Approved by the Legislative Commissioner

April 29, 2000

An Act Concerning Athletic Trainers And Physical Therapist Assistants.

Be it enacted by the Senate and House of Representatives in General Assembly convened:

Section 1. (NEW) As used in sections 1 to 7, inclusive, of this act:

(1) "Athletic training" means the application or provision, with the consent and under the direction of a health care provider, of (A) principles, methods and procedures of evaluation, prevention, treatment and rehabilitation of athletic injuries sustained by athletes, (B) appropriate preventative and supportive devices, temporary splinting and bracing, physical modalities of heat, cold, light massage, water, electric stimulation, sound, exercise and exercise equipment, (C) the organization and administration of athletic training programs, and (D) education and counseling to athletes, coaches, medical personnel and athletic communities in the area of the prevention and care of athletic injuries. For purposes of this subdivision, "health care provider" means a person licensed to practice medicine or surgery under chapter 370 of the general statutes, chiropractic under chapter 372 of the general statutes, podiatry under chapter 375 of the general statutes or naturopathy under chapter 373 of the general statutes;

(2) "Athletic injury" means any injury sustained by an athlete as a result of such athlete's participation in exercises, sports, games or recreation requiring strength, agility, flexibility, range of motion, speed or stamina, or any comparable injury that prevents such athlete from participating in any such activities;

(3) "Athlete" means any person who is a member of any professional, amateur, school or other sports team, or is a regular participant in sports or recreational activities, including, but not limited to, training and practice activities, that require strength, agility, flexibility, range of motion, speed or stamina. For purposes of this subdivision, "regular" means not less than three times per week;

(4) "Standing orders" means written protocols, recommendations and guidelines for treatment and care, furnished and signed by a health care provider specified under subdivision (1) of this section, to be followed in the practice of athletic training that may include, but not be limited to, (A) appropriate treatments for specific athletic injuries, (B) athletic injuries or other conditions requiring immediate referral to a licensed health care provider, and (C) appropriate conditions for the immediate referral to a licensed health care provider of injured athletes of a specified age or age group.

(5) "Commissioner" means the Commissioner of Public Health.

Sec. 2. (NEW) (a) Except as provided in section 4 of this act, no person may practice athletic training unless such person is licensed pursuant to section 6 of this act.

(b) No person may use the title "licensed athletic trainer" or make use of any title, words, letters or abbreviations indicating or implying that such person is licensed to practice athletic training unless such person is licensed pursuant to section 6 of this act.

Sec. 3. (NEW) (a) Each person who practices athletic training under standing orders shall make a written or oral referral to a licensed health care provider of any athlete who has an athletic injury whose symptoms have not improved for a period of four days from the day of onset, or who has any physical or medical condition that would constitute a medical contraindication for athletic training or that may require evaluation or treatment beyond the scope of athletic training. The injuries or conditions requiring a referral under this subsection shall include, but not be limited to, suspected medical emergencies or illnesses, physical or mental illness and significant tissue or neurological pathologies.

(b) Each person who practices athletic training, but not under standing orders, may perform initial evaluation and temporary splinting and bracing of any athlete with an athletic injury and shall, without delay, make a written or oral referral of such athlete to a licensed health care provider. The limitations on the practice of athletic training set forth in this subsection shall not apply in the case of any athlete that is referred to such person by a licensed health care provider, provided such practice shall be limited to the scope of such referral.

Sec. 4. (NEW) A license to practice athletic training shall not be required of: (1) A practitioner who is licensed or certified by a state agency and is performing services within the scope of practice for which such person is licensed or certified; (2) a student intern or trainee pursuing a course of study in athletic training, provided the activities of such student intern or trainee are performed under the supervision of a person licensed to practice athletic training and the student intern or trainee is given the title of "athletic trainer intern", or similar designation; (3) a person employed or volunteering as a coach of amateur sports who provides first aid for athletic injuries to athletes being coached by such person; (4) a person who furnishes assistance in an emergency; or (5) a person who acts as an athletic trainer in this state for less than thirty days per calendar year and who is licensed as an athletic trainer by another state or is certified by the National Athletic Trainers' Association Board of Certification, Inc., or its successor organization.

Sec. 5. (NEW) (a) Except as provided in subsections (b) and (c) of this section, an applicant for a license to practice athletic training shall have: (1) A baccalaureate degree from a regionally accredited institution of higher education, or from an institution of higher learning located outside of the United States that is legally chartered to grant postsecondary degrees in the country in which such institution is located; (2) successfully completed (A) a course of study in athletic training in a program that, at the time of the applicant's completion, is accredited by the National Athletic Trainers' Association, the Committee on Allied Health Education and Accreditation, or the Commission on Accreditation of Allied Health Education Programs, or (B) a program of study in athletic training during a period of at least two calendar years, a minimum of one thousand five hundred hours of athletic training experience under the supervision of an athletic trainer certified by the National Athletic Trainers' Association Board of Certification, Inc., or its successor organization, of which a minimum of one thousand hours shall be attained at the interscholastic, intercollegiate or professional sports level, and a minimum of three semester credits of formal education in each of the following areas: (i) Health, (ii) nutrition, (iii) psychology, (iv) human anatomy, (v) kinesiology or biomechanics, (vi) human physiology, (vii) physiology of exercise, (viii) basic athletic training, and (ix) advanced athletic training or therapeutic modalities and rehabilitative exercise; and (3) passed the national certification examination sponsored by the National Athletic Trainers' Association or the National Athletic Trainers' Association Board of Certification, Inc., or their successor organizations.

(b) An applicant for licensure to practice athletic training by endorsement shall present evidence satisfactory to the commissioner (1) of licensure or certification as an athletic trainer, or as a person entitled to perform similar services under a different designation, in another state having requirements for practicing in such capacity that are substantially similar to or higher than the requirements in force in this state, and (2) that there is no disciplinary action or unresolved complaint pending against such applicant.

(c) Before January 1, 2001, an applicant for a license to practice athletic training may, in lieu of the requirements set forth in subsection (a) of this section, present evidence satisfactory to the commissioner of (1) the continuous providing of services as an athletic trainer since October 1, 1979, or (2) certification as an athletic trainer by the National Athletic Trainers' Association Board of Certification, Inc.

Sec. 6. (NEW) (a) The commissioner shall grant a license to practice athletic training to an applicant who presents evidence satisfactory to the commissioner of having met the requirements of section 5 of this act. An application for such license shall be made on a form required by the commissioner. The fee for an initial license under this section shall be one hundred fifty dollars.

(b) A license to practice athletic training may be renewed in accordance with the provisions of section 19a-88 of the general statutes, as amended by this act. The fee for such renewal shall be one hundred dollars.

Sec. 7. (NEW) The commissioner may adopt regulations, in accordance with chapter 54 of the general statutes, to carry out the provisions of sections 1 to 6, inclusive, of this act. The commissioner shall administer the provisions of sections 1 to 6, inclusive, of this act within available appropriations.

Sec. 8. Subsection (c) of section 19a-14 of the general statutes, as amended by section 2 of public act 99-249 and section 60 of public act 99-2 of the June special session, is repealed and the following is substituted in lieu thereof:

(c) No board shall exist for the following professions that are licensed or otherwise regulated by the Department of Public Health:

(1) Speech pathologist and audiologist;

(2) Hearing aid dealer;

(3) Nursing home administrator;

(4) Sanitarian;

(5) Subsurface sewage system installer or cleaner;

(6) Marital and family therapist;

(7) Nurse-midwife;

(8) Licensed clinical social worker;

(9) Respiratory care practitioner;

(10) Asbestos contractor and asbestos consultant;

(11) Massage therapist;

(12) Registered nurse's aide;

(13) Radiographer;

(14) Dental hygienist;

(15) Dietitian-Nutritionist;

(16) Asbestos abatement worker;

(17) Asbestos abatement site supervisor;

(18) Licensed or certified alcohol and drug counselor;

(19) Professional counselor;

(20) Acupuncturist;

(21) Occupational therapist;

(22) Lead abatement contractor; [and]

(23) Nail technician; and

(24) Athletic trainer.

The department shall assume all powers and duties normally vested with a board in administering regulatory jurisdiction over said professions. The uniform provisions of this chapter and chapters 368v, 369 to 381a, inclusive, 383 to 388, inclusive, 393a, 395, 398, 399, 400a and 400c, including, but not limited to, standards for entry and renewal; grounds for professional discipline; receiving and processing complaints; and disciplinary sanctions, shall apply, except as otherwise provided by law, to the professions listed in this subsection.

Sec. 9. Subsection (e) of section 19a-88 of the general statutes, as amended by section 61 of public act 99-2 of the June special session, is repealed and the following is substituted in lieu thereof:

(e) Each person holding a license or certificate issued under section 19a-514, 20-74s, as amended, 20-195cc or 20-206ll and chapters 370 to 373, inclusive, 375, 378 to 381a, inclusive, 383 to 388, inclusive, 393a, 395, 398, 399 or 400a and section 20-206n, 20-206o, [or] section 56 of [this act] public act 99-2 of the June special session, or section 6 of this act shall, annually, during the month of [the applicant's] such person's birth, apply for renewal of such license or certificate to the Department of Public Health, giving [the applicant's] such person's name in full, [the applicant's] such person's residence and business address and such other information as the department requests. Each person holding a license or certificate issued pursuant to section 20-475 or 20-476 shall, annually, during the month of [the applicant's] such person's birth, apply for renewal of such license or certificate to the department. Each entity holding a license issued pursuant to section 20-475 shall, annually, during the anniversary month of initial licensure, apply for renewal of such license or certificate to the department.

Sec. 10. Section 20-1 of the general statutes, as amended by section 1 of public act 99-102, is repealed and the following is substituted in lieu thereof:

The practice of the healing arts means the practice of medicine, chiropractic, podiatry, natureopathy and, except as used in chapters 384a and 388, [and sections 19a-16a to 19a-16c, inclusive, ] the practice of optometry.

Sec. 11. Subdivision (17) of subsection (b) of section 20-9 of the general statutes is repealed and the following is substituted in lieu thereof:

(17) Any person [performing] practicing athletic training, as [described in section 19a-16a] defined in section 1 of this act.

Sec. 12. Section 20-66 of the general statutes, as amended by section 6 of public act 99-249, is repealed and the following is substituted in lieu thereof:

As used in this chapter, unless the context otherwise requires:

(1) "Physical therapist" means a person licensed to practice physical therapy in [Connecticut as defined in subdivision (2) of this section] this state;

(2) "Physical therapy" means the evaluation and treatment of any person by the employment of the effective properties of physical measures, the performance of tests and measurements as an aid to evaluation of function and the use of therapeutic exercises and rehabilitative procedures, with or without assistive devices, for the purpose of preventing, correcting or alleviating a physical or mental disability. [Physical therapy] "Physical therapy" includes the establishment and modification of physical therapy programs, treatment planning, instruction, peer review and consultative services, [. The term "physical therapy"] but does not include the use of cauterization or the use of Roentgen rays or radium for diagnostic or therapeutic purposes; [and]

(3) "Physical therapist assistant" means [(A) a graduate of a physical therapist assistant program approved by the State Board of Examiners for Physical Therapists, with the consent of the Commissioner of Public Health, (B) a graduate of a United States physical therapy school approved by the State Board of Examiners for Physical Therapists, or (C) a person who has completed twenty years of employment as a physical therapist assistant prior to October 1, 1989] a person licensed to assist in the practice of physical therapy in this state under the supervision of a physical therapist. For purposes of this subdivision and subdivision (2) of subsection (a) of section 20-73, as amended by this act, "supervision" means the overseeing of or the participation in the work of a physical therapist assistant by a licensed physical therapist, including, but not limited to: (A) Continuous availability of direct communication between the physical therapist assistant and a licensed physical therapist; (B) availability of a licensed physical therapist on a regularly scheduled basis to (i) review the practice of the physical therapist assistant, and (ii) support the physical therapist assistant in the performance of the physical therapist assistant's services; and (C) a predetermined plan for emergency situations, including the designation of an alternate licensed physical therapist in the absence of the regular licensed physical therapist; and

(4) "Assist in the practice of physical therapy" means the treatment of any person by the employment of the effective properties of physical measures and the use of therapeutic exercises and rehabilitative procedures, with or without assistive devices, for the purpose of preventing, correcting or alleviating a physical or mental disability, but does not include the interpretation of referrals, initial or discharge evaluation or assessment, or determination or modification of treatment or discharge plans.

Sec. 13. Section 20-70 of the general statutes is repealed and the following is substituted in lieu thereof:

(a) (1) Any person who is a graduate of a school of physical therapy approved by the [State] Board of Examiners for Physical Therapists, with the consent of the Commissioner of Public Health, or has successfully completed requirements for graduation from such school, shall be eligible for examination for licensure as a physical therapist upon the payment of a fee of two hundred twenty-five dollars. [Said department] The Department of Public Health, with the consent of the board, shall determine the subject matter of such examination, which shall be designed to show proficiency in physical therapy and related subjects, and shall determine whether such examination shall be written, oral or practical, or a combination thereof. Passing scores shall be established by the department with the consent of the board. Warning of such examination shall be given by [said] the department not less than two weeks in advance of the date set for the examination. If the applicant passes such examination, the [Department of Public Health] department shall issue to such applicant a license to practice physical therapy.

(2) Any person who is a graduate of a physical therapy or physical therapy assistant program accredited by the Commission on Accreditation in Physical Therapy shall be eligible for examination for licensure as a physical therapist assistant upon the payment of a fee of one hundred fifty dollars. The department, with the consent of the board, shall determine the subject matter of such examination, which shall be designed to show proficiency in physical therapy and related subjects, and shall determine whether such examination shall be written, oral or practical, or a combination thereof. Passing scores shall be established by the department with the consent of the board. Warning of such examination shall be given by the department not less than two weeks in advance of the date set for the examination. If the applicant passes such examination, the department shall issue to such applicant a physical therapist assistant license. Any applicant for examination for licensure as a physical therapy assistant whose application is based on a diploma issued to such applicant by a foreign physical therapy school shall furnish documentary evidence, satisfactory to the department, that the requirements for graduation are similar to or higher than those required of graduates of approved United States schools of physical therapy.

(b) (1) Any person who is a graduate of an approved United States physical therapy school and who has filed an application with the department may, between the dates of filing and the publication of the results of the next succeeding examination, practice as a physical therapist under the direct and immediate supervision of a licensed physical therapist in this state. If the person practicing pursuant to this [section] subdivision fails to pass the examination, all privileges under this [section] subdivision shall automatically cease.

(2) Any person who is a graduate of an approved United States physical therapist assistant school or an approved physical therapy school and who has filed an application with the department may, between the dates of filing and the publication of the results of the next succeeding examination, practice as a physical therapist assistant under the direct and immediate supervision of a licensed physical therapist in this state. If the person practicing pursuant to this subdivision fails to pass the examination, all privileges under this subdivision shall automatically cease.

(c) Any applicant under this section who fails to pass the examination prescribed by [said] the department with the consent of the board may take a subsequent examination on payment of an additional application fee.

Sec. 14. Section 20-71 of the general statutes is repealed and the following is substituted in lieu thereof:

(a) The [department] Department of Public Health may issue a license to practice physical therapy without examination, on payment of a fee of two hundred twenty-five dollars, to an applicant who is a physical therapist registered or licensed under the laws of any other state or territory of the United States, any province of Canada or any other country, if the requirements for registration or licensure of physical therapists in such state, territory, province or country were, at the time of application, similar to or higher than the requirements in force in this state.

(b) The department may issue a physical therapist assistant license without examination, on payment of a fee of one hundred fifty dollars, to an applicant who: (1) Is a physical therapist assistant registered or licensed under the laws of any other state or territory of the United States, any province of Canada or any other country, if the requirements for registration or licensure of physical therapist assistants in such state, territory, province or country were, at the time of application, similar to or higher than the requirements in force in this state; (2) was eligible for registration as a physical therapist assistant before the effective date of this act; or (3) as of July 1, 2000, (A) is a graduate of an approved United States physical therapy school, approved by the Board of Examiners for Physical Therapists, with the consent of the Commissioner of Public Health, or (B) has completed twenty years of employment as a physical therapist assistant prior to October 1, 1989.

Sec. 15. Section 20-73 of the general statutes, as amended by section 24 of public act 99-102, is repealed and the following is substituted in lieu thereof:

(a) (1) No person may practice as a physical therapist unless licensed pursuant to this chapter. No person may use the term "Registered Physical Therapist", "Licensed Physical Therapist" or "Physical Therapist" or the letters "R.P.T.", "L.P.T." or any other letters, words or insignia indicating or implying licensure as a physical therapist in this state unless the person is so licensed.

(2) No person may practice as a physical therapist assistant unless such person is licensed pursuant to this chapter and is under the supervision of a physical therapist licensed pursuant to this chapter. No person may use the term "Registered Physical Therapist Assistant", "Licensed Physical Therapist Assistant" or "Physical Therapist Assistant", or the letters "P.T.A." to represent or imply the term "Physical Therapist Assistant", or any other letters, words or insignia indicating or implying licensure as a physical therapist assistant in this state unless the person is so licensed.

(b) The treatment of human ailments by physical therapy shall only be performed by a person licensed under the provisions of this chapter as a physical therapist or physical therapist assistant upon the oral or written referral of a person licensed in this state, or in a bordering state having licensing requirements meeting the approval of the appropriate examining board in this state, to practice medicine and surgery, podiatry, natureopathy, chiropractic or dentistry, or an advanced practice registered nurse licensed to prescribe in accordance with section 20-94a, as amended, or a physician assistant licensed to prescribe in accordance with section 20-12d, as amended.

(c) Any person who violates the provisions of this section or who obtains or attempts to obtain licensure as a physical therapist or physical therapist assistant by any wilful misrepresentation or any fraudulent representation shall be fined not more than five hundred dollars or imprisoned not more than five years, or both. A physical therapist, physical therapist assistant or dentist who violates the provisions of this section shall be subject to licensure revocation in the same manner as is provided under section 19a-17, or in the case of a healing arts practitioner, section 20-45. For purposes of this section each instance of patient contact or consultation in violation of any provision of this section shall constitute a separate offense. Failure to renew a license in a timely manner shall not constitute a violation for the purposes of this section.

[(b) Each physical therapy assistant who is assisting in the practice of physical therapy under the supervision of a licensed physical therapist, as defined in section 20-66, shall, upon payment of an application fee of twenty-five dollars, register with the Department of Public Health on a form furnished by the department, giving his name in full, his residence and business addresses and such other information as the department requests. Each physical therapy assistant shall notify the department in writing within thirty days of any change in his name or residence or business addresses. A physical therapy assistant shall not practice physical therapy assisting without registering with the department pursuant to this section. The commissioner may, upon receipt of notification and investigation, assess a civil penalty of not more than one hundred dollars against any physical therapy assistant who has practiced physical therapy assisting without first registering with said department.]

Sec. 16. Section 20-73a of the general statutes, as amended by section 25 of public act 99-102, is repealed and the following is substituted in lieu thereof:

The Board of Examiners for Physical Therapists shall have jurisdiction to hear all charges of conduct that fails to conform to the accepted standards of the practice of physical therapy brought against any person licensed as a physical therapist or physical therapist assistant and, after holding a hearing, written notice of which shall be given to the person complained of, [said] the board, if it finds such person to be guilty, may revoke or suspend such person's license or take any of the actions set forth in section 19a-17. Any proceedings relative to such action may be begun by the filing of written charges with the Commissioner of Public Health. The causes for which such action may be taken are as follows: (1) Conviction in a court of competent jurisdiction, either within or without this state, of any crime in the practice of [his] such person's profession; (2) illegal, incompetent or negligent conduct in the practice of physical therapy or in the supervision of a physical therapist assistant; (3) aiding or abetting the unlawful practice of physical therapy; (4) treating human ailments by physical therapy without the oral or written referral by a person licensed in this state or in a bordering state having licensing requirements meeting the approval of the appropriate examining board in this state to practice medicine and surgery, podiatry, natureopathy, chiropractic or dentistry; (5) failure to register with the Department of Public Health as required by law; (6) fraud or deception in obtaining a license; (7) engaging in fraud or material deception in the course of professional services or activities; or (8) violation of any provision of this chapter, or any regulation adopted [hereunder] under this chapter. The clerk of any court in this state in which a person practicing physical therapy has been convicted of any crime as described in this section shall, immediately after such conviction, transmit a certified copy, in duplicate, of the information and judgment, without charge, to the Department of Public Health, containing the name and address of the physical therapist or physical therapist assistant, the crime of which [he] the physical therapist or physical therapist assistant has been convicted and the date of conviction. The hearing on such charges shall be conducted in accordance with the regulations adopted by the Commissioner of Public Health in accordance with chapter 54. Any person aggrieved by a final decision of [said] the board may appeal therefrom as provided in section 4-183, as amended. Such appeal shall have precedence over nonprivileged cases in respect to order of trial. The Attorney General shall act as attorney in the public interest in defending against such an appeal. The board may petition the superior court for the judicial district of Hartford to enforce any action taken pursuant to section 19a-17.

Sec. 17. Section 20-74 of the general statutes, as amended by section 26 of public act 99-102, is repealed and the following is substituted in lieu thereof:

(a) No provision of this chapter shall confer any authority to practice medicine or surgery, nor shall this chapter prohibit the incidental care of the sick by domestic servants or by persons principally employed as housekeepers or as athletic trainers, nor prohibit any person from the domestic administration of family remedies or the furnishing of assistance in the case of emergency. It shall not prohibit persons registered under the provisions of chapter 372, 373, 375 or 378 from administering care to patients, nor shall it prohibit the care of the sick with or without compensation or personal profit in connection with the practice of the religious tenets of any church by adherents thereof, provided such persons shall not otherwise engage in the practice of physical therapy or assist in the practice of physical therapy within the meaning of this chapter. It shall not prohibit students who are enrolled in schools or courses of physical therapy or physical therapist assistant programs approved by the Board of Examiners for Physical Therapists with the consent of the Commissioner of Public Health from performing such work as is incidental to their respective courses of study; nor shall it prohibit any physical therapist from another state from doing such therapist's work or other physical therapy activities as is incidental to the person's course of study when taking or giving a postgraduate course or other courses of study in this state approved by said board. [It shall not prohibit any person who is a physical therapist assistant from assisting in the practice of physical therapy under the supervision of a licensed physical therapist provided such assistance is limited to the treatment of a person by the employment of the effective properties of physical measures and the use of therapeutic exercises and rehabilitative procedures, with or without assistive devices, for the purpose of preventing, correcting or alleviating a physical or mental disability, and does not include the interpretation of referrals, initial or discharge evaluation or assessment, or determination or modification of treatment or discharge plans.] Any physical therapist who is a graduate from a school approved by [said] the board [of examiners] with the consent of the Department of Public Health but not licensed in this state may, with the approval of [said] the department and upon obtaining a temporary certificate from [said] the department, practice physical therapy in this state on a temporary basis for a period of six months, which period may be extended upon request at the discretion of the department, provided (1) such physical therapist does not claim to be licensed to practice in this state, and (2) application for licensure by examination, reciprocity or endorsement is filed with [said] the department within six months after starting such practice. Persons in the service of the federal government are excluded from the provisions of this chapter. [For the purposes of this section, supervision means the overseeing of or the participation in the work of a physical therapist assistant by a licensed physical therapist including but not limited to (1) continuous availability of direct communication between the physical therapist assistant and a licensed physical therapist; (2) availability of a licensed physical therapist on a regularly scheduled basis to (A) review the practice of the physical therapist assistant, and (B) support the physical therapist assistant in the performance of his services; and (3) a predetermined plan for emergency situations, including the designation of an alternate licensed physical therapist in the absence of the regular licensed physical therapist.]

(b) The Commissioner of Public Health shall administer the provisions of this chapter with respect to the licensing of physical therapist assistants within available appropriations.

Sec. 18. Subdivision (5) of subsection (c) of section 19a-88 of the general statutes, as amended by section 4 of public act 99-249, is repealed and the following is substituted in lieu thereof:

(5) (A) Each person holding a license to practice physical therapy shall, annually, during the month of such person's birth, register with the Department of Public Health, upon payment of the professional services fee for class B, as defined in section 33-182l, on blanks to be furnished by the department for such purpose, giving such person's name in full, [with] such person's residence and business address and such other information as the department requests.

(B) Each person holding a physical therapist assistant license shall, annually, during the month of such person's birth, register with the Department of Public Health, upon payment of the professional services fee for class A, as defined in section 33-182l, on blanks to be furnished by the department for such purpose, giving such person's name in full, such person's residence and business address and such other information as the department requests.

Sec. 19. Sections 19a-16a to 19a-16c, inclusive, of the general statutes are repealed.

Sec. 20. This act shall take effect the later of October 1, 2000, or on the date notice is published by the Commissioner of Public Health in the Connecticut Law Journal indicating that the licensing of athletic trainers and physical therapist assistants is being implemented by the Commissioner.

The following fiscal impact statement and bill analysis are prepared for the benefit of members of the General Assembly, solely for the purpose of information, summarization, and explanation, and do not represent the intent of the General Assembly or either House thereof for any purpose:

OFA Fiscal Note

Explanation

State Impact:

Passage of this bill will result in an uncertain fiscal impact to the Department of Public Health (DPH) . The bill spells out the parameters of licensure programs for athletic trainers and physical therapist assistants. However, it appears (from the bill’s effective date) that implementation would be contingent upon a decision of the Commissioner of Public Health to develop the licensure programs without statutory authorization. This makes it uncertain at what point in time, if any, the licensure programs will be established.

If the Commissioner elects to publish notice of his intent to implement the programs, the first year cost to the DPH will be approximately $131, 000, as the agency will require 1 Office Assistant, 1 Investigator and 1 Licensing Examination Assistant and associated other expenses and equipment to begin licensure of a projected 400 applicants seeking licensure as athletic trainers and 450 applicants seeking licensure as physical therapist assistants. Ongoing annual costs will be approximately $123, 200, as one-time equipment costs will not recur.

A projected first year revenue gain of $140, 060 would also result. This would include $69, 200 from athletic trainers, based upon collection of a $150 initial license fee and a $100 license renewal fee. A total of $70, 860 would be collected from physical therapist assistants, based upon a $150 application fee and a $30 license renewal fee. Since applicants for license renewal must submit their applications during the month of their birthday, a portion of those seeking licensure will pay both an initial license fee and a renewal fee in the first year of the programs.

In subsequent fiscal years, an estimated $40, 000 would be collected from athletic trainers renewing their licenses, while an estimated $13, 500 would be collected from physical therapist assistants renewing their licenses. An indeterminate number of new applicants in future years would pay the $150 initial license fees.

It should be noted that no funding has been included in either the Senate or House versions of the FY 01 Revised Appropriations Act for the purpose of supporting licensure of athletic trainers or physical therapist assistants.

House “A” changes the effective date of the bill from:

(a) October 1, 2000, to

(b) the later of October 1, 2000 or the date notice is published in the Connecticut Law Journal by the Commissioner of Public Health indicating the licensure programs are being implemented.

This appears to make the choice of whether to implement the licensure programs subject to the discretion of the Commissioner, and makes the fiscal impact of the bill uncertain, as it is unclear when or if the licensure programs will be initiated. To the extent that this delays their implementation, a corresponding savings and revenue loss will result for the DPH, as it will postpone hiring needed staff and licensure fees will not be collected. The magnitude of any savings and revenue loss cannot be determined at this time, as it would depend upon the date of program implementation.

The amendment also requires annual license renewal for physical therapist assistants. This results in a first year revenue gain of approximately $3, 360, and an ongoing annual revenue gain of approximately $13, 500, if the licensure program is implemented.

Other changes in the amendment are technical in nature and have no associated fiscal impact.

OLR Amended Bill Analysis

sHB 5794 (as amended by House A) *

AN ACT CONCERNING ATHLETIC TRAINERS AND PHYSICAL THERAPIST ASSISTANTS.

SUMMARY:

This bill requires the Department of Public Health (DPH) to license athletic trainers and physical therapy assistants (PTAs) . Currently, athletic trainers certified by the National Athletic Trainer Association, Inc. (NATA) can practice in Connecticut, while physical therapy assistants must register with the department.

Under the bill, licensed athletic trainers can work only with people who belong to sports teams or who participate in sports or recreation activities at least three times a week and then only to treat injuries they sustain in those activities. Current law allows them to treat anyone with an athletic injury. The bill establishes two classes of trainers, those who practice under a physician’s standing orders and those who do not. The latter can perform initial evaluations and provide temporary help but must otherwise immediately refer an injured athlete to a physician. The former can treat injured athletes for up to four days and then, if the symptoms do not improve, must refer them to a health care provider.

The bill establishes educational requirements for each license, allows certain people to be licensed without examination, and permits others to practice without a license. It sets the fee for an initial athletic trainer license at $150 and renewals at $100. A physical therapy assistant (PTA) must pay $150 to take the licensing exam or to obtain a license without an exam and must pay a $30 annual professional services fee. The bill subjects both licenses to the same disciplinary actions that can be imposed on other licensed health care providers.

*House Amendment “A” establishes two classes of athletic trainers, eliminates provisions governing trainers’ treatment of children under age 14, reinstates current law’s requirement that PTAs work under a physical therapist’s supervision, requires them to pay a $30 annual fee, requires DPH to implement PTA licensing within available appropriations, makes changes related to PTA schools’ accreditation requirements and provides for graduates of foreign physical therapy schools, and adds the alternative effective date.

EFFECTIVE DATE: October 1, 2000 or when the public health commissioner publishes notice in the Connecticut Law Journal that he is implementing the bill’s licensing provisions, whichever is later.

ATHLETIC TRAINERS

Scope of Practice

The bill limits athletic trainers to working only with athletes who suffer injuries while exercising or participating in sports or recreational activities, unless a licensed health care provider has referred a person and the trainer works within the scope of the referral. It defines an “athlete” as someone who participates at least three times a week in sports or recreational activities, including training and practice, or is a member of a sports team. Current law permits trainers to evaluate and treat athletic injuries and apply methods and procedures for athletes’ preconditioning, conditioning, and reconditioning, but it does not define either “athletic injury” or “athlete”.

The bill requires an athletic trainer practicing under standing orders from a licensed physician, podiatrist, naturopath, or chiropractor to make a written or oral referral to such a provider if an athlete’s symptoms do not improve within four days. As under current law, trainers must also refer when (1) athletic training methods are contraindicated for an athlete’s physical or medical condition or (2) his condition requires evaluation and treatment beyond the scope of athletic training. The bill also requires referrals for suspected medical emergencies or illnesses, physical or mental illness, and significant tissue or neurological pathologies. But athletic trainers who are not practicing under a licensed provider’s standing orders may only perform initial evaluations or temporarily splint or brace an injured athlete. Otherwise, they must refer injured athletes to a provider without delay.

The bill defines “standing orders” as a health care provider’s written and signed protocols, recommendations, and guidelines for treatment and care in athletic training practices. They may include appropriate treatments for specific athletic injuries, injuries and conditions that require immediate referral, and appropriate conditions for immediate referral by various age groups.

It permits trainers to work under the direction and with the consent of a physician, physician assistant, chiropractor, podiatrist, or naturopath. Under current law, they work upon referral from, or under the general direction of, these practitioners and osteopaths.

The bill adds organizing and administering athletic training programs to trainers’ scope of practice. As under current law, trainers can evaluate and treat athletic injuries; apply appropriate preventive and supportive devices; and educate athletes, parents, coaches, and medical personnel about preventing and caring for athletic injuries. The bill requires them to conduct their educational work and to organize athletic training programs under the direction of one of the licensed providers noted above.

License Requirements

The bill prohibits anyone from using the title “licensed athletic trainer” or implying that he is licensed to practice without a license from DPH. It sets the initial license fee at $150 and requires annual renewal costing $100. Currently, trainers certified by the National Athletic Trainers’ Association, Inc. (NATA) and those without certification who had practiced for at least 15 years before October 1975 can perform athletic training.

To obtain a license under the bill, an applicant must have:

1. a BA from a regionally accredited U.S. college or university or a legally chartered foreign college or university;

2. successfully completed a course of study that was, when completed, accredited by NATA, the Committee on Allied Health Education Programs, or the Commission on Accreditation of Allied Health Education Programs or;

3. instead of the above course of study, successfully completed a minimum two-year, 1, 500 hour training program under the supervision of an NATA-certified trainer that included at least 1, 000 hours working in scholastic, college, or professional sports and at least three semester credits of formal education in each of nine specified areas; and

4. passed a national certification exam sponsored by NATA or the National Athletic Trainers’ Association Board of Certification, Inc.

Applicants practicing in other states can obtain a license without meeting the above requirements if they show DPH that the state in which they are licensed, certified, or otherwise entitled to practice has requirements at least equivalent to Connecticut’s and they are not facing disciplinary action or unresolved complaints there. And people practicing here can obtain a license without meeting the bill’s requirements if, before January 1, 2001, they show DPH that they are certified by the NATA Board of Certification, Inc. or that they have practiced continually since October 1, 1979.

License Exemptions

An athletic training license is not needed by:

1. a state-licensed or –certified practitioner performing within his practice scope,

2. a student intern or trainee in an athletic training program who is identified as such and being supervised by a licensed trainer,

3. a paid or volunteer amateur athletics coach providing first aid to one of his athletes,

4. a person helping in an emergency, and

5. a trainer licensed in another state or certified by NATA who works in Connecticut for less than 30 days a year.

Under current law, students enrolled in an accredited college’s athletic training program and interns working toward NATA certification under a certified trainer’s supervision can perform without a certificate.

Disciplinary Actions

The bill subjects licensed athletic trainers to the same disciplinary actions DPH can currently take against a certified trainer or other licensed health professionals. These include:

1. suspending or revoking a license,

2. issuing a letter of reprimand to or censuring a person,

3. placing a practitioner on probation,

4. assessing a civil penalty of up to $10, 000, or

5. taking summary action against a license if the practitioner is found guilty of a state or federal felony or subject to disciplinary action in another jurisdiction.

Regulations

The bill allows DPH to adopt regulations governing athletic trainer licensing and scope of practice.

PHYSICAL THERAPY ASSISTANTS

Physical Therapy Assistance Scope of Practice

The bill requires PTAs, like physical therapists, to work on referral from a physician, physician assistant, podiatrist, naturopath, chiropractor, dentist, or advanced practice registered nurse licensed in Connecticut or a bordering state whose licensing requirements meet Connecticut licensing board approval. As under current law, they must work under the supervision of a licensed physical therapist. The bill retains the current definition of physical therapy assistance. This specifically excludes interpreting referrals, evaluating or assessing a patient initially or when discharged, or determining or modifying a discharge plan.

License Requirements

Under current law, PTAs must register with DPH and pay a $25 fee before they can practice. Registrants must have (1) graduated from a PTA program approved, with the commissioner’s consent, by the state Physical Therapy Examiners Board; (2) graduated from a U.S. therapy assistant school approved by the board; or (3) been employed as a physical therapy assistant for 20 years before October 1, 1989.

The bill prohibits people from practicing or calling themselves a registered, licensed, or other PTA (or using initials to that effect) without a DPH license. It requires DPH to administer this licensing program within its available appropriations. To obtain a license, a person must:

1. have graduated from a physical therapy or physical therapy assistant program accredited by the Commission on Accreditation in Physical Therapy or

2. have graduated from a foreign physical therapy school that has graduation requirements at least equal to those required for graduates of U.S. physical therapy schools as shown by satisfactory documentary evidence the candidate furnishes to DPH, and

3. passes a DPH test.

DPH develops the test and sets the passing score with the consent of the physical therapy examining board and determines how it will be administered. It must give candidates at least two weeks notice before the test. Test applicants must pay $150. DPH must issue a license to anyone who passes the test and meets the education requirements. Licensed PTAs must pay the state treasurer an annual $30 professional services fee and, annually during their birth month, register with DPH. They must provide their full name, residence and business address, and any other information the department requests.

As under current law, a PTA student in an approved school can work as required by their programs without a license. And licensing test applicants who have graduated from an approved U.S. PTA school or an approved physical therapy school can work under the direct and immediate supervision of a licensed physical therapist between the times they apply and when the test results are published. If they fail the test, they lose this privilege, but they can apply and pay to take the test again.

Licensing Without an Examination

The bill permits a person to obtain a license without an exam if he:

1. is licensed or registered as a PTA in another state or country whose requirements are at least equal to Connecticut’s when he applies here;

2. was eligible to be registered as a PTA before October 1, 2000; or

3. as of July 1, 2000, had graduated from a board-approved U.S. physical therapy school or had worked as a PTA for 20 years before October 1, 1989.

An applicant for a license without an exam must pay a $150 fee.

Disciplinary Actions

The bill subjects anyone who uses willful or fraudulent misrepresentation to obtain a PTA license, who works without a license, or who works without a referral to a fine of up to $500, five years in prison, or both. In the latter two situations, each instance of patient contact is a separate violation. DPH can revoke a PTA’s license for violations. Under current law, DPH can impose a civil penalty of up to $100 on a person who performs PTA activities without registering.

The bill gives the Physical Therapy Examiner’s Board authority to suspend or revoke a PTA’s license, after notice and a hearing, for:

1. conviction in any court of a crime involving his practice;

2. aiding or abetting the unlawful practice of physical therapy;

3. illegal, incompetent, or negligent practice;

4. treating people by physical therapy without a proper referral;

5. fraud or deception in obtaining a license;

6. fraud or material deception in providing professional services or activities; or

7. violating any provisions of physical therapy law or regulation.

BACKGROUND

Legislative History

The House referred this bill (file 374) to the Appropriations Committee on April 7, the Judiciary Committee on April 12, the Finance, Revenue and Bonding Committee on April 18, and the Education Committee on April 26. Each reported the bill favorably without change.

COMMITTEE ACTION

Public Health Committee

Joint Favorable Substitute Report

Appropriations Committee

Joint Favorable Report

Judiciary Committee

Joint Favorable Report

Finance, Revenue and Bonding Committee

Joint Favorable Report

Education Committee

Joint Favorable Report