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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