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  








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          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  








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              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.