BILL ANALYSIS �
Senate Appropriations Committee Fiscal Summary
Senator Kevin de Le�n, Chair
AB 1000 (Wieckowski) - Physical therapists: direct access to
services: professional corporations.
Amended: July 11, 2013 Policy Vote: B&P 8-0
Urgency: No Mandate: Yes
Hearing Date: August 12, 2013
Consultant: Brendan McCarthy
This bill meets the criteria for referral to the Suspense File.
Bill Summary: AB 1000 would allow patients to directly access
physical therapy services for a limited time before being seen
by a physician. The bill would also allow licensed health care
professionals to be employed by healthcare-related corporations.
Fiscal Impact:
Minor costs to update existing regulations by the Physical
Therapy Board (Physical Therapy Fund). The Physical Therapy
Board indicates that it will need to make minor updates to
existing regulations, which can be performed as part of
ongoing updates to existing regulations at minor additional
cost.
No additional costs to Medi-Cal or CalPERS health plans
(various funds). The bill specifically provides that "direct
access" to physical therapy services does not obligate
health plans or health insurers to provide coverage for such
services. Therefore, the bill will not require Medi-Cal
managed care plans or CalPERS health plans to pay for such
services. In addition, regulations governing Medi-Cal fee
for service require enrollees to gain prior authorization
for physical therapy services, which must also be prescribed
by a licensed health care practitioner.
Unknown costs to state agencies through the State
Compensation Insurance Fund (various funds). Like other
employers in the state, state agencies purchase insurance
for workplace-related injuries through the State
Compensation Insurance Fund (referred to as workers'
compensation). The bill does not specifically exempt the
State Compensation Insurance Fund from providing coverage
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for direct access to physical therapy services. In 2012,
state agencies paid about $12 million for physical therapy
services under this system. The extent to which additional
services would be provided under this bill is unknown, but
even a modest increase in demand for services could increase
costs to state agencies by hundreds of thousands to millions
of dollars annually.
Background: Under current law, physical therapists are licensed
and regulated by the Physical Therapy Board. Physical therapists
are authorized to provide physical corrective rehabilitation, by
various methods. Physical therapists are not authorized in law
to diagnose conditions. In order to provide physical therapy for
a medical condition or disease, generally a physician must
diagnose the condition or disease and refer the patient for
physical therapy.
Under current law, professional corporations are made up of
individuals of the same profession or trade. Professional
corporations may employ individuals from a different
professional, provided that a majority of the owners and/or
employees of the professional corporation are from the primary
profession. For example, a medical corporation is organized by
physicians to provide medical services. A medical corporation
may employ other health care professionals (such as nurses), but
the medical corporation must be majority-owned by physicians.
Current law does not specifically authorize medical corporations
or podiatric corporations to employ physical therapists.
Historically, the Physical Therapy Board interpreted the law to
allow medical and podiatric corporations to employ physical
therapists. However, recent legal opinions by Legislative
Counsel and the Department of Consumer Affairs indicate that
this practice is not allowed under California law.
Proposed Law: AB 1000 would allow patients to directly access
physical therapy services for a limited time before being seen
by a physician. The bill would also allow licensed health care
professionals to be employed by a healthcare-related
corporations.
With regard to access to physical therapy services, the bill
would:
Authorize a patient to directly access physical therapy
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services;
Limit direct access physical therapy services to 45 days or
12 visits, before requiring a physician or podiatrist to
approve the plan of care for the patient;
Specify that the bill does not require a health plan or
health insurance policy to provide coverage for directly
accessed physical therapy services;
Require certain notices to be provided to the patient.
With regard to employment by professional corporations, the bill
would:
Specifically add physical therapists to the licensed
professionals that may be employed by medical corporations
and podiatric corporations;
Provide that any licensed health care professional may be
employed by a professional corporation;
Authorize a physical therapy corporation to employ licensed
health care professionals.
Related Legislation:
SB 924 (Price, Steinberg and Walters, 2012) would have
allowed direct access to physical therapy services and would
have allowed physical therapists to be employed by
professional corporations. That bill was held in the
Assembly Rules Committee.
AB 783 (Hayashi, 2011) would have allowed physical
therapists and occupational therapists to be employed by
certain professional corporations. That bill was held in the
Senate Business, Professions and Economic Development
Committee.
AB 721 (Nava, 2009) would have allowed direct access to
physical therapy services. That bill was held in the
Assembly Business and Professions Committee.
AB 1444 (Emmerson, 2008) would have revised the definition
of physical therapy and allowed physical therapists to
initiate treatment. That bill was held in the Assembly
Business and Professions Committee.
Staff Comments: The only costs that may be incurred by local
governments due to the bill relate to crimes and infractions.
Under the California Constitution, such costs are not
reimbursable by the state.
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