BILL ANALYSIS �
SB 924
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Date of Hearing: August 8, 2012
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Felipe Fuentes, Chair
SB 924 (Price) - As Amended: June 18, 2012
Policy Committee: Business and
Professions Vote: 8-1
Urgency: No State Mandated Local Program:
Yes Reimbursable: No
SUMMARY
This bill allows physical therapists (PTs) to treat patients
directly, without a referral or diagnosis from a physician, for
a period of time under specified conditions. The conditions
include:
1)The PT must refer the patient to an appropriate health
professional if there is reason to believe treatment of the
patient's condition is beyond the PT's scope of practice.
2)The PT must comply with current law related to financial
incentives for providing care.
3)The PT must, with patient permission, notify the patient's
primary care doctor that the PT is treating the patient.
4)The PT shall not continue treating that patient beyond 30
business days or 12 visits, whichever occurs first, without
obtaining approval of the PT's plan of care, which must
include a physical exam of the patient.
5)The PT must provide the patient a disclosure form describing
the manner in which they may directly access PT services
without a diagnosis.
The bill also indicates it does not require coverage for direct
access to a physical therapist by a health plan, insurer,
worker's compensation plan, or any other person or entity,
including a state program or state employer.
The bill also allows medical and podiatric corporations to
SB 924
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employ a number of allied health professionals, including PT's,
and allows physical therapy corporations to employ physicians as
well as allied health professionals. It also contains related
disclosure and financial interest provisions.
FISCAL EFFECT
1)Potentially significant costs to the state as well as to other
employers and their insurers, including the State Compensation
Insurance Fund (SCIF), for worker's compensation claims.
These costs are difficult to project, but direct referral to
PTs could increase costs for worker's compensation for state
employees well in excess of $150,000. This bill specifies
that it does not require direct access to PT to be covered by
a "worker's compensation plan," but this provision may be
inadequate to protect the state from costs, as employers are
obligated to pay for treatment related to on-the-job injuries.
2)Potential minor, absorbable fee-supported special fund
enforcement costs to the Physical Therapy Board of California.
3)As this bill does not mandate health care plans and insurers
to cover direct access without a referral, the state will not
incur direct health care costs related to this bill. However,
individual patients may experience increased out-of-pocket
costs for accessing physical therapy services directly with no
diagnosis. Many health plans do not cover physical therapy
services without a physician referral and diagnosis.
COMMENTS
1)Rationale . There are two major components to this bill. The
author indicates the first component, related to direct access
to physical therapy, allows PTs to treat patients without the
delay and expense of seeking a diagnosis and referral from a
physician. The second component clarifies that PTs may
legally be employed by medical corporations, which the author
indicates has been the subject of legal challenges in recent
years.
In general, the physical therapy community tends to support
provisions of this bill relating to direct access, while the
medical community tends to support the provisions relating to
medical corporations.
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2)Background . PTs help people who have injuries or illnesses
improve their movement and manage their pain. They work as
part of a healthcare team, often consulting with physicians
and surgeons and other specialists. Under current law, PTs
treat individuals who have an injury or illness diagnosed by a
physician and surgeon or another practitioner who is
authorized to diagnose.
This bill allows PTs to treat individuals prior to receiving a
diagnosis or approval of a plan of care. After an initial
period of 30 business days or 12 visits, whichever occurs
first, a physical therapist would be required to obtain a
physician or podiatrist's approval of the physical therapy
plan of care, in order to continue treating a patient.
3)Coverage for Direct Access . Most health care coverage plans
and insurers, including Medicare, attach certain conditions to
coverage of physical therapy. One of the requirements for
Medicare coverage of PT is a plan of care that is certified by
a physician or other appropriate non-physician practitioner.
The plan of care must specify a diagnosis, long-term treatment
goals, and the type, amount, duration, and frequency of
therapy services.
If an individual accessed direct PT as allowed under this
bill, in many cases the services would only be covered if the
individual had obtained a previous diagnosis and/or referral.
4)Concerns . The California Medical Association opposes this
bill unless amended. CMA seeks amendments to limit the
initial period of direct access treatment to 30 calendar days,
and to require a diagnosis be obtained in order to continue
treatment beyond the initial treatment period.
Analysis Prepared by : Lisa Murawski / APPR. / (916) 319-2081