85R13698 TSR-F     By: Hughes S.B. No. 1941       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.