BILL ANALYSIS Ó
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UNFINISHED BUSINESS
Bill No: SB 198
Author: Lieu (D)
Amended: 9/6/13
Vote: 21
SENATE BUSINESS, PROF. & ECON. DEVELOP. COMM. : 10-0, 04/29/13
AYES: Price, Emmerson, Block, Corbett, Galgiani, Hernandez,
Hill, Padilla, Wyland, Yee
SENATE APPROPRIATIONS COMMITTEE : 6-0, 5/20/13
AYES: De León, Walters, Gaines, Hill, Padilla, Steinberg
NO VOTE RECORDED: Lara
SENATE FLOOR : 39-0, 5/28/13 (Consent)
AYES: Anderson, Beall, Berryhill, Block, Calderon, Cannella,
Corbett, Correa, De León, DeSaulnier, Emmerson, Evans, Fuller,
Gaines, Galgiani, Hancock, Hernandez, Hill, Hueso, Huff,
Jackson, Knight, Lara, Leno, Lieu, Liu, Monning, Nielsen,
Padilla, Pavley, Price, Roth, Steinberg, Torres, Walters,
Wolk, Wright, Wyland, Yee
NO VOTE RECORDED: Vacancy
ASSEMBLY FLOOR : Not available
SUBJECT : Physical Therapy Board of California
SOURCE : Physical Therapy Board of California
DIGEST : This bill reorganizes, revises, recasts and updates
the Physical Therapy Practice Act (Act).
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Assembly Amendments change the author of the bill; make
technical changes; add language to avoid chaptering-out issues
with AB 1000 (Wieckowski); and extend, until January 1, 2018,
the authority of the Physical Therapy Board (PTB) to administer
the Act and appoint an executive officer.
ANALYSIS :
Existing law:
1. Establishes the Act which provides for the licensing and
regulation of physical therapists (PTs) and physical
therapist assistants (PTAs) by the PTB.
2. Subjects the PTB to review by the appropriate policy
committees of the Legislature and sunsets the PTB on January
1, 2014.
3. Specifies the composition and membership of PTB.
4. Provides that the PTB shall evaluate the qualification of
applicants for licensure; provide for the examinations of PTs
and PTAs and establish a passing score for each examination;
issue all licenses for the practice of physical therapy in
California; and suspend and revoke licenses, and otherwise
enforce the provisions of the Act.
5. Provides that the PTB may employ such clerical assistants
and other employees as it may deem necessary to carry out the
powers and duties, and may as necessary select and contract
with physical therapy consultants to assist it in its
programs on an intermittent basis and may contract with these
consultants on a sole source basis. However, such
consultants shall be considered public employees.
6. Provides that notice of each meeting of the PTB shall be
given in accordance with the Bagley-Keene Open Meeting Act.
7. Requires a PT to document his/her evaluation, goals,
treatment plan, and summary of treatment in the patient
record, and to also include the care actually provided and to
sign the patient record and maintain patient records for no
less than seven years or otherwise as specified.
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8. Provides for the supervision of PTAs, as specified.
9. Specifies the requirements for a person to use the title as
"physical therapy assistant" and for the approval of PTA
education programs by the PTB.
10.Specifies licensure exemptions for students performing
physical therapy in a course of study.
11.Provides for specific examination requirements for a PT or
PTA from another state or territory.
12.Allows a graduate of an approved PT education program who
has filed an application with the PTB to perform as a "PT
license applicant" under the supervision of a licensed PT
pending results of their PT examination.
13.Provides for the renewal requirements and exemptions of a PT
and PTA.
14.Specifies education and curriculum requirements for a PT.
15.Provides that the PTB shall approve those PT education
programs that prove to the satisfaction of the PTB that they
comply with the minimum PT educational requirements as
approved by the PTB, and provides that those education
programs that are accredited by the Commission on
Accreditation in Physical Therapy Education (CAPTE) of the
American Physical Therapy Association (APTA) shall be deemed
approved by the PTB unless the PTB determines otherwise.
16.Provides that an applicant who has been issued a diploma by
a PT education program that is not approved by the PTB and is
not located in the United States shall meet other specified
requirements.
17.Specifies grounds for unprofessional conduct and for the PTB
to suspend, revoke, or impose probationary conditions upon a
licensee.
18.Establishes a Diversion Program under the PTB and provides
that the PTB shall seek ways and means to identify and
rehabilitate PTs and PTAs whose competency is impaired due to
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abuse of dangerous drugs or alcohol so that they may be
treated and returned to practice of physical therapy in a
manner which will not endanger the public health and safety.
This bill:
1. Revises and recasts the Act, eliminates redundant and
outdated provisions, updates and clarifies numerous
provisions, makes other technical and conforming changes, and
renumbers various sections within the Act.
2. Clarifies and reorganizes defined terms including the
"board," "physiotherapy," "physical therapist," "physical
therapist assistant" and redefines "physical therapist
technician" to be equivalent to a "physical therapy aide."
3. Extends, from January 1, 2014 to January 1, 2018, the PTB's
authority to enforce and administer the Act.
4. Clarifies and reorganizes provisions regarding the
qualifications of professional and public members, and board
member appointing authority and specific appointments.
5. Clarifies and reorganizes provisions regarding qualification
of applicants for licensure; examinations of PTs and PTAs;
issuing licenses for the practice of physical therapy in
California; and suspending and revoking licenses, and
otherwise enforcing the provisions of the Act.
6. Requires the PTB to administer a continuing competency
program; participate in Federation of State Boards of
Physical Therapy meetings; publish a newsletter; provide
timely orientation and training to new board appointees; and
adopt and administer a program of education in matters
relevant to the regulation of physical therapy.
7. Clarifies for purposes of selecting physical therapy
consultants that the PTB may enter into contracts to enforce
the Act.
8. Provides additional authority for the PTB to employ
individuals to fill specified positions, and allow the PTB to
fix compensation for these positions and services; requires
the Attorney General to act as PTB's legal counsel, as
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specified; and extends these provisions until January 1,
2018.
9. Clarifies that all enforcement proceedings, including those
related to probationary restrictions, are governed by the
Government Code.
10.Specifies the number of times the PTB may meet and that four
members of the PTB shall constitute a quorum.
11.Clarifies that the PTB shall comply with the Bagley-Keene
Open Meeting Act.
12.Conforms the requirements for maintaining patient records
with regulations adopted by the PTB, and grants authority to
the PTB to establish other requirements as necessary.
13.Provides that a PT shall be responsible for managing all
aspects of the care of each patient as set forth in
regulation and the supervision of physical therapist
assistants and aides, as specified.
14.Authorizes the PTB by regulation to prescribe, amend, or
repeal any rules contained within the code of professional
conduct appropriate to the establishment and maintenance of
integrity and dignity in the profession of physical therapy
and provides that every licensee shall be governed and
controlled by the rules and standards adopted by the PTB.
15.Clarifies and conforms the requirements for a licensed PTA
and supervision of assistants to current regulations of the
PTB.
16.Clarifies and conforms the requirements for an unlicensed
physical therapy aide and supervision of aides to current
regulations of the PTB.
17.Adds authority for the PTB to provide for licensure
exemptions for specific purposes for a limited period of time
for PTs or PTAs from another jurisdiction of the United
States, from another country, or in consultation with a
licensed PT within California.
18.Grants general authority for the PTB to establish specific
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application and licensure requirements in regulation.
19.Allows for the PTB to define what a "complete application" is
in regulation and adds requirements for the supervision of a
PT or PTA applicant, and adds other requirements applicable
to the license for which is being applied.
20.Reorganizes and consolidates renewal requirements and
exemptions or waivers for renewal and provides regulatory
authority for the PTB to define a completed renewal
application.
21.Specifies education requirements for both PTs and PTAs and
provides that curriculum requirements shall be those as
prescribed by the CAPTE of the APTA or Physiotherapy
Education Accreditation Canada (PEAC) and shall include a
combination of didactic and clinical experiences; clinical
experience shall include at least 18 weeks of full-time
experience with a variety of patients.
22.Provides that the PTB shall approve those PT and PTA
education programs that prove to the satisfaction of the PTB
that they comply with the minimum PT or PTA educational
requirements as approved by the PTB, and provides that those
education programs that are accredited by the CAPTE of the
APTA or the PEAC shall be deemed approved by the PTB unless
the PTB determines otherwise.
23.Provides that nothing shall prohibit the PTB from
disapproving any foreign PT or PTA educational program, or
denying an applicant, if in the opinion of the PTB, the
instruction received was not equivalent to that required
under the Act.
24.Reorganizes provisions related to licensing applicants who
have been issued a diploma by a PT education program that is
not approved by the PTB and is not located in the United
States as long as they meet other specified requirements and
allows the PTB to establish application requirements in
regulation.
25.Revises and specifies additional grounds for unprofessional
conduct and for the PTB to either cite, discipline, deny a
license, suspend or revoke a license, or impose probationary
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conditions upon a licensee.
26.Allows the PTB to issue a public letter of reprimand and to
require specified training or education for the licensee.
27.Specifies that if a licensee fails or refuses to comply with
a request for medical records of a patient, that is
accompanied by a patient's written authorization for release
of the records, within 15 days, shall pay to the PTB a civil
penalty of $1,000 per day, unless the licensee is unable to
provide the documents for good cause.
28.Provides that the PTB is within the jurisdiction of the
Health Quality Enforcement Section of the Attorney General
and the Medical Quality Hearing Panel of the Office of
Administrative Hearings.
29.Renames the "Diversion Program" as the "Substance Abuse
Rehabilitation Program" and makes conforming name changes.
30.Adds language to avoid chaptering-out issues with AB 1000
(Wieckowski).
Background
PTB . The Physical Therapy Practice Act (Act) was established in
1953, Chapter 1823 (AB 17) and Chapter 1826 (AB 1001), Statutes
of 1953, creating the Physical Therapy Examining Committee
(PTEC) under the auspices of the Medical Board of California.
The Act mandates the regulation of physical therapy by the PTEC.
A "practice act" safeguards the public by regulating a defined
scope of practice vs. a "title act" which merely restricts
action to revoking a title with no restriction of practice.
PTEC . Initially, the PTEC regulated two forms of licensure; one
required PTs to work under the direction of a physician, while
the other permitted PTs to work independently. In 1968, two
forms of licensure unified resulting in the PT license. This
licensure permitted all PTs to work independently. Beginning in
1971, PTs were authorized to utilize assistive personnel if
properly supervised by a PT. That same year PTAs became
licensed and were permitted to assist in the practice of
physical therapy under the supervision of a licensed PT.
However, PTAs did not gain title protection until 1997. In
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1973, PTs were also granted authority to utilize the services of
a physical therapy aide, an unlicensed person who performs
patient related tasks under the direct and immediate supervision
of a PT.
Several legislative amendments occurred between 1971 and 1996
transferring administrative oversight previously designated to
the Medical Board to the PTEC. One of those amendments renamed
the "Physical Therapy Examining Committee" the "Physical Therapy
Board of California."
The PTB took steps to remove itself from the oversight of the
Medical Board. In 2004 the PTB began utilizing the services of
the Department of Consumer Affair's Division of Investigation
(DOI) and subsequently absorbed its own probation monitoring
responsibilities. In 2007, the PTB, through a budget change
proposal, was authorized staff for its cashiering function.
The PTB regulates approximately 21,863 active PT licensees and
5,381 active PTA licensees. The PTB has issued over 40,000 PT
licenses and over 10,000 PTA licenses since its inception. The
active licensee population has stayed somewhat constant for the
past four years.
The requirements for licensure as a PT generally includes
graduation from a professional degree program of an accredited
postsecondary institution or institutions approved by the PTB
and passing a national physical therapy examination and an
examination provided by the PTB to test the knowledge of the
laws and regulations related to the practice of physical therapy
in California (California Law Examination). The requirements
for licensure as a PTA includes graduation from a PTA education
program approved by the PTB, or have training or experience or a
combination of training and experience which in the opinion of
the PTB is equivalent to that obtained in an approved
educational program, and successfully passing an examination
provided by the PTB. As for out-of-state and foreign
applicants, the PTB has wide discretion in determining whether
the applicant's education and training qualifies the applicant
to become licensed in California. They must determine whether
the training and/or education is either equal to or greater than
that provided in California and that the examination taken by
the applicant is comparable to the (national) examination
required in California. They must also pass the California Law
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Examination. APTA must be under the supervision of a PT and a
PT may generally not supervise more than two PTAs unless the PTB
determines otherwise. APT may also utilize the services of one
aide engaged in patient-related tasks to assist the PT in his or
her practice under specified conditions.
The PTB ensures continuing competency by requiring continuing
competency hours. This program began October 31, 2010.
Continuing competency hours must be obtained in subjects related
to either the professional practice of physical therapy or
patient/client management.
Comments
According to the PTB, in response to public and licensee
concerns that the Act was complex and difficult to use, the PTB
established the Physical Therapy Practice Act Review Task Force
(Task Force) in 2004. The Task Force was charged with reviewing
the Act for accuracy and currency. The Task Force referenced
the Model Practice Act developed by the Federation of State
Boards of Physical Therapy and the APTA's revised Guide to
Physical Therapist Practice in developing the proposed revisions
to recommend to the PTB.
The Task Force was comprised of various individual licensees and
representatives from the California Physical Therapy Association
(CPTA), as well as PTB staff and legal counsel. As noted, the
CPTA was involved in drafting the proposed revisions initially,
and recently has stated it supports the updated proposed
revisions. In addition to collaboration with the profession,
the PTB also exercised all available efforts to ensure public
access. The PTB conducted all business regarding the proposed
revisions in a public forum. Therefore, Task Force meetings
were public and noticed as such, and discussions and decisions,
including adoption of all versions of the proposed revisions to
the Act, occurred at meetings publically noticed in accordance
with the Bagley-Keene Open Meeting Act. The PTB also opens all
agenda items for public comment at every meeting, and, within
the last few years, webcasts meetings and posts all meeting
materials online, including the proposed revisions to the Act.
The proposed revisions that were adopted by the PTB primarily
reorganize the provisions within the Act for clarity, and
clean-up outdated provisions. Consequently, the proposed
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revisions need to be taken together as they are intended to
coincide; if some of the proposed revisions are taken without
the others, in most cases, this may result in duplicative or
lost provisions.
Review of the PTB . In 2013, the Senate Business, Professions
and Economic Development Committee conducted oversight hearings
to review 14 regulatory boards within the Department of Consumer
Affairs. The Committee began its review of these licensing
agencies in March and conducted three days of hearings. The PTB
was last reviewed by the former Joint Legislative Sunset Review
Committee (JLSRC) in 2005. At that time, the JLSRC identified
10 issues for discussion. On November 1, 2011, the PTBC
submitted its required Sunset Report to this Committee.
However, because of an audit of the PTB, which was to be
completed by the Bureau of Audits in 2012, it was decided to put
over the review of the PTB until the audit was finalized. The
PTB provided an update and addendum to its original report to
this Committee on December 1, 2012. In its 2011 report and its
2012 addendum, the PTB described actions it had taken (including
both regulatory and legislative) since its last sunset review.
The PTB also indicated both in its report to the Committee and
during its review the need to revise the Physical Therapy
Practice Act. According to the PTB, some of the proposed
revisions have been codified; however, the PTB attempted each
year, since 2006, to get all the revisions of the Act introduced
without success. The PTB continued to pursue this issue because
the PTB believed that the Act is such a crucial document, and as
a consumer agency, it is essential for consumers to easily
access and understand the functions of the PTB; the scope and
qualifications of PTs and PTAs; the requirements and
restrictions of the profession; and, the consequences for
violating the Act. Moreover, the PTB stated, consumers also
benefit from licentiates having a clear understanding of the
Act.
It was recommended that the revisions to the Physical Therapy
Practice Act should be included in a separate bill so that the
continuation of the PTB in a sunset bill will not be jeopardized
if there is any controversy surrounding changes to the Act. It
was also stated that the PTB should assure the Committee that
all concerned individuals and interested parties have had an
opportunity to express any concerns regarding the changes
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proposed to the Act and have been addressed, to the extent
possible, by the PTB.
FISCAL EFFECT : Appropriation: Yes Fiscal Com.: Yes
Local: Yes
According to the Senate Appropriations Committee, there are
annual costs of $90,000 for two years to revise existing
regulations by the PTB (Physical Therapy Fund).
SUPPORT : (Verified 9/10/13)
Physical Therapy Board of California (source)
MW:d:e:n 9/10/13 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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