Legislature(2019 - 2020)BELTZ 105 (TSBldg)
02/06/2020 01:30 PM Senate LABOR & COMMERCE
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| Audio | Topic |
|---|---|
| Start | |
| SB47 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 47 | TELECONFERENCED | |
| + | TELECONFERENCED |
SB 47-PHYSICAL/OCCUPATIONAL THERAPY BD/PRACTICE
1:31:10 PM
CHAIR BISHOP announced the consideration of SENATE BILL NO. 47,
"An Act relating to the State Physical Therapy and Occupational
Therapy Board; relating to the practice of physical therapy; and
relating to the practice of occupational therapy."
He advised that after the bill is presented, the committee would
adopt a committee substitute (CS).
1:32:32 PM
SENATOR CATHY GIESSEL, Alaska State Legislature, Juneau, Alaska,
sponsor of SB 47, stated that she was carrying the bill at the
request of the State Physical Therapy and Occupational Therapy
Board. She explained that there are two primary differences
between an occupational therapist and a physical therapist.
Occupational therapy focuses on improving a client's ability to
perform activities of daily living whereas physical therapy
focuses on a client's ability to perform movement of the
physical body. Both professions require a master's degree and
the physical therapy profession is transitioning to require a
doctoral degree as the level of entry. Right now there are both
master's prepared and doctoral prepared physical therapists.
After achieving a doctorate, physical therapists must then go on
to pass a national board certification test and then they are
able to apply for a license.
She explained that occupational therapists have certified
occupational therapy assistants that carry out the evaluation
and goals the therapist has set for the patient. Physical
therapists have physical therapy assistants to carry out the
rehabilitation plan the therapist developed. They also have
physical therapy aides who work under the direction of the
physical therapist to assist the patient.
1:35:20 PM
SENATOR GIESSEL said SB 47 clarifies terms and the composition
of the State Physical Therapy and Occupational Therapy Board.
The bill affects both professions. Currently the board has seven
members, composed of one physician, three physical therapists or
assistants, two occupational therapists or assistants, and one
public member. SB 47 replaces the physician seat with an
occupational therapist or an occupational therapy assistant.
This reflects the change in the professions. When the statute
was enacted, these professionals were regulated by the State
Medical Board. Once they were allowed to establish an
independent board, they agreed to have a physician seat to
provide oversight. She said that is no longer necessary and the
physician in that seat agrees.
She said SB 47 also updates some of the language related to the
education requirements. It replaces a reference to an obsolete
accrediting entity with broader language that allows the board
options to identify which accrediting agencies they would
require for educational purposes and certification. The bill
also allows the board to discipline a therapist for committing
any acts in AS 08.84.120(a), such as fraud, felony conviction,
gross negligence, and malpractice. The board can already suspend
or revoke the license of a person who commits those acts.
SB 47 also changes the terminology related to people who receive
their education outside the U.S. The term foreign trained will
be replaced with foreign educated. The bill changes all
references to "physical therapy assistant" to "physical
therapist assistant." This aligns with national terminology. SB
47 also provides title protection. If someone were to improperly
indicate they were a licensed physical therapist, they would be
subject to a class B misdemeanor for misuse of the term. She
described the bill as a long-overdue clean up.
1:39:26 PM
SENATOR STEVENS questioned the legitimacy of requiring a
doctorate to become a physical therapist. He asked if these
professionals receive a Doctor of Philosophy, and where they go
to school to get the degree.
SENATOR GIESSEL replied this is exactly what the nurse
practitioner profession is doing. She deferred to the physical
therapists waiting to testify to respond to the question more
completely.
CHAIR BISHOP said he had questions for Ms. Conway about Section
3.
1:40:45 PM
JANE CONWAY, Staff, Senator Cathy Giessel, Alaska State
Legislature, Juneau, Alaska, paraphrased the following sectional
analysis for SB 47, noting that many of the changes are to
conform the terminology for the physical therapist assistant:
Section 1 AS 08.84.010 Creation and membership of the
board. This section removes the seat for a physician
and balances out the board with 3 physical therapists
and 3 occupational therapists along with one public
member, to make up the 7-member board.
It also changes the term "physical therapy assistant"
to "physical therapist assistant" in this section and
throughout the entire statute. This is to conform to
title used nationally in the industry.
Section 2 AS 08.84.030 Qualifications for Licensing.
This section allows the board to have broader
authority over what entities will have accreditation
oversight over physical therapy education programs.
Some of the accrediting entities listed in statute are
now either renamed or no longer exist, making that
statute obsolete. The bill also changes the statute in
the same way for occupational therapists.
Section 2 also removes language from statute relating
to additional supervised field work that occupational
therapists must complete as these requirements are
covered by the accrediting bodies.
Section 3 AS 08.84.032 Foreign-Educated Applicants.
Changes the section headline from "trained" to
"educated." Puppies are trained, students are
educated. New language is added that requires foreign-
educated physical therapist students to have attended
a "substantially" equivalent educational program that
is accredited by a U.S. accreditation entity that has
been approved by the board. Outdated and obsolete
language is removed that can be found on page 4, lines
3 -9 of this bill.
Added to (3) of this section is language
that would require that a physical therapist
or physical therapist assistant pass a test
demonstrating competency of the English
language if their program was taught in a
foreign language.
1:43:50 PM
CHAIR BISHOP asked if the board develops the test to determine
an applicant is sufficiently fluent in English.
MS. CONWAY said it seems logical, but she would defer to the
experts to respond.
She continued:
(4) requires that a foreign educated applicant is
a legal alien or a U.S citizen
(7) requires them to pay the required fee and
meet any other qualifications for licensure set
by the board under 08.84.010(b)
All the above changes are replicated for occupational
therapists or occupational therapy assistants on page
4, lines 27-31 and over to page 5, lines 1-22.
Section 4 AS 08.84.060 Licensure by acceptance of
credentials. Makes conforming terminology changes
Section 5 AS 08.84.065(c) Makes conforming terminology
changes
Section 6 AS 08.84.075(b) Makes conforming terminology
changes
Section 7 AS 08.84.075(c) Changes language that would
now require a limited permit is valid for 120
consecutive days
Section 8 AS 08.84.075(d) Allows only one limited
permit per 12-month period.
Section 9 AS 08.84.090 Updates licensure terminology
Section 10 AS 08.84.120(a) Adds disciplinary action as
a possibility to actions a board might consider for an
infraction of their licensure and updates terminology
in item (7) and states in (9) that failure to comply
with the law or regulations or order of the board
might result in disciplinary action or suspension of a
license.
1:46:22 PM
Section 11 AS 08.04.130(a) Adds updated credentialing
and terminology
Section 12 AS 08.84.130(b) Updates terminology
Section 13 AS 08.84.190 Adds a new paragraph defining
the updated term "physical therapist assistant"
Section 14 AS 11.41.470(1) Updates definitions in
criminal law/sexual assault statute
Section 15 AS 47.17.290(14) Updates terminology under
definitions in child protection statute
Section 16 AS 08.84.190(7) Is repealed, which is the
definition using outdated term of physical therapy;
according to Leg. Legal, when the actual "term" used
for the definition is being changed, the entire citing
must be repealed. The new definition is set out on
page 8, Section 13, lines 11-14.
Section 17 Sets out the applicability clauses for
licensure for sections 2 and 3 of this Act and also
for sections 7 and 8
Section 18 Transition language for the board vacancy
and appointments for the PT/OT board, and states that
the changes do not apply to current licensees until it
is time for their licensure renewal and then all
changes to the law will apply.
1:48:46 PM
CHAIR BISHOP noted the updated fiscal note identifies $2,300 for
postage and other costs associated with mailing notifications.
He solicited a motion to adopt the work draft committee
substitute (CS).
1:49:10 PM
SENATOR STEVENS moved to adopt the work draft CS for SB 47, work
order 31-LS0109\U, as the working document.
CHAIR BISHOP objected for an explanation of the changes.
MS. CONWAY read the following explanation: [Original punctuation
provided.]
The CS (vsn U) contains a change from the original
bill, version M:
Page 8, line 14: "?therapist assistant do not include
testing or evaluation."
Removes "testing or" because the physical therapist
assistant does do some minimal testing on patients,
but they do not evaluate the results of the testing.
1:50:53 PM
CHAIR BISHOP removed his objection and Version U was adopted. He
asked Ms. Carrothers and Mr. Orr to provide their testimony.
1:51:26 PM
LEEANNE CARROTHERS, PhD, PT, Government Affairs Liaison, Alaska
Physical Therapy Association (AKAPTA), Anchorage, Alaska,
testified in support of SB 47. She advised that AKAPTA has about
400 licensed physical therapists and physical therapy
assistants. She responded to Senator Stevens' question about the
doctoral level of education by explaining that to attend a
professional entry-level school of physical therapy a bachelor's
degree in some discipline is required. There are also
prerequisites in anatomy, physiology, physics, chemistry, and
psychology, among others. The doctoral program is generally
three years, two of which are in the classroom and 12 months of
supervised clinical rotation.
She explained that a psychologist may hold a Doctor of
Philosophy (PhD) or a Doctor of Psychology (PsyD) and the Doctor
of Physical Therapy (DPT) would be analogous to the PsyD.
SENATOR STEVENS recapped that the doctoral program goes through
an accredited institution. He asked which schools offer a
doctorate.
MS. CARROTHERS replied many across the country, including
private graduate medical schools and some state universities.
She said that there are literally hundreds of programs because
of the need for physical therapists, particularly with the aging
population. The national accrediting body is the Commission on
Accreditation in Physical Therapy Education (CAPTE). To sit for
the national physical therapy licensing exam, an applicant must
have graduated from a CAPTE accredited school. This is a
requirement in every state in the U.S. The standards for that
accreditation are incredibly high, she said.
SENATOR STEVENS asked if this was the wave of the future with
more students going into a doctoral program.
MS. CARR answered yes. She said all of the entry-level physical
therapy programs are at the clinical doctorate level. Most
states have some form of direct access, which means that
patients do not need a prescription from a physician in order to
see their physical therapists. The Physical Therapy Association
decided that with that privilege came increased responsibility,
particularly the ability to be able to evaluate a patient and
know when the patient should not be seen by a physical
therapist. Courses were added in differential diagnosis,
radiology, and pharmacology to increase the level and degree to
which people are competent to be able to keep patients safe.
With that, the transition to the entry level doctorate was made,
she said.
SENATOR STEVENS related his understanding that the bill is not
making any additional requirements for a doctorate, it is simply
where the industry is headed.
MS. CORR agreed. She said Senator Giessel asked her to cover the
benefits of physical and occupational therapy, particularly
pertaining to opioids. She related that there is clear,
scientific evidence that early access to physical therapy
reduces the overall need for opioids. Sometimes people do not
even need them, she said. The old standard of practice would be
for patients with back pain to see their physician and leave
with a prescription for Percocet (Oxycodone and Acetaminophen)
and muscle relaxers. This could persist for months, she said.
With direct access, people can see a physical therapist first
and get back to work more quickly without opioids and often
avoiding expensive imaging or surgery. The conservative
treatment is the way to go, she said.
1:57:14 PM
MS. CORR stated her support for SB 47 and appreciation to
Senator Giessel. She summarized that the bill updates
terminology to the national practice. Nationally, physical
therapist assistants have not been referred as physical therapy
assistants since 1978. This bill will bring Alaska up to date.
It would also update the current accreditation bodies that
accredit programs. It would change the composition of the board,
which would remove the remnant of the need for physician
supervision for physical therapists, which has not been the case
since the 1960s. It would reduce obstacles to licensure of
foreign-educated applicants. She cited the example of a
colleague who went to school in London and had to take an
English proficiency exam to be eligible for licensure in Alaska.
She said SB 47 would also give the board disciplinary authority,
which will help contribute to public safety. Further, the bill
would provide term protection for physiotherapists, the title
P.T., and physical therapists, which will clarify to consumers
the type of clinician they are seeing.
1:59:13 PM
SENATOR STEVENS said he assumed that a patient would first see a
medical doctor who would make a referral to a physical
therapist, but he understood her to say that a patient could
proceed directly to the physical therapist.
MS. CORR said that is correct. Most states have direct access to
physical therapists without a prescription. Some insurance
companies require a prescription or a doctor's signature prior
to treatment, but Alaska has long been a direct access state.
This was done to reduce barriers in a state that has fewer
providers. Typically, if someone sprained an ankle, they would
see a primary care physician, be referred to an orthopedist who
would perform X-rays or other diagnostic tests and then refer
the patient to a physical therapist. With direct access, the
patient would go directly to a physical therapist and begin
treatment. The physical therapist will do a detailed examination
to determine if the injury relates to a musculoskeletal issue.
If that is not the case, the physical therapist would refer the
person to a physician or suggest imaging studies to be certain
the injury is a sprain and not a fracture. Direct access really
reduces barriers to care, she said.
SENATOR STEVENS said it seems more efficient and less costly.
2:01:23 PM
SENATOR GRAY-JACKSON admitted she was unaware that a
prescription was not needed in Alaska to see a physical
therapist. She asked if it is also based on insurance
requirements.
MS. CORR said some insurance companies, workers' compensation
for example, need a prescription or a referral prior to
treatment by a physical therapist. Medicare requires that the
physical therapist, after the initial patient evaluation, submit
the treatment plan to the physician who signs off on it. It is
not necessarily an approval, but rather a Medicare hoop, she
said. The physical therapist would ensure that the person had
the appropriate documents in place prior to treatment.
2:02:45 PM
SCOTTY ORR, OTD, OTR/L, President, Alaska Occupational Therapy
Association (AOTA), Anchorage, Alaska, testified in support of
SB 47. He stated that the AOTA represents about 120 occupational
therapists and certified occupational therapy assistants. He
said that AOTA supports the bill, specifically regarding updated
language to make it more current with national standards and
replacing the physician on the Physical Therapy and Occupation
Therapy Board member with an occupational therapist.
2:03:43 PM
MEGHAN PUDELER, Manager of State Affairs, American Occupational
Therapy Association (AOTA) , North Bethesda, Maryland, testified
in support of SB 47. She said AOTA is the national professional
association that represents the interests of more than 213,000
occupational therapists, students of occupational therapy, and
occupational therapy assistants. AOTA strongly supports the role
of state government in regulating the practice of occupational
therapy. She said the organization has advocated for state
occupational therapy laws with the same core licensure
requirements as successful completion of academic requirements
of an educational program for occupational therapists, or
occupational therapy assistants. The programs must be accredited
by the Accreditation Council for Occupational Therapy Education
(ACOTE) or predecessor organizations. Other requirements include
successful completion of a period of supervised field work
experience and passing the entry-level exam, she said.
MS. PUDELER said SB 47 proposes to revise qualifications for
licensing for occupational therapists and occupational therapy
assistants by removing from statute specific names of
organizations that exercise certification control over
occupational therapy. The bill would also clarify the
requirements for foreign-educated applicants. These changes will
also remove obsolete language, she said. The bill also proposes
a change to the composition of the board which will allow for
more balanced representation.
2:05:29 PM
JENNIFER CARLSON, Member, Alaska Physical Therapy and
Occupational Therapy Board, Fairbanks, Alaska, testified in
support of SB 47. She said she has served on the board since
March 2017. The changes in the bill are ones the board has
sought for many years. Further, SB 47 would update and clarify
the current law to ensure professional licensing requirements
and supporting documents are consistent and aligned with
national and international standards. A similar bill was
introduced in 2017, but due to the budget crisis and board
turnover, it did not get a hearing. She thanked the sponsor and
the committee for hearing the bill.
2:06:55 PM
CHAIR BISHOP opened public testimony and after determining no
one wished to testify, closed public testimony on SB 47.
CHAIR BISHOP stated that he would hold SB 47 in committee for
further consideration.
| Document Name | Date/Time | Subjects |
|---|---|---|
| SB 47 Sponsor Statement 1.30.2020.pdf |
SFIN 2/24/2020 9:00:00 AM SL&C 2/6/2020 1:30:00 PM |
SB 47 |
| SB47 Sectional Analysis vsn M 1.30.2020.pdf |
SL&C 2/6/2020 1:30:00 PM |
SB 47 |
| SB047- DRAFT Fiscal Note ver M- DCCED-CBPL- 01-31-2020.pdf |
SL&C 2/6/2020 1:30:00 PM |
SB 47 |
| SB 47 Work Draft vsn U 1.27.2020.pdf |
SL&C 2/6/2020 1:30:00 PM |
SB 47 |
| SB 47 Explanation of Changes ver M to U 2-5-2020.pdf |
SL&C 2/6/2020 1:30:00 PM |
SB 47 |
| SB 47 Supporting Document Current PT-OT Roster 1.31.2020.pdf |
SFIN 2/24/2020 9:00:00 AM SL&C 2/6/2020 1:30:00 PM |
SB 47 |
| SB 47 Supporting Document Principles of Practice 3.2015.pdf |
SL&C 2/6/2020 1:30:00 PM |
SB 47 |
| SB47 Supporting Document PT-OT comparison.pdf |
SL&C 2/6/2020 1:30:00 PM |
SB 47 |
| SB 47 Support Letters Received by 1.30.2020.pdf |
SL&C 2/6/2020 1:30:00 PM |
SB 47 |