RULES AND REGULATIONS
Title 49--PROFESSIONAL AND VOCATIONAL STANDARDS
STATE BOARD OF MEDICINE
[49 PA. CODE CH. 18]
Respiratory Care Continuing Education
[36 Pa.B. 4466]
[Saturday, August 12, 2006]The State Board of Medicine (Board) amends §§ 18.302 and 18.309 (relating to definitions; and renewal of certification) and adds §§ 18.309a and 18.309b (relating to requirement of continuing education; and approved educational courses) to read as set forth in Annex A.
A. Effective Date
This final-form rulemaking is effective upon publication in the Pennsylvania Bulletin.
B. Statutory Authority
The act of July 2, 2004 (No. 55, P. L. 484) (Act 55) amended the Medical Practice Act of 1985 (act) (63 P. S. §§ 422.1--422.51a) to provide for the continuing education of respiratory care practitioners. Section 36(f)(1) of the act (63 P. S. § 422.36(f)(1)) directs the Board to promulgate regulations as necessary to establish the requirements for continuing education for respiratory care practitioners.
C. Background and Purpose
This final-form rulemaking implements Act 55 by establishing requirements for continuing education to be met by individuals holding certifications as respiratory care practitioners as a condition of certificate renewal.
D. Summary of comments and Responses to Proposed Rulemaking
A proposed rulemaking was published at 35 Pa.B. 5520 (October 8, 2005). The Board entertained public comment for 30 days during which time the Board received comments from the Pennsylvania Society for Respiratory Care (PSRC), Soldiers + Sailors Memorial Hospital and two individual respiratory care practitioners. Following the close of the public comment period, the Board received comments from the Independent Regulatory Review Commission (IRRC) and the House Professional Licensure Committee (HPLC). The Senate Consumer Protection and Professional Licensure Committee (SCP/PLC) did not comment. The Board also had input from one of its members who is a respiratory care practitioner. The following is a summary of the comments and the Board's response.
The PSRC was supportive of the proposed rulemaking. The PSRC suggested that the regulations allow for a combination of traditional and nontraditional continuing education methods. Traditional education is considered ''live'' interaction with a presenter either in a classroom setting, a real-time web-cast or a teleconference. Nontraditional education includes prerecorded presentations, Internet-based presentations or journal review programs. The PSRC suggested that 50% of the continuing education hours be acquired through traditional education and 50% be acquired by nontraditional education. A further suggestion was that of the 20 continuing education hours required, 1 hour be required in the category of ethics and 1 hour be required in patient safety.
Soldiers + Sailors Memorial Hospital suggested that certificateholders be permitted no more than 8 to 10 hours in a nontraditional setting during the biennial renewal period. It was further suggested that the amount of hours obtained by taking advanced life support courses be limited to 12 credits. One of the respiratory care practitioners suggested the 50/50 split in traditional and nontraditional coursework. The other respiratory care practitioner offered no recommendations.
The HPLC and IRRC questioned the ability of certificateholders to meet the 20-hour requirement prior to the biennial renewal of December 31, 2006, in view of the time remaining. The HPLC requested information as to the Board's efforts to inform its certificateholders about the continuing education requirement and also suggested a prorating of the required hours for the current biennium. IRRC suggested that the requirements be effective with the biennial renewal period beginning January 1, 2007. The Board acknowledges the concerns of the HPLC and IRRC. However, all certificateholders have had a significant period of time to obtain the continuing education hours. In anticipation of these concerns and in recognition of the length of the regulatory review process, the Board sent a direct mailing to all respiratory care practitioners certified by the Board in the beginning of June 2005. In addition, the new requirements have been posted on the Board's website since September 2004. Therefore, all respiratory care practitioners certified by the Board have had personal notification in excess of 18 months to obtain the required hours. The Board believes 18 months is more than sufficient time to obtain 20 continuing education hours. IRRC further suggested that the Board permit a portion of the credit hours to be obtained by nontraditional methods.
The Board has no objection to the 50/50 split in the manner of obtaining the continuing education credits. Recognizing the benefits of modern technology as a tool in the learning process and acknowledging that individuals will learn and gain information in the manner which is most useful and relevant to them, the Board has determined to accept continuing education obtained through web-casting, teleconferencing and other nontraditional methods, so long as the provider has mechanisms in place to verify participation. The Board concurs with the PSRC, which appeared before the Board twice following the public comment period, that no more than 50% of the continuing education hours be obtained in a nontraditional manner. In reaching this conclusion, the Board has also taken into consideration that the nontraditional method of education is less expensive, which is a concern for certificateholders. Further, in consideration of the comment of the PSRC, and consistent with the continuing education requirements for other Board licensees, the Board has determined that 1 continuing education hour should be required in patient safety and 1 continuing education hour should be required in medical ethics. The Board has been assured by the PSRC that these types of continuing education credit hours are available.
The HPLC and IRRC suggested that the word ''next'' be replaced with the word ''current'' in § 18.309(c). The HPLC and IRRC further suggested that the phrase ''all or a portion of'' be added to § 18.309a(3). The HPLC and IRRC also suggested that the language in section 36.1(f)(4) of the act pertaining to waiver be added to § 18.309a(3). The HPLC recommended that the language in § 18.309(a)(2) be replaced with the language in section 36.1(f)(3) of the act. The HPLC and IRRC suggested that the term ''licensee'' in § 18.309a(4) be replaced with the word ''certificateholder'' to track the language of the act. The Board has no objection to these language modifications since they do not alter the intent of the provisions. These revisions have been incorporated in this final-form rulemaking.
The HPLC sought clarification from the Board on what the phrase ''advanced coursework in respiratory care'' means in § 18.309b(b). The Board has added language to that section to address the HPLC's concerns. The HPLC also requested a punctuation change, which had previously been made by the Legislative Reference Bureau prior to publication of this rulemaking in the Pennsylvania Bulletin.
The HPLC requested assurances that the final-form rulemaking will be in place by December 31, 2006. The Board is committed to the expeditious completion of this final-form rulemaking, and has acted accordingly. The Board does not anticipate any untoward delay by reviewing agencies or reviewing bodies under the Regulatory Review Act (71 P. S. §§ 745.1--745.15).
E. Description of Amendments
Section 18.309(c) is amended to delete ''next'' and substitute ''current.'' Section 18.309a is expanded by addition of § 18.309a(a)(2). Section 18.309a(a)(2) requires that at least 50% of the required credit hours be taken in lecture or clinical presentations and that no more than 50% of the required credit hours may be taken through individual study. Section 18.309a(a)(4) requires that 1 continuing education hour be completed in patient safety and 1 continuing education hour be completed in medical ethics beginning with the biennial period ending December 31, 2008. The language in § 18.309a(b), which was formerly § 18.309a(a)(2), is deleted and replaced by the language in section 36.1(f)(3) of the act. The phrase ''all or a portion of'' is inserted to amend § 18.309a(c), which was formerly § 18.309a(3). In addition, this subsection is further amended to add the language in section 36.1(f)(4) of the act pertaining to waiver.
As noted by the HPLC and IRRC, § 18.309a(4) of the proposed rulemaking erroneously referred to respiratory care practitioners as ''licensee'' instead of ''certificate- holder.'' This error is corrected in this final-form rulemaking in renumbered § 18.309a(d). As suggested by the HPLC, the Board clarifies what is intended to constitute advanced course work in § 18.309b(b).
F. Fiscal Impact and Paperwork Requirements
The final-form rulemaking has no adverse fiscal impact or additional paperwork requirements imposed on the Commonwealth, its political subdivisions or the private sector.
G. Sunset Date
The Board continuously monitors its regulations. Therefore, no sunset date has been assigned.
H. Regulatory Review
Under section 5(a) of the Regulatory Review Act (71 P. S. § 745.5(a)), on September 26, 2005, the Board submitted a copy of the notice of proposed rulemaking, published at 35 Pa.B. 5520, to IRRC and the Chairpersons of the HPLC and the SCP/PLC for review and comment.
Under section 5(c) of the Regulatory Review Act, IRRC, the HPLC and the SCP/PLC were provided with copies of the comments received during the public comment period, as well as other documents when requested. In preparing the final-form rulemaking, the Department has considered all comments from IRRC, the HPLC, the SCP/PLC and the public.
Under section 5.1(j.2) of the Regulatory Review Act (71 P. S. § 745.5a(j.2)), on June 13, 2006 this final-form rulemaking was approved by the HPLC. On July 5, 2006, the final-form rulemaking was deemed approved by the SCP/PLC. Under section 5.1(e) of the Regulatory Review Act, IRRC met on July 6, 2006, and approved the final-form rulemaking.
I. Contact Person
Further information may be obtained by contacting Sabina I. Howell, Counsel, State Board of Medicine, P. O. Box 2649, Harrisburg, PA 17105-2649, showell@state.pa.us.
J. Findings
The Board finds that:
(1) Public notice of proposed rulemaking was given under sections 201 and 202 of the act of July 31, 1968 (P. L. 769, No. 240) (45 P. S. §§ 1201 and 1202) and the regulations promulgated thereunder, 1 Pa. Code §§ 7.1 and 7.2.
(2) A public comment period was provided as required by law and all comments were considered.
(3) This final-form rulemaking does not enlarge the purpose of proposed rulemaking published at 35 Pa.B. 5520.
(4) This final-form rulemaking is necessary and appropriate for administering and enforcing the authorizing acts identified in Part B of this preamble.
K. Order
The Board, acting under its authorizing statutes, orders that:
(a) The regulations of the Board, 49 Pa. Code Chapter 18, are amended by amending §§ 18.302 and 18.309 and by adding §§ 18.309a and 18.309b to read as set forth in Annex A.
(b) The Board shall submit this order and Annex A to the Office of General Counsel and the Office of Attorney General as required by law.
(c) The Board shall certify this order and Annex A and deposit them with the Legislative Reference Bureau as required by law.
(d) This order shall take effect on publication in the Pennsylvania Bulletin.
CHARLES D. HUMMER, Jr., M. D.,
Chairperson(Editor's Note: For the text of the order of the Independent Regulatory Review Commission, relating to this document, see 36 Pa.B. 3919 (July 22, 2006).)
Fiscal Note: Fiscal Note 16A-4921 remains valid for the final adoption of the subject regulations.
Annex A
TITLE 49. PROFESSIONAL AND
VOCATIONAL STANDARDS
PART I. DEPARTMENT OF STATE
Subpart A. PROFESSIONAL AND
OCCUPATIONAL AFFAIRS
CHAPTER 18. STATE BOARD OF MEDICINE--PRACTITIONERS OTHER THAN MEDICAL DOCTORS
Subchapter F. RESPIRATORY CARE PRACTITIONERS § 18.302. Definitions.
The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise:
AARC--American Association for Respiratory Care, an organization which provides and approves continuing professional development programs.
AMA--American Medical Association, an organization which provides and approves continuing professional development programs.
AOA--American Osteopathic Association, an organization which provides and approves continuing professional development programs.
Act--The Medical Practice Act of 1985 (63 P. S. §§ 422.1--422.45.)
CRTT--The Certification Examination For Entry Level Respiratory Therapy Practitioners, a National uniform examination developed and administered by the NBRC for certified respiratory care therapy practitioners.
CSRT--Canadian Society of Respiratory Therapists, an organization which provides and approves continuing professional development programs.
Continuing education hour--Fifty minutes of continuing education.
JRCRTE--The Joint Review Committee on Respiratory Therapy Education, which accredits respiratory care programs.
NBRC--The National Board for Respiratory Care, the agency recognized by the Board to credential respiratory care practitioners.
Respiratory care practitioner--A person who has been certified in accordance with the act and this subchapter.
§ 18.309. Renewal of certification.
(a) A certification issued under this subchapter expires on December 31 of every even-numbered year unless renewed for the next biennium.
(b) Biennial renewal forms and other forms and literature to be distributed by the Board will be forwarded to the last mailing address given to the Board.
(c) To retain the right to engage in practice, the certificateholder shall renew certification in the manner prescribed by the Board, complete the continuing education requirement set forth in § 18.309a (relating to requirement of continuing education) and pay the required fee prior to the expiration of the current biennium.
(d) When a certification is renewed after December 31 of an even-numbered year, a penalty fee of $5 for each month or part of a month of practice beyond the renewal date will be charged in addition to the renewal fee.
§ 18.309a. Requirement of continuing education.
(a) The following continuing education requirements shall be completed each biennial cycle, commencing with the biennial period ending December 31, 2006:
(1) An applicant for biennial renewal or reactivation of certification is required to complete, during the 2 years preceding the application for renewal or reactivation, a minimum of 20 hours of continuing education as set forth in section 36.1(f)(2) of the act (63 P. S. § 422.36.1(f)).
(2) At least 10 continuing education hours shall be obtained through classroom lecture, clinical presentation, real-time web-cast or other live sessions where a presenter is involved.
(3) No more than 10 continuing education hours may be obtained through Internet presentations, journal review programs, prerecorded video presentations or similar means of nontraditional education. To qualify, the provider shall make available documented verification of completion of the course or program.
(4) Commencing with the biennial period ending December 31, 2008, 1 continuing education hour shall be completed in medical ethics, and 1 continuing education hour shall be completed in patient safety.
(b) An individual applying for the first time for certification is exempt from the continuing education requirement for the biennial renewal period following initial certification.
(c) The Board may waive all or a portion of the requirements of continuing education in cases of serious illness, or other demonstrated hardship or military service. It shall be the duty of each certificateholder who seeks a waiver to notify the Board in writing and request the waiver prior to the end of the renewal period. The request must be made in writing, with appropriate documentation, and include a description of circumstances sufficient to show why the certificateholder is unable to comply with the continuing education requirement. The Board will grant, deny or grant in part the request for waiver and will send the certificateholder written notification of its approval or denial in whole or in part of the request. A certificateholder who requests a waiver may not practice as a respiratory care practitioner after the expiration of the certificateholder's current certificate until the Board grants the waiver request.
(d) A certificateholder shall maintain the information and documentation supporting completion of the hours of continuing education required, or the waiver granted, for at least 2 years from the commencement of the biennial renewal period to which the continuing education or waiver applies and provide the information and documentation to representatives of the Board upon request.
§ 18.309b. Approved educational courses.
(a) The Board approves respiratory care continuing education programs designated for professional development credits by the AARC, the AMA, the AOA and the CSRT. The courses, locations and instructors provided by these organizations for continuing education in respiratory care are deemed approved by the Board. Qualifying AMA continuing education programs shall be in AMA PRA Category I as defined in § 16.1 (relating to definitions) and qualifying AOA continuing education programs shall be in Category 1A and 1B.
(b) Advanced course work in respiratory care successfully completed at a degree-granting institution of higher education approved by the United States Department of Education which offers academic credits is also approved for continuing education credit by the Board. Advanced course work is any course work beyond the academic requirements necessary for certification as a respiratory care practitioner. Proof of completion of the academic credits shall be submitted to the Board for determination of number of continuing education hours completed.
(c) The Board will not accept courses of study which do not relate to the clinical aspects of respiratory care, such as studies in office management and financial procedures.
[Pa.B. Doc. No. 06-1541. Filed for public inspection August 11, 2006, 9:00 a.m.]
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