Second Regular Session S.B. 1267
PROPOSED
SENATE AMENDMENTS TO S.B. 1267
(Reference to printed bill)
Page 1, line 42, strike "or certificate"
Page 2, line 5, after the second quotation mark insert ":
(a)"
Between lines 12 and 13, insert:
"(b) Includes supervision provided through telehealth as defined in section 36-3601."
Line 16, strike "certification" insert "licensure"
Strike line 32, insert "imaging and laboratory tests."
Page 3, strike lines 7 and 8
Renumber to conform
Between lines 21 and 22, insert:
"Sec. 2. 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. 3. 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. 4. 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. 5. 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. 6. 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. 7. 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. 8. 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."
Renumber to conform
Page 4, after line 23, insert:
"Sec. 10. 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. 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. 11. 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.
Sec. 12. Conforming legislation
The legislative council staff shall prepare proposed legislation conforming the Arizona Revised Statutes to the provisions of this act in the fifty-seventh legislature, first regular session."
Amend title to conform