BILL ANALYSIS                                                                                                                                                                                                    Ó




                   Senate Appropriations Committee Fiscal Summary
                            Senator Kevin de León, 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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