POWERS AND DUTIES; RULES. (a) The board shall administer and enforce this chapter.

(b) The board shall adopt rules necessary to implement this chapter.

Sec. 606.052. FEES. (a) The board by rule shall establish reasonable and necessary fees in amounts sufficient to cover the costs of administering and enforcing this chapter.

(b) The board may modify the fee for the issuance or renewal of a license as necessary to cover the costs of enforcing this chapter.

SUBCHAPTER C. LICENSE REQUIREMENTS

Sec. 606.101. LICENSE REQUIRED. (a) A person may not act as or offer to act as a neurodiagnostic practitioner or neurodiagnostic technologist unless the person holds the applicable license issued under this chapter.

(b) A person who is not licensed under this chapter, or whose license has been suspended or revoked, may not:

(1) use the word "neurodiagnostic" on a sign, name tag, or any form of advertising unless the person is expressly exempt from the licensing requirements of this chapter;

(2) use in connection with the person's practice any abbreviations or credentials indicating or implying that the person is a neurodiagnostic practitioner or neurodiagnostic technologist; or

(3) directly or by implication represent in any way that the person is a neurodiagnostic practitioner or neurodiagnostic technologist.

(c) A license:

(1) is valid only with respect to the person named on the license; and

(2) authorizes the license holder to engage in the neurodiagnostic procedure for which the license holder has a credential issued by a credentialing organization.

(d) A license issued under this chapter is not transferable or assignable.

Sec. 606.102. LICENSING APPLICATION. (a) An applicant for a license must:

(1) apply to the board on a form prescribed by the board and under rules adopted by the board;

(2) submit with the application a nonrefundable application fee in an amount set by the board; and

(3) pass a credentialing organization examination administered or accepted by the board.

(b) The board by rule shall specify the information that must be included on an application submitted to the board. The rules must require:

(1) each application to include the name and address of the applicant; and

(2) each applicant for a license by examination to present satisfactory evidence to the board that the applicant is:

(A) at least 18 years of age; and

(B) of good moral character.

Sec. 606.103. CRIMINAL BACKGROUND CHECKS. (a) On receipt of an application for a license under this chapter, the board shall conduct a criminal background check on the applicant.

(b) An applicant is not eligible for a license under this chapter if the applicant, in the 10 years preceding the date of the application, has been finally convicted of a misdemeanor involving moral turpitude or a felony.

Sec. 606.104. EXAMINATIONS ADMINISTERED OR ACCEPTED BY BOARD. The board may administer or accept for licensing a credentialing organization examination as determined by rule.

Sec. 606.1041. REDUCED LICENSE REQUIREMENTS. (a) A person who applies for a license under this chapter not later than July 1, 2017, is exempt from the examination required under this chapter if the person presents satisfactory evidence to the board that the person has been actively performing neurodiagnostic procedures since before January 1, 2017.

(b) Satisfactory evidence under Subsection (a) must be in the form of a signed letter submitted by the employer or supervising physician of the applicant.

(c) A person who qualifies under this section for an exemption from the requirement to take the examination required under this chapter must comply with all other requirements under this chapter for the issuance and renewal of a license.

(d) This section expires July 1, 2018.

Sec. 606.105. TEMPORARY LICENSES. (a) The board may adopt rules and set fees relating to granting temporary licenses.

(b) A temporary license under this chapter expires on the second anniversary of the date the temporary license is issued or the date the applicant presents satisfactory evidence to the board that the applicant has passed the examination required under this chapter, whichever date occurs first.

(c) The board by rule may extend the expiration date of a temporary license by not more than an additional 12 months.

SUBCHAPTER D. LICENSE RENEWAL

Sec. 606.151. LICENSE RENEWAL. (a) A license is valid for two years from the date of issuance and may be renewed biennially.

(b) The board by rule may adopt a system under which licenses expire on various dates during the year.

(c) A person may renew an unexpired license by paying the required renewal fee to the board before the license expiration date.

(d) To renew a license under this chapter, a person must submit proof satisfactory to the board that the person has:

(1) maintained the appropriate credentials issued by a credentialing organization; and

(2) complied with the continuing education requirements prescribed by the board.

Sec. 606.152. CONTINUING EDUCATION. (a) The board shall establish for the renewal of a license or temporary license uniform continuing education requirements of not less than 30 continuing education hours for each renewal period.

(b) The board shall adopt a procedure to assess a license holder's participation in continuing education programs.

SUBCHAPTER E. PRACTICE BY LICENSE HOLDER

Sec. 606.201. ADVERTISING. (a) A license holder shall include the license holder's license number in each advertisement.

(b) A person who advertises that the person is a neurodiagnostic practitioner or neurodiagnostic technologist is presumed to be engaging in conduct regulated by this chapter.

SUBCHAPTER F. PROHIBITED PRACTICES AND ENFORCEMENT PROVISIONS

Sec. 606.251. PROHIBITED PRACTICES. (a) A license holder may not engage in a neurodiagnostic procedure for which the license holder does not hold the proper credential issued by a credentialing organization.

(b) A license holder may not:

(1) interpret neurodiagnostic data, including making a determination of normal or abnormal findings and identifying the presence, absence, type, severity, or likelihood of an illness, injury, or other condition;

(2) provide clinical correlation of data, including making statements about the meaning of test results based on a person's symptoms, medical history, physical examination, or other clinical test results;

(3) perform needle insertion electromyography in a clinical setting; or

(4) meet with a patient except under the direct supervision of a physician.

Sec. 606.252. INVESTIGATION OF COMPLAINTS. (a) The board shall investigate any complaint alleging that a violation of this chapter or a rule or order adopted under this chapter has occurred.

(b) A complaint must be filed in a manner prescribed by the board.

Sec. 606.253. SANCTIONS. The board may impose sanctions under this chapter in the same manner as provided by Chapter 164 for imposition of sanctions against a physician.

SUBCHAPTER G. PENALTIES

Sec. 606.301. ADMINISTRATIVE PENALTY. The board may impose an administrative penalty against a person under this chapter in the same manner as provided by Subchapter A, Chapter 165, against a physician, 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. 606.302. CRIMINAL PENALTY. (a) A person commits an offense if the person violates this chapter.

(b) An offense under this section is a Class A misdemeanor.

SECTION 2. Not later than February 1, 2018, the Texas Medical Board shall adopt rules and forms necessary to implement Chapter 606, Occupations Code, as added by this Act.

SECTION 3. The Texas Medical Board shall issue a neurodiagnostic practitioner or neurodiagnostic technologist license, as applicable, under Chapter 606, Occupations Code, as added by this Act, to an applicant who:

(1) applies for the license under this section not later than July 1, 2018;

(2) submits to the board the information required by rule;

(3) meets the requirements of Section 606.1041, Occupations Code, as added by this Act; and

(4) pays the application fee established by the board.

SECTION 4. (a) Except as provided by Subsection (b) of this section, this Act takes effect September 1, 2017.

(b) Section 606.101 and Subchapter G, Chapter 606, Occupations Code, as added by this Act, take effect September 1, 2018.