Physical Therapists Practice Act Voted Out of House Committee

Legislation to update the practice act for physical therapists was introduced by Representative Bill Reineke (R- Tiffin) and Representative (R – Bowling Green) at the beginning of the 132nd . House Bill 131 was assigned to the House Health and Aging committee. Representative Gavarone, joint sponsor of this legislation, serves as the Health and Aging committee vice-Chairwoman. As introduced, House Bill 131 would have done two important things for the practice of Physical Therapy: clarify that “physical therapy” includes determining a diagnosis in order to treat a person’s physical impairments, functional limitations, and physical disabilities; determining a prognosis; and determining a plan of therapeutic intervention, and add that physical therapy includes ordering tests such as diagnostic imaging and studies that are performed and interpreted by other licensed health care professionals.

After hours of conference calls, meetings, and stakeholder discussions there has been an agreement reached. The Ohio State Medical Association, who came out as an opponent to the as-introduced bill, has agreed to take their positon to neutral by only moving the diagnosis portion of the bill forward at this time. The agreed to language reads: "Physical therapy diagnosis" means a judgment that is made after examining the neuromusculoskeletal system or evaluating or studying its symptoms and that utilizes the techniques and science of physical therapy to establish a plan of therapeutic intervention. "Physical therapy diagnosis" does not include a medical diagnosis.

After considerable effort, Sub. HB 131 was voted favorably out of the House Health Committee on Wednesday, March 21st. Although uncommon, the committee accepted the substitute version and voted on the legislation in the same day. The final vote count was 15 yes, 0 no. OPTA representatives are working with sponsors to pass the legislation out of the House in the coming weeks.

Substitute Licenses for Licensed Medical Professionals

Representative Jay Edwards (R- Nelsonville) introduced House Bill 491 which is intended to help cut down the burden of dual licensing for certain licensed related service personnel and their ability to work in a school based setting as a short and long-term substitute.

Currently, the Ohio Department of Education requires that school based PTs must obtain a Pupil Services License to practice in a school setting, in addition to the board license issued by the State. Many school districts across the State are seeing a shortage in many specified disciplines and it is becoming difficult to find short and long-term substitutes that need to have the additional professional licensure to provide the service to students. This legislation would apply for short and long-term substitute purposes only.

The proposed legislation would apply to the following licensed professionals:

1. School Speech-Language Pathologist 2. School Nurse 3. School Audiologist 4. Occupational Therapist 5. Physical Therapist 6. Occupational Therapy Assistant 7. Physical Therapy Assistant 8. School Social Worker House Bill 491 was reported out of House Education and Career Readiness Committee on March 21st with an amendment that requires substitute nurses to hold bachelor's degrees.

Licensure Board Considers Rule Revisions

The OTPTAT Board is considering a series of rule modifications. The OPTA has had the opportunity to review the proposed changes and have not identified anything problematic. The Board provided the following summary of the rules up for review.

4755-1-01, -02, -03: These rules govern notice given for various board activities under the occupational therapy section, including meetings, rule-making, and investigations. Rule amendments are proposed to simplify the language, streamline internal business practices, and refer to applicable Ohio Revised Code section instead of repeating language located elsewhere.

4755-3-11: This rule provides detail on what is needed to obtain a temporary license to practice as an occupational therapist or occupational therapist assistant in Ohio. No changes are proposed.

4755-24-03, -04, -05, -06, -07, -08. -09: These rules lay out the maximum amount of fees that can be charged for various activities under the physical therapy section. There are no plans to change the fee amounts that are currently in place. One change in 4755-24-05 eliminates the need for a notarized statement, which lines the rule up with current practice and places less burden on the licensee.

4755-48-01, -02: These rules detail processes for investigations, inspections, and discipline for the athletic trainer’s section. A slight change is being made to reflect current practice that a license holder in a disciplinary situation must pay for any health examinations required by the board.

Price Transparency

Representative and practicing physician Steve Huffman (R – Tipp City), has introduced House Bill 416 to address healthcare price transparency as well. HB 416 provides that beginning June 1, 2018 a healthcare provider must, on the request of a patient or the patient's representative, provide to that individual a reasonable, good faith estimate of the cost for each scheduled service. Under the bill "scheduled service" means a health care service or procedure that a patient or the patient's representative has scheduled at least seven days before the service or procedure is to occur.

The estimate may be given in writing, electronically, or verbally and must include the following:

• If the patient is insured, the estimate shall specify the amount the healthcare provider expects to receive as payment from the patient's health plan issuer for each scheduled service. • The estimate shall specify the amount that the patient or party responsible for the patient's care will be required to pay to the healthcare provider for each scheduled service. • The estimate shall include a disclaimer that the information provided is only an estimate based on facts available at the time the estimate was prepared and that other required health care items, services, or procedures could change the estimate. • If applicable and known to the healthcare provider at the time the estimate is given, the estimate shall include a notification that the provider is out-of-network for the patient.

The estimate required must be based on information available at the time the estimate is provided and need not take into account any information that subsequently arises, such as unexpected additional services or procedures. The legislation also provides that the patient is responsible for payment of the healthcare service or procedure even if they do not receive a cost estimate.

These requirements would not apply in either of the following circumstances:

1. The patient is insured and the health plan issuer fails to supply the necessary information to the health care provider within 48 hours of the provider's request to the issuer for that information. In that case, the health care provider may notify the patient or the patient's representative of the health plan issuer's failure. 2. The scheduled service the patient is to receive requires preauthorization from the patient's health plan issuer. In that case, section 3726.03 of the Revised Code applies.

House Bill 416 has had three hearings in the House Insurance committee. Providing remarks in support of the bill were the Ohio Hospital Association and the Ohio State Medical Association. Opposing the measure was the Ohio Association of Health Plans.

House Bill 289 – Would Require Review of All Boards and Commissions

Legislation has been introduced by Representatives Ron Hood (R – Ashville) and Rob McColley (R – Napoleon) that would require the Ohio General Assembly to review and evaluate all boards and commissions every five years. Without the legislature passing legislation to continue the operation of each licensing board, boards would automatically expire. During the review process “each board shall have the burden of demonstrating to the standing committee a public need for its continued existence.”

The legislative committee reviewing the board will look to provide for the “least restrictive regulation” for each profession to protect consumers from present, significant, and substantiated harms that threaten public health and safety. The legislative service commission (LSC) would also be charged with evaluating for the “least restrictive regulation”.

Under HB 289; "Least restrictive regulation" means the public policy of relying on one of the following, listed from the least to the most restrictive, as a means of consumer protection: market competition; third-party or consumer-created ratings and reviews; private certification; specific private civil cause of action to remedy consumer harm; actions under Chapter 1345. of the Revised Code; regulation of the process of providing the specific goods or services to consumers; inspection; bonding or insurance; registration; government certification; specialty occupational license for medical reimbursement; and occupational license.

The legislation goes on to specify that:

Where the state finds it is necessary to displace competition, the state will use the least restrictive regulation to protect consumers from present, significant, and substantiated harms that threaten public health and safety. The policy of employing the least restrictive regulation shall presume that market competition and private remedies are sufficient to protect consumers. Where needed, regulations shall be tailored to meet the predominate identified need to protect consumers, as follows:

(1) If regulations are intended to protect consumers against fraud, the appropriate state action shall be to strengthen powers under deceptive trade practices acts. (2) If regulations are intended to protect consumers against unsanitary facilities and general health and safety concerns, the appropriate state action shall be to require periodic inspections. (3) If regulations are intended to protect consumers against potential damages to third parties who are not party to a contract between the seller and buyer, and other types of externalities, the appropriate state action shall be to require bonding or insurance. (4) If regulations are intended to protect consumers against potential damages by transient providers, the appropriate state action shall be to require registration with the secretary of state. (5) If regulations are intended to protect consumers against asymmetrical information between the seller and buyer, the appropriate state action shall be to offer voluntary certification. (6) If regulations are intended to facilitate governmental reimbursement for providing medical services for an emerging medical specialty, the appropriate state action shall be to require a specialty occupational license for medical reimbursement.

This legislation has been referred to House Government Accountability and Oversight where it has had two hearings.

Since introduction of House Bill 289, Representative McColley was appointed to serve in the . He has introduced similar legislation, Senate Bill 255, which has the same intent of HB 289, without the anti trust provisions that were included in the previous budget bill. SB 255 has been referred to Senate Government Oversight and Reform where it has had two hearings.

Prohibiting Commercial Solicitation

Senators (R – Columbus) and (R – Lima) have introduced Senate Bill 148. SB 148 would create a section on accident reports that allow for those involved in an accident to indicate whether they wish to be contacted for commercial solicitation purposes. The bill goes on to further state that no person shall use the information contained in an accident report to contact any other person for commercial solicitation purposes unless that other person specified in the accident report that the person wishes to be contacted.

SB 148 is being considered by the Senate Local Government, Public Safety and Veterans Affairs Committee. There have been three hearings on the bill.

Legislation has also been introduced by Representative Catherine Ingram (D- Cincinnati) to prohibit the sale of personal information obtained from accident reports to prevent businesses from soliciting accident victims for profit. House Bill 331 is being dubbed the Accident Victim Privacy Protection Act.

Accident reports are available to the public form the Ohio Department of Public Safety or local law enforcement. Often times, vendors sell this information to businesses for medical or lawsuit purposes. House Bill 331 would allow victims to report this to the Ohio Attorney General’s office, which would warrant an investigation.

House Bill 331 has been referred to House Economic Development, Commerce, and Labor but has yet to be scheduled for a sponsor hearing.

Bus Driver Medical Exams

House Bill 338, introduced by Representative Ginter (R- Salem), is legislation that works to amend section 3327 of the Ohio Revised Code regarding medical examinations for school bus drivers. Current Ohio law requires school bus drivers to complete an annual physical, which can be administered by a number of medical professionals including Physician Assistants, Nurse Practitioners, Nurse Specialists, Nurse-Midwives, or any person licensed under Chapter 4731 to practice medicine and surgery or Osteopathic medicine and surgery.

House Bill 338 would amend the section above by including licensed Chiropractors as medical professionals who are qualified to perform an annual physical.

HB 338 has passed out of the House with a vote of 93-0 and is currently receiving hearings in Senate Government Oversight and Reform.

Medicaid's Skilled Therapy Rule Review

Medicaid recently proposed rule changes for the five skilled therapy rules (OAC 5160-8-30 through 34), which are proposed to be rescinded, streamlined and consolidated into a single new rule numbered 5160-8-35.

According the summary from Medicaid, the rule change proposals include:

Medicare provider requirement: This requirement and Medicare provider exemption language is being removed. This long standing policy was to avoid cost shifting to Medicaid for services covered by Medicare and assure access to dual eligible consumers for rehabilitation services. Coverage of developmental services has resulted in enrollment of many therapy providers whose patient population are not covered by Medicare so are not Medicare providers. This requirement has caused confusion and issues for ODM enrollment staff and providers.

Prescription for skilled therapy services: The Federal requirement that skilled therapy services must be rendered in response to either a prescription or referral from a licensed practitioner of the healing arts is being re-implemented. This requirement was removed from current rule in 2014. CMS has reiterated the Federal requirement of a physician or other licensed practitioner prescription for skilled therapy services (CFR 42~440.100). This condition does not apply to services rendered through the Medicaid school program due to a change in the Ohio Revised Code in 2017. Sub. H.B. 89 (131st General Assembly) authorizes certain physical therapists, occupational therapists, speech-language pathologists and audiologists to refer Medicaid recipients to services they provide so that the recipients can receive the services under the Medicaid school program.

Frequency of evaluations /reevaluations: Several multidisciplinary providers of developmental services have requested clarification of policy regarding reevaluation of patients. Language is being added to clarify allowable reevaluation frequencies for rehabilitative services (not more frequently than thirty days and the maximum period without reevaluation is sixty days) and developmental services (not more frequently than thirty days and the maximum period without reevaluation is six months).

OPTA participated on conference call with the Ohio Department of Medicaid on March 19, 2018. OPTA questioned the addition of the “Prescription for skilled therapy services” provisions, as this is not included in the current rule language nor was it included in the original draft changes released for comment.

Exemption from First Aid Training

It was brought to the attention of OPTA that PTs who are Board Certified in Sports Physical Therapy are also required to take a first aid training course and fulfill the requirements of the Pupil Activity Permit if they want to pursue a coaching position within certain school districts. There is an exemption to this requirement for many other licensed healthcare professionals. Upon reviewing the board certification requirements for sports physical therapy, we saw that many requirements are redundant. OPTA submitted a request to the Office of Educator Licensure within the Department of Education to ask that Physical Therapists who are Board Certified in Sports Physical Therapy also be exempt from these additional training requirements.

On March 8th Sports Certified Specialists were added to the list of providers and are now exempt from additional training requirements. For more information, please visit http://education.ohio.gov/Topics/Teaching/Licensure/Audiences/Coaching-Permits

Copies of legislation – Go to www.legislature.state.oh.us How to Contact Your Lobbyists

Amanda Sines and Mikayla Pollitt Government Advantage Group 17 South High Street, Suite 750 Columbus, Ohio 43215 614-221-7157 [email protected] [email protected]

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