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Senate Engrossed
physical therapy assistants; students; supervision |
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State of Arizona Senate Fifty-sixth Legislature Second Regular Session 2024
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SENATE BILL 1267 |
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An Act
amending sections 32-2001, 32-2002, 32-2003, 32-2022, 32-2023, 32-2024, 32-2026, 32-2027, 32-2028, 32-2029, 32-2030, 32-2031, 32-2032, 32-2042, 32-2043, 32-2044, 32-2046, 32-2047, 32-2050, 32-2051 and 36-2907, Arizona Revised Statutes; relating to the board of physical therapy.
(TEXT OF BILL BEGINS ON NEXT PAGE)
Be it enacted by the Legislature of the State of Arizona:
Section 1. Section 32-2001, Arizona Revised Statutes, is amended to read:
32-2001. Definitions
In this chapter, unless the context otherwise requires:
1. "Assistive personnel":
(a) Includes:
(i) Physical therapist assistants.
(ii) Physical therapy aides.
(iii) Other assistive personnel who are trained or educated health care providers and who are not physical therapist assistants or physical therapy aides but who perform specific designated tasks related to physical therapy under the supervision of a physical therapist. At the discretion of the supervising physical therapist, and if properly credentialed and not prohibited by any other law, other assistive personnel may be identified by the title specific to their training or education.
(b) Does not include either:
(i) Personnel assisting other health care professionals licensed pursuant to this title in performing delegable treatment responsibilities within their scope of practice.
(ii) Student physical therapists and student physical therapist assistants.
2. "Board" means the board of physical therapy.
3. "Business entity" means a business organization that has an ownership that includes any persons who are not licensed or certified to provide physical therapy services in this state, that offers to the public professional services regulated by the board and that is established pursuant to the laws of any state or foreign country.
4. "Dry needling" means a skilled intervention performed by a physical therapist that uses a thin filiform needle to penetrate the skin and stimulate underlying neural, muscular and connective tissues to evaluate and manage neuromusculoskeletal conditions, pain and movement impairments.
5. "General supervision" means that the supervising physical therapist is on call and is readily available via telecommunications when the physical therapist assistant is providing treatment interventions.
6. "Interim permit" means a permit issued by the board that allows a person to practice as a physical therapist in this state or to work as a physical therapist assistant for a specific period of time and under conditions prescribed by the board before that person is issued a license or certificate.
7. "Manual therapy techniques" means a broad group of passive interventions in which physical therapists use their hands to administer skilled movements designed to modulate pain, increase joint range of motion, reduce or eliminate soft tissue swelling, inflammation or restriction, induce relaxation, improve contractile and noncontractile tissue extensibility, and improve pulmonary function. These interventions involve a variety of techniques, such as the application of graded forces.
8. "On-site supervision":
(a) Means that the supervising physical therapist is on site and is present in the facility or on the campus where assistive personnel, or a holder of an interim permit, a student physical therapist or a student physical therapist assistant is performing services, is immediately available to assist the person being supervised in the services being performed and maintains continued involvement in appropriate aspects of each treatment session in which a component of treatment is delegated.
(b) Includes supervision provided through telehealth as defined in section 36-3601.
9. "Physical therapist" means a person who is licensed pursuant to this chapter.
10. "Physical therapist assistant" means a person who meets the requirements of this chapter for certification licensure and who performs physical therapy procedures and related tasks that have been selected and delegated by according to the physical therapy plan of care under the on-site supervision of the supervising physical therapist.
11. "Physical therapy" means the care and services provided by or under the direction and supervision of a physical therapist who is licensed pursuant to this chapter.
12. "Physical therapy aide" means a person who is trained under the direction of a physical therapist and who performs designated and supervised routine physical therapy tasks.
13. "Practice of physical therapy" means:
(a) Examining, evaluating and testing persons who have mechanical, physiological and developmental impairments, functional limitations and disabilities or other health and movement related conditions in order to determine a diagnosis, a prognosis and a plan of therapeutic intervention and to assess the ongoing effects of intervention, including ordering musculoskeletal imaging consisting of plain film radiographs. imaging and ordering laboratory tests within the scope of practice and with appropriate training and education approved by the board, or to form the basis for referring patients to other health care professionals.
(b) Alleviating impairments and functional limitations by managing, designing, implementing and modifying therapeutic interventions including:
(i) Therapeutic exercise.
(ii) Functional training in self-care and in home, community or work reintegration.
(iii) Manual therapy techniques.
(iv) Therapeutic massage.
(v) Assistive and adaptive orthotic, prosthetic, protective and supportive devices and equipment.
(vi) Pulmonary hygiene.
(vii) Debridement and wound care.
(viii) Physical agents or modalities.
(ix) Mechanical and electrotherapeutic modalities.
(x) Patient related instruction.
(c) Reducing the risk of injury, impairments, functional limitations and disability by means that include promoting and maintaining a person's fitness, health and quality of life.
(d) Engaging in administration, consultation, education and research.
14. "Restricted certificate" means a certificate on which the board places any restrictions as the result of a disciplinary action.
15. 14. "Restricted license" means a license on which the board places restrictions or conditions, or both, as to the scope of practice, place of practice, supervision of practice, duration of licensed status or type or condition of a patient to whom the licensee may provide services.
16. 15. "Restricted registration" means a registration on which the board places any restrictions as the result of disciplinary action.
16. "Student physical therapist" means a person who is enrolled in a doctor of physical therapy program that is accredited by or has candidate status by the commission on accreditation in physical therapy EDUCATION.
17. "Student physical therapist assistant" MEANS a person who is enrolled in an academic physical therapist assistant program that is accredited by or has candidate status by the commission on accreditation in physical therapy education.
Sec. 2. Section 32-2002, Arizona Revised Statutes, is amended to read:
32-2002. Board of physical therapy; membership; appointment; qualifications; terms; removal; reimbursement; immunity
A. The board of physical therapy is established consisting of members appointed by the governor pursuant to section 38-211. Four members shall be physical therapists who are residents of this state, possess an unrestricted license to practice physical therapy in this state and have been practicing in this state for at least five years before their appointment. One member shall be a physical therapist assistant who is a resident of this state, possesses an unrestricted certificate license issued pursuant to this chapter and has been performing selected interventions in this state for at least five years before the person's appointment. The governor shall also appoint two public members who are residents of this state and who are not affiliated with, and do not have a financial interest in, any health care profession but who have an interest in consumer rights.
B. Board members serve staggered four year four-year terms. Board members shall not serve for more than two successive four year four-year terms or for more than ten consecutive years. By approval of a majority of the board, a member's service may extend at the completion of a four year four-year term until a new member is appointed or the current member is reappointed.
C. If requested by the board the governor may remove a board member for misconduct, incompetence or neglect of duty.
D. Board members are eligible for reimbursement of expenses pursuant to title 38, chapter 4, article 2 to cover necessary expenses for attending each board meeting or for representing the board in an official board approved activity.
E. A board member who acts within the scope of board duties, without malice and in the reasonable belief that the person's action is warranted by law is immune from civil liability.
Sec. 3. Section 32-2003, Arizona Revised Statutes, is amended to read:
32-2003. Board; powers and duties
A. The board shall:
1. Evaluate the qualifications of applicants for licensure and certification.
2. Provide for national examinations for physical therapists and physical therapist assistants and adopt passing scores for these examinations.
3. Issue licenses, and permits and certificates to persons who meet the requirements of this chapter.
4. Regulate the practice of physical therapy by interpreting and enforcing this chapter.
5. Adopt and revise rules to enforce this chapter.
6. Meet at least once each quarter in compliance with the open meeting requirements of title 38, chapter 3, article 3.1 and keep an official record of these meetings.
7. Establish the mechanisms for assessing continuing professional competence of physical therapists to engage in the practice of physical therapy and the competence of physical therapist assistants to work in the field of physical therapy.
8. At its first regular meeting after the start of each calendar year, elect officers from among its members and as necessary to accomplish board business.
9. Provide for the timely orientation and training of new professional and public appointees to the board regarding board licensing and disciplinary procedures, this chapter, board rules and board procedures.
10. Maintain a current list of all persons regulated under this chapter. This list shall include the person's name, current business and residential addresses, telephone numbers and license or certificate number.
11. Subject to title 41, chapter 4, article 4, employ necessary personnel to carry out the administrative work of the board. Board personnel are eligible to receive compensation pursuant to section 38-611.
12. Enter into contracts for services necessary for adequate enforcement of this chapter.
13. Report final disciplinary action taken against a licensee or a certificate holder to a national disciplinary database recognized by the board.
14. Publish, at least annually, final disciplinary actions taken against a licensee or a certificate holder.
15. Publish, at least annually, board rulings, opinions and interpretations of statutes or rules in order to guide persons who are regulated pursuant to this chapter.
16. Not later than December 31 of each year, submit a written report of its actions and proceedings to the governor.
17. Establish and collect fees.
18. Provide information to the public regarding the board, its processes and consumer rights.
B. The board may establish a committee or committees to assist it in carrying out its duties for a time prescribed by the board. The board may require a committee appointed pursuant to this subsection to make regular reports to the board.
Sec. 4. Section 32-2022, Arizona Revised Statutes, is amended to read:
32-2022. Qualifications for licensure; fingerprint clearance card
A. An applicant for a license as a physical therapist who has been educated in the United States shall:
1. Complete the application process.
2. Be a graduate of a professional physical therapy education program that is accredited by a national accreditation agency approved by the board.
3. Have successfully passed the national examination approved by the board.
4. Have successfully passed a jurisprudence examination that tests the applicant's knowledge of board statutes and rules.
5. Obtain a valid fingerprint clearance card issued pursuant to section 41-1758.03.
B. An applicant for a license as a physical therapist who has been educated outside of the United States shall:
1. Complete the application process.
2. Provide satisfactory evidence that the applicant's education is substantially equivalent to the requirements of physical therapists educated in accredited educational programs as determined by the board. If the board determines that a foreign-educated applicant's education is not substantially equivalent, it may require the person to complete additional coursework before it proceeds with the application process. It is not necessary that coursework completed by the applicant be identical in all respects to that required by an education program in the United States for an entry-level physical therapy degree, but all required content areas must be evident as required by board rules. Deficiencies may occur only in coursework and not in essential areas of professional education and shall not be of a magnitude that would cause the education to be deemed below entry-level preparation for practice in this state.
3. Provide written proof of legal authorization to practice as a physical therapist without limitation in the country where the professional education occurred. The board may waive this requirement on receipt of written proof that the applicant cannot demonstrate legal authorization based on the citizenship requirements of the country where the professional education occurred.
4. Provide proof of legal authorization to reside and seek employment in the United States or its territories.
5. Have passed the board-approved English proficiency examinations if the applicant's native language is not English.
6. Have participated in an interim supervised clinical practice period before licensure as approved by the board or shall have already met this requirement to the board's satisfaction by virtue of the applicant's clinical practice in another jurisdiction of the United States.
7. Have successfully passed the national examination approved by the board.
8. Have successfully passed a jurisprudence examination that tests the applicant's knowledge of board statutes and rules.
9. Obtain a valid fingerprint clearance card issued pursuant to section 41-1758.03.
C. Notwithstanding the requirements of subsection B of this section, if the foreign-educated physical therapist applicant is a graduate of an accredited educational program as determined by the board, the board may waive the requirements of subsection B, paragraphs 2 and 6 of this section.
D. An applicant for certification licensure as a physical therapist assistant shall meet the following requirements:
1. Complete the application process.
2. Be a graduate of a physical therapist assistant education program accredited by an agency approved by the board.
3. Have successfully passed the national examination approved by the board.
4. Have successfully passed a jurisprudence examination that tests the applicant's knowledge of board statutes and rules.
5. Obtain a valid fingerprint clearance card issued pursuant to section 41-1758.03.
E. For the purposes of subsection B, paragraph 2 of this section, "substantially equivalent" means that the applicant provides documentation satisfactory to the board that:
1. The applicant graduated from a physical therapist education program that prepares the applicant to engage without restriction in the practice of physical therapy.
2. The applicant's school of physical therapy education is recognized by its own ministry of education. The board may waive this requirement for good cause shown.
3. The applicant has undergone a credentials evaluation as directed by the board that determines that the applicant has met uniform criteria for educational requirements pursuant to board rules.
4. The applicant has completed any additional education required by the board.
Sec. 5. Section 32-2023, Arizona Revised Statutes, is amended to read:
32-2023. Application; denial; hearing
A. An applicant for licensure or certification shall file a completed application as required by the board. The applicant shall include the application fee prescribed in section 32-2029.
B. The board may deny a license or certificate to an applicant, or a licensee or a certificate holder for any of the following:
1. Knowingly making a false statement of fact required to be revealed in the initial application, renewal application or reinstatement application for a license or certificate.
2. Committing fraud in the procurement of a license or certificate.
3. Committing a felony, whether or not involving moral turpitude, or a misdemeanor involving moral turpitude. In either case conviction by a court of competent jurisdiction is conclusive evidence of the commission.
4. Attempting to engage in conduct that subverts or undermines the integrity of the examination or the examination process, including using in any manner recalled or memorized examination questions from or with a person or entity, failing to comply with all test center security procedures, communicating or attempting to communicate with other examinees during the examination or copying or sharing examination questions or portions or of questions.
5. Engaging in any conduct that would be considered a violation of section 32-2044.
C. If the board denies an application because of deficiencies or reasons in an application or for a reason prescribed in subsection B of this section, the board must inform an applicant of those specific deficiencies. On receipt of a written request by an applicant who disagrees with the board's decision to deny an application, the board shall hold a hearing pursuant to title 41, chapter 6, article 10.
Sec. 6. Section 32-2024, Arizona Revised Statutes, is amended to read:
32-2024. Examinations
A. The board shall prescribe examinations for licensure and certification and determine the passing score.
B. An applicant may take the examinations for licensure if either of the following applies:
1. The applicant has met all of the requirements of section 32-2022, subsection A, paragraphs 1 and 2 and has paid the fees prescribed by this chapter.
2. The applicant has:
(a) Met all of the requirements of section 32-2022, subsection A, paragraph 1.
(b) Paid the fees prescribed by this chapter.
(c) Submitted with the application a letter on the official letterhead of the accredited educational institution where the applicant is completing an accredited educational program that includes the signature of the program director, the department chairperson or a similarly authorized person of the university or college and that states that:
(i) The applicant is a candidate for a degree as a physical therapist at the next scheduled graduation date.
(ii) The date the national examination for licensure is to be taken by the applicant is the one nearest to and before the applicant's expected graduation date and is not more than one hundred twenty days before the date of the applicant's expected graduation date.
(iii) The applicant meets any other established requirements of the accredited educational program, if applicable.
C. An applicant may take the examinations for licensure if the applicant has met all of the requirements of section 32-2022, subsection B, paragraphs 1 through 5 and has paid the fees prescribed by this chapter.
D. An applicant may take the examinations for certification licensure if either of the following applies:
1. The applicant has met all of the requirements of section 32-2022, subsection D, paragraphs 1 and 2 and has paid the fees prescribed by this chapter.
2. The applicant has:
(a) Met all of the requirements of section 32-2022, subsection D, paragraph 1.
(b) Paid the fees prescribed by this chapter.
(c) Submitted with the application a letter on the official letterhead of the accredited educational institution where the applicant is completing an accredited educational program that includes the signature of the program director, the department chairperson or a similarly authorized person of the university, school or college and that states that:
(i) The applicant is a candidate for a certificate or degree as a physical therapist assistant at the next scheduled graduation date.
(ii) The date the national examination for certification licensure is to be taken by the applicant is the one nearest to and before the applicant's expected graduation date and is not more than one hundred twenty days before the date of the applicant's expected graduation date.
(iii) The applicant meets any other established requirements of the accredited educational program, if applicable.
E. An applicant for licensure or certification who does not pass the national examination after the first attempt may retake the examination one additional time within six months after the first failure without reapplication for licensure or certification. An applicant may retake the examinations as prescribed by the organization that administers the examinations.
F. The board shall not issue a license or certificate to a person who passes an examination through fraud.
G. The national examination for licensure as a physical therapist shall test entry-level competence related to physical therapy theory, examination and evaluation, diagnosis, prognosis, treatment intervention, prevention and consultation. The national examination for certification licensure as a physical therapist assistant shall test for requisite knowledge and skills in the technical application of physical therapy services.
Sec. 7. Section 32-2026, Arizona Revised Statutes, is amended to read:
32-2026. Licensure by endorsement
A. The board shall issue a license to a physical therapist who has a valid unrestricted license from another jurisdiction of the United States if that person, when granted the license, met all of the requirements prescribed in section 32-2022, subsection A or B and any applicable board rules.
B. The board shall issue a certificate license to a physical therapist assistant who has a valid unrestricted license or certificate from another jurisdiction of the United States if that person, when granted the license or certificate, meets met all of the requirements prescribed in section 32-2022, subsection D and any applicable board rules.
Sec. 8. Section 32-2027, Arizona Revised Statutes, is amended to read:
32-2027. License renewal; suspension
A. A licensee or certificate holder shall renew the license or certificate pursuant to board rules. Except as provided in section 32-4301, a licensee or certificate holder who fails to renew the license or certificate on or before its expiration date shall not practice as a physical therapist or work as a physical therapist assistant in this state.
B. The board shall administratively suspend a license or certificate if the licensee or certificate holder does not submit a complete application for renewal and pay the renewal fee pursuant to board rules.
Sec. 9. Section 32-2028, Arizona Revised Statutes, is amended to read:
32-2028. Reinstatement of license
A. The board may reinstate a license or certificate that it suspended pursuant to section 32-2027, subsection B on payment of a renewal fee and reinstatement fee and completion of the application process as prescribed by the board.
B. If a person's license or certificate has been suspended pursuant to section 32-2027, subsection B for more than three consecutive years, the license or certificate expires and that person shall reapply for a license or certificate pursuant to section 32-2022 or 32-2026 and pay all applicable fees. The person must also demonstrate to the board's satisfaction competency by satisfying one or more of the following as prescribed by the board:
1. Practicing for a specified time under an interim permit.
2. Completing remedial courses.
3. Completing continuing competence requirements for the period of the lapsed license.
4. Passing an examination.
Sec. 10. Section 32-2029, Arizona Revised Statutes, is amended to read:
32-2029. Fees
The board shall establish and collect fees of not more than:
1. Three hundred dollars $300 for an application for an original license or certificate. This fee is nonrefundable.
2. Three hundred dollars $300 for a certificate of renewal of a license or certificate.
3. Three hundred dollars $300 for an application for reinstatement of licensure.
4. Fifty dollars $50 for each duplicate license or certificate.
Sec. 11. Section 32-2030, Arizona Revised Statutes, is amended to read:
32-2030. Business entities; patient records; protocol; exemptions; rules
A. Beginning September 1, 2011, A business entity shall not offer physical therapy services pursuant to this chapter unless:
1. The business entity is registered with the board pursuant to this section.
2. The physical therapy services are conducted by a licensee or certificate holder pursuant to this chapter.
B. The business entity must file a registration application on a form prescribed by the board. The application shall include:
1. A description of the entity's services offered to the public.
2. The name of the manager who is authorized and who is responsible for managing the physical therapy services offered at each office.
3. The names and addresses of the officers and directors of the business entity.
4. A registration fee prescribed by the board by rule.
C. A business entity must file a separate registration application and pay a fee for each branch office in this state.
D. A registration expires on August 31 of odd numbered odd-numbered years in accordance with the physical therapist professional licensing schedule. A business entity that wishes to renew a registration must submit an application for renewal as prescribed by the board on a biennial basis on a form prescribed by the board before the expiration date. An entity that fails to renew the registration before the expiration date is subject to a late fee as prescribed by the board by rule.
E. The business entity must notify the board in writing within thirty days after any change:
1. In the business entity's name, address or telephone number.
2. In the officers or directors of the business entity.
3. In the name of the manager who is authorized and who is responsible for managing the physical therapy services in any facility.
F. The business entity must establish and implement a written protocol for the secure storage, transfer and access of the physical therapy records of the business entity's patients. This protocol must include, at a minimum, procedures for:
1. Notifying patients of the future locations of their records if the business entity terminates or sells the practice.
2. Disposing of unclaimed physical therapy records.
3. The timely response to requests by patients for copies of their records.
G. The business entity must notify the board within thirty days after the dissolution of any registered business entity or the closing or relocation of any facility and must disclose to the board the entity's procedure by which its patients may obtain their records.
H. This section does not apply to:
1. A sole proprietorship or partnership that consists exclusively of persons who are licensed by a health profession regulatory board as defined in section 32-3201.
2. A facility regulated by the federal government or a state, district or territory of the United States.
3. An administrator or executor of the estate of a deceased physical therapist or a person who is legally authorized to act for a physical therapist who has been adjudicated to be mentally incompetent for not more than one year from the date the board receives notice of the physical therapist's death or incapacitation.
4. A health care institution that is licensed pursuant to title 36.
I. A facility that offers physical therapy services to the public by persons licensed under this chapter must be registered by the board unless the facility is any of the following:
1. Owned by a licensee.
2. Regulated by the federal government or a state, district or territory of the United States.
J. Except for issues relating to insurance coding and billing that require the name, signature and license number of the physical therapist providing treatment, this section does not:
1. Authorize a licensee in the course of providing physical therapy services for an entity registered pursuant to this section to disregard or interfere with a policy or practice established by the entity for the operation and management of the business.
2. Authorize a business entity registered pursuant to this section to establish or enforce a business policy or practice that may interfere with the professional judgment of the licensee in providing physical therapy services for the business entity or may compromise a licensee's ability to comply with this chapter.
K. The board shall adopt rules that provide a method for the board to receive the assistance and advice of business entities registered pursuant to this section in all matters relating to the regulation of business entities.
L. The board shall adopt rules necessary to enforce this chapter in the practice settings of its licensees, certificate holders and registrants if the practice settings are not regulated by the department of health services.
Sec. 12. Section 32-2031, Arizona Revised Statutes, is amended to read:
32-2031. Retired status; reinstatement to active status
A. The board shall place a licensee or certificate holder on retired status and waive the renewal fee and continuing competence requirements if a licensee or certificate holder presents a written affidavit to the board that the licensee or certificate holder has retired from the practice of physical therapy or from work as a physical therapist assistant, is in good standing with the board and has paid all fees required by this chapter before the waiver.
B. During the period of waiver pursuant to subsection A of this section, the retired licensee or certificate holder may not engage in the practice of physical therapy or work as a physical therapist assistant.
C. A retired licensee or certificate holder must renew the retired license or certificate every two years by verifying the person's contact information and using the same schedule for renewal of an active license or certificate. The board may not charge a fee for renewal of a retired license or certificate.
D. If a licensee or certificate holder fails to renew the retired status of the license or certificate on or before its expiration date, the retired license or certificate expires. If the person seeks to reinstate the person's retired status after the retired license or certificate has expired, the person must make a request for retired status pursuant to subsection A of this section.
E. The board may reinstate a retired licensee or certificate holder to active practice or work on payment of the renewal fee and presentation of evidence satisfactory to the board that the retired licensee or certificate holder is professionally able to engage in the practice of physical therapy or work as a physical therapist assistant and still possesses the professional knowledge required. If the retired licensee or certificate holder has held a retired license or certificate for more than three consecutive years, the person must also demonstrate competency to the board's satisfaction by satisfying one or more of the following as prescribed by the board:
1. Practicing or working for a specified time under an interim permit.
2. Completing remedial courses.
3. Completing continuing competence requirements for the period of the retired license or certificate.
4. Passing an examination as prescribed by the board.
Sec. 13. Section 32-2032, Arizona Revised Statutes, is amended to read:
32-2032. Inactive status; reinstatement to active status
A. The board shall place a licensee or certificate holder on inactive status and waive the continuing competence requirements if a licensee or certificate holder presents a written affidavit to the board that the licensee or certificate holder is not currently engaged in the practice of physical therapy or working as a physical therapist assistant in this state, is in good standing with the board and has paid all fees required by this chapter.
B. During the period of inactive status pursuant to subsection A of this section, the inactive licensee or certificate holder may not engage in the practice of physical therapy or work as a physical therapist assistant in this state.
C. A licensee or certificate holder on inactive status must renew the inactive license or certificate every two years using the same schedule for renewal of an active license or certificate. The board by rule shall prescribe the fee for the renewal of an inactive license or certificate.
D. An inactive licensee or certificate holder who applies to the board for reinstatement to active licensure or certification within three years after the date the board issues a notice of inactive status must submit the full annual license renewal fee and prove to the board's satisfaction that the licensee or certificate holder has met continuing competence requirements as prescribed by the board by rule.
E. An inactive licensee or certificate holder who applies to the board for reinstatement to active licensure or certification and who has not been actively engaged in the practice of physical therapy or working as a physical therapist assistant in this state for more than three consecutive years after the date the board issues a notice of inactive status must submit the full annual license renewal fee and demonstrate competency to the board's satisfaction by satisfying one or more of the following as prescribed by the board:
1. Practicing or working for a specified time under an interim permit.
2. Completing remedial courses.
3. Completing continuing competence requirements for the period of the inactive license or certificate.
4. Passing an examination.
Sec. 14. Section 32-2042, Arizona Revised Statutes, is amended to read:
32-2042. Use of titles; restrictions; violation; classification
A. A physical therapist shall use the letters "PT" in connection with the physical therapist's name or place of business to denote licensure under this chapter. A physical therapist on retired status shall use "(retired)" or "(ret.)" after the letters "PT" in connection with the physical therapist's name or place of business to denote the physical therapist's retired status pursuant to section 32-2031.
B. A physical therapist assistant shall use the letters "PTA" in connection with that person's name to denote certification licensure pursuant to this chapter. A physical therapist assistant on retired status shall use "(retired)" or "(ret.)" after the letters "PTA" in connection with the physical therapist assistant's name or place of business to denote the physical therapist assistant's retired status pursuant to section 32-2031.
C. A person or business entity or its employees, agents or representatives shall not use in connection with that person's name or the name or activity of the business the words "physical therapy", "physical therapist", "physiotherapy", "physiotherapist" or "registered physical therapist", the letters "PT", "LPT", "RPT", "MPT", "DScPT" or "DPT" or any other words, abbreviations or insignia indicating or implying directly or indirectly that physical therapy is provided or supplied, including the billing of services labeled as physical therapy, unless these services are provided by or under the direction of a physical therapist who is licensed pursuant to this chapter. A person or entity that violates this subsection is guilty of a class 1 misdemeanor.
D. A person or business entity shall not advertise, bill or otherwise promote a person who is not licensed pursuant to this chapter as being a physical therapist or offering physical therapy services.
E. A person shall not use the title "physical therapist assistant" or use the letters "PTA" in connection with that person's name or any other words, abbreviations or insignia indicating or implying directly or indirectly that the person is a physical therapist assistant unless that person is certified licensed as a physical therapist assistant pursuant to this chapter. A person who violates this subsection is guilty of a class 1 misdemeanor.
Sec. 15. Section 32-2043, Arizona Revised Statutes, is amended to read:
32-2043. Supervision; patient care management
A. A physical therapist is responsible for patient care given by assistive personnel, student physical therapists and student physical therapy assistants under the physical therapist's supervision. A physical therapist may delegate to assistive personnel and supervise selected acts, tasks or procedures that fall within the scope of physical therapy practice but that do not exceed the education or training of the assistive personnel.
B. A physical therapist assistant who is certified pursuant to this chapter may perform selected interventions provide physical therapy services under the general supervision of a physical therapist who is licensed pursuant to this chapter.
C. A physical therapy aide and other assistive personnel shall perform designated routine tasks only under the on-site supervision of a licensed physical therapist who is present in the facility.
D. A licensed physical therapist must provide on-site supervision of an interim permit holder.
E. A physical therapist student and a physical therapist assistant student must practice under the on-site supervision of a licensed physical therapist.
F. A physical therapist is responsible for managing all aspects of the physical therapy care of each patient. A physical therapist must provide:
1. The initial evaluation of and documentation for a patient.
2. Periodic reevaluation of and documentation for a patient.
3. The documented discharge of a patient, including the response to therapeutic intervention at the time of discharge.
G. A physical therapist must verify the qualifications of physical therapist assistants and other assistive personnel under the physical therapist's direction and supervision.
H. For each patient on each date of service, a physical therapist must provide and document all of the therapeutic intervention that requires the expertise of a physical therapist and must determine the use of physical therapist assistants and other assistive personnel to ensure the delivery of care that is safe, effective and efficient. Documentation for each date of service must be as prescribed by the board by rule.
I. A physical therapist assistant must document care provided but may do so without the co-signature cosignature of the supervising physical therapist if the physical therapist complies with the requirements of subsections G and H of this section.
J. A physical therapist's responsibility for patient care management includes accurate documentation and billing of the services provided.
Sec. 16. Section 32-2044, Arizona Revised Statutes, is amended to read:
32-2044. Grounds for disciplinary action
The following are grounds for disciplinary action:
1. Violating this chapter, board rules or a written board order.
2. Practicing or offering to practice beyond the scope of the practice of physical therapy.
3. Obtaining or attempting to obtain a license or certificate by fraud or misrepresentation.
4. Engaging in the performance of substandard care by a physical therapist due to a deliberate or negligent act or failure to act regardless of whether actual injury to the patient is established.
5. Engaging in the performance of substandard care by a physical therapist assistant, including exceeding the authority to perform tasks selected and delegated by the supervising licensee regardless of whether actual injury to the patient is established.
6. Failing to supervise assistive personnel, physical therapy students or interim permit holders in accordance with this chapter and rules adopted pursuant to this chapter.
7. Conviction of a felony, whether or not involving moral turpitude, or a misdemeanor involving moral turpitude. In either case conviction by a court of competent jurisdiction is conclusive evidence of the commission and the board may take disciplinary action when the time for appeal has lapsed, when the judgment of conviction has been affirmed on appeal or when an order granting probation is made suspending the imposition of sentence, irrespective of a subsequent order. For the purposes of this paragraph, "conviction" means a plea or verdict of guilty or a conviction following a plea of nolo contendere.
8. Practicing as a physical therapist or working as a physical therapist assistant when physical or mental abilities are impaired by disease or trauma, by the use of controlled substances or other habit-forming drugs, chemicals or alcohol or by other causes.
9. Having had a license or certificate revoked or suspended or other disciplinary action taken or an application for licensure or certification refused, revoked or suspended by the proper authorities of another state, territory or country.
10. Engaging in sexual misconduct. For the purposes of this paragraph, "sexual misconduct" includes:
(a) Engaging in or soliciting sexual relationships, whether consensual or nonconsensual, while a provider-patient relationship exists.
(b) Making sexual advances, requesting sexual favors or engaging in other verbal conduct or physical contact of a sexual nature with patients.
(c) Intentionally viewing a completely or partially disrobed patient in the course of treatment if the viewing is not related to patient diagnosis or treatment under current practice standards.
11. Directly or indirectly requesting, receiving or participating in the dividing, transferring, assigning, rebating or refunding of an unearned fee or profiting by means of any credit or other valuable consideration such as an unearned commission, discount or gratuity in connection with the furnishing of physical therapy services. This paragraph does not prohibit the members of any regularly and properly organized business entity recognized by law and composed of physical therapists from dividing fees received for professional services among themselves as they determine necessary to defray their joint operating expense.
12. Failing to adhere to the recognized standards of ethics of the physical therapy profession.
13. Charging unreasonable or fraudulent fees for services performed or not performed.
14. Making misleading, deceptive, untrue or fraudulent representations in violation of this chapter or in the practice of the profession.
15. Having been adjudged mentally incompetent by a court of competent jurisdiction.
16. Aiding or abetting a person who is not licensed or certified in this state and who directly or indirectly performs activities requiring a license or certificate.
17. Failing to report to the board any direct knowledge of an unprofessional, incompetent or illegal act that appears to be in violation of this chapter or board rules.
18. Interfering with an investigation or disciplinary proceeding by failing to cooperate, by wilful misrepresentation of facts or by the use of threats or harassment against any patient or witness to prevent the patient or witness from providing evidence in a disciplinary proceeding or any legal action.
19. Failing to maintain patient confidentiality without prior written consent of the patient or unless otherwise required by law.
20. Failing to maintain adequate patient records. For the purposes of this paragraph, "adequate patient records" means legible records that comply with board rules and that contain at a minimum an evaluation of objective findings, a diagnosis, the plan of care, the treatment record, a discharge summary and sufficient information to identify the patient.
21. Promoting an unnecessary device, treatment intervention or service for the financial gain of the practitioner or of a third party.
22. Providing treatment intervention unwarranted by the condition of the patient or treatment beyond the point of reasonable benefit.
23. Failing to report to the board a name change or a change in business or home address within thirty days after that change.
24. Failing to complete continuing competence requirements as established by the board by rule.
25. Failing to demonstrate professional standards of care and training and education qualifications, as established by the board by rule, in the performance of dry needling when provided as a therapeutic modality.
Sec. 17. Section 32-2046, Arizona Revised Statutes, is amended to read:
32-2046. Informal and formal hearings
A. The board may request an informal hearing with a licensee, a certificate holder or any unlicensed person in order to further its investigation or to resolve a complaint.
B. If at an informal hearing the board finds a violation of this chapter has occurred that constitutes grounds for disciplinary action, it may take any disciplinary actions prescribed in section 32-2047, paragraph 1, 2 or 6, except that a civil penalty may not exceed five hundred dollars $500.
C. If the results of an informal hearing indicate that suspension, revocation or a civil penalty might be in order, the board shall notify the subject of the investigation of the time and place for a hearing pursuant to title 41, chapter 6, article 10.
D. In lieu of or in addition to an informal hearing as provided in subsection A of this section, the board may serve on a licensee or a certificate holder a summons and complaint setting forth the grounds for disciplinary action and notice of a hearing to be held before the board at least thirty days after the date of the notice. The notice shall state the time and place of the hearing.
E. A motion for rehearing or review of the board's decision in a disciplinary action shall be filed pursuant to title 41, chapter 6, article 10.
F. The service of a summons and complaint and the service of a subpoena shall be as provided for service in civil cases.
G. If a person disobeys a subpoena, the board may petition the superior court for an order requiring appearance or the production of documents.
Sec. 18. Section 32-2047, Arizona Revised Statutes, is amended to read:
32-2047. Disciplinary actions; penalties
On proof that any grounds prescribed in section 32-2044 have been violated or that any requirements prescribed in section 32-2030 have been violated, the board may take the following disciplinary actions singly or in combination:
1. Issue a decree of censure.
2. Restrict a license, certificate or registration. The board may require a licensee, certificate holder or registrant to report regularly to the board on matters related to the grounds for the restricted license or certificate or registration.
3. Suspend a license, certificate or registration for a period prescribed by the board.
4. Revoke a license, certificate or registration.
5. Refuse to issue or renew a license, certificate or registration.
6. Impose a civil penalty of at least two hundred fifty dollars $250 but not more than ten thousand dollars $10,000 for each violation of this chapter. In addition, the board may assess and collect the reasonable costs incurred in a disciplinary hearing when action is taken against a person's license or certificate.
7. Accept a voluntary surrendering of a license, certificate or registration pursuant to an order of consent by the board.
Sec. 19. Section 32-2050, Arizona Revised Statutes, is amended to read:
32-2050. Substance abuse recovery program
In lieu of a disciplinary proceeding prescribed by this article, the board may permit allow a licensee or certificate holder to actively participate in a board approved board-approved substance abuse recovery program if:
1. The board has evidence that the licensee or certificate holder is an impaired professional.
2. The licensee or certificate holder has not been convicted of a felony relating to a controlled substance in a court of law of the United States or any other territory or country.
3. The licensee or certificate holder enters into a written agreement with the board for a restricted license and complies with all of the terms of the agreement, including making satisfactory progress in the program and adhering to any limitations on the licensee's practice imposed by the board to protect the public. Failure to enter into such an agreement shall activate an immediate investigation and disciplinary proceedings by the board.
4. As part of the agreement established between the licensee or certificate holder and the board, the licensee or certificate holder signs a waiver allowing the substance abuse program to release information to the board if the licensee or certificate holder does not comply with the requirements of this section or is unable to practice with reasonable skill or safety.
Sec. 20. Section 32-2051, Arizona Revised Statutes, is amended to read:
32-2051. Rights of consumers
A. The public has access to the following information:
1. A list of licensees and interim permit holders that includes the licensee's and interim permit holder's place of practice, license or interim permit number, date of license or interim permit expiration and status of license or interim permit.
2. A list of physical therapist assistants certified who are licensed in this state, including place of employment, certificate license number, date of certificate license expiration and status of certificate license.
3. Public records.
B. The home addresses and telephone numbers of physical therapists and physical therapist assistants are not public records and shall be kept confidential by the board unless they are the only addresses and telephone numbers of record.
C. If a referring practitioner is deriving direct or indirect compensation from the referral to physical therapy, the physical therapist shall disclose this information in writing to the patient.
D. A physical therapist shall disclose in writing to a patient any financial interest in products the physical therapist endorses and recommends to the patient and shall document this disclosure in the patient's record.
E. A physical therapist shall ensure that each patient understands that the patient has freedom of choice in services and products.
F. Information relating to the physical therapist-patient relationship is confidential and shall not be communicated to a third party who is not involved in that patient's care without the prior written consent of the patient. The physical therapist shall divulge to the board information it requires in connection with any investigation, public hearing or other proceeding. The physical therapist-patient privilege does not extend to cases in which the physical therapist has a duty to report information as required by law. The confidentiality requirements and privileges of this subsection also apply to physical therapist assistants.
G. Each licensee and certificate holder shall display a copy of the license or certificate and current renewal verification in a location accessible to public view at the licensee's place of practice. If the licensee or certificate holder is unable to display the license, certificate or current renewal verification, the licensee or certificate holder must produce that documentation on request.
H. The board shall keep all information relating to the receipt and investigation of complaints filed against a licensee or certificate holder confidential unless the information is disclosed in the course of the investigation or any subsequent proceeding or if that information is required to be disclosed by law.
I. The following are confidential and are not available to the public:
1. Patient records, including clinical records, patient files, and any report or oral statement relating to a diagnostic finding or treatment of a patient.
2. Any information from which a patient or a patient's family might be identified.
3. Information received and records or reports kept by the board as a result of an investigation made pursuant to this chapter.
Sec. 21. Section 36-2907, Arizona Revised Statutes, is amended to read:
36-2907. Covered health and medical services; modifications; related delivery of service requirements; rules; definition
A. Subject to the limits and exclusions specified in this section, contractors shall provide the following medically necessary health and medical services:
1. Inpatient hospital services that are ordinarily furnished by a hospital to care for and treat inpatients and that are provided under the direction of a physician or a primary care practitioner. For the purposes of this section, inpatient hospital services exclude services in an institution for tuberculosis or mental diseases unless authorized under an approved section 1115 waiver.
2. Outpatient health services that are ordinarily provided in hospitals, clinics, offices and other health care facilities by licensed health care providers. Outpatient health services include services provided by or under the direction of a physician or a primary care practitioner, including occupational therapy.
3. Other laboratory and X-ray services ordered by a physician or a primary care practitioner.
4. Medications that are ordered on prescription by a physician or a dentist who is licensed pursuant to title 32, chapter 11. Persons who are dually eligible for title XVIII and title XIX services must obtain available medications through a medicare licensed or certified medicare advantage prescription drug plan, a medicare prescription drug plan or any other entity authorized by medicare to provide a medicare part D prescription drug benefit.
5. Medical supplies, durable medical equipment, insulin pumps and prosthetic devices ordered by a physician or a primary care practitioner. Suppliers of durable medical equipment shall provide the administration with complete information about the identity of each person who has an ownership or controlling interest in their business and shall comply with federal bonding requirements in a manner prescribed by the administration.
6. For persons who are at least twenty-one years of age, treatment of medical conditions of the eye, excluding eye examinations for prescriptive lenses and the provision of prescriptive lenses.
7. Early and periodic health screening and diagnostic services as required by section 1905(r) of title XIX of the social security act for members who are under twenty-one years of age.
8. Family planning services that do not include abortion or abortion counseling. If a contractor elects not to provide family planning services, this election does not disqualify the contractor from delivering all other covered health and medical services under this chapter. In that event, the administration may contract directly with another contractor, including an outpatient surgical center or a noncontracting provider, to deliver family planning services to a member who is enrolled with the contractor that elects not to provide family planning services.
9. Podiatry services that are performed by a podiatrist who is licensed pursuant to title 32, chapter 7 and ordered by a primary care physician or primary care practitioner.
10. Nonexperimental transplants approved for title XIX reimbursement.
11. Dental services as follows:
(a) Except as provided in subdivision (b) of this paragraph, for persons who are at least twenty-one years of age, emergency dental care and extractions in an annual amount of not more than $1,000 per member.
(b) Subject to approval by the centers for medicare and medicaid services, for persons treated at an Indian health service or tribal facility, adult dental services that are eligible for a federal medical assistance percentage of one hundred percent and that exceed the limit prescribed in subdivision (a) of this paragraph.
12. Ambulance and nonambulance transportation, except as provided in subsection G of this section.
13. Hospice care.
14. Orthotics, if all of the following apply:
(a) The use of the orthotic is medically necessary as the preferred treatment option consistent with medicare guidelines.
(b) The orthotic is less expensive than all other treatment options or surgical procedures to treat the same diagnosed condition.
(c) The orthotic is ordered by a physician or primary care practitioner.
15. Subject to approval by the centers for medicare and medicaid services, medically necessary chiropractic services that are performed by a chiropractor who is licensed pursuant to title 32, chapter 8 and that are ordered by a primary care physician or primary care practitioner pursuant to rules adopted by the administration. The primary care physician or primary care practitioner may initially order up to twenty visits annually that include treatment and may request authorization for additional chiropractic services in that same year if additional chiropractic services are medically necessary.
16. For up to ten program hours annually, diabetes outpatient self-management training services, as defined in 42 United States Code section 1395x, if prescribed by a primary care practitioner in either of the following circumstances:
(a) The member is initially diagnosed with diabetes.
(b) For a member who has previously been diagnosed with diabetes, either:
(i) A change occurs in the member's diagnosis, medical condition or treatment regimen.
(ii) The member is not meeting appropriate clinical outcomes.
B. The limits and exclusions for health and medical services provided under this section are as follows:
1. Circumcision of newborn males is not a covered health and medical service.
2. For eligible persons who are at least twenty-one years of age:
(a) Outpatient health services do not include speech therapy.
(b) Prosthetic devices do not include hearing aids, dentures, bone-anchored hearing aids or cochlear implants. Prosthetic devices, except prosthetic implants, may be limited to $12,500 per contract year.
(c) Percussive vests are not covered health and medical services.
(d) Durable medical equipment is limited to items covered by medicare.
(e) Nonexperimental transplants do not include pancreas-only transplants.
(f) Bariatric surgery procedures, including laparoscopic and open gastric bypass and restrictive procedures, are not covered health and medical services.
C. The system shall pay noncontracting providers only for health and medical services as prescribed in subsection A of this section and as prescribed by rule.
D. The director shall adopt rules necessary to limit, to the extent possible, the scope, duration and amount of services, including maximum limits for inpatient services that are consistent with federal regulations under title XIX of the social security act (P.L. 89-97; 79 Stat. 344; 42 United States Code section 1396 (1980)). To the extent possible and practicable, these rules shall provide for the prior approval of medically necessary services provided pursuant to this chapter.
E. The director shall make available home health services in lieu of hospitalization pursuant to contracts awarded under this article. For the purposes of this subsection, "home health services" means the provision of nursing services, home health aide services or medical supplies, equipment and appliances that are provided on a part-time or intermittent basis by a licensed home health agency within a member's residence based on the orders of a physician or a primary care practitioner. Home health agencies shall comply with the federal bonding requirements in a manner prescribed by the administration.
F. The director shall adopt rules for the coverage of behavioral health services for persons who are eligible under section 36-2901, paragraph 6, subdivision (a). The administration acting through the regional behavioral health authorities shall establish a diagnostic and evaluation program to which other state agencies shall refer children who are not already enrolled pursuant to this chapter and who may be in need of behavioral health services. In addition to an evaluation, the administration acting through regional behavioral health authorities shall also identify children who may be eligible under section 36-2901, paragraph 6, subdivision (a) or section 36-2931, paragraph 5 and shall refer the children to the appropriate agency responsible for making the final eligibility determination.
G. The director shall adopt rules providing for transportation services and rules providing for copayment by members for transportation for other than emergency purposes. Subject to approval by the centers for medicare and medicaid services, nonemergency medical transportation shall not be provided except for stretcher vans and ambulance transportation. Prior authorization is required for transportation by stretcher van and for medically necessary ambulance transportation initiated pursuant to a physician's direction. Prior authorization is not required for medically necessary ambulance transportation services rendered to members or eligible persons initiated by dialing telephone number 911 or other designated emergency response systems.
H. The director may adopt rules to allow the administration, at the director's discretion, to use a second opinion procedure under which surgery may not be eligible for coverage pursuant to this chapter without documentation as to need by at least two physicians or primary care practitioners.
I. If the director does not receive bids within the amounts budgeted or if at any time the amount remaining in the Arizona health care cost containment system fund is insufficient to pay for full contract services for the remainder of the contract term, the administration, on notification to system contractors at least thirty days in advance, may modify the list of services required under subsection A of this section for persons defined as eligible other than those persons defined pursuant to section 36-2901, paragraph 6, subdivision (a). The director may also suspend services or may limit categories of expense for services defined as optional pursuant to title XIX of the social security act (P.L. 89-97; 79 Stat. 344; 42 United States Code section 1396 (1980)) for persons defined pursuant to section 36-2901, paragraph 6, subdivision (a). Such reductions or suspensions do not apply to the continuity of care for persons already receiving these services.
J. All health and medical services provided under this article shall be provided in the geographic service area of the member, except:
1. Emergency services and specialty services provided pursuant to section 36-2908.
2. That the director may allow the delivery of health and medical services in other than the geographic service area in this state or in an adjoining state if the director determines that medical practice patterns justify the delivery of services or a net reduction in transportation costs can reasonably be expected. Notwithstanding the definition of physician as prescribed in section 36-2901, if services are procured from a physician or primary care practitioner in an adjoining state, the physician or primary care practitioner shall be licensed to practice in that state pursuant to licensing statutes in that state that are similar to title 32, chapter 13, 15, 17 or 25 and shall complete a provider agreement for this state.
K. Covered outpatient services shall be subcontracted by a primary care physician or primary care practitioner to other licensed health care providers to the extent practicable for purposes including, but not limited to, making health care services available to underserved areas, reducing costs of providing medical care and reducing transportation costs.
L. The director shall adopt rules that prescribe the coordination of medical care for persons who are eligible for system services. The rules shall include provisions for transferring patients and medical records and initiating medical care.
M. Subject to approval by the centers for medicare and medicaid services, the administration and its contractors shall provide an exception to any visit limitation for physical therapy services when a member's condition is justified by documentation indicating that the member requires continued skilled therapy.
M. N. Notwithstanding section 36-2901.08, monies from the hospital assessment fund established by section 36-2901.09 may not be used to provide for either:
1. Chiropractic services as prescribed in subsection A, paragraph 15 of this section.
N. Notwithstanding section 36-2901.08, monies from the hospital assessment fund established by section 36-2901.09 may not be used to provide
2. Diabetes outpatient self-management training services as prescribed in subsection A, paragraph 16 of this section.
O. For the purposes of this section, "ambulance" has the same meaning prescribed in section 36-2201.
Sec. 22. Physical therapist assistants; licensure
A physical therapist assistant who is certified pursuant to title 32, chapter 19, Arizona Revised Statutes, on the effective date of this act may retain the certification until renewal, at which time the board of physical therapy shall issue a license.