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NEW JERSEY REGISTER
VOLUME 38, ISSUE 21
ISSUE DATE: NOVEMBER 6, 2006
RULE PROPOSALS
LAW AND PUBLIC SAFETY
DIVISION OF CONSUMER AFFAIRS
STATE BOARD OF RESPIRATORY CARE
Applicant Qualifications; Board-Approved Examination;
License Renewals; Continuing Education

Proposed Repeals and New Rules: N.J.A.C. 13:44F-7.2 and 7.3
Proposed Amendments: N.J.A.C. 13:44F-1.2, 4.1 and 7.1
Proposed New Rules: N.J.A.C. 13:44F-10

Authorized By: State Board of Respiratory Care, Dorcas O'Neal, Executive Director.

Authority: N.J.S.A. 45:14E-7 and 16, and 45:1-7.1 and 7.2.

Calendar Reference: See Summary below for explanation of exception to calendar requirement.

Proposal Number: PRN 2006-363.

Submit comments by January 5, 2007 to:
Dorcas O'Neal, Executive Director
State Board of Respiratory Care
PO Box 45031
124 Halsey Street
Newark, New Jersey 07101

The agency proposal follows:

Summary

These proposed amendments, new rules and repeals implement the changes from P.L. 2004, c. 167, which became effective December 7, 2004. More specifically, as a result of the changes in the law, the Board of Respiratory Care (the Board) is proposing to amend the definition of "respiratory care" and to establish continuing education requirements. In addition, pursuant to its rulemaking authority set forth in N.J.S.A. 45:14E-7, the Board is proposing to amend the rules in Subchapters 4 and 7 to be consistent with the Uniform Enforcement Act, N.J.S.A. 45:1-1 et seq. and Division policies.

Subchapter 1. Purpose and Scope; Definitions

At N.J.A.C. 13:44F-1.2, Definitions, the Board is proposing to amend the term "respiratory care." The Board is proposing to replace the reference to the abnormalities of the cardio-respiratory system with the reference to the abnormalities of the cardiopulmonary system. This proposed amendment is consistent with the statutory changes.

Subchapter 4. Applicant Qualifications; Board Approved Examination

The Board is proposing to amend N.J.A.C. 13:44F-4.1(b)3 to require applicants to have passed the National Board for Respiratory Care Entry Level Examination within the five years preceding the date of application for licensure. This requirement ensures that applicants will have been examined on the current trends in the respiratory care field.

Subchapter 7. License Renewals

The Board is proposing amendments to this subchapter to reflect the Uniform Enforcement Act at N.J.S.A. 45:1-7.1 and 7.2. The amendment to N.J.A.C. 13:44F-7.1(a) establishes that in addition to a renewal fee, a licensee, who is seeking renewal, must submit a completed renewal application on a form provided by the Board and a statement indicating satisfactory completion of the continuing education requirements. N.J.A.C. 13:44F-7.1(b) establishes that if a licensee elects inactive status, that licensee shall not engage in the practice of respiratory care in New Jersey. N.J.A.C. 13:44F-7.1(c) establishes that a licensee, who did not renew prior to its expiration date, but renews within 30 days of its expiration date, must provide the Board with a statement that all continuing education requirements have been fulfilled. N.J.A.C. 13:44F-7.1(d) establishes that if a license is not renewed with 30 days of its expiration, it shall be automatically suspended. The Board is proposing new language, which is reflective of the Uniform Enforcement Act, that the Board shall send a notice of renewal to each licensee, at least 60 days prior to the expiration of the license. If the notice to renew is not sent 60 days prior to the expiration date, no monetary penalty or fines shall apply to the holder for any unlicensed practice during the period following the licensure expiration, not to exceed the number of days short of 60 before the renewals were issued.

The Board is proposing to repeal its current requirements at N.J.A.C. 13:44F-7.2 and replace them with the requirements of the Uniform Enforcement Act. For instance, at N.J.A.C. 13:44F-7.2(a), the Board is requiring that if a licensee elects inactive status and has been on inactive status for five years or less, that license may be reactivated by the Board upon submission of certain documentation. Such documentation includes an application, payment of the reinstatement fee, an affidavit of employment during the period the licensee was on inactive status, and proof of completion of the continuing education credits required for each biennial licensure period for which the licensee was on inactive status. The Board is proposing at N.J.A.C. 13:44F-7.2(b) that if a licensee whose license has been on inactive status for more than five years and then wishes to return to active status, the licensee must submit an application, pay the reinstatement fee, submit an affidavit of employment during the period the licensee was on inactive status and successfully complete the examination required for initial licensure prior to reinstatement of his or her license.

In addition, the Board is proposing to repeal the current requirements of N.J.A.C. 13:44F-7.3, Reinstatement of suspended license, and replace them with those of the Uniform Enforcement Act. N.J.A.C. 13:44F-7.3(a) establishes the proposed new reinstatement requirements for a licensee whose license has been automatically suspended for five years or less for failure to renew and wishes to have his or her license reinstated. The rule requires the licensee to submit to the Board an application, pay the reinstatement fee and all past delinquent biennial renewal fees, submit an affidavit of employment during the period of suspended license, and provide proof of completion of the continuing education credits required for each biennial licensure period for which the licensee was suspended. N.J.A.C. 13:44F-7.3(b) establishes the reinstatement procedure for a licensee whose license has been automatically suspended for more than five years and wishes to have his or her license reinstated. The Board is proposing that such licensees submit to the Board an application, the reinstatement fee and all past delinquent biennial renewal fees, an affidavit of employment during the period of suspended license, and successfully complete the examination required for initial licensure.

Subchapter 10. Continuing Education

The Board is proposing this new subchapter to reflect its new statutory authority to require continuing education requirements for biennial renewal. The Board is proposing that a licensee applying for biennial license renewal be required to complete 30 continuing education credits, during the preceding biennial period. An applicant applying for initial licensure is exempt from the continuing education requirements for the initial biennial period of licensure. A licensee shall be required to complete 15 CE credits, 10 CE credits in respiratory care clinical practices and five CE credits in any health care related field, for the biennial renewal period beginning on April 1, 2006, if this section becomes effective after October 1, 2006 and on or before April 1, 2007. Or, a licensee shall be exempt from the CE requirements for the biennial renewal period beginning on April 1, 2006, if this section becomes effective after April 1, 2007. If a licensee completes more than 30 continuing education credits, he or she may carry over no more than five of those excess credits for the following biennial period only, so long as those additional credits were completed within one year prior to the end of the biennial licensing period. Pursuant to new rule N.J.A.C. 13:44F-10.1(c), licensees must complete at least one credit in infection control, at least one credit in patient safety/medical errors, and at least one credit in ethics. At least 20 credits must be in other areas of respiratory care clinical practice. The remaining credits may be in any health related field. N.J.A.C. 13:44F-10.1(e) establishes that the Board may direct a licensee to complete continuing education credits to correct a deficiency in the licensee's continuing education requirement. The Board is also proposing at N.J.A.C. 13:44F-10.1(f) that if a licensee is required to complete remedial continuing education pursuant to Board action, the licensee may not utilize those credits toward the mandatory 30 continuing education credits.

N.J.A.C. 13:44F-10.2 establishes the acceptable sources of continuing education programs, courses, seminars and articles and the determination of credits. Acceptable sources of continuing education programs, courses, seminars and articles include those offered or approved by the New Jersey Society for Respiratory Care or the American Association for Respiratory Care, successful completion of courses related to any health care related field at certain accredited colleges and universities, successful completion of any certification or recertification course approved by the American Heart Association in Pediatric Advanced Cardiac Life Support or Advanced Cardiac Life Support or approved by the American Academy of Pediatrics in Neonatal Resuscitation Protocol, authorship of published peer-reviewed textbooks, articles or manuals directly related to respiratory care or successful completion of distance learning courses approved by either the New Jersey Society for Respiratory Care or the American Association for Respiratory Care. Pursuant to proposed new rule N.J.A.C. 13:44F-10.3, licensees are required, unless they are seeking a waiver, to certify on the biennial renewal application that he or she has complied with the mandatory continuing education requirements. Falsification of this information may result in disciplinary action. In addition, licensees must maintain all evidence of verification of continuing education requirements and provide the Board with such verification, upon request. The Board will conduct random audits to determine licensee compliance with the continuing education requirements.

The Board is proposing new rule N.J.A.C. 13:44F-10.4 to permit waiver or modification of continuing education requirements. The Board may extend, waive or otherwise modify continuing education requirements for reasons of hardship. A licensee seeking an extension, waiver or other modification of the continuing education requirements must apply to the Board in writing and set forth in detail the reasons for the request. Documentation supporting this request must accompany the written application. Requests for waivers, extensions or other modifications must be made no later than 60 days prior to the end of the biennial licensing period. The Board is proposing that all requests be sent to the Board office by certified mail, return receipt requested. As the Board has provided a 60-day comment period on this notice of proposal, this notice is exempted from the rulemaking calendar requirement pursuant to N.J.A.C. 1:30-3.3(a)5.

Social Impact

The Board believes that the proposed repeals, amendments and new rules will have a positive social impact upon the licensed community and upon the consumers they serve. More specifically, the proposed amendment to Subchapter 4 will have a social impact upon licensees since the amendment establishes a time frame from the date of taking the qualifying examination to the date the licensees file an application. The proposed amendment requires that licensees file an application with the Board for licensure within five years of taking the qualifying examination. The proposed amendments to Subchapter 7 will also have a social impact upon licensees because the amendments establish with specificity the procedures licensees must follow for licensure renewal, reinstatement and/or inactive/active status. In addition, since the new rules at Subchapter 10 ensure that respiratory care practitioners supplement their knowledge and education on an ongoing basis, the proposed new rules will have an impact upon licensed respiratory care practitioners, as well as the patients who receive such professional services. Although these practitioners must commit time to complete the continuing education credits and to maintain adequate documentation, the proposed new rules will also provide a benefit to respiratory care practitioners in terms of increased professional knowledge and to the consumer who receives such services from highly qualified, capable, and well-informed professionals. Thus, the proposed amendments and new rules weigh strongly in favor of the public interest and furnish the Board with guidelines to enforce continuing competency requirements pursuant its legislative authority and to maintain a high-level of professionalism in the respiratory care field.

Economic Impact

The proposed amendments at Subchapter 7 will have an economic impact upon licensees, who must pay biennial licensing fees. In addition, the proposed amendments will have an economic impact upon licensees who fail to renew their licenses prior to its expiration date because such licensees will be required to pay a late fee along with the renewal fee. The proposed amendments will also have an economic impact upon those licensees whose license has been automatically suspended for up to five years for non-payment of a biennial renewal and wish to have their license reinstated because these licensees must pay a reinstatement fee and all past delinquent biennial renewal fees. In addition, licensees who elect inactive status and have been on inactive status for less than five years will experience an economic impact if they wish to be reinstated because they must pay a reinstatement fee. Moreover, the proposed amendments will have an economic impact upon all licensees who have been either suspended for more than five years and wish to be reinstated or who have elected to be inactive for more than five years and wish to be reinstated, since these individuals will have to pay all fees associated with initial licensure. The proposed new rules at Subchapter 10 will have an economic impact upon the respiratory care practitioners licensed in the State who will incur ongoing costs to complete continuing education courses, programs, or seminars. The cost to each licensee will vary depending upon the course, program, or seminar which each individual licensee selects to satisfy the requirements. The Board does not anticipate that the new rules will cause respiratory care practitioners to increase their fees in order to recoup the costs of maintaining professional competence. The Board believes that if any economic impact is experienced by applicants for licensure or licensees as a result of the proposed amendments, repeals and new rules, such economic impact is significantly outweighed by the consumer protection measures these rules afford.

Federal Standards Statement

A Federal standards analysis is not required because the proposed amendments, repeals and new rules are governed by N.J.S.A. 45:14B-1 et seq., and, therefore, are not subject to any Federal standards or requirements.

Jobs Impact

The Board does not expect that the proposed amendments, repeals and new rules will result in the creation or loss of jobs in the State.

Agriculture Industry Impact

The Board does not believe that the proposed amendments, repeals and new rules will have any impact on the agriculture industry in the State.

Regulatory Flexibility Analysis

If, for purposes of the Act, licensees are considered "small businesses" within the meaning of the statute, then the following analysis applies. The proposed amendments at Subchapter 7 will impose compliance requirements upon licensees since the amendments more clearly establish the process a licensee must comply with if the licensee elects to renew, reinstate and/or inactivate his or her license. With respect to reporting and compliance requirements, each licensee who applies for an active license renewal, pursuant to N.J.A.C. 13:44F-10.1, must comply with the continuing education requirements established by the Board and indicate on the renewal application that he or she has completed the 30 credits of continuing education and the type of continuing education credits. A licensee who seeks a waiver of continuing education requirements, pursuant to N.J.A.C. 13:44F-10.4, must submit a detailed explanation for the waiver request together with any necessary supporting documentation. With respect to recordkeeping requirements, the proposed new rules require, at N.J.A.C. 13:44F-10.3, that licensees keep records verifying completion of the continuing education requirements.

No additional professional services will be needed to comply with the proposed amendments, repeals and new rules. In order to ensure that all State-licensed respiratory care practitioners are subject to the same professional requirements and foster uniform provision of respiratory care services to patients, no differing compliance requirements based on size with the business have been provided.

Smart Growth Impact

The proposed amendments, repeals and new rules are not anticipated to have an impact on the achievement of smart growth and the implementation of the State Development and Redevelopment Plan.

Full text of the rules proposed for repeal may be found in the New Jersey Administrative Code at N.J.A.C. 13:44F-7.2 and 7.3.

Full text of the proposed amendments and new rules follows (additions indicated in boldface thus; deletions indicated in brackets [thus]):

13:44F-1.2 Definitions

The following words and terms, when used in this chapter, shall have the following meanings unless the context clearly indicates otherwise.

"Respiratory care" means the health specialty involving the treatment, management, control, and care of patients with deficiencies and abnormalities of the [cardio-respiratory] cardiopulmonary system, as further defined in N.J.S.A. 45:14E-3(c).

13:44F-4.1 Eligibility for licensure

(a) (No change.)

(b) An applicant shall submit, with the completed application form and the required fee, satisfactory proof that the applicant:

1.-2. (No change.)

3. Has passed the examination specified in N.J.A.C. 13:44F-4.2 within the five years preceding the date of application for licensure.

13:44F-7.1 Biennial license renewal; inactive status

(a) All licenses issued by the Board shall be issued for a two-year biennial licensure period. A licensee who seeks renewal of the license shall submit a completed license renewal application on a form provided by the Board, a statement that the licensee has fulfilled the continuing education requirement set forth in N.J.A.C. 13:44F-10.1 and the license renewal fee set forth in N.J.A.C. 13:44F-8.1 prior to the expiration date of the license.

(b) Renewal applications shall provide the applicant with the option of either active or inactive status. A licensee electing inactive status shall pay the inactive license fee set forth in N.J.A.C. 13:44F-8.1, and shall not engage in the practice of respiratory care in this State.

(c) If the licensee does not renew the license prior to its expiration date, the licensee may renew it within 30 days of its expiration by submitting a renewal application, a statement that the licensee has fulfilled the continuing education requirement set forth in N.J.A.C. 13:44F-10.1, a license renewal fee and a late fee, as set forth in N.J.A.C. 13:44F-8.1.

(d) A license that is not renewed within 30 days of its expiration shall be automatically suspended. An individual who continues to practice with a suspended license shall be deemed to be engaged in unlicensed practice. The Board shall send a notice of renewal to each licensee, at least 60 days prior to the expiration of the license. If the notice to renew is not sent 60 days prior to the expiration date, no monetary penalty or fines shall apply to the holder for any unlicensed practice during the period following the licensure expiration, not to exceed the number of days short of 60 before the renewals were issued.

13:44F-7.2 Change of license status: inactive to active

(a) A licensee who elected inactive status and has been on inactive status for five years or less may be reactivated by the Board upon submission of the following:

1. A completed reinstatement application on a form provided by the Board;

2. Payment of the reinstatement fee pursuant to N.J.A.C. 13:44F-8.1;

3. An affidavit of employment listing each job held during the period the license was on inactive status, which includes the name, address, and telephone number of each employer; and

4. Proof of completion of the continuing education credits required for each biennial licensure period for which the licensee was on inactive status.

(b) In addition to fulfilling the requirements set forth in (a)1 through 3 above, a licensee whose license has been on inactive status for more than five years who wishes to return to active status shall successfully complete the examination required for initial licensure prior to reinstatement of his or her license as specified in N.J.A.C. 13:44F-4.2 within five years of the application for return to active status.

13:44F-7.3 Reinstatement of suspended license

(a) A licensee whose license has been automatically suspended for five years or less for failure to renew pursuant to N.J.A.C. 13:44F-7.1(d) may be reinstated by the Board upon submission of the following:

1. A completed reinstatement application on a form provided by the Board;

2. Payment of the reinstatement fee and all past delinquent biennial renewal fees as set forth in N.J.A.C. 13:44F-8.1;

3. An affidavit of employment listing each job held during the period of suspended license which includes the name, address, and telephone number of each employer; and

4. Proof of completion of the continuing education credits required for each biennial licensure period for which the license was suspended.

(b) In addition to fulfilling the requirements set forth in (a)1 through 3 above, a licensee whose license has been automatically suspended for more than five years who wishes to return to practice shall successfully complete the examination required for initial licensure as specified in N.J.A.C. 13:44F-4.2 within five years of the application for return to active status.

SUBCHAPTER 10. CONTINUING EDUCATION

13:44F-10.1 Continuing education requirements for biennial renewal

(a) A licensee applying for biennial license renewal shall complete, during the preceding biennial period, 30 continuing education (CE) credits as specified in (c) below. Applicants for initial licensure are exempt from the continuing education requirements of this section for the initial biennial period of licensure.

1. A licensee shall be required to complete 15 CE credits, 10 CE credits in respiratory care clinical practices and five CE credits in any health care related field, for the biennial renewal period beginning on April 1, 2006, if this section becomes effective on or before April 1, 2007.

2. A licensee shall be exempt from the CE requirements for the biennial renewal period beginning on April 1, 2006, if this section becomes effective after April 1, 2007.

(b) Each licensee shall confirm on the application for biennial licensure renewal that he or she has completed 30 continuing education credits.

(c) A licensee shall complete a minimum of 30 continuing education credits, in programs permitted under N.J.A.C. 13:44F-10.2, as follows:

1. At least one CE credit in infection control;

2. At least one CE credit in patient safety/medical errors;

3. At least one CE credit in ethics;

4. At least 20 CE credits in other respiratory care clinical practices; and

5. Any remaining credits in any health care related field.

(d) A licensee who completes credit hours in excess of the 30 credits required may apply no more than five of those credits to the continuing education requirement for the following biennial period only, so long as those additional credits were completed within one year prior to the end of the biennial licensing period.

(e) The Board may direct a licensee to complete continuing education credits to correct a deficiency in the licensee's continuing education requirement.

(f) A licensee who is required to complete remedial continuing education pursuant to Board action shall not receive credit for such imposed continuing education toward the mandatory 30 credits of biennial licensure period.

13:44F-10.2 Approval of continuing education programs, courses, seminars and articles; determination of credits

(a) The following are acceptable sources of continuing education programs, courses, seminars and articles, as long as the programs, courses, seminars or articles fall within the content areas set forth in N.J.A.C. 13:44F-10.1(c):

1. Successful completion of programs, courses or seminars offered or approved by the New Jersey Society for Respiratory Care or the American Association for Respiratory Care: one continuing education credit for each course credit awarded;

2. Successful completion of courses related to any health care related field at colleges and universities accredited by the Middle States Association of Colleges and Schools. Commission on Higher Education or any other regional accrediting agency with standards that are substantially similar to the standards utilized by the Middle States Association of Colleges and Schools, Commission on Higher Education: one continuing education credit for each course credit awarded;

3. Successful completion of any certification or recertification course approved by the American Heart Association in Pediatric Advanced Cardiac Life Support (PALS) or Advanced Cardiac Life Support (ACLS) or approved by the American Academy of Pediatrics in Neonatal Resuscitation Protocol (NRP): one continuing education credit for each instructional hour awarded, with a maximum of 12 credits per biennial licensure period;

4. Authorship of published peer-reviewed textbooks, articles or manuals directly related to respiratory care: three credits for each textbook, article or manual; and

5. Successful completion of videotaped, Internet, and other distance learning courses, approved by one of the organizations listed in (a)1 above, with verification by the course provider that the course was monitored and successfully completed by the licensee: one continuing education credit for each course credit awarded with a maximum of 15 credits per biennial licensure period.

(b) A licensee shall receive one continuing education credit for each hour of attendance at programs, courses and seminars approved by one of the organizations listed in (a)1 above. Credit shall not be granted for courses that are less than one instructional hour long. For purposes of this subchapter, an "instructional hour" represents a 60-minute clock hour with no less than 50 minutes of content within the hour. Programs may include one 10-minute break for each instructional hour.

13:44F-10.3 Licensee certification of compliance; recordkeeping; audit

(a) A licensee shall:

1. Certify completion of the required number of continuing education credits on the application for biennial renewal. Falsification of any information submitted on the renewal application shall be cause for disciplinary action;

2. Maintain all evidence of verification of continuing education requirements for two full biennial licensing periods after completion of the credits and submit such documentation to the Board upon request; and

3. Provide to the Board upon request, documentation of the licensees completion of continuing education requirements as follows:

i. For programs, courses and seminars: the course provider's written verification of attendance;

ii. For college courses: an official transcript;

iii. For articles published in a peer-reviewed professional journal: the published article;

iv. For authored textbooks or manuals: the textbook or manual; and

v. Videotaped, Internet and other distance learning courses: written verification from the course provider.

(b) The Board shall conduct random audits to determine licensee compliance with continuing education requirements.

13:44F-10.4 Waiver or modification of continuing education requirements

(a) The Board may extend, waive or otherwise modify continuing education requirements, including the time period for completion or the number of continuing education credits, on an individual basis for reasons of hardship, such as severe illness, disability or military service.

(b) A licensee seeking an extension, waiver or other modification of the continuing education requirements shall apply to the Board in writing and set forth in specific detail the reasons for the request. The licensee shall submit to the Board all documentation in support of the request for extension, waiver or other modification.

(c) A licensee shall apply for an extension, waiver or other modification no later than 60 days prior to the end of the biennial licensing period. All requests shall be sent to the offices of the Board, as provided in N.J.A.C. 13:44F-2.2, by certified mail, return receipt requested.



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