BILL ANALYSIS �
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|SENATE RULES COMMITTEE | SB 924|
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THIRD READING
Bill No: SB 924
Author: Price (D), et al.
Amended: 1/26/12
Vote: 21
SENATE BUSINESS, PROF. & ECON. DEV. COMM. : 5-2, 5/2/11
AYES: Price, Emmerson, Negrete McLeod, Walters, Wyland
NOES: Correa, Vargas
NO VOTE RECORDED: Corbett, Hernandez
SENATE APPROPRIATIONS COMMITTEE : Senate Rule 28.8
SUBJECT : Physical therapists: direct access to services
and professional
corporations
SOURCE : Author
DIGEST : This bill allows patients to initiate physical
therapy treatment directly from a licensed physical
therapist, provided the treatment is within the scope of
practice of a physical therapist. In addition, this bill
adds licensed physical therapists and licensed occupational
therapists to the list of healing arts practitioners who
may be shareholders, officers, directors, or professional
employees of medical and podiatry corporations.
ANALYSIS :
Existing law:
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1.Establishes the Physical Therapy Act, which is enforced
by the Physical Therapy Board of California (PT Board),
to license and regulate the practice of physical
therapists.
2.Defines physical therapy as the art and science of
physical or corrective rehabilitation or of physical or
corrective treatment of any bodily or mental condition of
any person by the use of the physical, chemical, and
other properties of heat, light, water, electricity,
sound, massage, and active, passive, and resistive
exercise, and shall include physical therapy evaluation,
treatment planning, instruction and consultative
services. Indicates that the practice of physical
therapy includes the promotion and maintenance of
physical fitness to enhance the bodily movement related
health and wellness of individuals through the use of
physical therapy interventions. Specifies that the use
of roentgen rays and radioactive materials, for
diagnostic and therapeutic purposes, and the use of
electricity for surgical purposes, including
cauterization, are not authorized under the term
"physical therapy." Indicates that a physical therapy
license issued pursuant does not authorize the diagnosis
of disease.
3.Provides that an applicant for a physical therapy license
must be a graduate of a professional degree program of an
accredited postsecondary institution/s approved by the PT
Board, and must complete academic coursework and clinical
internship in physical therapy.
4.Provides that the words "diagnose" or "diagnosis" include
any undertaking by any method, device, or procedure
whatsoever, and whether gratuitous or not, to ascertain
or establish whether a person is suffering from any
physical or mental disorder. Such terms shall also
include the taking of a person's blood pressure and the
use of mechanical devices or machines for the purpose of
making a diagnosis and representing to such person any
conclusion regarding his/her physical or mental
condition. Machines or mechanical devices for measuring
or ascertaining height or weight are excluded from this
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section.
This bill:
1. Adds licensed physical therapists and licensed
occupational therapists to the list of healing arts
practitioners who may be shareholders, officers,
directors, or professional employees of medical
corporations and podiatry corporations, and provides
that specified healing arts licensees may be
shareholders, officers, directors, or professional
employees of a physical therapy corporation.
2. Requires a medical corporation, podiatry corporation or
physical therapy corporation disclose to its patients,
orally and in writing, when initiating any physical
therapy treatment services, that the patient may seek
physical therapy treatment services from a physical
therapy provider of his/her choice who may not
necessarily be employed by the medical or podiatry
corporation.
3. Provides that this disclosure requirement does not apply
to any medical corporation that contracts with a health
care service plan with a license issued pursuant to the
Knox-Keene Health Care Service Plan Act of 1975 if the
licensed health care service plan is also exempt from
federal taxation pursuant to Section 501(c)(3) of the
Internal Revenue Code.
4. Allows patients to initiate physical therapy treatment
directly from a licensed physical therapist provided
that the treatment is within the scope of practice of
physical therapists, as specified, and all of the
following conditions are met:
A. If, at any time, the physical therapist has reason
to believe that the patient has signs or symptoms of
a condition that requires treatment beyond the scope
of practice of a physical therapist, the physical
therapist shall refer the patient to a person holding
a physician and surgeon's certificate issued by the
Medical Board of California (MBC) or by the
Osteopathic Medical Board of California (OMBC) or to
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a person licensed to practice dentistry, podiatric
medicine, or chiropractic.
B. The physical therapist complies with existing law
relating to unearned rebates, refunds and discounts.
C. With the patient's written authorization, the
physical therapist shall notify the patient's
physician and surgeon, if any, that the physical
therapist is treating the patient.
D. The physical therapist shall not continue treating
that patient beyond 30 business days or 12 visits,
whichever occurs first, without receiving, from a
person holding a physician and surgeon's certificate
from the MBC or the OMBC, a dated signature on the
physical therapist's plan of care indicating approval
of the physical therapist's plan of care.
E. Approval of the physical therapist's plan of care
shall include an appropriate patient examination by
the person holding a physician and surgeon's
certificate from the MBC or the OMBC.
5. Provides that the conditions specified in #4A to E
above, do not apply to a physical therapist when
providing evaluation or wellness physical therapy
services to a patient, as specified.
6. States that this bill shall be not construed to expand
or modify the scope of practice for physical therapists,
as specified, including the prohibition on a physical
therapist diagnosing a disease.
7. Provides that this bill shall not be construed to
require a health care service plan, insurer or workers
compensation insurance plan to provide coverage for
direct access to treatment by a physical therapist.
8. Requires, when a person initiates physical therapy
services, a physical therapist not perform physical
therapy treatment services without first providing a
specified written notice, orally and in writing, on one
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page, in at least 14-point type, and obtaining a patient
signature on the notice.
Background
The Physical Therapy Act (PT Act) defines the practice of
physical therapy as the art and science of physical or
corrective rehabilitation or of physical or corrective
treatment of any bodily or mental condition of any person
by the use of the physical, chemical, and other properties
of heat, light, water, electricity, sound, massage, and
active, passive, and resistive exercise, and shall include
physical therapy evaluation, treatment planning,
instruction and consultative services. Furthermore, the
practice of physical therapy includes the promotion and
maintenance of physical fitness to enhance the bodily
movement related health and wellness of individuals through
the use of physical therapy interventions. However, the
use of roentgen rays and radioactive materials, for
diagnostic and therapeutic purposes, and the use of
electricity for surgical purposes, including cauterization,
are not authorized under the term "physical therapy." The
PT Act provides that a physical therapy license does not
authorize the diagnosis of disease. Additionally, the PT
Act indicates that a physical therapist, upon specified
authorization of a physician and surgeon, may perform
tissue penetration for the purpose of evaluating
neuromuscular performance as part of the practice of
physical therapy, provided that the physical therapist is
certified by the PT Board to perform the tissue penetration
and evaluation and the physical therapist does not develop
or make diagnostic or prognostic interpretations of data
produced. To obtain licensure, a physical therapy
applicant must be a graduate of a professional degree
program of an accredited postsecondary institution/s
approved by the PT Board, and must complete academic
coursework and clinical internship in physical therapy.
To access physical therapy treatment, an initial diagnosis
for a medical condition must be made by a physician and
surgeon or another practitioner who is authorized to
diagnose. This current state of the law was echoed by a
1965 Attorney General (AG) Opinion which reviewed the
validity of a statute that allowed a physical therapist to
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conduct specified methods of treatment but prohibits
him/her from making a diagnosis. The issue was whether
this statute was invalid because it was indefinite and
uncertain. In upholding the statute, the AG Opinion
indicated that the practice of medicine consists of three
parts: diagnosis, prescription, and treatment. The AG
opinion pointed out that although it is impossible to treat
a bodily or mental condition without first ascertaining the
condition, this does not imply that the one rendering the
treatment must also have performed the diagnosis. However,
the AG opinion was clear that a licensed physical therapist
in not authorized to diagnose, and that the AG perceived no
conflicts, ambiguities, or uncertainties in limiting the
practice of licensed physical therapists to treating
ailments diagnosed by those found to be qualified and
authorized by law to diagnose. Therefore, a licensed
physical therapist may only treat an ailment basing his
treatment upon a physician's diagnosis.
The federal Medicare Program covers physical therapy
services but limits how much is covered for
medically-necessary outpatient physical therapy. The
outpatient therapy limits for 2011, is $1,870 for physical
therapy and speech language pathology combined. There are
certain exceptions to these limits if the services are
medically necessary. Medicare coverage for physical
therapy requires that a patient must be under the care of a
physician, the services must be furnished under a plan of
care, and the plan of care must be certified/recertified
periodically by a physician (usually every 30 days).
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: Yes
CTW:mw 1/30/12 Senate Floor Analyses
SUPPORT/OPPOSITION: NONE RECEIVED
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