OLR Bill Analysis
AN ACT CONCERNING PATIENT ACCESS TO PHYSICAL THERAPY.
This bill allows physical therapists meeting certain standards to treat patients directly, without referral from another health care practitioner. But under three conditions it requires a referral. The bill specifies procedures a physical therapist must follow in treating patients directly. It specifies that “physical therapy” does not include surgery; prescribing drugs; or diagnosing disease, injury, or illness.
The bill (1) specifies acceptable continuing education activities; (2) authorizes the Board of Examiners for Physical Therapists to take disciplinary action, including license suspension or revocation, against a physical therapist who fails to comply with continuing education requirements; and (3) modifies the process for seeking a waiver from continuing education requirements.
EFFECTIVE DATE: October 1, 2006 for sections 1, 3, 5, and 7; the later of October 1, 2000 or the date notice is published by the DPH commissioner in the Connecticut Law Journal that the licensing of athletic trainers and physical therapist assistants is being implemented for sections 2, 4, and 6.
DIRECT ACCESS TO PHYSICAL THERAPISTS
Under current law, physical therapists can only treat patients referred to them by a physician, podiatrist, natureopath, chiropractor, dentist, advanced practice registered nurse, or physician assistant, except in the case of wellness care. However, they can provide wellness care to anyone without symptoms of illness or injury, with or without referral from one of these health care providers. “Wellness care” means services related to conditioning and fitness, strength training, workplace ergonomics, or injury prevention.
This bill allows a licensed physical therapist to treat human ailments without an oral or written referral if he:
1. has practiced physical therapy for at least three out of the most recent six years of his clinical practice or earned a master's or higher degree in physical therapy from an accredited institution of higher education;
2. requires the patient to disclose or confirm the name of his primary care provider or provider of record the first time he treats him without referral;
3. provides information to anyone seeking treatment about the need to consult with his primary care provider or provider of record regarding the person's underlying condition if it is prolonged, does not improve within 30 days, or still requires continuous treatment; and
4. refers the patient to one of the licensed practitioners listed above if, after examination or reexamination, the condition for which the patient sought physical therapy does not show objective, measurable, functional improvement in any 30-day consecutive period or at the end of six visits, whichever occurs sooner.
REFERRALS REQUIRED FOR PHYSICAL THERAPY
The bill establishes three conditions under which an oral or written referral is required before a person can receive physical therapy. The physical therapist:
1. does not meet the above standards for direct access,
2. is required to perform a Grade V spinal manipulation but does not hold a PhD in physical therapy from an accredited university or have proof that he has (a) completed 25 hours of course work in Grade V spinal manipulation that meets the Physical Therapy Board of Examiners' minimum standards and (b) three years experience in such treatment, and
3. knows the condition for which the patient is seeking treatment is connected to a job-related injury.
A physical therapist does not violate the requirement for a referral to treat work-related injuries if he asks the patient about the source and nature of his condition and the patient does not disclose that it “arose out of and in the course of the patient's employment. ” This term encompasses an accidental injury or occupational disease that started while the patient was working at the employer's work site or elsewhere at the employer's direction. For a police officer, firefighter, and certain Department of Correction employees, it includes travel to and from home and work.
As under current law, the referral must come from one of the practitioners listed above. Under the bill, the person may be licensed in Connecticut or any state whose licensing requirements meet Department of Public Health (DPH) standards and those of the appropriate examining board in this state. Current law recognizes referrals from in-state practitioners and out-of-state practitioners from bordering states whose licensure requirements are approved by a Connecticut examining board.
The law requires licensed physical therapists to complete 20 hours of continuing education during each 12-month registration period in order to renew their licenses. The bill specifies that courses offered or approved by the Connecticut Physical Therapy Association are considered qualifying continuing education activities.
Physical therapists completing continuing education activities must get a completion certificate from the provider of the activity. Currently, a physical therapist must submit the certificate to the DPH upon request. The bill requires submission within 45 days after DPH requests it.
By law, DPH can grant a waiver or time extension for completing continuing education requirements in the case of medical disability or illness. The bill requires the licensee to submit a waiver or extension application to DPH, certification by a licensed physician of the disability or illness, and any other documentation DPH may require. It allows DPH to grant the waiver or time extension for up to one registration period, rather than for any time period. DPH can grant additional waivers or extensions if the disability or illness continues beyond the waiver or extension period and the licensee applies to DPH for that additional period.
Public Health Committee