BILL ANALYSIS �
SB 924
Page 1
SENATE THIRD READING
SB 924 (Price, Walters and Steinberg)
As Amended August 24, 2012
Majority vote
SENATE VOTE : 36-0
BUSINESS & PROFESSIONS 8-1APPROPRIATIONS 17-0
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|Ayes:|Bill Berryhill, Allen, |Ayes:|Gatto, Harkey, |
| |Butler, Eng, Hagman, | |Blumenfield, Bradford, |
| |Hill, Ma, Smyth | |Charles Calderon, Campos, |
| | | |Davis, Donnelly, Fuentes, |
| | | |Hall, Hill, Cedillo, |
| | | |Mitchell, Nielsen, Norby, |
| | | |Solorio, Wagner |
| | | | |
|-----+--------------------------+-----+--------------------------|
|Nays:|Hayashi | | |
| | | | |
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SUMMARY : Allows physical therapists (PTs) to treat patients
without a diagnosis from a physician for 30 business days, and
thereafter under specified conditions, and specifies who may be
shareholders, officers, directors, or professional employees of
medical corporations, podiatry corporations, chiropractic
corporations, and physical therapy corporations. Specifically,
this bill :
1)Allows PTs to treat patients without a diagnosis from a
physician, provided the treatment is within the scope of
practice of PTs, as specified, 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, the PT
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 a person licensed to practice
dentistry, podiatric medicine, or chiropractic;
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b) The PT complies with existing law relating to unearned
rebates, refunds and discounts;
c) With the patient's written authorization, the PT shall
notify the patient's primary physician and surgeon, if any,
that the PT is treating the patient; and,
d) The PT shall not continue treating that patient beyond
30 business days or 12 visits, whichever occurs first,
without receiving from a physician, an osteopathic
physician or a podiatrist a dated signature on the PT's
plan of care indicating approval of the plan of care, or a
medical diagnosis.
2)Provides that the conditions described in c) and d), above, do
not apply to a PT when providing evaluation or wellness
physical therapy services to a patient, as specified.
3)States that this bill shall be not construed to expand or
modify the scope of practice for PTs, as specified, including
the prohibition on a PT diagnosing a disease.
4)States that this bill shall not be construed to require a
health care service plan, insurer, workers compensation
insurance plan or any other person or entity, including, but
not limited to, a state program or state employer, to provide
coverage for direct access to treatment by a PT.
5)Prohibits, when a person initiates direct physical therapy
services, a PT from performing physical therapy treatment
services without first providing a specified written notice,
orally and in writing, on one page, in at least 14-point type,
and obtaining a patient signature on the notice.
6)Adds licensed PTs and licensed occupational therapists to the
list of persons who may be shareholders, officers, directors,
or professional employees of medical corporations, podiatry
corporations, and chiropractic corporations.
7)Provides that the following healing arts licensees may be
shareholders, officers, directors, or professional employees
of a physical therapy corporation: licensed physicians and
surgeons, licensed doctors of podiatric medicine, licensed
acupuncturists, naturopathic doctors, licensed occupational
therapists, licensed speech-language pathologists, licensed
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audiologists, registered nurses, licensed psychologists, and
licensed physician assistants, and licensed chiropractors.
8)Requires a medical corporation, podiatry corporation,
chiropractic corporation or physical therapy corporation to
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 or her choice who may not
necessarily be employed by the medical corporation, podiatry
corporation, chiropractic corporation or physical therapy
corporation.
9)Provides that the disclosure requirement described above 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.
FISCAL EFFECT : According to the Assembly Appropriations
Committee:
1)Possible 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.
These costs may be mitigated somewhat by language requiring a
diagnosis after the initial treatment period.
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
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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 : According to the author, "Since there is currently no
direct access to physical therapy services, many patients must
endure unnecessary delays and additional expense in order to
access physical therapy treatment. Delays in treatment can
result in higher costs to consumers and insurance companies,
along with decreased functional outcomes. Family members of
patients are also inconvenienced by additional visits to health
care providers, which often require them to take time from
work?Further, in the 36 states with 'direct access,' Medicare
pays for the direct treatment by PTs in states that allow such
practice. SB 924 would allow California to take advantage of
federal health care dollars and allow Medicare recipients to
begin physical therapy treatment immediately and eliminate wait
time and the added expense of an extra physician visit.
"At least two legal opinions called into question the ability of
a medical or podiatric corporation to hire a PT since they are
not one of the listed health care practitioners who may be
employed by the professional corporation. For many years, these
professional corporations have employed PTs and believed that
they were not prohibited from doing so under current law. This
bill will clarify under the Corporations Code that medical
corporations and podiatric corporations may directly employ PTs
to work within their professional corporation."
Analysis Prepared by : Angela Mapp / B.,P. & C.P. / (916)
319-3301
FN: 0005597