BILL REQ. #:  H-4796.1 

Read first time 01/24/08.   Referred to Committee on Health Care & Wellness.

     AN ACT Relating to radiologist assistants; amending RCW 18.84.010, 18.84.020, 18.84.030, 18.84.040, 18.84.080, 18.84.100, 18.84.110, 43.70.110, 43.70.250, and 43.70.280; and adding new sections to chapter 18.84 RCW.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

Sec. 1   RCW 18.84.010 and 1991 c 222 s 1 are each amended to read as follows:
     It is the intent and purpose of this chapter to protect the public by the certification and registration of practitioners of radiological technology. By promoting high standards of professional performance, by requiring professional accountability, and by credentialing those persons who seek to provide radiological technology under the title of ((radiological)) radiologic technologists, and by regulating all persons utilizing ionizing radiation on human beings this chapter identifies those practitioners who have achieved a particular level of competency. Nothing in this chapter shall be construed to require that individual or group policies or contracts of an insurance carrier, health care service contractor, or health maintenance organization provide benefits or coverage for services and supplies provided by a person certified under this chapter.
     The legislature finds and declares that this chapter conforms to the guidelines, terms, and definitions for the credentialing of health or health-related professions specified under chapter 18.120 RCW.

Sec. 2   RCW 18.84.020 and 2000 c 93 s 42 are each amended to read as follows:
     ((Unless the context clearly requires otherwise,)) The definitions in this section apply throughout this chapter unless the context clearly requires otherwise.
     (1) "Department" means the department of health.
     (2) "Secretary" means the secretary of health.
     (3) "Licensed practitioner" means any licensed health care practitioner performing services within the person's authorized scope of practice.
     (4) "Radiologic technologist" means an individual certified under this chapter, other than a licensed practitioner, who practices radiologic technology as a:
     (a) Diagnostic radiologic technologist, who is a person who actually handles X-ray equipment in the process of applying radiation on a human being for diagnostic purposes at the direction of a licensed practitioner, this includes parenteral procedures related to radiologic technology when performed under the direct supervision of a physician licensed under chapter 18.71 or 18.57 RCW; ((or))
     (b) Therapeutic radiologic technologist, who is a person who uses radiation-generating equipment for therapeutic purposes on human subjects at the direction of a licensed practitioner, this includes parenteral procedures related to radiologic technology when performed under the direct supervision of a physician licensed under chapter 18.71 or 18.57 RCW; ((or))
     (c) Nuclear medicine technologist, who is a person who prepares radiopharmaceuticals and administers them to human beings for diagnostic and therapeutic purposes and who performs in vivo and in vitro detection and measurement of radioactivity for medical purposes at the direction of a licensed practitioner; or
     (d) Radiologist assistant, who is an advanced-level certified diagnostic radiologic technologist who practices under levels of supervision defined by the secretary, and:
     (i) Enhances patient care by assisting the radiologist in the diagnostic imaging environment;
     (ii) Performs advanced diagnostic procedures including injecting agents that facilitate or enable diagnostic imaging, performs selected diagnostic aspirations and needle localizations for biopsy under radiologist direction and supervision, performs fluoroscopy, and placing nasoenteric and oroenteric feeding tubes in uncomplicated patients;
     (iii) Monitors and tailors selected examinations;
     (iv) Communicates preliminary observations to a radiologist and communicates final radiologist reports to referring health care providers when directed;
     (v) Performs selected peripheral venous diagnostic procedures; and
     (vi) Assists radiologists with invasive procedures and performs additional procedures under radiologist direction and supervision.
     (5) "Approved school of radiologic technology" means a school of radiologic technology or radiologist assistant program approved by the council on medical education of the American medical association or the American registry of radiologic technologists or a school found to maintain the equivalent of such a course of study as determined by the department. Such school may be operated by a medical or educational institution, and for the purpose of providing the requisite clinical experience, shall be affiliated with one or more general hospitals.
     (6) "Radiologic technology" means the use of ionizing radiation upon a human being for diagnostic or therapeutic purposes.
     (7) "Radiologist" means a physician certified by the American board of radiology or the American osteopathic board of radiology.
     (8) "Registered X-ray technician" means a person who is registered with the department, and who applies ionizing radiation at the direction of a licensed practitioner and who does not perform parenteral procedures.

Sec. 3   RCW 18.84.030 and 1991 c 222 s 3 are each amended to read as follows:
     No person may practice radiologic technology without being registered or certified under this chapter, unless that person is a licensed practitioner as defined in RCW 18.84.020(3). A person represents himself or herself to the public as a certified ((radiological)) radiologic technologist when that person adopts or uses a title or description of services that incorporates one or more of the following items or designations:
     (1) Certified radiologic technologist or CRT, for persons so certified under this chapter;
     (2) Certified radiologic therapy technologist, CRTT, or CRT, for persons certified in the therapeutic field;
     (3) Certified radiologic diagnostic technologist, CRDT, or CRT, for persons certified in the diagnostic field; ((or))
     (4) Certified nuclear medicine technologist, CNMT, or CRT, for persons certified as nuclear medicine technologists; or
     (5) Certified radiologist assistant or CRA for persons certified as radiologist assistants.

Sec. 4   RCW 18.84.040 and 1994 sp.s. c 9 s 506 are each amended to read as follows:
     (1) In addition to any other authority provided by law, the secretary may:
     (a) Adopt rules, in accordance with chapter 34.05 RCW, necessary to implement this chapter;
     (b) ((Set all registration, certification, and renewal fees in accordance with RCW 43.70.250;
     (c))) Establish forms and procedures necessary to administer this chapter;
     (((d))) (c) Evaluate and designate those schools from which graduation will be accepted as proof of an applicant's eligibility to receive a certificate;
     (((e))) (d) Determine whether alternative methods of training are equivalent to formal education, and to establish forms, procedures, and criteria for evaluation of an applicant's alternative training to determine the applicant's eligibility to receive a certificate;
     (((f))) (e) Prepare, grade, and administer, or determine the nature of, and supervise the grading and administration of examinations for obtaining a certificate;
     (f) Issue a certificate to any applicant who has met the education, training, examination, preceptorship, and conduct requirements for certification; and
     (g) Issue a registration to an applicant who meets the requirement for a registration.
     (2) The secretary may hire clerical, administrative, and investigative staff as needed to implement this chapter.
     (3) The uniform disciplinary act, chapter 18.130 RCW, governs the issuance and denial of registrations and certifications, unregistered and uncertified practice, and the discipline of registrants and certificants under this chapter. The secretary is the disciplining authority under this chapter.
     (4) The secretary may appoint ad hoc members of the profession to serve in an ad hoc advisory capacity to the secretary in carrying out this chapter. The members will serve for designated times and provide advice on matters specifically identified and requested by the secretary. The members shall be compensated in accordance with RCW 43.03.220 and reimbursed for travel expenses under RCW 43.03.040 and 43.03.060.

Sec. 5   RCW 18.84.080 and 1991 c 3 s 209 are each amended to read as follows:
     (1) The secretary shall issue a certificate to any applicant who demonstrates to the secretary's satisfaction, that the following requirements have been met to practice as:
     (a) A diagnostic radiologic technologist, therapeutic radiologic technologist, or nuclear medicine technologist:
     (i) Graduation from an approved school or successful completion of alternate training that meets the criteria established by the secretary; and
     (((b))) (ii) Good moral character; or
     (b) A radiologist assistant:
     (i) Satisfactory completion of a baccalaureate degree, postbaccalaureate certificate, or master's degree encompassing a radiologist assistant curriculum from an approved school of radiologic technology;
     (ii) Satisfactory completion of a radiologist-directed clinical preceptorship; and
     (iii) Satisfactory completion of a radiologist assistant examination approved by the secretary.
     (2) Applicants shall be subject to the grounds for denial or issuance of a conditional license under chapter 18.130 RCW.
     (3) The secretary shall establish by rule what constitutes adequate proof of meeting the requirements for certification and for designation of certification in a particular field of radiologic technology.

Sec. 6   RCW 18.84.100 and 1996 c 191 s 71 are each amended to read as follows:
     Applications for certification must be submitted on forms provided by the secretary. The secretary may require any information and documentation that reasonably relates to the determination of whether the applicant meets the requirements for certification provided for in this chapter and chapter 18.130 RCW. Each applicant shall comply with administrative procedures((,)) and administrative requirements((, and fees)) determined by the secretary ((as provided in RCW 43.70.250 and 43.70.280)).

Sec. 7   RCW 18.84.110 and 1996 c 191 s 72 are each amended to read as follows:
     The secretary shall establish the administrative procedures((,)) and administrative requirements((, and fees)) for renewal of certificates ((as provided in RCW 43.70.250 and 43.70.280)).

NEW SECTION.  Sec. 8   A new section is added to chapter 18.84 RCW to read as follows:
     (1) The date and location of radiologist assistant examinations must be established by the secretary. Applicants who have been found by the secretary to meet the other requirements for obtaining a certificate must be scheduled for the next examination following the filing of the application. The secretary shall establish by rule the examination application deadline.
     (2) The secretary or the secretary's designee shall examine each applicant, by means determined most effective, on subjects appropriate to the scope of practice, as applicable. The examinations must be limited to the purpose of determining whether the applicant possesses the minimum skill and knowledge necessary to practice competently.
     (3) The examination papers, all grading of the papers, and the grading of any practical work must be preserved for a period of not less than one year after the secretary has made and published the decisions. All examinations must be conducted under fair and wholly impartial methods.
     (4) Any applicant failing to make the required grade in the first examination may take up to two subsequent examinations as the applicant desires. Upon failing four examinations, the secretary may invalidate the original application and require remedial education before the person may take future examinations.
     (5) The secretary may approve an examination prepared or administered by a private testing agency or association of credentialing agencies for use by an applicant in meeting the credentialing requirements, including examinations prepared and administered by the American registry of radiologic technologists.

NEW SECTION.  Sec. 9   A new section is added to chapter 18.84 RCW to read as follows:
     It is unprofessional conduct under chapter 18.130 RCW for any person registered or certified under this chapter to interpret images, make diagnoses, prescribe medications or therapies, or perform other procedures that may be prohibited by rule.

Sec. 10   RCW 43.70.110 and 2007 c 259 s 11 are each amended to read as follows:
     (1) The secretary shall charge fees to the licensee for obtaining a license. After June 30, 1995, municipal corporations providing emergency medical care and transportation services pursuant to chapter 18.73 RCW shall be exempt from such fees, provided that such other emergency services shall only be charged for their pro rata share of the cost of licensure and inspection, if appropriate. The secretary may waive the fees when, in the discretion of the secretary, the fees would not be in the best interest of public health and safety, or when the fees would be to the financial disadvantage of the state.
     (2) Except as provided in subsection (3) of this section, fees charged shall be based on, but shall not exceed, the cost to the department for the licensure of the activity or class of activities and may include costs of necessary inspection.
     (3) License fees shall include amounts in addition to the cost of licensure activities in the following circumstances:
     (a) For registered nurses and licensed practical nurses licensed under chapter 18.79 RCW, support of a central nursing resource center as provided in RCW 18.79.202, until June 30, 2013;
     (b) For all health care providers licensed under RCW 18.130.040, the cost of regulatory activities for retired volunteer medical worker licensees as provided in RCW 18.130.360; and
     (c) For physicians licensed under chapter 18.71 RCW, physician assistants licensed under chapter 18.71A RCW, osteopathic physicians licensed under chapter 18.57 RCW, osteopathic physicians' assistants licensed under chapter 18.57A RCW, naturopaths licensed under chapter 18.36A RCW, podiatrists licensed under chapter 18.22 RCW, chiropractors licensed under chapter 18.25 RCW, psychologists licensed under chapter 18.83 RCW, registered nurses licensed under chapter 18.79 RCW, optometrists licensed under chapter 18.53 RCW, mental health counselors licensed under chapter 18.225 RCW, massage therapists licensed under chapter 18.108 RCW, clinical social workers licensed under chapter 18.225 RCW, and acupuncturists licensed under chapter 18.06 RCW, the license fees shall include up to an additional twenty-five dollars to be transferred by the department to the University of Washington for the purposes of RCW 43.70.112.
     (4) Department of health advisory committees may review fees established by the secretary for licenses and comment upon the appropriateness of the level of such fees.
     (5) Nothing in this section authorizes the secretary to establish or collect fees of any nature from a radiologist assistant certified under chapter 18.84 RCW.

Sec. 11   RCW 43.70.250 and 2006 c 72 s 4 are each amended to read as follows:
     (1) It shall be the policy of the state of Washington that the cost of each professional, occupational, or business licensing program be fully borne by the members of that profession, occupation, or business. The secretary shall from time to time establish the amount of all application fees, license fees, registration fees, examination fees, permit fees, renewal fees, and any other fee associated with licensing or regulation of professions, occupations, or businesses administered by the department. In fixing said fees, the secretary shall set the fees for each program at a sufficient level to defray the costs of administering that program and the cost of regulating licensed volunteer medical workers in accordance with RCW 18.130.360, except as provided in RCW 18.79.202 until June 30, 2013. All such fees shall be fixed by rule adopted by the secretary in accordance with the provisions of the administrative procedure act, chapter 34.05 RCW.
     (2) Nothing in this section authorizes the secretary to establish or collect fees of any nature from a radiologist assistant certified under chapter 18.84 RCW.

Sec. 12   RCW 43.70.280 and 1999 c 34 s 1 are each amended to read as follows:
     (1) The secretary, in consultation with health profession boards and commissions, shall establish by rule the administrative procedures, administrative requirements, and fees for initial issue, renewal, and reissue of a credential for professions under RCW 18.130.040, including procedures and requirements for late renewals and uniform application of late renewal penalties. Failure to renew invalidates the credential and all privileges granted by the credential. Administrative procedures and administrative requirements do not include establishing, monitoring, and enforcing qualifications for licensure, scope or standards of practice, continuing competency mechanisms, and discipline when such authority is authorized in statute to a health profession board or commission. For the purposes of this section, "in consultation with" means providing an opportunity for meaningful participation in development of rules consistent with processes set forth in RCW 34.05.310.
     (2) Notwithstanding any provision of law to the contrary which provides for a licensing period for any type of license subject to this chapter including those under RCW 18.130.040, the secretary of health may, from time to time, extend or otherwise modify the duration of any licensing, certification, or registration period, whether an initial or renewal period, if the secretary determines that it would result in a more economical or efficient operation of state government and that the public health, safety, or welfare would not be substantially adversely affected thereby. However, no license, certification, or registration may be issued or approved for a period in excess of four years, without renewal. Such extension, reduction, or other modification of a licensing, certification, or registration period shall be by rule or regulation of the department of health adopted in accordance with the provisions of chapter 34.05 RCW. Such rules and regulations may provide a method for imposing and collecting such additional proportional fee as may be required for the extended or modified period.
     (3) Nothing in this section authorizes the secretary to establish or collect fees of any nature from a radiologist assistant certified under chapter 18.84 RCW.