BILL ANALYSIS �
AB 1000
Page 1
CONCURRENCE IN SENATE AMENDMENTS
AB 1000 (Wieckowski and Maienschein)
As Amended September 6, 2013
Majority vote
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|ASSEMBLY: |77-0 |(May 29, 2013) |SENATE: |33-0 |(September 10, |
| | | | | |2013) |
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Original Committee Reference: B., P. & C.P.
SUMMARY : Allows patients to access physical therapy services
without a referral for 45 calendar days or 12 visits, whichever
comes first, after which the patient must receive an in-person
examination from a physician and surgeon or podiatrist, who must
also sign off on the physical therapist's plan of care; expands
the types of licensed professionals permitted to work for a
professional corporation; and permits a licensed physical
therapist (PT) to be a shareholder, officer, or director of a
medical and podiatric professional corporation, as specified.
Specifically, this bill :
1)Requires a physician and surgeon, podiatrist, or other
referring practitioner who refers a patient to receive
services from a PT employed by a professional corporation to
comply with existing law regarding financial arrangements for
referrals, and requires the referring practitioner to provide
notice to the patient, orally and in writing, in a least
14-point type and signed by the patient, of the following:
a) That the patient may seek physical therapy treatment
services from a PT of his or her choice who may not
necessarily be employed by the medical or podiatry
corporation; and,
b) If the patient chooses to be treated by an employed PT,
the financial interest, if any, the referring practitioner
has in the corporation.
2)States that the provision requiring the referring practitioner
to provide notice that the patient may go to the PT of his or
her choice, and to notify the patient of any financial
interest the referring provider has in the medical
corporation, shall not apply to a physician and surgeon,
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podiatrist, or other referring practitioner who is in a
medical group with which a licensed non-profit health care
service plan exclusively contracts to provide professional
medical services.
3)Permits a person to initiate physical therapy treatment
directly from a licensed PT if the treatment is within the
PT's scope of practice and all of the following conditions are
met:
a) If, at any time, the PT has reason to believe that the
patient has signs or symptoms of a condition that requires
treatment beyond the scope of practice of a PT, or the
patient is not progressing toward documented treatment
goals as demonstrated by objective, measurable or
functional improvement, the PT shall refer the patient to a
physician and surgeon, dentist, podiatrist, or
chiropractor, as appropriate;
b) The PT shall comply with laws relating to his or her
title, as specified, and shall disclose to the patient any
financial interest he or she has in treating the patient
and, if working in a physical therapy corporation, shall
comply with existing law regarding financial arrangements
for referrals, as specified;
c) With the patient's written authorization, the PT shall
notify the patient's physician and surgeon, if any, that
the PT is treating the patient; and,
d) The PT shall not continue treating the patient beyond 45
calendar days or 12 visits, whichever occurs first, without
receiving, from a physician and surgeon or a podiatrist,
and acting within his or her scope of practice, a dated
signature on the PT's plan of care indicating approval.
Approval of the PT'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.
4)States that the 45 calendar day or 12 visit conditions do not
apply to a PT when he or she is only providing wellness
physical therapy services to a patient, as specified.
5)Clarifies that this bill does not restrict or alter the scope
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of practice of any other health care professional.
6)Clarifies that this bill does not expand or modify the scope
of practice for PTs, including the prohibition on a physical
therapist diagnosing a disease.
7)States that the provisions of this bill shall not be construed
to require a health care service plan, insurer, workers'
compensation insurance plan, employer, or state program to
provide coverage for direct access to treatment by a PT.
8)Requires a PT to provide notice orally and in writing, in at
least 14-point type and signed by the patient, to a person
initiating physical therapy treatment services directly but
before providing those services, as specified.
9)States that violation of these provisions constitutes
unprofessional conduct.
10)States that existing law which provides for the types of
licensees a professional corporation may employ as
shareholders, officers, directors, or a professional employee,
as specified, does not limit employment by a professional
corporation to only those professions specifically designated.
11)Permits any person licensed as a healing arts professional
under the Business and Professions Code (BPC), the
Chiropractic Act, or the Osteopathic Act to be employed to
render professional services by a professional corporation, as
specified.
12)Permits a licensed PT to be a shareholder, officer, or
director of a medical and podiatric professional corporation,
as specified.
13)Makes technical and conforming changes.
14)Makes legislative findings and declarations.
15)Adds language to avoid chaptering issues with SB 198 (Lieu).
The Senate amendments :
1)Clarify that the provision requiring the referring
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practitioner to provide notice that the patient may go to the
PT of his or her choice, and to notify the patient of any
financial interest the referring provider has in the medical
corporation shall not apply to a physician and surgeon,
podiatrist, or other referring practitioner who is in a
medical group with which a licensed non-profit health care
service plan exclusively contracts to provide medical
services.
2)Clarify that the bill does not restrict or alter the scope of
practice of any other health care professional.
3)Expand the list of entities that are not required, by the
terms of this bill, to provide coverage for direct access to
treatment by a physical therapist to include a workers'
compensation insurance plan, employers, and state programs.
4)Make technical and clarifying changes.
5)Add language to avoid chaptering issues with SB 198 (Lieu).
FISCAL EFFECT : According to the Senate Appropriations
Committee:
1)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.
2)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.
COMMENTS :
1)Purpose of this bill . This bill would allow consumers to have
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direct access without physician referral to a PT for treatment
for up to 45 calendar days or 12 visits, whichever comes
first. It also authorizes the creation of a professional
physical therapy corporation, and generally permits any
healing arts licensee to be a shareholder, officer, director,
or professional employee of an authorized professional
corporation. AB 1000 aims to represent the reconciled
interests of certain physician, orthopedic physician, and
physical therapist groups as they relate to direct access to
physical therapy and employment in professional corporations.
This bill is sponsored by the California Physical Therapy
Association.
2)Access to physical therapy in California . Under current law,
a PT may work with a patient directly to "promote and maintain
physical fitness," but a PT must have a doctor's diagnosis and
referral to "perform tissue penetration for the purpose of
evaluating neuromuscular performance," on a patient, which is
essentially the heart of physical therapy practice. This
interpretation of law is based on a 1965 Attorney General
Opinion.
MediCal covers physical therapy services but requires that a
patient be under the care of a physician. MediCal also
requires that the services be furnished pursuant to a plan of
care, and that the plan be certified and recertified
periodically by a physician (usually every 30 days).
According to the Federation of State Physical Therapy Boards
(FSPTB), there are 17 jurisdictions that have unlimited direct
access to physical therapy, 30 jurisdictions with limited
direct access and 6 jurisdictions that have no direct access.
This bill would make California a limited direct access state,
allowing patients to visit a PT for 45 days or 12 visits,
whichever comes first, before requiring an in-person
examination by a physician. The rationale for limited direct
access is that any condition serious enough that it cannot be
resolved within 45 days or 12 visits warrants examination and
possible diagnosis by a physician to rule out more serious
problems.
3)Professional corporations . A professional corporation is an
organization made up primarily of individuals of the same
trade or profession. The Moscone-Knox Professional
Corporations Act of 1968 authorized the formation of
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professional corporations to obtain certain benefits of the
corporate form of doing business, such as limited legal
liability. Current law specifies which healing arts licensees
may be shareholders, officers, directors or professional
employees of professional corporations controlled by a
differing profession so long as the sum of all shares owned by
those differently licensed persons does not exceed 49% of the
total number of shares of the professional corporation.
This bill would also authorize the creation of a PT
corporation, allow any person licensed under BPC, the
Chiropractic Act, or the Osteopathic Act to be employed to
render professional services under the 16 authorized types of
professional corporations, and permit a PT to be a
shareholder, officer, or director of a medical or podiatric
professional corporation.
Analysis Prepared by : Sarah Huchel / B.,P. & C.P. / (916)
319-3301
FN:
0002730