RULES AND REGULATIONS
Title 49—PROFESSIONAL AND VOCATIONAL STANDARDS
STATE BOARD OF MEDICINE
[ 49 PA. CODE CHS. 16 AND 18 ]
Physician Assistants and Respiratory Therapists
[44 Pa.B. 583]
[Saturday, February 1, 2014]The State Board of Medicine (Board) amends §§ 16.11, 16.13, 18.122, 18.145, 18.301, 18.302, 18.304—18.309, 18.309a, 18.309b and 18.310 and adds § 18.146 (relating to professional liability insurance coverage for licensed physician assistants) to read as set forth in Annex A.
Effective Date
This final-form rulemaking will be effective upon publication of the in the Pennsylvania Bulletin.
Statutory Authority
The amendments are authorized under sections 8, 8.1, 13(c) and 13.1(c) of the Medical Practice Act of 1985 (act) (63 P. S. §§ 422.8, 422.8a, 422.13(c) and 422.13a(c)).
Background and Need for the Amendment
The act of July 4, 2008 (P. L. 580, No. 45) (Act 45) amended the act to change references to the ''certification of respiratory care practitioners'' to the ''licensure of respiratory therapists'' and revised the standards for licensure as a respiratory therapist and for receipt of a temporary practice permit. Act 45 also identified additional specific acts of practice for physician assistants and required physician assistants to complete continuing education and maintain professional liability insurance.
Summary of Comments to the Proposed Rulemaking and the Board's Response
The Board published a proposed rulemaking at 42 Pa.B. 2469 (May 2, 2012) with a 30-day public comment period. The Board received public comments from the Pennsylvania Society for Respiratory Care, Inc. (PSRC) and three respiratory care practitioners. The Board also received comments from the House Professional Licensure Committee (HPLC) and the Independent Regulatory Review Commission (IRRC) as part of their review under the Regulatory Review Act (71 P. S. §§ 745.1—745.12).
Comments from Practitioners
The Board received three comments from practitioners, two of which were a form letter. The form letter opposed increasing the continuing education requirement for respiratory therapists from 20 hours biennially to 30 hours biennially, citing both financial challenge and lack of courses that present new information. The third letter also objected to the increased continuing education requirement, citing financial challenge and insisting that the PSRC and government officials are wrong in thinking that quality of care is related to the amount of mandatory continuing education credits an individual obtains. In response, the Board notes that the increase in the number of continuing education hours required biennially was made by the General Assembly and the Board lacks statutory authority to retain the 20-hour requirement. Regarding the assertion that respiratory therapist continuing education seminars repeat the same topics, the Board will work with the PSRC and other continuing education providers to encourage a wider range of topics.
Comments from the PSRC
The PSRC sent the Board four comments on June 7, 2012. Regarding § 18.307(l)(i) (relating to criteria for licensure as a respiratory therapist), the PSRC requested that the Board identify the ''credentialing examination'' as the examination for entry to practice rather than the ''CRTT.'' IRRC agreed. In addition to making this change, the Board clarified the examination in § 18.306(b) (relating to temporary permits), a necessary amendment noted by the HPLC.
The PSRC also recommended that the Board delete § 18.306. The PSRC opined that temporary permits are unnecessary because graduates may now schedule the entry level examination immediately upon graduation. Act 45 revised qualifications of applicants for a temporary permit so that section 36.1(b) of the act (63 P. S. § 422.36a(b)) sets forth the criteria for the Board issuing a temporary permit to individuals who have applied for licensure and section 36.1(c) of the act sets forth the duration and effect of temporary permits. These recent amendments indicate that the General Assembly has reaffirmed the viability of temporary permits for respiratory therapists and, accordingly, the Board believes that it lacks statutory authority to eliminate temporary permits.
In addition, the Board believes there is some value to retaining temporary permits. A temporary permit to practice is valid for 12 months, unless the holder fails the entry level credentialing examination. Upon notification to the permit holder that the examination attempt was not successful, the permit becomes null and void. An applicant is not required to obtain a temporary permit, but may apply for a temporary permit to allow practice prior to the time the applicant takes the licensing examination, while the applicant is waiting for the examination results or while the applicant's application for licensure is being processed. In short, a temporary permit bridges a time gap that may occur between graduation and licensure and allows graduates to become employed without delay.
The PSRC also recommended changes to § 18.309a (relating to requirement of continuing education). The PSRC suggested that the provision, as drafted, was confusing to new graduates. In response, the Board rewrote subsection (b) for clarity to read: ''An individual applying for the first time for licensure in this Commonwealth is exempt from completing the continuing education requirements during the initial biennial renewal period in which the license is issued.'' This language exempts the three types of applicants who may obtain initial Pennsylvania licensure from the continuing education requirement: 1) new graduates from this Commonwealth; 2) new graduates from other states; and 3) licensees in other states who are seeking licensure in this Commonwealth.
The PSRC suggested eliminating the exemption for licensees in other states who are seeking licensure in this Commonwealth who are not ''new graduates.'' The Board declines to make this change. Continuing education is required for license renewal in the 48 states where respiratory therapists are licensed. If a practicing respiratory therapist from another state applies for a license in this Commonwealth and has not taken as many hours of continuing education as now required in this Commonwealth, that individual will still have both experience and knowledge gained while practicing in another state. The exemption is applied to only the first biennial renewal period for all of the allied health professionals licensed by the Board. Finally, eliminating the exemption would be time consuming and difficult for the Board to administer because it would require the Board to distinguish between licensees whose initial license was granted in this Commonwealth and licensees whose initial license was granted by another state. For all of these reasons, the Board maintains that the new language in § 18.309a(b) clarifies this subsection and that further changes are not necessary or warranted.
The PSRC asked the Board to approve advanced life support courses accredited by the American Heart Association (AHA) or similar groups in § 18.309b(a) (relating to approved educational courses). AHA advanced life support courses are approved by the American Medical Association (AMA). Section 18.309b(a) already provides approval for AMA-approved continuing education programs. Therefore, AHA advanced life support courses are already approved as continuing education for respiratory therapists.
Comments from the HPLC
On June 13, 2012, the HPLC submitted two comments. The first comment noted the Board's timing for the submission of this rulemaking as proposed. The Board respectfully understands the HPLC's comments and will work to provide more timely proposed rulemakings in the future.
Second, as noted previously, the HPLC suggested that references to the ''credentialing examination'' should be amended to references to the ''entry level credentialing examination.'' The Board made this change to §§ 18.306(b) and 18.307(1)(i).
Comments from IRRC
On July 11, 2012, IRRC submitted seven comments. IRRC pointed out that the ''Note'' section of Act 45 requires the Board and the State Board of Osteopathic Medicine to jointly promulgate these regulations. The act and the Osteopathic Medical Practice Act (63 P. S. §§ 271.1—271.18) authorize the Board and the State Board of Osteopathic Medicine to license and regulate only those who practice under each act, respectively. The amendments to each act in Act 45 and the act of July 4, 2008 (P. L. 589, No. 46) do not change which board licenses and regulates the professionals under the jurisdiction of each board. Likewise, the Board and the State Board of Osteopathic Medicine do not jointly license or regulate the professionals under the jurisdiction of each board. The Board and the State Board of Osteopathic Medicine proposed similar regulations and now adopt substantially identical final-form rulemakings. By promulgating these regulations at the same time, the statutorily mandated changes will be effective at the same time, regardless of which board has jurisdiction over an individual practitioner. The Board believes this process meets with the statutory intent.
With respect to Subchapter D (relating to physician assistants), IRRC raised two issues. IRRC noted that § 18.145(c) (relating to biennial registration requirements; renewal of physician assistant license) requires physician assistants to maintain National certification and recommended that the final-form rulemaking should identify the recertification mechanisms recognized by the Board or identify how a physician assistant can access this information. The Board adds to the first sentence of this subsection a reference to the National Commission on Certification of Physician Assistants (NCCPA) and directs physician assistants to the NCCPA's web site (www.nccpa.net) to access the information.
IRRC recommended that the Board clarify where it will publish any future recognition of an organization's certification of physician assistants. The Board addressed this request at § 18.145(c), noting that any additional National certification organization will be announced on the Board's web site.
IRRC's remaining comments addressed Subchapter F (relating to respiratory therapists). IRRC indicated some confusion in § 18.306(a), which refers to an individual ''who is recognized as a credentialed respiratory therapist. . . .'' (Emphasis added by IRRC.) The Board amended this subsection to clarify that an applicant for a temporary permit would not yet be a licensee of the Board. The reference to a ''credentialed respiratory therapist'' is intended to mean an individual who holds one of the credentials issued by the National Board for Respiratory Care.
IRRC echoed the suggestion made by the HPLC to replace ''credentialing examination'' with ''entry level credentialing examination,'' changes which were also made to §§ 18.306(b) and 18.307(1)(i).
IRRC made two recommendations regarding § 18.309a. IRRC recommended that the Board address in the Regulatory Analysis Form (RAF) any additional costs that the increase in the minimum number of mandatory continuing education hours will impose on the regulated community. The Board added this analysis in the RAF. Many courses are offered free of charge or at low cost through the American Association for Respiratory Care (AARC) free online courses. Most hospital respiratory therapy departments sponsor lectures at their facilities for their staff to attend at no charge and some offer ''grand rounds'' in their intensive care units. Print publications (such as Saxe Healthcare Communications at www.saxetesting.com) are also offered online at no charge. Because many courses are offered free of charge or at a low price, the Board estimates a cost of $10 per credit hour, for a total cost for the additional 10 hours of continuing education of $100 per licensee during a biennial renewal period or $50 per year. Respiratory therapists may also receive free or low cost continuing education by joining AARC at a cost of $90 annually. If one assumes that a licensee joins AARC primarily to receive low cost or free continuing education, then the total estimated cost of the additional continuing education and AARC membership is $140 a year.
IRRC recommended consistency between the Board's proposed elimination of the limit on the number of continuing education hours that would be creditable for biennial renewal from nontraditional continuing education (prerecorded presentations, Internet-based presentations and journal review programs) and the State Board of Osteopathic Medicine's proposal that at least 10 hours of continuing education be earned in traditional continuing education (classroom lecture, clinical presentation, real-time web-cast or other live sessions where a presenter is involved). The Board and the State Board of Osteopathic Medicine have agreed that at least 10 hours of continuing education shall be taken from traditional sources to ensure consistent standards between the two boards.
IRRC also recommended that the Board define ''practice building'' in § 18.309b(c). The Board defined the term in § 18.302 (relating to definitions) as ''marketing or any other activity that has as its primary purpose increasing the business volume or revenue of a licensee or the licensee's employer.''
IRRC suggested that the Board's description of amendments to the final-form rulemaking address first physician assistant provisions first, followed by the respiratory therapist provisions. The Board has done so.
IRRC asked the Board to add Purdon's citations to § 18.146(c) and (d) and § 18.305(b) (relating to functions of respiratory therapists). The Board confirmed with the Legislative Reference Bureau that the proposed rulemaking is correct. Purdon's citations to a cross-referenced statute are to appear only the first time the section of the act is referenced within a particular section of a regulation. The first citation applies to all subsequent references of the same statutory section or any subsection or paragraph of the same statutory section. Accordingly, the Board did not make the requested additions to §§ 18.146(c) and (d) and 13.305(b).
Description of Amendments to the Final-Form Rulemaking
In Chapter 16, the Board amended the paragraph number in § 16.11(b) (relating to licenses, certificates and registrations) that refers to the respiratory therapist license, as the Board has already published a final-form rulemaking regarding behavior specialists, athletic trainers and perfusionists in paragraphs (6)—(8), respectively. Thus, the respiratory therapist license will appear in paragraph (9).
In Chapter 18, the Board made amendments regarding physician assistants in Subchapter D. In § 18.122 (relating to definitions), the Board further defined NCCPA as the organization recognized by the Board to certify and recertify physician assistants by requiring continuing education and examination. In § 18.145, the Board directed physician assistants to the NCCPA's web site for information regarding maintenance of certification and clarified that it will publish recognition of additional National organizations on the Board's web site.
The remaining changes in the final-form rulemaking appear in Subchapter F. The Board added at a definition of ''practice building'' in § 18.302.
In § 18.306, the Board clarified that a temporary permit will be issued to an applicant who is not yet a licensee of the Board. Furthermore, as requested by the PSRC, the HPLC and IRRC, the Board replaced CRTT with ''entry level credentialing examination'' in §§ 18.306(b) and 18.307(1)(i).
The Board amended § 18.309a(a)(3) to make the traditional and nontraditional continuing education requirements the same for both the Board and the State Board of Osteopathic Medicine. The provision provides that respiratory therapists shall complete at least 10 hours of traditional continuing education such as classroom lecture, clinical presentation, real-time web-case or other sessions when a presenter is involved to meet the biennial continuing education requirement. Prior to the statutory increase to the total number of credits required biennially, the Board had required 10 hours to be completed in traditional continuing education, but had proposed elimination of this restriction. Upon agreement with the State Board of Osteopathic Medicine, both boards will both retain this requirement.
The Board amended § 18.309a(b) to clarify that new licensees are exempt from the continuing education requirement for the first biennial renewal period. The new language states: ''An individual applying for the first time for licensure in this Commonwealth is exempt from completing the continuing education requirements during the initial biennial renewal period in which the license is issued.''
Fiscal Impact and Paperwork Requirements
There are minimal fiscal impacts upon physician assistants because they are already required to complete continuing education to maintain National certification and because virtually all physician assistants already carry professional liability insurance, usually provided by their employers. There will not be adverse fiscal impact on the Commonwealth or its political subdivisions. Likewise, the amendments in this final-form rulemaking will not impose additional paperwork requirements upon the Commonwealth, political subdivisions or the private sector. The final-form rulemaking will have only a minor fiscal impact on respiratory therapists who shall take an additional 10 credit hours of continuing education during a biennial period and may impact those small businesses who pay continuing education costs for employed respiratory therapists.
Sunset Date
The Board continuously monitors its regulations. Therefore, a sunset date has not been assigned.
Regulatory Review
Under section 5(a) of the Regulatory Review Act (71 P. S. § 745.5(a)), on May 2, 2012, the Board submitted a copy of the notice of proposed rulemaking, published at 42 Pa.B. 2469, to IRRC and the Chairpersons of the HPLC and the State Consumer Protection and Professional Licensure Committee (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 Board 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 December 11, 2013, the final-form rulemaking was approved by the HPLC. On December 11, 2013, the final-form rulemaking was deemed approved by the SCP/PLC. Under section 5.1(e) of the Regulatory Review Act, IRRC met on December 12, 2013, and approved the final-form rulemaking.
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) The amendments to the final-form rulemaking do not enlarge the purpose of the proposed rulemaking published at 42 Pa.B. 2469.
(4) This final-form rulemaking is necessary and appropriate for administering and enforcing the authorizing act identified in this Preamble.
Order
The Board, acting under its authorizing statute, orders that:
(a) The regulations of the Board, 49 Pa. Code Chapters 16 and 18, are amended by adding § 18.146 and amending §§ 16.11, 16.13, 18.122, 18.145, 18.301, 18.302, 18.304—18.309, 18.309a, 18.309b and 18.310 are amended to read as set forth in Annex A, with ellipses referring to the existing text of the regulations.
(Editor's Note: Section 18.122 was not included in the proposed rulemaking published at 42 Pa.B. 2469.)
(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 immediately upon publication in the Pennsylvania Bulletin.
ANDREW J. BEHNKE, MD,
Chairperson(Editor's Note: For the text of the order of the Independent Regulatory Review Commission relating to this document, see 43 Pa.B. 7606 (December 28, 2013).)
Fiscal Note: Fiscal Note 16A-4930 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 16. STATE BOARD OF MEDICINE—GENERAL PROVISIONS
Subchapter B. GENERAL LICENSE, CERTIFICATION AND REGISTRATION PROVISIONS § 16.11. Licenses, certificates and registrations.
(a) The following medical doctor licenses are issued by the Board:
(1) License without restriction.
(2) Institutional license.
(3) Extraterritorial license.
(4) Graduate license.
(5) Temporary license.
(6) Interim limited license.
(b) The following nonmedical doctor licenses and certificates are issued by the Board:
(1) Nurse-midwife license.
(2) Nurse-midwife certificate of prescriptive authority.
(3) Physician assistant license.
(4) Acupuncturist license.
(5) Practitioner of Oriental medicine license.
(6) Behavior specialist license.
(7) Athletic trainer license.
(8) Perfusionist license.
(9) Respiratory therapist license.
(c) The following registrations are issued by the Board:
(1) Registration as a supervising physician of a physician assistant.
(2) Biennial registration of a license without restriction.
(3) Biennial registration of an extraterritorial license.
(4) Biennial registration of a midwife license.
(5) Biennial registration of a physician assistant license.
(6) Biennial registration of a drugless therapist license.
(7) Biennial registration of a limited license—permanent.
(8) Biennial registration of an acupuncturist license.
(9) Biennial registration of a practitioner of Oriental medicine license.
(10) Biennial registration of a behavior specialist license.
(11) Biennial registration of athletic trainer license.
(12) Biennial registration of a perfusionist license.
§ 16.13. Licensure, certification, examination and registration fees.
* * * * * (g) Respiratory Therapist License:
Application, temporary permit
$30Application, initial certification
$30Biennial renewal
$25(h) Athletic Trainer License:
* * * * *
CHAPTER 18. STATE BOARD OF MEDICINE—PRACTITIONERS OTHER THAN MEDICAL DOCTORS
Subchapter D. PHYSICIAN ASSISTANTS
GENERAL PROVISIONS § 18.122. Definitions.
The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise:
* * * * * NCCPA—The National Commission on Certification of Physician Assistants, the organization recognized by the Board to certify and recertify physician assistants by requiring continuing education and examination.
* * * * *
LICENSURE OF PHYSICIAN ASSISTANTS AND REGISTRATION OF SUPERVISING PHYSICIANS § 18.145. Biennial registration requirements; renewal of physician assistant license.
(a) A physician assistant shall register biennially according to the procedure in § 16.15 (relating to biennial registration; inactive status and unregistered status).
(b) The fee for the biennial registration of a physician assistant license is set forth in § 16.13 (relating to licensure, certification, examination and registration fees).
(c) To be eligible for renewal of a physician assistant license, the physician assistant shall complete continuing medical education as required by the NCCPA and maintain National certification by completing current recertification mechanisms available to the profession, identified on the NCCPA's web site as recognized by the Board. The Board recognizes certification through the NCCPA and its successor organizations and certification through any other National organization for which the Board publishes recognition of the organization's certification of physician assistants on the Board's web site.
(d) The Board will keep a current list of persons licensed as physician assistants. The list will include:
(1) The name of each physician assistant.
(2) The place of residence.
(3) The current business address.
(4) The date of initial licensure, biennial renewal record and current supervising physician.
§ 18.146. Professional liability insurance coverage for licensed physician assistants.
(a) A licensed physician assistant shall maintain a level of professional liability insurance coverage as required under section 36(f) of the act (63 P. S. § 422.36(f)).
(b) Proof of professional liability insurance coverage may include:
(1) A certificate of insurance or copy of the declaration page from the applicable insurance policy setting forth the effective date, expiration date and dollar amounts of coverage.
(2) Evidence of a plan of self-insurance approved by the Insurance Commissioner of the Commonwealth under regulations of the Insurance Department in 31 Pa. Code Chapter 243 (relating to medical malpractice and health-related self-insurance plans).
(c) A license that was issued in reliance upon a letter from the applicant's insurance carrier indicating that the applicant will be covered against professional liability effective upon the issuance of the applicant's license as permitted under section 36(f)(2) of the act will become inactive as a matter of law 30 days after issuance of the license if the licensee has not provided proof of professional liability insurance coverage and will remain inactive until the licensee provides proof of insurance coverage.
(d) A licensee who does not have professional liability insurance coverage as required under section 36(f) of the act may not practice as a physician assistant in this Commonwealth.
Subchapter F. RESPIRATORY THERAPISTS § 18.301. Purpose.
This subchapter implements sections 13.1 and 36.1 of the act (63 P. S. §§ 422.13a and 422.36a), which were added by section 3 of the act of July 2, 1993 (P. L. 424, No. 60) to provide for the licensure of respiratory therapists.
§ 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—422.5(a).
CoARC—The Committee on Accreditation for Respiratory Care, an organization which accredits respiratory care programs.
CSRT—Canadian Society of Respiratory Therapists, an organization which provides and approves continuing professional development programs.
Continuing education hour—Fifty minutes of continuing education.
NBRC—The National Board for Respiratory Care, the agency recognized by the Board to credential respiratory therapists.
Practice building—Marketing or any other activity that has as its primary purpose increasing the business volume or revenue of a licensee or the licensee's employer.
Respiratory therapist—A person who has been licensed in accordance with the act and this subchapter.
§ 18.304. Licensure of respiratory therapists; practice; exceptions.
(a) A person may not practice or hold himself out as being able to practice as a respiratory therapist in this Commonwealth unless the person holds a valid, current temporary permit or license issued by the Board, or the State Board of Osteopathic Medicine under Chapter 25 (relating to State Board of Osteopathic Medicine), or is exempted under section 13.1(e) of the act (63 P. S. § 422.13a(e)) or section 10.1(e) of the Osteopathic Medical Practice Act (63 P. S. § 271.10a(e)).
(b) A person may not use the words ''licensed respiratory therapist'' or ''respiratory care practitioner,'' the letters ''LRT,'' ''RT'' or ''RCP'' or similar words and related abbreviations to imply that respiratory care services are being provided, unless the services are provided by a respiratory therapist who holds a valid, current temporary permit or license issued by the Board or the State Board of Osteopathic Medicine and only while working under the supervision of a licensed physician.
§ 18.305. Functions of respiratory therapists.
(a) Under section 13.1(d) of the act (63 P. S. § 422.13a(d)), a respiratory therapist may implement direct respiratory care to an individual being treated by either a licensed medical doctor or a licensed doctor of osteopathic medicine, upon prescription or referral by a physician, certified registered nurse practitioner or physician assistant, or under medical direction and approval consistent with standing orders or protocols of an institution or health care facility. This care may constitute indirect services such as consultation or evaluation of an individual and also includes, but is not limited to, the following services:
(1) Administration of medical gases.
(2) Humidity and aerosol therapy.
(3) Administration of aerosolized medications.
(4) Intermittent positive pressure breathing.
(5) Incentive spirometry.
(6) Bronchopulmonary hygiene.
(7) Management and maintenance of natural airways.
(8) Maintenance and insertion of artificial airways.
(9) Cardiopulmonary rehabilitation.
(10) Management and maintenance of mechanical ventilation.
(11) Measurement of ventilatory flows, volumes and pressures.
(12) Analysis of ventilatory gases and blood gases.
(b) Under section 13.1(d) of the act, a respiratory therapist may perform the activities listed in subsection (a) only upon prescription or referral by a physician, certified registered nurse practitioner or physician assistant, or while under medical direction consistent with standing orders or protocols in an institution or health care facility.
§ 18.306. Temporary permits.
(a) A temporary permit will be issued to an applicant, who is not yet a licensee, who submits evidence satisfactory to the Board, on forms supplied by the Board, that the applicant has met one or more of the following criteria:
(1) Has graduated from a respiratory care program approved by the CoARC.
(2) Is enrolled in a respiratory care program approved by the CoARC and expects to graduate within 30 days of the date of application to the Board for a temporary permit.
(3) Meets all applicable requirements and is recognized as a credentialed respiratory therapist by the NBRC.
(b) A temporary permit is valid for 12 months and for an additional period as the Board may, in each case, specially determine except that a temporary permit expires if the holder fails the entry level credentialing examination. An applicant who fails the entry level credentialing examination may apply to retake it.
§ 18.307. Criteria for licensure as a respiratory therapist.
The Board will approve for licensure as a respiratory therapist an applicant who:
(1) Submits evidence satisfactory to the Board, on forms supplied by the Board, that the applicant has met one or more of the following criteria:
(i) Has graduated from a respiratory care program approved by the CoARC and passed the entry level credentialing examination as determined by the NBRC.
(ii) Holds a valid license, certificate or registration as a respiratory therapist in another state, territory or the District of Columbia which has been issued based on requirements substantially the same as those required by the Commonwealth, including the examination requirement.
(2) Has paid the appropriate fee in a form acceptable to the Board.
§ 18.308. Change of name or address.
A licensee shall inform the Board in writing within 10 days of a change of name or mailing address.
§ 18.309. Renewal of licensure.
(a) A license 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 licensee shall renew licensure 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 license 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:
(1) An applicant for biennial renewal or reactivation of licensure is required to complete, during the 2 years preceding the application for renewal or reactivation, a minimum of 30 hours of continuing education as set forth in section 36.1(f)(2) of the act (63 P. S. § 422.36a(f)(2)).
(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) At least 10 continuing education hours shall be obtained through traditional continuing education such as classroom lecture, clinical presentation, real-time web-cast or other live sessions where a presenter is involved. To qualify for credit, the provider shall make available documented verification of completion of the course or program.
(4) One continuing education hour shall be completed in medical ethics, and 1 continuing education hour shall be completed in patient safety.
(5) Credit will not be given for continuing education in basic life support, including basic cardiac life support and cardiopulmonary resuscitation. In any given biennial renewal period, a licensee may receive credit for no more than 8 continuing education hours in advanced life support, including advanced cardiac life support, neonatal advanced life support/neonatal resuscitation and pediatric advanced life support.
(6) A licensee will not receive continuing education credit for participating in a continuing education activity with objectives and content identical to those of another continuing education activity within the same biennial renewal period for which credit was granted.
(b) An individual applying for the first time for licensure in this Commonwealth is exempt from completing the continuing education requirements during the initial biennial renewal period in which the license is issued.
(c) The Board may waive all or a portion of the requirements of continuing education in cases of serious illness, other demonstrated hardship or military service. It shall be the duty of each licensee 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 licensee 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 licensee written notification of its approval or denial in whole or in part of the request. A licensee who requests a waiver may not practice as a respiratory therapist after the expiration of the licensee's current license until the Board grants the waiver request.
(d) A licensee shall maintain the information and documentation supporting completion of the hours of continuing education required, or the waiver granted, for at least 2 years after the conclusion of the biennial renewal period to which the continuing education or waiver applies, the date of completion of the continuing education or grant of the waiver, whichever is latest, 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 licensure as a respiratory therapist. 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 or practice building.
§ 18.310. Inactive status.
(a) A licensee who does not intend to practice in this Commonwealth and who does not desire to renew licensure shall inform the Board in writing. Written confirmation of inactive status will be forwarded to the licensee.
(b) A licensee shall notify the Board, in writing, of the licensee's desire to reactivate the license.
(c) A licensee who is applying to return to active status is required to pay fees which are due for the current biennium and submit a sworn statement stating the period of time during which the licensee was not engaged in practice in this Commonwealth.
(d) The applicant for reactivation will not be assessed a fee or penalty for preceding biennial periods in which the applicant did not engage in practice in this Commonwealth.
[Pa.B. Doc. No. 14-234. Filed for public inspection January 31, 2014, 9:00 a.m.]
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