Regular Session 2019-2020 Senate Bill 1228 P.N. 1846

PRINTER'S NO. 1846

THE GENERAL ASSEMBLY OF PENNSYLVANIA

SENATE BILL

No.

1228

Session of

2020

INTRODUCED BY SCAVELLO, ARGALL, YUDICHAK, PHILLIPS-HILL AND

BROOKS, JULY 13, 2020

REFERRED TO CONSUMER PROTECTION AND PROFESSIONAL LICENSURE,

JULY 13, 2020

AN ACT

Amending the act of October 10, 1975 (P.L.383, No.110), entitled

"An act relating to the practice of physical therapy,"

further providing for definitions, for powers and duties of

board, for continuing education, for practice of physical

therapy and for physical therapist assistant, education and

examination, scope of duties and certification.

The General Assembly of the Commonwealth of Pennsylvania

hereby enacts as follows:

Section 1. The definitions of "certificate of authorization"

and "physical therapy" in section 2 of the act of October 10,

1975 (P.L.383, No.110), known as the Physical Therapy Practice

Act, are amended and the section is amended by adding a

definition to read:

Section 2. Definitions.--The following definitions shall

apply, when used in this act, unless otherwise expressed

therein:

* * *

["Certificate of authorization" means a certificate, approved

by the board, to practice physical therapy without a referral

under section 9(a).]

* * *

"Dry needling" means a physical intervention that uses a

filiform needle to stimulate trigger points, diagnose and treat

neuromuscular pain and functional movement deficits. The term

does not include the stimulation of auricular or any other

points based upon areas of oriental medicine or the practice of

acupuncture under the act of February 14, 1986 (P.L.2, No.2),

known as the Acupuncture Licensure Act.

* * *

"Physical therapy" means any of the following:

(1) The evaluation, examination and testing of individuals

with mechanical, physiological and developmental impairments,

functional limitations and disabilities, other health-related or

movement-related conditions, performed to determine a diagnosis,

prognosis and plan of treatment intervention within the scope of

this act or to assess the ongoing effects of intervention.

(2) The performance of tests and measurements as an aid in

diagnosis or evaluation of function and the treatment of the

individual through the utilization of the effective properties

of physical measures such as mechanical stimulation, dry

needling, heat, cold, light, air, water, electricity, sound,

massage or mobilization-manual therapy.

(3) The use of therapeutic exercises and rehabilitative

procedures, including training in functional activities, with or

without the utilization of assistive devices, for the purpose of

limiting or preventing disability and alleviating or correcting

any physical or mental conditions.

(4) Reducing the risk of injury, impairment, functional

limitation and disability, including the promotion and

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maintenance of fitness, health and wellness in populations of

all ages as well as engaging in administration, consultation,

education and research.

* * *

Section 2. Sections 3(a), 7.2, 9(b), (c) and (e) and 9.1(c)

of the act are amended to read:

Section 3. Powers and Duties of Board.--(a) It shall be the

duty of the board to pass upon the qualifications of applicants

for licensure as physical therapists and certification as

physical therapist assistants, to conduct examinations, to issue

and renew licenses [and certificates of authorization] to

physical therapists and certificates to physical therapist

assistants who qualify under this act, and in proper cases to

refuse to issue, suspend or revoke the license [or certificate

of authorization] of any physical therapist or certificate of

any physical therapist assistant. The board may adopt rules and

regulations not inconsistent with law as it may deem necessary

for the performance of its duties and the proper administration

of this law. The board is authorized and empowered to appoint

hearing examiners and to conduct investigations and hearings

upon charges for discipline of a licensee or certificate holder

or for violations of this act and to cause, through the office

of the Attorney General, the prosecution and enjoinder of

individuals violating this act. The board shall maintain a

licensed to practice in this State, and every physical therapist

assistant duly certified pursuant to section 9.1, such

individual's last known place of residence, and the date and

number of the physical therapist's license and the physical

therapist assistant's certificate. Residential information shall

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not be considered a public record under the act of June 21, 1957

(P.L.390, No.212), referred to as the Right-to-Know Law.

* * *

Section 7.2. Continuing Education.--For each license

renewal, a licensee shall complete within the immediately

preceding two-year period at least 30 hours of continuing

physical therapy education as approved by the board. The

licensee shall provide the board with evidence of the completion

of the continuing education. [A physical therapist who has met

the continuing education requirements for a certificate of

authorization set forth in section 9(c)(1) shall be deemed to

have met the continuing education requirement for license

renewal. No credit shall be given for any course in office

management or practice building.]

Section 9. Practice of Physical Therapy.--* * *

(b) Licensees who meet the standards set forth in this

subsection may [apply to the board for a certificate of

authorization to] practice physical therapy under this act

without the required referral under subsection (a). [A

certificate of authorization to] The practice of physical

therapy without a referral under subsection (a) shall not

authorize a physical therapist either to treat a condition in an

individual which is a nonneurologic, nonmuscular or nonskeletal

condition or to treat an individual who has an acute cardiac or

acute pulmonary condition unless the physical therapist has

consulted with the individual's licensed physician, dentist or

podiatrist regarding the individual's condition and the physical

therapy treatment plan or has referred the individual to a

licensed physician, dentist or podiatrist for diagnosis and

referral. [The certificate of authorization shall be issued only

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to licensed physical therapists practicing physical therapy. The

certificate of authorization shall be displayed by the

certificate holder in a manner conspicuous to the public. The

renewal of the certificate of authorization shall coincide with

the renewal of the license of the licensee. Licensees making

application for a certificate of authorization] To practice

physical therapy under this subsection, a licensee shall present

satisfactory evidence to the board of all of the following:

(1) That the licensee has[:

(i)] passed an examination for licensure to practice

physical therapy, which examination included testing on the

appropriate evaluative procedures to treat an individual without

a referral.[; or

(ii) passed an examination for licensure to practice

physical therapy prior to 1990 and successfully completed a

course approved by the board on the appropriate evaluative

procedures to treat an individual without a referral.

(2) That the licensee has:

(i) practiced physical therapy as a licensed physical

therapist in the delivery of patient care in accordance with

this act on a continuous basis for at least two years

immediately preceding the application for a certificate of

authorization;

(ii) been licensed under section 6(d.1) and has practiced

physical therapy in the delivery of patient care as a licensed

physical therapist in a reciprocal state on a continuous basis

for at least two years immediately preceding the application for

a certificate of authorization; or

(iii) provided proof of meeting the standards of clause (i)

or (ii) of this paragraph through the application of any

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combination thereof.]

(3) That the license of that licensee has been maintained in

good standing.

(4) That the licensee has professional liability insurance

in accordance with the following provisions:

(ii) A licensee shall notify the board within 30 days of the

licensee's failure to be covered by the required insurance.

Failure to notify the board shall be actionable under section 11

or 12. [Further, the certificate of authorization of that

licensee shall automatically be suspended upon failure to be

covered by the required insurance and shall not be restored

until submission to the board of satisfactory evidence that the

licensee has the required professional liability insurance

coverage.]

(iii) The board shall accept from licensees as satisfactory

evidence of insurance coverage under this subsection any or all

of the following: self-insurance, personally purchased

professional liability insurance, professional liability

insurance coverage provided by the licensee's employer or any

similar type of coverage.

(iii.1) A licensee under this act, practicing in this

Commonwealth, shall maintain a level of professional liability

insurance coverage in the minimum amount of $1,000,000 per

occurrence or claims made. Failure to maintain insurance

coverage as required shall subject the licensee to disciplinary

proceedings. The board shall accept as satisfactory evidence of

insurance coverage any of the following:

(A) self-insurance;

(B) personally purchased liability insurance; or

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the physical therapist's employer or similar insurance coverage

acceptable to the board.

(iii.2) A license applicant shall provide proof that the

applicant has obtained professional liability insurance in

accordance with subparagraph (iii.1). It is sufficient if the

applicant files with the application a copy of a letter from the

applicant's professional liability insurance carrier indicating

that the applicant will be covered against professional

liability in the required amounts effective upon the issuance of

the applicant's license to practice physical therapy in this

Commonwealth.

(iii.3) Upon issuance of a license, a licensee has 30 days

to submit to the board the certificate of insurance or a copy of

the policy declaration page.

(iv) The board shall adopt, by regulation, standards and

procedures established by the Insurance Commissioner for self-

insurance. In the absence of these standards and procedures, the

board, after consultation with the Insurance Commissioner, shall

establish standards and procedures by regulation for self-

insurance under this subsection.

[(c) (1) For each renewal of the certificate of

authorization, the licensee shall complete within the

immediately preceding two-year period at least 30 hours of

continuing physical therapy education related to keeping the

certificate holder apprised of advancements and new developments

in the practice of the physical therapy profession. At least ten

of the 30 hours shall be in appropriate evaluative procedures to

treat an individual without a referral. No credit shall be given

for any course in office management or practice building. The

licensee shall provide the board with evidence of the completion

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of the continuing education.

(2) Continuing education programs and program providers

under this subsection shall be approved by the board in

accordance with standards and criteria established by the board

by regulation. The regulation shall include any fees necessary

to implement this provision and provide for waiver of the

continuing education requirement due to illness or hardship in

any licensing renewal period.]

* * *

(e) A physical therapist may treat an individual without a

referral as provided for in subsection (b) for up to [30] 90

days from the date of the first treatment. A physical therapist

shall not treat an individual beyond [30] 90 days from the date

of the first treatment unless he or she has obtained a referral

from a licensed physician; a licensed physician assistant

practicing pursuant to a written agreement with a physician; a

certified registered nurse practitioner practicing pursuant to a

collaborative agreement with a physician; or a licensed dentist

or licensed podiatrist, for the treatment of a condition that is

within the scope of practice of dentistry or podiatry. The date

of the first treatment for purposes of this subsection is the

date the individual is treated by any physical therapist

treating without a referral.

* * *

Section 9.1. Physical Therapist Assistant; Education and

Examination; Scope of Duties; Certification.--* * *

licensed physical therapist in the practice of physical therapy

shall only perform patient-related physical therapy acts and

services that are assigned or delegated by and under the

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supervision of a licensed physical therapist. Such acts and

services of a physical therapist assistant shall not include

evaluation, testing, dry needling, interpretation, planning or

modification of patient programs. For purposes of this section

the term "supervision" means as follows:

(1) In all practice settings, the performance of selected

acts and services by the physical therapist assistant shall be:

(i) The responsibility of the licensed physical therapist at

all times.

(ii) Based on the following factors:

(A) Complexity and acuity of the patient's needs.

(B) Proximity and accessibility of the licensed physical

therapist to the certified physical therapist assistant.

critical event.

(D) Type of practice setting in which the service is

provided.

(2) In all practice settings, the initial patient contact

shall be made by a licensed physical therapist for evaluation of

the patient and establishment of a plan of care.

(3) Supervision requirements of a physical therapist

assistant shall be dependent upon the practice setting in which

the care is delivered:

(i) When care is delivered to an individual in an acute care

hospital, acute inpatient rehabilitation center, long-term acute

care hospital facility setting or as otherwise required by

Federal or State law or regulation, the physical therapist

assistant shall be under the direct on-premises supervision of a

licensed physical therapist.

(ii) When care is provided to an individual in a preschool,

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primary school, secondary school or other similar educational

setting, a licensed physical therapist shall make an onsite

visit and examine the patient at least every four patient visits

or every 30 days, whichever shall occur first.

(iii) When care is provided to a patient in a physical

therapy independent private practice outpatient facility, a

licensed physical therapist shall provide direct on-premises

supervision of a physical therapist assistant for at least 50%

of the hours worked by the physical therapist assistant during

the calendar week unless otherwise required by Federal law, and

the physical therapist shall be immediately available by

telecommunication if not providing direct on-premises

supervision.

(iv) For any home health care, facility or practice setting

not specified in subparagraph (i), (ii) or (iii), a licensed

physical therapist shall make an onsite visit and actively

participate in the treatment of the patient at least every seven

patient visits or every 14 days, whichever shall occur first.

The board shall review and make recommendations to the Consumer

Protection and Professional Licensure Committee of the Senate

and to the Professional Licensure Committee of the House of

Representatives relating to the implementation of this paragraph

three years following the effective date of this paragraph.

(4) In all practice settings, a physical therapist assistant

shall be under the direct on-premises supervision of a licensed

physical therapist until the physical therapist assistant

submits for approval evidence satisfactory to the board of:

(i) at least 2,000 hours of experience providing patient-

related acts and services verified by a supervising licensed

physical therapist; or

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(ii) employment as a physical therapist assistant for at

least three of the five years immediately preceding the

effective date of this paragraph.

(5) Upon compliance with paragraph (4), a physical therapist

assistant may only provide physical therapy acts and services

when the licensed physical therapist is available and accessible

in person or by telecommunication to the physical therapist

assistant during all working hours of the physical therapist

assistant and is present within a 100-mile radius of the

treatment location. A physical therapist assistant shall consult

with the supervising physical therapist in the event of a change

in the patient's condition which may require the assessment of a

licensed physical therapist.

(6) A licensed physical therapist shall not supervise more

than three physical therapist assistants at any time.

(7) In the event of a change of the supervising licensed

physical therapist, the subsequent supervisor shall assume

responsibility for the ongoing supervision of any certified

physical therapist assistant providing physical therapy acts and

services and shall become the supervising physical therapist.

* * *

Section 3. This act shall take effect in 60 days.

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