Physical Therapists Practice Act Legislation Reaches Agreement

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1 Physical Therapists Practice Act Legislation Reaches Agreement Legislation to update the practice act for physical therapists was introduced by Representative Bill Reineke (R- Tiffin) and Representative Theresa Gavarone (R Bowling Green) at the beginning of the 132nd Ohio General Assembly. 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 will read: "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. OPTA representatives have been in constant communication with bill sponsors regarding the status and progress of Sub. HB 131. We are hopeful this version of the bill will be accepted and favorably passed 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: School Speech-Language Pathologist School Nurse School Audiologist Occupational Therapist Physical Therapist Occupational Therapy Assistant Physical Therapy Assistant School Social Worker House Bill 491 has already begun hearings before the House Education and Career Readiness Committee. A sponsor hearing has been held and the bill will have proponent testimony on February 27th. 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

2 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 of the Revised Code applies. House Bill 416 has had two hearings in the House Insurance committee. Ohio Right to Shop Act Introduced Representatives Mike Henne (R Clayton) and Jim Butler (R - Oakwood) have introduced comprehensive legislation regarding insurance and healthcare. The legislation would do all of the following: Price transparency/cost estimates Exempts a provider from giving a good-faith estimate if the health insurer has done so. Requires the good-faith estimate include the facility fee along with the professional s fee (along with applicable CPT codes). The cost estimate required by this section shall be based on information provided at the time an appointment is made or, in the absence of an appointment, at the time the patient initially presents for the health care product, service, or procedure. In addition, the estimate need not take into account any information that subsequently arises, such as unknown, unanticipated, or subsequently needed health care products, services, or procedures provided for any reason after the initial check-in or appointment. Only one estimate is required per visit. The cost estimate required by this section shall be provided within 24 hours of the date the appointment for the health care product, service, or procedure is made or the time the patient initially presents for the product, service, or procedure, whichever is sooner. If the insurer does not provide the healthcare professional the required information, the professional shall notify the patient that the insurer failed to comply. A patient is responsible for payment for an administered health care product, service, or procedure even if the patient does not receive a cost estimate under this section before the product, service, or procedure is received. If the service, product, or procedure is delivered in the hospital, the hospital is responsible for providing the estimate.

3 Requires licensure boards to create a document explaining the requirements in the bill. This document must be sent to all licensees annually. Insurers would be required to create a website for providers to submit necessary information to get the cost estimate. The site must also allow enrollees to generate estimates. Those websites must be submitted to ODI by October 18, The bill provides fining authority for violations against both the insurer and the provider though ODI, ODH, and the licensure boards. Prior Authorization Requires the Office of Health Transformation (OHT) to develop a standardized prior authorization form by January 1, Specifies that prior authorization is not required for drugs that cost less than $100 for a 30-day supply, or for medical equipment/tests/procedures that cost less than $100. Specifies that prior authorization is not required for the top 25% of prescribers that have prior authorizations approved. Additional provisions Requires OHT, in consultation with the Ohio Department of Insurance and the Ohio Department of Medicaid, to study the administrative burdens placed on healthcare providers. Puts limits and prohibitions on Step therapy protocols. Requires coverage to continue even when a drug is removed from a formulary or the insurer puts new restrictions on a product or procedure. Creates a Shared Saving Incentive Program which is a program established by a health plan issuer under which the health plan issuer provides to an individual covered under a health benefit plan offered by the issuer a shared savings incentive payment for utilizing a shoppable health care service. Shoppable health care services shall include health care services in the following categories: o Physical and occupational therapy services; o Obstetrical and gynecological services; o Radiology and imaging services; o Laboratory services; o Infusion therapy; o Inpatient and outpatient surgical procedures; o Outpatient nonsurgical diagnostic tests or procedures; o Any other category determined by the superintendent of insurance. The patient shall receive at least 50% of the savings. House Bill 399 has been referred to House Health where it is awaiting sponsor testimony. 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 of the Revised Code; regulation of the process of providing the specific goods or services to consumers;

4 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 Ohio Senate. 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. Prohibiting Commercial Solicitation Senators Stephanie Kunze (R Columbus) and Matt Huffman (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.

5 BWC Comments Submitted The OPTA, in conjunction with OOTA, submitted a letter to the Ohio Bureau of Workers Compensation in regards to Ohio Administrative Code OAC provides standards for governing reimbursement for health and behavior assessment and intervention (HBAI) services offered to injured workers. OPTA and OOTA requested that PTs and OTs be permitted to initiate this service. OPTA/OOTA requested that a healthcare practitioner should be able to initiate a referral for this service when health and behavior barriers are suspected to delay recovery. Currently a HBAI has to be requested by the physician of record. The OPTA/OOTA also commented on section (C)(3) which references a list of provider types who can provide assessment and intervention. It was suggested that this be modified to state the health and behavioral assessment may be performed by any practitioner that is qualified based on their education, training, and scope of practice to provide this service. Feedback from Ohio Bureau of Workers Compensation came on January 11 th. BWC completed their review and revisions and made updates. OPTA comments were accepted in part and the rule draft was modified to allow any provider acting within their scope to perform health and behavioral assessments. 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 has 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. OPTA representatives have stayed in contact with the Department regarding a decision to this request. Copies of legislation Go to How to Contact Your Lobbyists Amanda Sines and Mikayla Pollitt Government Advantage Group 17 South High Street, Suite 750 Columbus, Ohio amanda@gov-advantage.com mikayla@gov-advantage.com Follow us on Twitter!