HB2050 - 572R

Be it enacted by the Legislature of the State of Arizona:

Section 1. Section 30-672, Arizona Revised Statutes, is amended to read:

START_STATUTE30-672. Licensing and registration of sources of radiation; exemptions; rules

A. The department by rule shall provide for general or specific licensing of by-product materials, source materials, special nuclear materials or devices or equipment using those materials. The department shall require from the applicant satisfactory evidence that the applicant is using methods and techniques that are demonstrated to be safe and that the applicant is familiar with the rules adopted by the department under section 30-654, subsection B, paragraph 5 relative to uniform radiation standards, total occupational radiation exposure norms, labels, signs and symbols, storage, waste disposal and shipment of radioactive materials. The department may require that, before it issues a license, the employees or other personnel of an applicant who may deal with sources of radiation receive a course of instruction approved by the department concerning department rules. The department shall require that the applicant's proposed equipment and facilities be adequate to protect health and safety and that the applicant's proposed administrative controls over the use of the sources of radiation requested be adequate to protect health and safety.

B. The department may require registration or licensing of other sources of radiation if deemed necessary to protect public health or safety.

C. The department may exempt certain sources of radiation or kinds of uses or users from the licensing or registration requirements set forth in this section if it finds that exempting such sources of radiation or kinds of uses or users will not constitute a significant risk to the health and safety of the public.

D. The director may suspend or revoke, in whole or in part, any license issued under subsection A of this section if the licensee or an officer, agent or employee of the licensee:

1. Violates this chapter or rules of the department adopted pursuant to this chapter.

2. Has been, is or may continue to be in substantial violation of the requirements for licensure of the source of radiation source and as a result the health or safety of the general public is in immediate danger.

E. If the licensee, or an officer, agent or employee of the licensee, refuses to allow the department or its employees or agents to inspect the licensee's premises, such an action shall be deemed reasonable cause to believe that a substantial violation under subsection D, paragraph 2 of this section exists.

F. A license may not be suspended or revoked under this chapter without affording the licensee notice and an opportunity for a hearing as provided in title 41, chapter 6, article 10.

G. The department shall not require persons who are licensed in this state to practice as a dentist, physician assistant, registered nurse practitioner, chiropodist or veterinarian or licensed in this state to practice medicine, surgery, osteopathic medicine, chiropractic or naturopathic medicine to obtain any other license to use a diagnostic x-ray machine, but these persons are governed by their own licensing acts.

H. Persons who are licensed by the federal communications commission with respect to the activities for which they are licensed by that commission are exempt from this chapter.

I. Rules adopted pursuant to this chapter may provide for recognition of other state or federal licenses as the department deems desirable, subject to such registration requirements as the department prescribes.

J. Any licenses issued by the department shall state the nature, use and extent of use of the source of radiation. If at any time after a license is issued the licensee desires any change in the nature, use or extent, the licensee shall seek an amendment or a new license under this section.

K. The department shall prescribe by rule requirements for financial security as a condition for licensure under this article. The department shall deposit all amounts posted, paid or forfeited as financial security in the radiation regulatory and perpetual care fund established by section 30-694.

L. Persons applying for licensure shall provide notice to the city or town where the applicant proposes to operate as part of the application process.

M. Any facility that provides diagnostic mammography or screening mammography examinations by or under the direction of a person who is exempt from further licensure under subsection G of this section shall obtain certification by the department. The department shall prescribe by rule the requirements of certification in order to ensure the accuracy and safety of diagnostic mammography and screening mammography. END_STATUTE

Sec. 2. Section 32-2804, Arizona Revised Statutes, is amended to read:

START_STATUTE32-2804. School approval; standards; considerations

A. The department may approve a school of radiologic technology as maintaining a satisfactory standard if its the school's course of study:

1. Is for a period of at least twenty-four months of full-time study or its equivalent and is accredited by the committee on allied health accreditation commission on accreditation of allied health EDUCATION programs or the joint review committee on education in radiologic technology or accredited as recognized by the united States department of education, or meets or exceeds the standards of this chapter.

2. Includes at least four hundred hours of classroom work, including radiation protection, x-ray physics, radiographic techniques, processing techniques, nursing radiographic imaging and patient care procedures, anatomy and physiology, radiographic positioning, radiation therapy an introduction to other imaging modalities and professional ethics.

3. Includes at least one thousand eight six hundred fifty hours devoted to clinical experience.

4. Includes demonstrations, discussions, seminars and supervised practice.

5. Includes at least eighty hours of regularly scheduled supervised film image critiques.

B. An approved school of radiologic technology may be operated by a medical or educational institution or other public or private agency or institution and, for the purpose of providing the requisite clinical experience, shall be affiliated with one or more hospitals that the department determines are likely to provide this experience.

C. In approving a school of radiologic technology, the department shall consider the standards adopted by appropriate professional organizations, including the joint review committee on education in radiologic technology, and may accept the certification of a school of radiologic technology or the accreditation of a hospital to provide requisite clinical experience if the department finds that certification or accreditation was granted on the basis of standards that will afford the same protection to the public as the standards provided by this chapter. END_STATUTE

Sec. 3. Section 32-2813, Arizona Revised Statutes, is amended to read:

START_STATUTE32-2813. Examination; contents; subsequent examinations

A. Examinations for certification shall include the subjects of radiation protection, x-ray physics, radiographic techniques, processing techniques, nursing radiographic imaging and patient care procedures, anatomy terminology, radiological mathematics, professional ethics and such other subjects as the department may deem appropriate, including the content specifications outlined by the American registry of radiologic technologists.

B. The department shall prepare lists of examination questions or problems and administer the examinations.

C. Examinations shall include written questions but may also include practical and oral portions. Following each examination, the papers and the practical and oral examinations shall be graded and the standing of each applicant shall be recorded. The department shall either pass or reject each applicant.

D. An applicant who fails to pass an examination may reapply for examination in the manner prescribed by section 32-2812. The department shall require a candidate who fails the examination three times to successfully complete additional training prescribed by the department before accepting the candidate for reexamination. END_STATUTE

Sec. 4. Section 32-2815, Arizona Revised Statutes, is amended to read:

START_STATUTE32-2815. Rules; bone densitometry certification; nuclear medicine certification; continuing education

A. The department shall adopt rules regarding the certification of practical technologists in bone densitometry to allow the certificate holder to apply ionizing radiation to a person's hips, spine and extremities through the use of a bone densitometry machine. The rules shall prescribe:

1. The minimum education and training qualifications for certification. The qualifications prescribed by the department shall allow a person who does not meet the education and training requirements of a radiologic technologist or a practical technologist in radiology to obtain a certificate as a practical technologist in bone densitometry.

2. The application and renewal fees.

B. Subsection A of this section does not prohibit a radiologic technologist or a practical technologist in radiology from operating a bone densitometry machine.

C. A person who wishes to practice as a nuclear medicine technologist must apply to the department for certification as prescribed by rule. The department shall adopt rules to establish minimum educational and training requirements for nuclear medicine technologists.

D. The department shall adopt rules to prescribe the following minimum continuing education requirements for the renewal of the following certificates:

1. Practical technologist in podiatry, two hours every two years.

2. Practical technologist in radiology, six hours every two years.

3. Practical technologist in bone densitometry, two hours every two years.

4. Unlimited practical technologist in radiology, twenty-four hours every two years.

5. Nuclear medicine technologist, twenty-four hours every two years.

6. Radiologist assistant, fifty hours every two years.

7. Radiologic technologist, twenty-four hours every two years.

8. Radiation therapy technologist, twenty-four hours every two years.

E. The department may require an applicant for renewal to document compliance with the appropriate continuing education requirements of subsection D of this section. END_STATUTE

Sec. 5. Section 32-2819, Arizona Revised Statutes, is amended to read:

START_STATUTE32-2819. Radiologist assistants; certification; rules; scope of practice

A. A person who wishes to practice as a radiologist assistant must apply to the department for a certificate on a form and in the manner prescribed by the department pursuant to the requirements of section 32-2812.

B. The department shall adopt rules to implement this section. The rules shall include the following:

1. Continuing education requirements.

2. Any other requirements the department considers appropriate to implement this section.

C. Pursuant to rules adopted by the department and except as provided in section 32-2819.01, a radiologist assistant may do the following under the direct supervision of a radiologist:

1. Perform fluoroscopic procedures.

2. Assess and evaluate the physiologic and psychological responsiveness of patients who are undergoing radiologic procedures.

3. Evaluate image quality, make initial image observations and communicate observations to the supervising radiologist.

4. Administer contrast media or other medications prescribed by the supervising radiologist.

5. Perform any other procedures consistent with rules adopted by the department.

D. In adopting rules pursuant to subsection C of this section, the department shall consider guidelines established by the the American society of radiologic technologists and the American registry of radiologic technologists.

E. A radiologist assistant shall not interpret images, make diagnoses or prescribe medications or therapies.

F. A radiologist who supervises a radiologist assistant may authorize the radiologist assistant to perform only those radiologic procedures described in this section.

G. A person shall not do any of the following without a certificate issued pursuant to this section:

1. Perform the radiologic procedures described in subsection C of this section.

2. Claim to be a radiologist assistant, including using any sign, advertisement, card, letterhead, circular or other writing, document or design to induce others to believe the person is authorized to practice as a radiologist assistant.

H. Subsection G of this section does not apply to either of the following:

1. A person who is engaging in the scope of practice for which the person holds a valid license or certificate.

2. A person who is performing a task as part of an advanced academic program.END_STATUTE

Sec. 6. Title 32, chapter 28, article 2, Arizona Revised Statutes, is amended by adding section 32-2819.01, to read:

START_STATUTE32-2819.01. Radiologist assistants; general supervision; rural counties; critical access hospitals; definition

A. In a county with a population of less than five hundred thousand persons or a health care institution that is licensed as a critical access hospital, the department shall allow for general supervision of radiologist assistants if the HEALTH CARE facility ensures all of the following:

1. The HEALTH care facility OR RADIOLOGIST:

(a) Has established a written protocol for the application of radiation to a patient for each procedure that may be conducted by a radiologist assistant under the general supervision of a radiologist, including follow-up instructions for the patient.

(b) Reviews and, as necessary, revises the written protocol at least annually.

2. Each Radiologist assistant follows the applicable written protocol when delivering radiation to a patient.

3. At least every six months, the radiologist:

(a) Observes each radiologist assistant while the radiologist assistant is performing a procedure to ensure the radiologist assistant's adherence to the applicable written protocol.

(b) Documents the radiologist's observation and assessment of the radiologist assistant.

4. A radiologist is on-site and available for consultation about patient care at least once every five working days, as verified in documentation maintained by the registrant.

5. The health and safety of patients are maintained.

B. A radiologist that uses general supervision to comply with the requirements of this section shall develop, maintain and implement policies and procedures to monitor both:

1. The performance of each procedure by a radiologist assistant under general supervision.

2. The quality of patient care.

C. For the purposes of this section, "general supervision" means supervision by a radiologist who is licensed in this state and who is readily accessible by telecommunication.END_STATUTE

Sec. 7. Section 32-2841, Arizona Revised Statutes, is amended to read:

START_STATUTE32-2841. Mammographic technologists; computed tomography technologists; certification; renewal

A. A person who wishes to perform diagnostic mammography or screening mammography as defined in section 30-651 shall obtain a mammographic technologist certificate from the department. A person who wishes to perform computed tomography shall obtain a computed tomography technologist certificate from the department. The department shall issue a certificate to an applicant who:

1. Pays a twenty dollar the application fee that is prescribed in rule by the department.

2. Holds a current radiologic technology certificate issued by the department.

3. For a mammographic technologist certification, completes the training and education requirements of subsection B of this section and passes an examination as prescribed in subsection D of this section.

4. For a computed tomography technologist certification, provides documentation of two years of experience in computed tomography and completion of twelve hours of computed tomography specific education or passes an examination as prescribed in subsection D of this section.

B. To satisfy the education requirements of subsection A of this section, an applicant shall meet the initial training and education requirements of the mammography quality standards act regulations for quality standards of mammographic technologists, (21 Code of Federal Regulations section 900.12).

C. The department shall issue a student mammography permit, preceptorship or temporary certificate to a person who is in training and who meets the requirement of subsection A, paragraph 2 of this section if the applicant also provides the department with verification of employment and the name of the radiologist who agrees to be responsible for the applicant's supervision and training. A student mammography permit, preceptorship or temporary certificate is valid for one year from after the date it is issued and may not be renewed. If the holder completes all of the requirements of subsection A of this section within the permitted period, the department shall issue a mammographic technologist or computed tomography technologist certificate. The mammographic technologist or computed tomography technologist certificate shall be renewed as prescribed under by subsection E of this section.

D. To satisfy the examination requirements of this section, an applicant shall pass an examination in mammography or computed tomography administered by the department or, in lieu of its own examination, the department may accept a certificate issued on the basis of an examination by a certificate-granting body recognized by the department.

E. Except as provided in section 32-4301, a certificate that is issued under this section is valid for two years. The department shall notify a certificate holder thirty days before the expiration date of the certificate. An applicant for renewal of a mammographic technologist certificate shall meet the continuing education requirements of the mammography quality standards act regulations for quality standards of mammographic technologists, (21 Code of Federal Regulations section 900.12). If a radiologic technologist is certified by the American registry of radiologic technologists, that person must satisfy the continuing education requirements of this subsection by providing the department with evidence of the radiologic technologist's good standing and current certification with that registry. The applicant shall also pay a twenty dollar renewal fee to as prescribed in rule by the department.

F. A person or facility that employs a person who is certified under this section shall report any suspected violations of section 32-2821 to the department. The department shall investigate the complaint. If in the course of its investigation the department determines that a person regulated by another regulatory agency of this state may have violated that agency's laws, the department shall report the violation to the other agency for disciplinary action. END_STATUTE

Sec. 8. Section 36-3601, Arizona Revised Statutes, is amended to read:

START_STATUTE36-3601. Definitions

For the purposes of in this chapter, unless the context otherwise requires:

1. "Health care decision maker" has the same meaning prescribed in section 12-2801.

2. "Health care provider":

(a) Means a person who is licensed pursuant to title 32, chapter 7, 8, 13, 14, 15, 15.1, 16, 17, 18, 19, 19.1, 25, 28, 29, 33, 34, 35, 39, 41 or 42, or chapter 4, article 6 of this title, chapter 6, article 7 of this title or chapter 17 of this title.

(b) Includes:

(i) A health care institution that is licensed pursuant to chapter 4 of this title.

(ii) A person who holds a training permit pursuant to title 32, chapter 13 or 17.

3. "Health care provider regulatory board or agency" means a board or agency that regulates one or more health care provider professions in this state.

4. "Telehealth" means:

(a) The interactive use of audio, video or other electronic media, including asynchronous store-and-forward technologies and remote patient monitoring technologies, for the practice of health care, assessment, diagnosis, consultation or treatment and the transfer of medical data.

(b) Includes the use of an audio-only telephone encounter between the patient or client and health care provider if an audio-visual telehealth encounter is not reasonably available due to the patient's functional status, the patient's lack of technology or telecommunications infrastructure limits, as determined by the health care provider.

Sec. 9. Legislative intent

The legislature intends that the change made to the list of health professionals that do not require additional licensure to use diagnostic x-ray in section 30-672, subsection G, Arizona Revised Statutes, as amended by this act, prompt an advisory opinion from the state board of nursing that details appropriate radiation safety training and operator certification to perform imaging.