SB 1226 adds a list of explicit exceptions to whatever statutory prohibition otherwise restricts who may perform respiratory care in California. Rather than broadly expanding the license of respiratory care practitioners, the bill identifies specific situations and categories of people who may lawfully provide respiratory services — from students in training to family caregivers and certain home‑based workers — and directs the respiratory board to authorize limited services by non‑specialists under defined conditions.
For practitioners and compliance officers, the practical effect is a tailored loosening of scope rules: the bill creates alternative, circumstance‑based pathways (training, employer authorization, and certification requirements) that let certain non‑respiratory specialists — notably licensed vocational nurses in specified settings — perform defined respiratory tasks. That raises immediate questions about training standards, oversight, liability, and how regulators will implement the board’s delegated authorities.
At a Glance
What It Does
The bill enumerates exceptions to prohibitions on providing respiratory care and authorizes the respiratory board to identify which limited tasks can be performed by non‑respiratory practitioners, subject to training, employer authorization, or certification requirements. It preserves emergency, research, and student‑training activities as lawful and creates narrow operational pathways for home‑ and community‑based care.
Who It Affects
Directly affects licensed vocational nurses (LVNs), home health agencies and employees of home medical device retailers, school health staff, daycare and pediatric respite centers, and respiratory care boards and certifying bodies. Indirectly affects respiratory therapists, county hospital programs, and families who provide home care.
Why It Matters
The measure shifts some respiratory service delivery out of the exclusive respiratory‑therapist model into employer‑driven and community settings, which could expand access while raising training, supervision, and liability issues for healthcare employers and regulators.
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What This Bill Actually Does
SB 1226 does not rewrite respiratory‑care licensure but creates an exceptions catalogue — a carved pathway allowing certain people and settings to provide respiratory services the law might otherwise reserve. The bill preserves traditional exclusions (student learning, family or self‑care, emergency paramedical action, research) so those common, noncommercial activities remain lawful without a respiratory license.
It also recognizes the need for surge capacity: during epidemics, disasters, or declared emergencies the board may authorize temporary respiratory work by non‑specialists.
Where the bill is operational, it relies on a mix of employer‑led, patient‑specific training and third‑party competency certificates rather than wholesale scope expansion. For non‑respiratory personnel to perform board‑identified respiratory tasks, employers must provide patient‑specific training that meets either their own standards (for a transitional period) or the respiratory board’s later guidance developed with the vocational nursing board.
The statute names a small set of certifying organizations as acceptable sources of competency certification for specific tasks.The law is narrowly targeted at settings outside acute hospital care: it contemplates services in small licensed congregate care and intermediate care facilities, adult and pediatric day health centers, small family homes, home health agency employment or private duty nursing contexts, and during community‑based transportation and respite activities. It also preserves limited, school‑based respiratory assistance when a credentialed school nurse supervises vocational nurses, and exempts a cohort of Los Angeles County hospital employees who have long histories of performing pulmonary function testing.
The approach is pragmatic: expand where workforce shortages and continuity of care demand it, and try to gate that expansion with training and certification requirements.
The Five Things You Need to Know
The bill explicitly allows licensed vocational nurses to perform respiratory services identified by the respiratory board if they complete patient‑specific employer training (transitional standard) and hold a current competency certification from an approved organization.
The respiratory board must publish training guidelines in collaboration with the Board of Vocational Nursing and Psychiatric Technicians; employer‑based patient‑specific training becomes subject to those guidelines as of January 1, 2028.
Certain small congregate and intermediate care facilities (designated six beds or fewer), adult and pediatric day health centers, small family homes, home health agency employment, and private duty nursing during daily transportation are enumerated as permitted settings for LVN‑performed respiratory tasks.
The statute expressly preserves emergency and disaster flexibility: formally trained paramedical personnel and temporally authorized groups or students may carry out respiratory care during epidemics, pandemics, public disasters, or emergencies under board‑identified authorizations.
Los Angeles County pulmonary function testing personnel with at least 15 years’ experience are grandfathered to continue performing pulmonary function testing; separately, daycare staff and school‑based staff retain narrow authorities to administer inhaled medication or suctioning under specified supervision rules.
Section-by-Section Breakdown
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Education, self‑care, professional development exceptions
These subsections carve out ordinary, non‑commercial activities from the prohibition: students in approved respiratory therapy programs may perform respiratory care as part of training; patients may self‑administer care and family or friends may provide gratuitous assistance; licensed respiratory practitioners may apply advanced techniques learned through further training. Practically, this preserves standard clinical education and informal caregiving without requiring regulatory change.
Emergency response, temporary surge capacity, and research
The bill expressly allows paramedical personnel who hold licenses in their specialty to perform respiratory care in emergencies and authorizes the board to identify temporary respiratory roles for other health personnel, students, or groups during epidemics, pandemics, public disasters, or emergencies. It also protects cardiopulmonary research activity. These clauses give regulators latitude to mobilize non‑traditional responders during public health crises without running afoul of scope‑of‑practice rules.
Daycare, home device retailers, and home health agency personnel
Subsection (g) preserves the authority of trained licensees and staff at child day care facilities to administer inhaled medications under the Health and Safety Code. Subsection (h) authorizes specific, limited respiratory tasks by employees of home medical device retail facilities and home health agencies where the board authorizes those tasks. For compliance teams, this creates an on‑ramp for non‑licensed commercial actors to perform narrowly defined care, but only with board authorization and within limits the board sets.
Licensed vocational nurse pathway — training, certification, and settings
These pivotal subsections establish the LVN pathway: an LVN may perform board‑identified respiratory services after completing patient‑specific employer training and holding a competency certification from an approved certifying organization. The provision enumerates permitted settings (small congregate/intermediate facilities, adult and pediatric day health centers, home health employment and private duty situations, small family homes, and transportation/respite contexts) and conditions the pathway on later board guidance. This creates a conditional scope extension tied to training and certification rather than statutory reclassification of LVNs.
Local‑practice grandfathering and school‑based suctioning
Subsection (k) contains a narrow grandfather clause allowing current employees of Los Angeles County hospitals with 15 or more years of pulmonary function testing experience to continue that practice. Subsection (l) preserves the ability of vocational nurses to perform suctioning and other basic respiratory tasks under supervision of a credentialed school nurse, citing Education Code provisions. These clauses function as targeted exceptions that reflect existing local practice and school health workflows.
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Explore Healthcare in Codify Search →Who Benefits and Who Bears the Cost
Every bill creates winners and losers. Here's who stands to gain and who bears the cost.
Who Benefits
- Patients in home‑ and community‑based settings: the bill increases access to respiratory services in residences, small licensed facilities, day health centers, and during transport and respite by enabling non‑respiratory staff to perform defined tasks under training and certification.
- Licensed vocational nurses (LVNs): LVNs gain a defined pathway to add respiratory tasks to their practice in enumerated settings, potentially increasing job utility and local staffing flexibility.
- Home health agencies and home medical device retailers: these employers can expand the services their staff provide, which can lower referral burdens and improve continuity of care for patients with chronic respiratory needs.
- School and daycare programs: formalized permissions for inhaled medication administration and supervised suctioning preserve and clarify existing day‑to‑day care practices for children with respiratory needs.
- County hospital programs with long‑tenured staff (Los Angeles County): the grandfathering provision protects continuity of specialized diagnostic services for experienced local staff.
Who Bears the Cost
- Licensed respiratory therapists and respiratory‑care programs: the shift of limited tasks to LVNs and other staff may reduce demand for some billable respiratory services and could create professional‑practice tensions.
- Employers (home health agencies, device retailers, small facilities): employers must design and deliver patient‑specific training, obtain or verify competency certifications, and evaluate supervisory arrangements — tasks that impose staffing and compliance costs.
- Regulatory agencies (respiratory board and BVNPT): the bill requires them to draft interoperable guidance, approve certifying organizations, and oversee delegated authorities — work likely to require rulemaking resources and cross‑board coordination.
- School districts and credentialed school nurses: supervising LVN suctioning and ensuring compliance with Education Code references could increase nursing oversight burdens and liability exposure for districts.
- Insurers and payers: changes in who performs services may affect billing codes, reimbursement rates, and utilization patterns, producing administrative and cost implications for payers.
Key Issues
The Core Tension
The central dilemma is access versus specialization: the bill tries to increase access to essential respiratory care in community and small‑facility settings by allowing less‑specialized personnel to perform limited tasks under training and certification, but doing so risks diluting the quality controls that come with specialized respiratory training; regulators must choose between rapid workforce flexibility and the slower, more burdensome path of preserving specialized standards.
Two implementation problems stand out. First, the bill relies heavily on employer‑provided, patient‑specific training as the primary safeguard for expanded practice.
Employer training can vary widely across settings; without robust, enforceable minimum standards there is a real risk of uneven competency. The statute attempts to address that by directing the respiratory board to issue guidelines in collaboration with the vocational nursing board, but those guidelines are prospective — meaning a period of variable practice quality is likely unless the boards act quickly and precisely.
Second, the bill hands significant discretion to the respiratory board to identify the respiratory tasks that non‑specialists may perform and to approve certifying organizations. That delegation is sensible from an administrative standpoint but concentrates regulatory power without creating a transparent certification or audit mechanism in the statute itself.
Questions remain about how the board will assess certifying bodies, monitor employer compliance, and resolve disputes between respiratory therapists and newly authorized LVNs or other workers. Liability allocation — who is responsible when a patient suffers harm after a delegated task — is not addressed in the statutory text and will fall to contracts, employer policies, and the courts or regulators to sort out.
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