The document discusses various legislative initiatives regarding certification and licensure requirements for medical imaging providers, including ultrasound technicians. It outlines current bills in New Mexico and Oregon that would require certification or licensure to perform medical ultrasound. Concerns are raised that the bills could restrict non-prescriptive providers like nurses from using ultrasound. The document advocates working with relevant societies to address these issues and ensure ultrasound remains within the scope of practice for vascular access professionals.

1. IMPACT ON VASCULAR ACCESS Imaging Provider Certification and Licensure Initiatives

2. Legislative Background CARE Bill (Consistency, Accuracy, Responsibility and Excellence in Medical Imaging) originally introduced by ASRT and Alliance for Quality Imaging in 2000. Education and credentialing standards for non-physician providers of imaging Ultrasound was excluded Legislation reintroduced every year since 2000 Ultrasound added in 2007 at request of SDMS (Society for Diagnostic Medical Sonography) Historically, ultrasound has not been included in a State-based legislation

3. Current Legislative Initiatives Alliance for Quality Imaging seeking original cosponsors to reintroduce CARE bill in 111 th Congress Ultrasound will be in the bill New Mexico HB 498 passed legislature in March; signed by Governor in April 2009 Licensure for sonographers State education and training standards tied to certification Oregon HB 2245 passed House Currently in Joint Ways & Means Committee Then to Senate

4. General Concerns Restriction of non-prescriptive providers with ultrasound usage (MDs, PAs, NPs all exempt) Could exclude nurses – varies per bill Non-diagnostic usage of ultrasound is not clearly addressed Hard to anticipate total impact Each Bill is different and has to be dealt with individually

5. Specifics of Federal Legislation (CARE Bill) Drafted to be effective January 1, 2013 if passed Individuals qualified to perform or plan the technical component of medical imaging examinations…must— “ (A) possess current certification in each medical imaging or radiation therapy modality and service provided from a certification organization designated by the Secretary pursuant to subsection (c); or “ (B) possess current State licensure, or certification, where— “ (i) such services and modalities are within the scope of practice as defined by the State for such profession; and “ (ii) the requirements for licensure, certification or registration meet or exceed the standards established by the Secretary pursuant to this section.

6. Influencing Federal Legislation Society for Diagnostic Medical Sonography Main group submitting Bill Will consider requested changes Hoping to avoid controversy Aware of difficulties associated with sonographer requirements for PICC nurses American Society for Radiological Technologists

7. Specifics of New Mexico Legislation Department of Environment Program Manager, Steven Sanchez Intend to modify rules licensing techs for ionizing radiation Expect to seat Council by November, 2009 Council will review proposal in January; deliberate in April 2010 meeting (public) Regulations to Board in Summer of 2010 One year grace period “ Allow the practice of medicine to continue unimpeded.”

8. Specifics of New Mexico Legislation It is unlawful, unless licensed by the department as a medical imaging professional, for any person to use non-ionizing radiation on humans The Environmental Improvement board shall, A. adopt and promulgate such rules, regulations and licensure standards as may be necessary to effectuate the provisions of the Act and to maintain high standards of practice as verified by credentialing organizations for medical imaging; and B. adopt rules and regulations establishing continuing education requirements as a condition of licensure renewal The division (environmental health division of the department of environment) shall: A. maintain and enforce licensure standards for diagnostic medical sonography and B. refer to national educational accreditation standards for educational programs and, pursuant to those standards, establish criteria for education programs of diagnostic medical sonography; C. establish scope of practice and ethics rules."

9. Exclusions – New Mexico Bill The requirement of a medical imaging license shall not apply to a licensed practitioner or auxiliary or health practitioner licensed or certified by an independent board; provided that any certification and examination program for auxiliaries or health practitioners established by an independent board shall be submitted to the advisory council and approved by the board.

10. Oregon Legislation A person may not Practice any of the medical imaging modalities if the person is not licensed in accordance with the provisions of ORS 688.455 After January 1, 2014, the Board of Medical Imaging may not issue a license to a person unless the person has been awarded a credential by a credentialing organization in a medical imaging modality recognized by the board . The provisions of ORS 688.405 to 688.605 do not apply to the following persons: Specific licensed health care providers, other than physicians, who use sonographic equipment within their lawful scope of practice.

11. Addressing Oregon Legislation Oregon Board of Nursing has expressed the intent to add ultrasound to Oregon State Nursing Licensure scope

12. Next Steps Represent AVA to Contact and address submission process with NM Medical Imaging and Radiation Therapy Health and Safety Act Develop exclusionary language for the Federal CARE Bill and coordinate with the SDMS Work together with the Oregon BON to establish ultrasound within scope of RN practice Monitor other State bill activity through NCSL/MITA

13. Legislative Alert for Members Sample: AVA has recently become aware there is legislative work being done to require certification for the use of ultrasound by medical professionals other than MDs and sonographers. We support safety and quality within the medical community, and as such know the use of ultrasound for placement of intravenous devices should not be restricted by those trained to use it for vascular access. Activity is on-going to ensure scope of practice with ultrasound for members. We will continue to watch the Federal and State legislation and let you know if there are actions you should take.

14. NANCY MOUREAU Thanks for the time