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 30, 2013 Consultant: Brendan McCarthy SUSPENSE FILE. AS AMENDED. 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 (as approved on August 30, 2013): 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, CalPERS health plans, or state employers (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. 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 AB 1000 (Wieckowski) Page 1 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 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 AB 1000 (Wieckowski) Page 2 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. Committee amendments: would clarify that workers' compensation plans, employers, or state programs are not required to pay for directly accessed physical therapy services.