Amended in Assembly April 25, 2013

Amended in Assembly March 21, 2013

California Legislature—2013–14 Regular Session

Assembly Bill No. 1000

Introduced by Assembly begin delete Member end delete begin insert Members end insert Wieckowski begin insert and Maienschein end insert

February 22, 2013

An act to amend Sections begin delete 2620 end delete begin insert 2406 end insert and 2660 of, and to add begin delete Section end delete begin insert Sections 2406.5 and end insert 2620.1 to, the Business and Professions Code, begin insert and to amend Section 13401.5 of the Corporations Code, end insert relating to begin delete physical therapy. end delete begin insert healing arts. end insert

LEGISLATIVE COUNSEL’S DIGEST

AB 1000, as amended, Wieckowski. Physical therapists: direct access to begin delete services. end delete begin insert services: professional corporations. end insert

Existing law, the Physical Therapy Practice Act, creates the Physical Therapy Board of California and makes it responsible for the licensure and regulation of physical therapists. begin delete The act defines the term “physical therapy” for its purposes as, among other things, including physical therapy evaluation, treatment planning, instruction, and consultative services. end delete The act makes it a crime to violate any of its provisions. The act authorizes the board to suspend, revoke, or impose probationary conditions on a license, certificate, or approval issued under the act for unprofessional conduct, as specified.

begin delete

This bill would revise the definition of “physical therapy” to instead include examination and evaluation to determine a physical therapy diagnosis, as defined, prognosis, treatment plan, instruction, or consultative service.

end delete

This bill would specify that patients may access physical therapy treatment directly and would, in those circumstances, require a physical therapist to refer his or her patient to another specified healing arts practitioner if the physical therapist has reason to believe the patient has a condition requiring treatment or services beyond that scope of practice begin insert or if the patient is not progressing end insert , to disclose to the patient any financial interest he or she has in treating the patient, and, with the patient’s written authorization, to notify the patient’s physician and surgeon, if any, that the physical therapist is treating the patient. begin insert The bill would prohibit a physical therapist from treating a patient who initiated services directly for the lesser of more than 45 calendar days or 12 visits, except as specified, and would prohibit a physical therapist from performing services on that patient before obtaining the patient’s signature on a specified notice regarding these limitations on treatment. end insert The bill would provide that failure to comply with these provisions constitutes unprofessional conduct subject to disciplinary action by the board.

Because the bill would specify additional requirements under the Physical Therapy Practice Act, the violation of which would be a crime, it would impose a state-mandated local program.

begin insert

The Moscone-Knox Professional Corporation Act provides for the organization of a corporation under certain existing law for the purposes of qualifying as a professional corporation under that act and rendering professional services. The act authorizes specified healing arts practitioners to be shareholders, officers, directors, or professional employees of a designated professional corporation, subject to certain limitations relating to ownership of shares. Existing law also defines a medical corporation or podiatry corporation that is authorized to render professional services as long as that corporation and its shareholders, officers, directors, and employees rendering professional services who are physicians, psychologists, registered nurses, optometrists, podiatrists or, in the case of a medical corporation only, physician assistants, are in compliance with the act.

end insert begin insert

This bill would specify that those provisions do not limit employment by a professional corporation of only those specified licensed professionals. The bill would authorize any person duly licensed under the Business and Professions Code, the Chiropractic Act, or the Osteopathic Act to be employed to render professional services by a professional corporation. The bill would add physical therapists to the list of healing arts professionals who may be professional employees of a medical corporation or podiatry corporation. The bill would also provide that specified healing arts licensees may be shareholders, officers, directors, or professional employees of a physical therapy corporation. The bill would also require a practitioner who refers a patient to a physical therapist who is employed by a medical corporation or podiatry corporation to make a specified disclosure to the patient.

end insert

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: yes.

The people of the State of California do enact as follows:

SECTION 1.  

The Legislature finds and declares that an
individual’s access to early intervention to physical therapy
treatment may decrease the duration of a disability, reduce pain,
and lead to a quicker recovery.

begin delete

SEC. 2.  

Section 2620 of the Business and Professions Code is
amended to read:

2620.  

(a) Physical therapy means the art and science of
physical or corrective rehabilitation or of physical or corrective
treatment of any bodily or mental condition of any person by the
use of the physical, chemical, and other properties of heat, light,
water, electricity, sound, massage, and active, passive, and resistive
exercise, and shall include examination and evaluation to determine
a physical therapy diagnosis, prognosis, treatment plan, instruction,
or consultative service. The practice of physical therapy includes
the promotion and maintenance of physical fitness to enhance the
bodily movement related health and wellness of individuals through
the use of physical therapy interventions. The use of roentgen rays
and radioactive materials, for diagnostic and therapeutic purposes,
and the use of electricity for surgical purposes, including
cauterization, are not authorized under the term “physical therapy”
as used in this chapter, and a license issued pursuant to this chapter
does not authorize the diagnosis of disease.

(b) For the purposes of this section, “physical therapy diagnosis”
means a systematic examination process that culminates in
assigning a diagnostic label identifying the primary dysfunction
toward which physical therapy treatment will be directed, but shall
not include a medical diagnosis or a diagnosis of disease.

(c) Nothing in this section shall be construed to restrict or
prohibit other healing arts practitioners licensed or registered under
this division from practice within the scope of their license or
registration.

end delete

begin insert

begin insert SEC. 2. end insert   

end insert

begin insert Section 2406 of the end insert begin insert Business and Professions Code end insert begin insert is
amended to read: end insert

2406.  

A medical corporation or podiatry corporation is a
corporation begin delete which end delete begin insert that end insert is authorized to render professional services,
as defined in Sections 13401 and 13401.5 of the Corporations
Code, so long as that corporation and its shareholders, officers,
begin delete directors end delete begin insert directors, end insert and employees rendering professional services
who are physicians begin insert and surgeons end insert , psychologists, registered nurses,
optometrists, podiatrists begin insert , end insert begin insert chiropractors, acupuncturists,
naturopathic doctors, physical therapists, occupational therapists, end insert
or, in the case of a medical corporation only, physician assistants,
begin insert marriage and family therapists, clinical counselors, or clinical
social workers, end insert are in compliance with the Moscone-Knox
Professional Corporation Act, the provisions of this begin delete article end delete begin insert article, end insert
and all other statutes and regulations now or hereafter enacted or
adopted pertaining to the corporation and the conduct of its affairs.

With respect to a medical corporation or podiatry corporation,
the governmental agency referred to in the Moscone-Knox
Professional Corporation Act is the begin delete Division of Licensing end delete begin insert board end insert .

begin insert

begin insert SEC. 3. end insert   

end insert

begin insert Section 2406.5 is added to the end insert begin insert Business and Professions
Code end insert begin insert , to read: end insert

begin insert

begin insert 2406.5. end insert   

When a physician and surgeon, podiatrist, or other
referring practitioner refers a patient to receive services by a
physical therapist employed by a professional corporation as
defined in Sections 13401 and 13401.5 of the Corporations Code,
the referring practitioner shall comply with Article 6 (commencing
with Section 650) of Chapter 1, and shall provide notice of the
following to the patient, orally and in writing, in at least 14-point
type and signed by the patient:

(a) That the patient may seek physical therapy treatment services
from a physical therapy provider of his or her choice who may not
necessarily be employed by the medical or podiatry corporation.

(b) If the patient chooses to be treated by an employed physical
therapist, any financial interest the referring practitioner has in
the corporation.

end insert

begin delete SEC. 3. end delete
begin insert SEC. 4. end insert   

Section 2620.1 is added to the Business and Professions
Code, to read:

2620.1.  

(a) In addition to receiving begin delete wellness and evaluation
services from a physical therapist, end delete begin insert those services authorized by
Section 2620, end insert a person may initiate physical therapy treatment
directly from a licensed physical therapist if the treatment is within
the scope of practice of physical therapists, as defined in Section
2620, and all of the following conditions are met:

(1) If, at any time, the physical therapist has reason to believe
that the patient has signs or symptoms of a condition that requires
treatment beyond the scope of practice of a physical therapist begin insert or
the patient is not progressing toward documented treatment goals
as demonstrated by objective, measurable, or functional
improvement end insert , the physical therapist shall refer the patient to a
person holding a physician and surgeon’s certificate issued by the
Medical Board of California or by the Osteopathic Medical Board
of California or to a person licensed to practice dentistry, podiatric
medicine, or chiropractic.

(2) The physical therapist shall begin insert end insert begin insert comply with Section 2633, and
shall end insert disclose to the patient any financial interest he or she has in
treating the patient begin insert and, if working in a physical therapy
corporation, shall comply with Article 6 (commencing with Section
650) of Chapter 1 end insert .

(3) With the patient’s written authorization, the physical
therapist shall notify the patient’s physician and surgeon, if any,
that the physical therapist is treating the patient.

begin insert

(4) The physical therapist shall not continue treating the patient
beyond 45 calendar days or 12 visits, whichever occurs first,
without receiving, from a person holding a physician and surgeon’s
certificate from the Medical Board of California or the Osteopathic
Medical Board of California or from a person holding a certificate
to practice podiatric medicine from the California Board of
Podiatric Medicine and acting within his or her scope of practice,
a dated signature on the physical therapist’s plan of care indicating
approval of the physical therapist’s plan of care. Approval of the
physical therapist’s plan of care shall include an in-person patient
examination and evaluation of the patient’s condition and, if
indicated, testing by the physician and surgeon or podiatrist.

end insert

(b) The conditions in begin delete paragraphs (1), (2), and (3) end delete begin insert paragraph (4) end insert
of subdivision (a) do not apply to a physical therapist when begin insert he or
she is only end insert begin delete providing evaluation or end delete wellness physical therapy
services to a patient as described in subdivision (a) of Section
2620.

(c) This section does not expand or modify the scope of practice
for physical therapists set forth in Section 2620, including the
prohibition on a physical therapist diagnosing a disease.

(d) This section does not require a health care service plan or
insurer to provide coverage for begin delete direct access to treatment by a
physical therapist. end delete begin insert services rendered to a patient who directly
accessed the services of a physical therapist. end insert

begin insert

(e) When a person initiates physical therapy treatment services
directly, pursuant to this section, the physical therapist shall not
perform physical therapy treatment services without first providing
the following notice to the patient, orally and in writing, in at least
14-point type and signed by the patient:

end insert
begin insert end insert
begin insert

Direct Physical Therapy Treatment Services

end insert
begin insert end insert
begin insert

You are receiving direct physical therapy treatment services
from an individual who is a physical therapist licensed by the
Physical Therapy Board of California.

end insert begin insert

Under California law, you may continue to receive direct
physical therapy treatment services for a period of up to 45
calendar days or 12 visits, whichever occurs first, after which time
a physical therapist may continue providing you with physical
therapy treatment services only after receiving, from a person
holding a physician and surgeon’s certificate issued by the Medical
Board of California or by the Osteopathic Medical Board of
California, or from a person holding a certificate to practice
podiatric medicine from the California Board of Podiatric
Medicine and acting within his or her scope of practice, a dated
signature on the physical therapist’s plan of care indicating
approval of the physical therapist’s plan of care and that an
in-person patient examination and evaluation was conducted by
the physician and surgeon or podiatrist.

end insert begin insert

Patient’s Signature/Date

end insert

begin delete SEC. 4. end delete
begin insert SEC. 5. end insert   

Section 2660 of the Business and Professions Code is
amended to read:

2660.  

The board may, after the conduct of appropriate
proceedings under the Administrative Procedure Act, suspend for
not more than 12 months, or revoke, or impose probationary
conditions upon any license, certificate, or approval issued under
this chapter for unprofessional conduct that includes, but is not
limited to, one or any combination of the following causes:

(a) Advertising in violation of Section 17500.

(b) Fraud in the procurement of any license under this chapter.

(c) Procuring or aiding or offering to procure or aid in criminal
abortion.

(d) Conviction of a crime that substantially relates to the
qualifications, functions, or duties of a physical therapist or
physical therapist assistant. The record of conviction or a certified
copy thereof shall be conclusive evidence of that conviction.

(e) Habitual intemperance.

(f) Addiction to the excessive use of any habit-forming drug.

(g) Gross negligence in his or her practice as a physical therapist
or physical therapist assistant.

(h) Conviction of a violation of any of the provisions of this
chapter or of the Medical Practice Act, or violating, or attempting
to violate, directly or indirectly, or assisting in or abetting the
violating of, or conspiring to violate any provision or term of this
chapter or of the Medical Practice Act.

(i) The aiding or abetting of any person to violate this chapter
or any regulations duly adopted under this chapter.

(j) The aiding or abetting of any person to engage in the unlawful
practice of physical therapy.

(k) The commission of any fraudulent, dishonest, or corrupt act
that is substantially related to the qualifications, functions, or duties
of a physical therapist or physical therapist assistant.

(l) Except for good cause, the knowing failure to protect patients
by failing to follow infection control guidelines of the board,
thereby risking transmission of bloodborne infectious diseases
from licensee to patient, from patient to patient, and from patient
to licensee. In administering this subdivision, the board shall
consider referencing the standards, regulations, and guidelines of
the State Department of Public Health developed pursuant to
Section 1250.11 of the Health and Safety Code and the standards,
regulations, and guidelines pursuant to the California Occupational
Safety and Health Act of 1973 (Part 1 (commencing with Section
6300) of Division 5 of the Labor Code) for preventing the
transmission of HIV, hepatitis B, and other bloodborne pathogens
in health care settings. As necessary, the board shall consult with
the Medical Board of California, the California Board of Podiatric
Medicine, the Dental Board of California, the Board of Registered
Nursing, and the Board of Vocational Nursing and Psychiatric
Technicians of the State of California, to encourage appropriate
consistency in the implementation of this subdivision.

The board shall seek to ensure that licensees are informed of the
responsibility of licensees and others to follow infection control
guidelines, and of the most recent scientifically recognized
safeguards for minimizing the risk of transmission of bloodborne
infectious diseases.

(m) The commission of verbal abuse or sexual harassment.

(n) Failure to comply with the provisions of Section 2620.1.

begin insert

begin insert SEC. 6. end insert   

end insert

begin insert Section 13401.5 of the end insert begin insert Corporations Code end insert begin insert is amended
to read: end insert

13401.5.  

Notwithstanding subdivision (d) of Section 13401
and any other provision of law, the following licensed persons
may be shareholders, officers, directors, or professional employees
of the professional corporations designated in this section so long
as the sum of all shares owned by those licensed persons does not
exceed 49 percent of the total number of shares of the professional
corporation so designated herein, and so long as the number of
those licensed persons owning shares in the professional
corporation so designated herein does not exceed the number of
persons licensed by the governmental agency regulating the
designated professional begin delete corporation: end delete begin insert corporation. This section
does not limit employment by a professional corporation designated
in this section of only those licensed professionals listed under
each subdivision. Any person duly licensed under the Business
and Professions Code, the Chiropractic Act, or the Osteopathic
Act may be employed to render professional services by a
professional corporation designated in this section. end insert

(a) Medical corporation.

(1) Licensed doctors of podiatric medicine.

(2) Licensed psychologists.

(3) Registered nurses.

(4) Licensed optometrists.

(5) Licensed marriage and family therapists.

(6) Licensed clinical social workers.

(7) Licensed physician assistants.

(8) Licensed chiropractors.

(9) Licensed acupuncturists.

(10) Naturopathic doctors.

(11) Licensed professional clinical counselors.

(b) Podiatric medical corporation.

(1) Licensed physicians and surgeons.

(2) Licensed psychologists.

(3) Registered nurses.

(4) Licensed optometrists.

(5) Licensed chiropractors.

(6) Licensed acupuncturists.

(7) Naturopathic doctors.

(c) Psychological corporation.

(1) Licensed physicians and surgeons.

(2) Licensed doctors of podiatric medicine.

(3) Registered nurses.

(4) Licensed optometrists.

(5) Licensed marriage and family therapists.

(6) Licensed clinical social workers.

(7) Licensed chiropractors.

(8) Licensed acupuncturists.

(9) Naturopathic doctors.

(10) Licensed professional clinical counselors.

(d) Speech-language pathology corporation.

(1) Licensed audiologists.

(e) Audiology corporation.

(1) Licensed speech-language pathologists.

(f) Nursing corporation.

(1) Licensed physicians and surgeons.

(2) Licensed doctors of podiatric medicine.

(3) Licensed psychologists.

(4) Licensed optometrists.

(5) Licensed marriage and family therapists.

(6) Licensed clinical social workers.

(7) Licensed physician assistants.

(8) Licensed chiropractors.

(9) Licensed acupuncturists.

(10) Naturopathic doctors.

(11) Licensed professional clinical counselors.

(g) Marriage and family therapist corporation.

(1) Licensed physicians and surgeons.

(2) Licensed psychologists.

(3) Licensed clinical social workers.

(4) Registered nurses.

(5) Licensed chiropractors.

(6) Licensed acupuncturists.

(7) Naturopathic doctors.

(8) Licensed professional clinical counselors.

(h) Licensed clinical social worker corporation.

(1) Licensed physicians and surgeons.

(2) Licensed psychologists.

(3) Licensed marriage and family therapists.

(4) Registered nurses.

(5) Licensed chiropractors.

(6) Licensed acupuncturists.

(7) Naturopathic doctors.

(8) Licensed professional clinical counselors.

(i) Physician assistants corporation.

(1) Licensed physicians and surgeons.

(2) Registered nurses.

(3) Licensed acupuncturists.

(4) Naturopathic doctors.

(j) Optometric corporation.

(1) Licensed physicians and surgeons.

(2) Licensed doctors of podiatric medicine.

(3) Licensed psychologists.

(4) Registered nurses.

(5) Licensed chiropractors.

(6) Licensed acupuncturists.

(7) Naturopathic doctors.

(k) Chiropractic corporation.

(1) Licensed physicians and surgeons.

(2) Licensed doctors of podiatric medicine.

(3) Licensed psychologists.

(4) Registered nurses.

(5) Licensed optometrists.

(6) Licensed marriage and family therapists.

(7) Licensed clinical social workers.

(8) Licensed acupuncturists.

(9) Naturopathic doctors.

(10) Licensed professional clinical counselors.

(l) Acupuncture corporation.

(1) Licensed physicians and surgeons.

(2) Licensed doctors of podiatric medicine.

(3) Licensed psychologists.

(4) Registered nurses.

(5) Licensed optometrists.

(6) Licensed marriage and family therapists.

(7) Licensed clinical social workers.

(8) Licensed physician assistants.

(9) Licensed chiropractors.

(10) Naturopathic doctors.

(11) Licensed professional clinical counselors.

(m) Naturopathic doctor corporation.

(1) Licensed physicians and surgeons.

(2) Licensed psychologists.

(3) Registered nurses.

(4) Licensed physician assistants.

(5) Licensed chiropractors.

(6) Licensed acupuncturists.

(7) Licensed physical therapists.

(8) Licensed doctors of podiatric medicine.

(9) Licensed marriage and family therapists.

(10) Licensed clinical social workers.

(11) Licensed optometrists.

(12) Licensed professional clinical counselors.

(n) Dental corporation.

(1) Licensed physicians and surgeons.

(2) Dental assistants.

(3) Registered dental assistants.

(4) Registered dental assistants in extended functions.

(5) Registered dental hygienists.

(6) Registered dental hygienists in extended functions.

(7) Registered dental hygienists in alternative practice.

(o) Professional clinical counselor corporation.

(1) Licensed physicians and surgeons.

(2) Licensed psychologists.

(3) Licensed clinical social workers.

(4) Licensed marriage and family therapists.

(5) Registered nurses.

(6) Licensed chiropractors.

(7) Licensed acupuncturists.

(8) Naturopathic doctors.

begin insert

(p) Physical therapy corporation.

end insert begin insert

(1) Licensed physicians and surgeons.

end insert begin insert

(2) Licensed doctors of podiatric medicine.

end insert begin insert

(3) Licensed acupuncturists.

end insert begin insert

(4) Naturopathic doctors.

end insert begin insert

(5) Licensed occupational therapists.

end insert begin insert

(6) Licensed speech-language therapists.

end insert begin insert

(7) Licensed audiologists.

end insert begin insert

(8) Registered nurses.

end insert begin insert

(9) Licensed psychologists.

end insert begin insert

(10) Licensed physician assistants.

end insert

begin delete SEC. 5. end delete
begin insert SEC. 7. end insert   

No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution because
the only costs that may be incurred by a local agency or school
district will be incurred because this act creates a new crime or
infraction, eliminates a crime or infraction, or changes the penalty
for a crime or infraction, within the meaning of Section 17556 of
the Government Code, or changes the definition of a crime within
the meaning of Section 6 of Article XIII B of the California
Constitution.

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CORRECTIONS:

Text--Page 16

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