Chapter 06. Licensure of Polysomnographic Technologists

“Board” means the State Board of Physicians.

“Board eligible” means a physician’s status that starts upon completion of all the requirements to take a sleep medicine certifying examination and lasts for a limited period of time, as determined by the American Board of Medical Specialties or the American Osteopathic Association.

“Capnography” means measurement of the amount of CO₂ being eliminated from the lungs.

“Committee” means the Polysomnography Professional Standards Committee established under Health Occupations Article, §14-5C-05, Annotated Code of Maryland.

“Direct supervision” means supervision by a licensed physician who is physically present on the premises while services are provided.

“Electroencephalography” means a test that measures the electrical activity of the brain as recorded by electrodes placed on the scalp.

“Electromyography” means a test that measures the electrical activity of the muscles.

“Electrooculography” means a test that measures the movements of the eye.

“Enrolled in a sleep technologist educational program” means that a student has started the Accredited Sleep Technology Program self-study online modules developed by the American Academy of Sleep Medicine but has not completed the final self-study module.

“General supervision” means supervision by a licensed physician who is available to give immediately available direction, either in person, by telephone, or by electronic means.

“License” means a license issued by the Board.

“Licensed polysomnographic technologist” means an individual licensed by the Board to practice polysomnography under the supervision of a licensed physician.

“Licensed physician” means an individual who is licensed by the Board to practice medicine.

“Oximetry” means a test that measures the concentration of oxygen in the blood.

“PH probe” means a device to measure the acidity of the esophagus.

“Plethysmography” means a test to measure changes in blood flow or air volume in different parts of the body.

“Practice polysomnography” means:

“Registered polysomnographic technologist” means a polysomnographic technologist who is registered by the Board of Registered Polysomnographic Technologists.

“Student” means an individual who is:

“Supervision” means general supervision or direct supervision of a licensed polysomnographic technologist by a licensed physician.

Three polysomnographic technologists who:

Three licensed physicians with specialty certification in sleep medicine who are specialists in the following areas:

One consumer member who is a member of the general public and who:

The term of a member is 3 years.

The terms of the members are staggered.

At the end of a term, a member continues to serve until a successor is appointed.

An individual may be reappointed for a second term but the individual may not serve more than two full consecutive terms.

If a vacancy occurs, the Board shall appoint a new member to serve.

The successor member shall only serve for the remainder of the term, unless reappointed.

A majority of the members then serving on the Committee is a quorum.

Business may not be conducted at a Committee meeting unless there is a quorum.

Make recommendations to the Board regarding the practice of, and regulations governing, polysomnographic technologists;

Make recommendations to the Board on the requirements for licensure as a polysomnographic technologist;

Review selected applications for licensure as a polysomnographic technologist and make recommendations to the Board on the applications;

At the request of the Board, review complaints against polysomnographic technologists and respond to the Board's questions; and

Keep a record of the Committee's proceedings.

Complete an application on a form supplied by the Board;

Pay the required application fee set by the Board in Regulation .09 of this chapter;

Be 18 years old or older;

Be of good moral character;

Demonstrate spoken and written competency in English by any of the following:

Provide documentation of current certification as a registered polysomnographic technologist by the Board of Registered Polysomnographic Technologists or by another national certification agency approved by the Board;

Provide documentation of licensure, certification, or registration from all states where the applicant has ever held a license, certificate, or registration in any health profession; and

Meet the requirements of §B of this regulation.

Graduation from a polysomnographic educational program that is accredited by the Commission on Accreditation of Allied Health Education Programs;

In regard to a respiratory care educational program:

In regard to an electroneurodiagnostic technology educational program:

In regard to a sleep technologist educational program, completion of the requirements of §C of this regulation.

Provide proof of meeting core competencies in the 3 years preceding the date of the submission of the licensure application as assessed by a sleep technologist credentialed as a Registered Polysomnographic Technologist, a sleep technologist with national certification approved by the Board, or a physician who is either board-eligible or board-certified in sleep medicine by the American Board of Sleep Medicine, American Board of Medical Specialties, or American Osteopathic Association;

Provide a letter of attestation for completion of clinical hours and competencies from a physician who is either board-eligible or board-certified in sleep medicine by the American Board of Sleep Medicine, American Board of Medical Specialties, or American Osteopathic Association where the applicant practiced; and

Provide proof of completion of a minimum of 546 hours of clinical experience in the 3 years preceding the date of the submission of the licensure application as either:

Monitoring and recording physiologic data during sleep, including sleep-related respiratory disturbances;

Using data collected under §C(1) of this regulation to assist a licensed physician in the diagnosis and treatment of sleep and wake disorders;

Assisting with the diagnosis and treatment of individuals who suffer from sleep disorders as a result of developmental defects, the aging process, physical injury, disease, or actual or anticipated somatic dysfunction;

Observing and monitoring physical signs and symptoms, general behavior, and general physical responses to polysomnographic evaluation, and determining whether initiation, modification, or discontinuation of a treatment regimen is warranted;

Using evaluation techniques that include limited cardiopulmonary function assessments, the need and effectiveness of therapeutic modalities and procedures, and the assessment and evaluation of the need for extended care; and

Using the following techniques, equipment, and procedures:

A licensed polysomnographic technologist shall advise the Board in writing of any change in name or mailing address within 60 days.

The Board may impose a fine of $100 for failure to notify the Board of a change in name or mailing address.

The Board may not renew a license until the Comptroller of Maryland has verified that the individual has paid all undisputed taxes and unemployment insurance contributions, or arranged for repayment.

An individual who has been licensed by the Board as a polysomnographic technologist may renew the license on or before the date specified by the Board by:

Completes a reinstatement application on a form supplied by the Board;

Pays the required reinstatement fee and any other fees specified in Regulation .09 of this chapter;

Documents evidence of completion of at least 20 hours of approved continuing education in the 2-year period preceding the date of the submission of the application for reinstatement, as specified in Regulation .08 of this chapter; and

Meets any additional requirements set by the Board for reinstatement of a license.

A licensed polysomnographic technologist is not required to obtain continuing education hours for the first renewal after initial licensure or reinstatement.

Except as stated in §A(1) of this regulation, the Board may not renew or reinstate the license of a polysomnographic technologist unless the polysomnographic technologist has met the requirements for continuing education described in §B of this regulation.

A polysomnographic technologist shall earn at least 20 continuing education hours as described in §B(2) of this regulation during the 2-year period preceding:

The Board shall recognize sleep-related continuing education hours approved by one of the following organizations or any other organization recommended by the Committee and approved by the Board:

A polysomnographic technologist shall obtain the required documentation of continuing education attendance and retain this documentation for the succeeding 6 years for possible inspection by the Board.

The required documentation shall contain the:

Initial licensure application fee — $200;

License renewal fees:

Reinstatement fee — $200; and

Written verification of licensure fee — $25.

Fraudulently, or deceptively obtains or attempts to obtain a license for the applicant or licensee, or for another;

Fraudulently or deceptively uses a license;

Is guilty of unprofessional or immoral conduct in the practice of polysomnography;

Is professionally, physically, or mentally incompetent;

Abandons a patient;

Is habitually intoxicated;

Is addicted to or habitually abuses any narcotic or controlled dangerous substance as defined in Criminal Law Article, §5-101, Annotated Code of Maryland;

Provides professional services while:

Promotes the sale of services, drugs, devices, appliances, or goods to a patient so as to exploit the patient for financial gain;

Willfully makes or files a false report or record in the practice of polysomnography;

Willfully fails to file or record any report as required under law, willfully impedes or obstructs the filing or recording of a report, or induces another to fail to file or record a report;

Breaches patient confidentiality;

Pays or agrees to pay any sum or provide any form of remuneration or material benefit to any individual for bringing or referring a patient, or accepts or agrees to accept any sum or any form of remuneration or material benefit from an individual for bringing or referring a patient;

Knowingly makes a misrepresentation while practicing polysomnography;

Knowingly practices polysomnography with an unauthorized individual, or aids an unauthorized individual in the practice of polysomnography;

Knowingly delegates a polysomnographic duty to an unlicensed individual;

Offers, undertakes, or agrees to cure or treat disease by a secret method, treatment, or medicine;

Is disciplined by a licensing or disciplinary authority, is convicted or disciplined by a court of any state or country, or is disciplined by any branch of the United States uniformed services or the U.S. Department of Veterans Affairs for an act that would be grounds for disciplinary action under the Board's disciplinary statutes;

Fails to meet appropriate standards for the delivery of polysomnographic services performed in a hospital sleep laboratory or a stand-alone sleep center;

Knowingly submits false statements to collect fees for which services are not provided;

Has been subject to investigation or disciplinary action by a licensing or disciplinary authority or by a court of any state or country for an act that would be grounds for disciplinary action under the Board's disciplinary statutes and has:

Knowingly fails to report suspected child abuse in violation of Family Law Article, §5-704, Annotated Code of Maryland;

Sells, prescribes, gives away, or administers drugs for illegal or illegitimate medical purposes;

Practices or attempts to practice beyond the authorized scope of practice;

Is convicted of, or pleads guilty or nolo contendere to, a felony or to a crime involving moral turpitude, whether or not any appeal or other proceeding is pending to have the conviction or plea set aside;

Refuses, withholds from, denies, or discriminates against an individual with regard to the provision of professional services for which the licensee is licensed and qualified to render because the individual is HIV positive;

Practices or attempts to practice a polysomnography procedure or uses or attempts to use polysomnography equipment if the applicant or licensee has not received education and training in the performance of the procedure or the use of the equipment; or

Fails to cooperate with a lawful investigation conducted by the Board.

Proceedings for crimes of moral turpitude under Health Occupations Article, §14-5C-17(c), Annotated Code of Maryland, shall be held in accordance with COMAR 10.32.02.07.

On the filing of certified docket entries with the Board by the Office of the Attorney General, a disciplinary panel shall order the suspension of a license if the licensee is convicted of, or pleads guilty or nolo contendere with respect to, a crime involving moral turpitude, whether or not any appeal or other proceeding is pending to have the conviction or plea set aside.

After completion of the appellate process, if the conviction has not been reversed or the plea has not been set aside with respect to a crime involving moral turpitude, the disciplinary panel shall order the revocation of a license on the certification by the Office of the Attorney General.

A person who violates Health Occupations Article, §14-5C-22.1, Annotated Code of Maryland, is subject to a civil fine of not more than $5,000 to be levied by the Board.

The Board shall pay any fine collected under §D of this regulation into the State’s General Fund.

Sections F and G of this regulation and Regulation .13 of this chapter do not apply to offenses for which a mandatory sanction is set by statute or regulation.

Except as provided in §G of this regulation, for violations of the sections of the Maryland Polysomnography Act listed in the sanctioning guidelines, a disciplinary panel shall impose a sanction not less severe than the minimum listed in the sanctioning guidelines nor more severe than the maximum listed in the sanctioning guidelines for each offense.

Ranking of Sanctions.

The disciplinary panel may impose more than one sanction, provided that the most severe sanction neither exceeds the maximum nor is less than the minimum sanction permitted in the chart.

Any sanction may be accompanied by conditions reasonably related to the offense or to the rehabilitation of the offender. The inclusion of conditions does not change the ranking of the sanction.

If a licensee has violated more than one ground for discipline as set out in the sanctioning guidelines:

Notwithstanding the sanctioning guidelines set forth in Regulation .13 of this chapter, in order to resolve a pending disciplinary action, the disciplinary panel and the licensee may agree to a surrender of license or a consent order with terms and sanction agreed to by the disciplinary panel, the administrative prosecutor, and the licensee.

Depending on the facts and circumstances of each case, and to the extent that the facts and circumstances apply, the disciplinary panel may consider the aggravating and mitigating factors set out in §G(4) and (5) of this regulation and may in its discretion determine, based on those factors, that an exception should be made and that the sanction in a particular case should fall outside the range of sanctions listed in the sanctioning guidelines.

If the disciplinary panel imposes a sanction that departs from the sanctioning guidelines as set forth in Regulation .13 of this chapter, the disciplinary panel shall state its reasons for doing so in its final decision and order.

Depending on the facts and circumstances of each case, and to the extent that the facts and circumstances apply, the disciplinary panel may consider the aggravating and mitigating factors set out in §G(4)—(5) of this regulation and may in its discretion determine, based on those factors, that an exception should be made and that the sanction in a particular case should fall outside the range of sanctions listed in the sanctioning guidelines.

Nothing in this regulation requires the disciplinary panel or an Administrative Law Judge to make findings of fact with respect to any of these factors.

The existence of one or more of these factors does not impose on the disciplinary panel or an Administrative Law Judge any requirement to articulate its reasoning for not exercising its discretion to impose a sanction outside of the range of sanctions set out in the sanctioning guidelines.

Mitigating factors may include, but are not limited to, the following:

Aggravating factors may include, but are not limited to, the following:

A departure from the sanctioning guidelines set forth in Regulation .13 of this chapter is not a ground for any hearing or appeal of a disciplinary panel action.

If a licensee has submitted an application claiming the completion of continuing education credits and the licensee fails to document the completion of such continuing education credits when audited by the Board, the licensee may be charged under one or more of the following, as appropriate:

Upon a finding of a violation, the disciplinary panel may impose any discipline authorized under Health Occupations Article, §14-5C-17, Annotated Code of Maryland, and the sanctioning guidelines.

An individual shall pay to the Board any fine imposed pursuant to this regulation within 15 calendar days of the date of the order, unless the order specifies otherwise.

Filing an appeal under State Government Article, §10-222, Annotated Code of Maryland, does not stay payment of a fine imposed pursuant to this regulation.

If an individual fails to pay, in whole or in part, a fine imposed pursuant to this regulation, the Board may not restore, reinstate, or renew a license until the fine has been paid in full.

In its discretion, the Board may refer all cases of delinquent payment to the Central Collection Unit of the State Department of Budget and Management to institute and maintain proceedings to ensure an individual’s prompt payment.