BILL ANALYSIS Ó
AB 1972
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Date of Hearing: April 8, 2014
ASSEMBLY COMMITTEE ON BUSINESS, PROFESSIONS AND CONSUMER
PROTECTION
Susan A. Bonilla, Chair
AB 1972 (Jones) - As Amended: March 28, 2014
SUBJECT : Respiratory care practitioners.
SUMMARY : Requires an applicant for a respiratory care
practitioner (RCP) license to pass the national registered
respiratory therapist examination (RRT) instead of the national
certified respiratory therapist examination (CRT) in certain
cases, and authorizes the Respiratory Care Board (board) to
extend the dates an applicant may practice as an RCP applicant.
Specifically, this bill :
1)Prohibits an applicant from receiving an RCP license without
first successfully passing all parts of the RRT.
2)Provides that a person applying for licensure who provides
evidence that he or she has passed the CRT prior to January 1,
2015 is not required to pass the RRT if there is no evidence
of prior license or job-related discipline, as determined by
the board in its discretion.
3)Deletes the written examination exemption for an applicant who
at the time of his or her application has passed an
examination that is equivalent to the examination given in
this state.
4)Deletes the requirement that an applicant who has filed an
application for licensure pass the CRT, if ever attempted, in
order to perform as an RCP applicant.
5)Authorizes the board to extend the date an applicant may
perform as an RCP applicant if the applicant is unable to
complete the licensure application due to causes completely
outside his or her control.
6)Authorizes the board to extend the date an applicant may
perform as an RCP applicant for up to six months from the date
of graduation or the date the application was filed, whenever
is later, if an applicant provides evidence that he or she has
successfully passed the CRT, and the applicant has otherwise
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completed the application for licensure and has not previously
been authorized to practice as an RCP applicant.
7)States that those provisions relating to practice as an RCP
applicant shall not be construed to prohibit the board from
denying or rescinding the privilege to work as an RCP
applicant for any reason, including, but not limited to,
failure to pass the RRT or if cause exists to deny the
license.
8)Makes other clarifying and conforming changes.
EXISTING LAW
1)Establishes the Respiratory Care Practice Act (Act), which is
enforced by the Respiratory Care Board (board), to license and
regulate the practice of RCPs. (Business and Professions Code
Section (BPC) 3700 et seq.)
2)Prohibits an applicant from receiving a license without first
successfully passing the national respiratory therapist
examination, and in the manner and under the rules and
regulations, as the board may prescribe, except as specified.
(BPC 3735)
3)Provides that the requirements to pass the written examination
shall not apply to an applicant who at the time of his or her
application has passed, to the satisfaction of the board, an
examination that is, in the opinion of the board, equivalent
to the examination given in this state. (BPC 3735.5)
4)Authorizes every person who has filed an application for
licensure with the board to perform as an RCP applicant under
the direct supervision of an RCP licensed in this state,
between the dates specified by the board, if he or she has met
education requirements for licensure as may be certified by
his or her respiratory care program, and, if ever attempted,
has passed the CRT examination. (BPC 3739(a)(1))
5)Ceases all privileges to practice as an RCP applicant on the
date specified by the board if for any reason the license is
not issued or the applicant fails the CRT examination. (BPC
3739(a)(3),(b))
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6)Prohibits an applicant for an RCP license from performing as
an RCP applicant if cause exists to deny the license. (BPC
3739(c))
7)Requires, except as specified, all applicants for licensure to
have completed an education program for respiratory care that
is accredited by the Commission on Accreditation for
Respiratory Care or its successor and been awarded a minimum
of an associate degree. (BPC 3740(a))
8)Deems as equivalent to the required education an applicant's
enrollment in a baccalaureate degree program, as specified,
and completion of science, general academic, and respiratory
therapy coursework commensurate with the requirements of an
associate degree for respiratory care. (BPC 3740(b))
9)Authorizes the board to waive its educational requirements if
evidence is presented and the board deems it as meeting the
current educational requirements that will ensure the safe and
competent practice of respiratory care. (BPC 3740(g))
FISCAL EFFECT : Unknown
COMMENTS :
1)Purpose of this bill . This bill seeks to update examination
requirements for RCPs by requiring applicants to pass the more
rigorous RRT examination, which was designed to test advanced
level respiratory therapists instead of the entry-level CRT
exam, in order to reflect updated educational standards that
qualify all current graduates to take the RRT. Under AB 1972,
graduates from phased-out entry level programs would have two
years from their graduation date to take and pass the CRT
examination for licensure without being subject to the new RRT
requirement, and the board would have the discretion to extend
a temporary work permit for an additional six months for
applicants who need additional time to pass the RRT
examination.
Currently, applicants may take the CRT or the RRT. However, it
is necessary to require passage of the RRT to ensure that
applicants meet the level of competency that is now expected
through all educational programs, as reflected in advancements
made in training, education, and accreditation standards, in
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order to ensure consumer protection.
This bill is sponsored by the California Society for Respiratory
Care (CSRC).
2)Author's statement . According to the author, "Since 1985, the
National Board for Respiratory Care, Inc. (NBRC) has offered
two credentials specific to respiratory care that are both
nationally recognized: 1) The Certified Respiratory Therapist
(CRT) - entry level credential and 2) the Registered
Respiratory Therapist (RRT) credential - advanced level
credential. For approximately 25 years, the [board] has
recognized the passage of the CRT examination as the minimum
exam requirement for licensure as a RCP.
"All current graduates from RCP educational programs meet the
minimum admission requirements to take the RRT exam. In
addition, the accreditation status of RCP educational programs
hinges upon the RRT exam passage rate. According to the most
recent program accreditation standards (June 2010), each
respiratory care educational program is required to have the
following goal: 'To prepare graduates with demonstrated
competence in the cognitive (knowledge), psychomotor (skills),
and affective (behavior) learning domains of respiratory care
practice as performed by registered respiratory therapists
(RRTs).'
"This makes the current CRT exam requirement obsolete.
"Advancements in technology and accreditation standards
coupled with the restructuring of nationally recognized exams
(effective 1/1/15), will make the current requirement to pass
the CRT exam for licensure as an [RCP] inadequate, outdated
and insufficient in meeting the [board's] consumer protection
mandate or the needs of the healthcare industry."
3)Respiratory therapy, and the CRT and RRT examinations .
Licensed respiratory care practitioners (RCPs) are specialized
health care workers, who work under the supervision of medical
directors and are involved in the prevention, diagnosis,
treatment, management, and rehabilitation of problems
affecting the heart and lungs and other disorders, as well as
providing diagnostic, educational, and rehabilitation
services. RCPs provide treatments for patients who have
breathing difficulties and care for those who are dependent
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upon life support and cannot breathe on their own. RCPs treat
patients with acute and chronic diseases, including Chronic
Obstructive Pulmonary Disease (COPD), trauma victims, and
surgery patients. They are typically employed in hospitals,
however, a growing number of RCPs work in alternative settings
like skilled nursing facilities, physician's offices,
hyperbaric oxygen therapy facilities and sleep laboratories,
to name a few. The law governing RCPs is a practice act that
requires licensure for individuals performing respiratory
care.
In addition to educational and coursework requirements for
licensure, RCP applicants are required by law to pass either
the CRT or the RRT examination. According to the board, the
CRT examination has always been designed to measure essential
knowledge, skills, and abilities of entry-level therapists,
while the RRT examination was developed to measure knowledge,
skills, and abilities of advanced-level therapists.
Currently, the CRT examination consists of a written
examination, while the RRT consists of a written examination
and a clinical simulation examination. Effective January 1,
2015, the new exam structure will consist of a single written
examination for both the CRT and the RRT and a clinical
examination, and test takers will be eligible for the clinical
portion if he or she achieves the RRT-level passing score
required on the written portion, thereby eliminating
duplicative testing fees.
According to the board, two types of respiratory educational
programs existed prior to 2002: one year entry-level programs
and two year advanced-level programs. In 2002, accreditation
requirements changed to require an associate degree as part of
any educational program, and although programs were now
required to be two years long, they were still considered
entry-level or advanced-level programs based on content. In
2011, entry-level programs began to phase out, and December
2012, was the last month a student could graduate from an
entry-level program. As of January 2013, only one type of
educational program exists: the advanced-level program
offering an associate degree. As a result, all current and
future graduates will be qualified to sit for the RRT
examination. In addition, changes to national accreditation
standards now mean that the accreditation status of
educational programs depends upon its RRT passage rate.
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4)Impact on workforce . In 2007, the board conducted a formal
workforce study that estimated the state would need at least
21,000 licensees by 2030 in order to meet expected demands.
While the study was prepared prior to the Affordable Care Act,
the board has already surpassed that number with over 21,700
active licensees, and believes that it has and will continue
to have an ample workforce of RCPs.
The board has recognized, however, that requiring passage of the
RRT examination will decrease the number of licenses issued by
the board based on the increased difficulty of the RRT
examination. Nationwide, the average passage rate from 2008
to 2010, for the CRT written examination was 75% for first
time takers and 26% for repeat takers. In that same period,
the average passage rate for the RRT written examination was
61% for first time takers and 33% for repeat takers, and for
the RRT clinical examination, 53% for first time takers and
48% for repeat takers. In California, for fiscal year
2011/12, 1,351 first time and repeat takers passed the CRT
examination.
Applying the average passage rates for the RRT examination to
that population, the board anticipates that 1,193 first time
and repeat takers will pass the RRT written examination, and
that 922 of those 1,193 will pass the RRT clinical
examination, resulting in 429, or roughly 30%, fewer
applicants who are eligible for licensure under current law.
While the average passage rates for the RRT examination were
lower than the rates for the CRT examination, the CRT
examination was required for licensure, while the RRT
examination was optional. As a result, the RRT examination
passage rates may rise if the examination becomes mandatory
for licensure because applicants may be better prepared before
taking a mandatory examination.
5)Arguments in support . According to the sponsor, CSRC, "[This
bill] proposes to eliminate the [CRT] test from exams required
for licensure as [an RCP] in California, and instead require
passage of the RRT exam. All current graduates from [RCP]
accredited educational programs meet the minimum admission
requirements to take the RRT exam as this is the direction the
industry is headed. Employers now seek RCPs who have passed
the RRT exam rather than the CRT exam. Changes made by the
national exam provider and oversight accreditation agency make
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it necessary to remove the obsolete exam requirement."
In addition, the board states that "[it] fully supports this
bill which will increase the minimum exam threshold to the RRT
to provide better consumer protection by ensuring new
graduates meet the competency threshold that is now expected
through all educational programs. Moreover, [this bill] will
align the licensure examination with changes made to the
structure of the national exams and the standards of the
national respiratory care accrediting agency."
6)Related legislation . AB 2102 (Ting) of 2014 requires the
board to annually collect and report specific demographic data
relating to its licensees to the Office of Statewide Health
Planning and Development. That bill is currently pending in
this Committee.
7)Previous legislation . SB 1575 (Committee on Business,
Professions and Economic Development) (Chapter 799, Statutes
of 2012) specified that during clinical training, a student
RCP is required to practice under the direct supervision of a
person with a valid, current, and unrestricted license, and
authorized the board to discipline a licensee for negligence
or for illegally possessing paraphernalia associated with
controlled substances or drugs, as specified.
SB 821 (Committee on Business, Professions and Economic
Development) (Chapter 307, Statutes of 2009) clarified
controlled substances prohibitions, authorized the board to
discipline a licensee who uses alcoholic beverages to an
extent it is injurious to self or others or impacts the safe
practice of respiratory care, and required a renewing
applicant for licensure to provide additional information
requested by the board, and, if the applicant failed to
provide that information within 30 days, made his or her
license inactive until that information was received.
SB 1111 (Committee on Business, Professions and Economic
Development) (Chapter 621, Statutes of 2005) required an
applicant for a license to practice respiratory care to
successfully pass the CRT.
REGISTERED SUPPORT / OPPOSITION :
Support
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California Society for Respiratory Care (sponsor)
California Hospital Association
Respiratory Care Board
Opposition
None on file.
Analysis Prepared by : Eunie Linden / B.,P. & C.P. / (916)
319-3301