February 21, 2003
HOUSE BILL No. 1174
_____
DIGEST OF HB 1174
(Updated February 20, 2003 10:34 AM - DI 77)
Citations Affected: IC 25-10; IC 25-27.
Synopsis: Physical therapists. Amends practices that are prohibited for
a physical therapist. Requires that a physical therapist adhere to the
profession's standard of ethics. Provides restrictions if a person goes to
a physical therapist without a referral. Allows a physical therapist to
treat a previously referred patient subsequently for the same condition.
Defines "manual adjustment" and "manual therapy".
Effective: July 1, 2003.
Hasler, Reske, Frizzell, Becker
January 8, 2003, read first time and referred to Committee on Public Health.
February 20, 2003, amended, reported _ Do Pass.
February 21, 2003
First Regular Session 113th General Assembly (2003)
PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana
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HOUSE BILL No. 1174
A BILL FOR AN ACT to amend the Indiana Code concerning
professions and occupations.
Be it enacted by the General Assembly of the State of Indiana:
SOURCE: IC 25-10-1-1.5; (03)HB1174.1.1. -->
SECTION 1. IC 25-10-1-1.5 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2003]: Sec. 1.5. (a) There is created
a board of chiropractic examiners. The board shall consist of seven (7)
members appointed by the governor, not more than four (4) of whom
may be affiliated with the same political party. Six (6) of the board
members must be licensed under this chapter and must have had at
least five (5) years of experience as a chiropractor prior to their
appointment. One (1) member is to represent the general public and
must be:
(1) a resident of this state; and
(2) in no way associated with the profession of chiropractic other
than as a consumer.
(b) All members shall be appointed for a term of three (3) years and
serve until their successors are appointed and qualified. A vacancy
occurring on the board shall be filled by the governor by appointment.
Each appointed member shall serve for the unexpired term of the
vacating member.
(c) The members of the board are entitled to the minimum salary per
diem provided by IC 4-10-11-2.1(b). Members are also entitled to
reimbursement for traveling expenses as provided under IC 4-13-1-4
and other expenses actually incurred in connection with the member's
duties as provided in the state policies and procedures established by
the Indiana department of administration and approved by the budget
agency.
(d) The members of the board shall organize by the election of a
chairman and a vice chairman from among its membership. The
officers serve for a term of one (1) year. The board shall meet at least
once each year and on other occasions as it considers necessary and
advisable. A meeting of the board may be called by its chairman or by
a majority of the members on the board. Four (4) members of the board
constitute a quorum for the transaction of business. All decisions are
required to be made by a majority vote of the quorum.
(e) The bureau shall provide a secretary of the board and other
personnel necessary for the proper performance of the board's duties
and responsibilities under this chapter. The board, through the bureau,
shall receive and account for all money collected under this chapter and
pay the money to the treasurer of state to be deposited by the treasurer
in the general fund of the state.
(f) The board may do the following:
(1) Establish reasonable application, examination, and renewal
procedures for certification under this chapter.
(2) Use an examination under this chapter that is designed by the
board, designed by another person, or designed in part by the
board and in part by another person.
(3) Conduct in the manner prescribed by the board examinations
of applicants for certification under this chapter. The board may
conduct any part of the examinations through a person other than
the bureau who is approved by the board. The bureau may
conduct any part of the examinations under IC 25-1-5-4.
(4) Issue, deny, suspend, revoke, and renew certificates.
(5) Subject to IC 25-1-7, investigate and conduct hearings, upon
complaint against individuals certified or not certified under this
chapter, concerning alleged violation of this chapter with hearings
to be conducted in accordance with IC 4-21.5.
(6) Initiate the prosecution and enjoinder of a person violating this
chapter.
(7) Adopt rules necessary for the proper performance of the
board's duties, in accordance with IC 4-22-2.
(8) Maintain a current list of individuals certified under this
chapter.
(9) Establish a code of professional conduct.
(10) Adopt rules under IC 4-22-2 to allow chiropractors licensed
under this chapter to delegate the manual manipulation, manual
adjustment, or manual mobilization of the spinal column or the
vertebral column under section 14(c)(4) 14(d)(4) of this chapter.
(11) Adopt rules under IC 4-22-2 establishing standards for the
registration and regulation of chiropractic management
consultants (as defined by the board under IC 25-10-2).
(12) Set fees for the annual registration of a chiropractic
management consultant under IC 25-10-2.
(g) The board shall adopt rules establishing standards for the
competent practice of the science of the chiropractic in accordance
with IC 4-22-2.
(h) All expenses incurred in the administration of this chapter shall
be paid from the state general fund upon appropriation being made in
the manner provided by law for the making of appropriations.
SOURCE: IC 25-10-1-14; (03)HB1174.1.2. -->
SECTION 2. IC 25-10-1-14 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2003]: Sec. 14. (a) This section
applies to all persons, including persons listed in IC 25-22.5-1-2.
(b) As used in this section, "manual adjustment" means a
skilled, passive, manual maneuver that:
(1) carries a joint complex beyond the normal physiological
range of motion;
(2) is applied without exceeding the boundaries of anatomical
integrity of the joint complex or other articulations; and
(3) is intended to result in cavitation of the joint or reduce
subluxation.
(c) A person may manually manipulate, manually adjust, or
manually mobilize the spinal column or the vertebral column of an
individual only if the person is:
(1) a chiropractor who has been issued a license under this
chapter;
(2) a physician who has been issued an unlimited license to
practice medicine under IC 25-22.5; or
(3) an osteopathic physician who has been issued a license to
practice osteopathic medicine under IC 25-22.5.
(c) (d) A person may not delegate the manual manipulation, manual
adjustment, or manual mobilization of the spinal column or the
vertebral column of an individual to another person, unless the other
person is:
(1) licensed as a chiropractor under this chapter;
(2) licensed as a physician with an unlimited license to practice
medicine under IC 25-22.5;
(3) licensed as an osteopathic physician with a license to practice
osteopathic medicine under IC 25-22.5;
(4) a student in the final year of course work at an accredited
chiropractic school participating in a preceptorship program and
working under the direct supervision of a chiropractor licensed
under this chapter; or
(5) a graduate of a chiropractic school who holds a valid
temporary permit issued under section 5.5 of this chapter.
(d) (e) If a violation of subsection (b) or (c) (c) or (d) is being
committed:
(1) the board in its own name;
(2) the board in the name of the state; or
(3) the prosecuting attorney of the county in which the violation
occurs, at the request of the board and in the name of the state;
may apply for an order enjoining the violation from the circuit court of
the county in which the violation occurs.
(e) (f) Upon a showing that a person has violated subsection (b) or
(c) (c) or (d), the court may grant without bond an injunction, a
restraining order, or other appropriate order.
(f) This section does not apply to a physical therapist practicing
under IC 25-27. However, a physical therapist may not practice
chiropractic (as defined in IC 25-10-1-1) or medicine (as defined in
IC 25-22.5-1-1.1) unless licensed to do so.
SOURCE: IC 25-27-1-1; (03)HB1174.1.3. -->
SECTION 3. IC 25-27-1-1 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2003]: Sec. 1. For the purposes of
this chapter:
(1) "Physical therapy" means the evaluation of, administration of,
or instruction in physical rehabilitative and habilitative
techniques,
manual therapy, and procedures to evaluate, prevent,
correct, treat, alleviate, and limit physical disability,
pathokinesiological function, bodily malfunction, pain from
injury, disease, and any other physical disability or
mental
disorder, including:
(A) the use of physical measures, agents, and devices for
preventive and therapeutic purposes;
(B) neurodevelopmental procedures;
(C) the performance, interpretation, and evaluation of physical
therapy tests and measurements; and
(D) the provision of consultative, educational, and other
advisory services for the purpose of preventing or reducing the
incidence and severity of physical disability, bodily
malfunction, and pain.
(2) "Physical therapist" means a person who practices physical
therapy as defined in this chapter.
(3) "Physical therapist's therapist assistant" means a person who
assists in the practice of physical therapy as defined in this
chapter.
(4) "Board" refers to the medical licensing board.
(5) "Committee" refers to the Indiana physical therapy committee
established under section 4 of this chapter.
(6) "Person" means an individual.
(7) "Manual therapy" means a group of techniques
comprising a continuum of skilled passive movements to the
joints or related soft tissues throughout the normal range of
physiological motion that are applied at varying speeds and
amplitudes, including a small amplitude and high velocity
therapeutic movement.
SOURCE: IC 25-27-1-2; (03)HB1174.1.4. -->
SECTION 4. IC 25-27-1-2 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2003]: Sec. 2. (a) Except as
otherwise provided in this chapter, it is unlawful for a person to
practice physical therapy or to profess to be a physical therapist,
physiotherapist, or physical therapy technician or to use the initials
"P.T.", "P.T.T.", or "R.P.T.", or any other letters, words, abbreviations,
or insignia indicating that the person is a physical therapist, or to
practice or to assume the duties incident to physical therapy without
first obtaining from the board a license authorizing the person to
practice physical therapy in this state.
(b)
It is unlawful for a person to practice physical therapy other than
upon the order or referral of a physician, podiatrist, psychologist,
chiropractor, or dentist holding an unlimited license to practice
medicine, podiatric medicine, psychology, chiropractic, or dentistry,
respectively. It is unlawful for a physical therapist to
do any of the
following:
(1) Use the services of a physical
therapist's therapist assistant
except as provided under this chapter.
For the purposes of this
subsection, the function of:
(1) teaching;
(2) doing research;
(3) providing advisory services; or
(4) conducting seminars on physical therapy;
is not considered to be a practice of physical therapy.
(2) Practice or offer to practice beyond the scope of the
practice of physical therapy.
(3) Promote an unnecessary device, a treatment intervention,
or a service for the financial gain of:
(A) the practitioner; or
(B) a third party.
(4) Provide treatment intervention unwarranted by the
patient's condition.
(c) A physical therapist shall refer a person under the physical
therapist's care to a physician, podiatrist, psychologist,
chiropractor, optometrist, or dentist and suspend treatment if:
(1) the physical therapist has a reasonable belief that
symptoms or conditions are present that require services
beyond the physical therapist's scope of practice; or
(2) physical therapy is contraindicated.
(d) If a person goes to a physical therapist without a referral,
the following restrictions apply:
(1) The physical therapist shall:
(A) refer the person to the person's own physician licensed
under IC 25-22.5 immediately if at least thirty (30) days
have elapsed since the person's initial visit to any physical
therapist for the same condition; and
(B) suspend treatment.
(2) The physical therapist may not render a medical diagnosis
but must evaluate the person to identify the person's
impairments, functional limitations, and disabilities that may
benefit from physical therapy.
(e) A person previously referred to a physical therapist may
receive subsequent treatment from the physical therapist for the
same condition for not more than twelve (12) months without
another referral from a physician, podiatrist, psychologist,
chiropractor, optometrist, or dentist.
(c) (f) Except as otherwise provided in this chapter, it is unlawful
for a person to act as a physical therapist's therapist assistant or to use
initials, letters, words, abbreviations, or insignia indicating that the
person is a physical therapist's therapist assistant without first
obtaining from the board a certificate authorizing the person to act as
a physical therapist's therapist assistant. It is unlawful for the person
to act as a physical therapist's therapist assistant other than under the
direct supervision of a licensed physical therapist who is in responsible
charge of a patient. or under the direct supervision of a physician.
However, nothing in this chapter prohibits a person licensed or
registered in this state under another law from engaging in the practice
for which the person is licensed or registered. These exempted persons
include persons engaged in the practice of osteopathy, chiropractic, or
podiatric medicine.
(g) This chapter does not authorize a person who is licensed as
a physical therapist to:
(1) practice medicine, surgery (as described in
IC 25-22.5-1-1.1(a)(1)(C)), dentistry, optometry, osteopathy,
psychology, chiropractic, or podiatric medicine; or
(2) prescribe a drug used in medicine.
(d) (h) This chapter does not authorize a person who is licensed as
a physical therapist or certified as a physical therapist's therapist
assistant to:
(1) evaluate any physical disability or mental disorder; except
upon the order or referral of a physician, podiatrist, psychologist,
chiropractor, or dentist;
(2) practice medicine, surgery (as described in
IC 25-22.5-1-1.1(a)(1)(C)), dentistry, optometry, osteopathy,
psychology, chiropractic, or podiatric medicine; or
(3) prescribe a drug or other remedial substance used in medicine.
SOURCE: IC 25-27-1-3.5; (03)HB1174.1.5. -->
SECTION 5. IC 25-27-1-3.5 IS ADDED TO THE INDIANA CODE
AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY
1, 2003]: Sec. 3.5. A physical therapist licensed under this chapter
may lawfully provide any service within the scope of physical
therapy (as defined in IC 25-27-1-1), notwithstanding any other
law.
SOURCE: IC 25-27-1-4; (03)HB1174.1.6. -->
SECTION 6. IC 25-27-1-4 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2003]: Sec. 4. (a) There is created
a five (5) member Indiana physical therapy committee to assist the
board in carrying out this chapter regarding the qualifications and
examinations of physical therapists and physical
therapist's therapist
assistants. The committee is comprised of:
(1) three (3) physical therapists;
(2) a licensed physician; and
(3) one (1) member who is a resident of the state and who is not
associated with physical therapy in any way, other than as a
consumer.
(b) The governor shall make each appointment for a term of three
(3) years. Each physical therapist appointed must:
(1) be a licensed physical therapist meeting the requirements of
this chapter;
(2) have had not less than three (3) years experience in the actual
practice of physical therapy immediately preceding appointment;
and
(3) be a resident of the state and actively engaged in this state in
the practice of physical therapy during incumbency as a member
of the committee.
SOURCE: IC 25-27-1-5; (03)HB1174.1.7. -->
SECTION 7. IC 25-27-1-5 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2003]: Sec. 5. (a) The committee
shall:
(1) pass upon the qualifications of physical therapists who apply
for licensure and physical therapist's therapist assistants who
apply for certification;
(2) provide all examinations either directly or by delegation under
subsection (c);
(3) determine the applicants who successfully pass examinations;
(4) license qualified applicants; and
(5) propose rules concerning the competent practice of physical
therapy to the board.
(b) The board shall adopt rules, considering the committee's
proposed rules, establishing standards for the competent practice of
physical therapy.
(c) The committee may approve and utilize the services of a testing
company or agent to prepare, conduct, and score examinations.
SOURCE: IC 25-27-1-6; (03)HB1174.1.8. -->
SECTION 8. IC 25-27-1-6 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2003]: Sec. 6. (a) Each applicant
for a license as a physical therapist or certification as a physical
therapist's therapist assistant must present satisfactory evidence that
the applicant:
(1) does not have a conviction for a crime that has a direct bearing
on the applicant's ability to practice competently; and
(2) has not been the subject of a disciplinary action initiated by
the licensing agency of another state or jurisdiction on the
grounds that the applicant was unable to practice as a physical
therapist or physical
therapist's therapist assistant without
endangering the public.
(b) Each applicant for a license as a physical therapist must submit
proof to the committee of the applicant's graduation from a school or
program of physical therapy that meets standards set by the committee.
Each applicant for a certificate as a physical
therapist's therapist
assistant must present satisfactory evidence that the applicant is a
graduate of a two (2) year college level education program for physical
therapist's therapist assistants that meets the standards of the
committee. At the time of making application, each applicant must pay
a fee determined by the board after
consideration of any
recommendation of the committee. committee's recommendation.
(c) An applicant may appeal the committee's decision to deny
licensure to the committee within fifteen (15) days after the applicant
receives notification of the committee's decision. Upon receiving an
appeal under this subsection, the committee shall set the matter for an
administrative hearing under IC 4-21.5.
SOURCE: IC 25-27-1-7; (03)HB1174.1.9. -->
SECTION 9. IC 25-27-1-7 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2003]: Sec. 7. (a) All examinations
of the applicants for licensure as physical therapists or for certification
as physical therapist's therapist assistants shall be held in Indiana at
least twice a year.
(b) Examinations shall include a written or computer examination
which must test the applicant's knowledge of the basic and clinical
sciences as they relate to physical therapy, physical therapy theory and
procedures, and such other subjects as the committee may deem useful
to test the applicant's fitness to practice physical therapy or to act as a
physical therapist's therapist assistant.
(c) Any qualified applicant who fails an examination and is refused
a license or certificate may take another examination within the time
limits set by the committee upon payment of after paying an additional
fee determined by the board after consideration of considering any
recommendation of the committee.
(d) Nothing in This section shall not be construed as prohibiting a
prohibition against any qualified applicant who has failed an
examination from making further application for a license to practice
physical therapy or for a certificate to act as a physical therapist's
therapist assistant when the application is accompanied by the fee
determined by the board after consideration of considering any
recommendation of the committee.
SOURCE: IC 25-27-1-8; (03)HB1174.1.10. -->
SECTION 10. IC 25-27-1-8 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2003]: Sec. 8. (a) The committee
shall license as a physical therapist each applicant who:
(1) successfully passes the examination provided for in this
chapter; and
(2) is otherwise qualified as required by this chapter.
(b) All licenses and certificates issued by the committee expire on
the date of each even-numbered year specified by the health
professions bureau under IC 25-1-5-4. A renewal fee established by the
board after
consideration of considering any recommendation of the
committee must be paid biennially on or before the date specified by
the health professions bureau, and, if not paid on or before that date,
the license or certificate becomes invalid without further action by the
committee. A penalty fee set by the board after consideration of
considering any recommendation of the committee shall be in effect
for any reinstatement within three (3) years from the original date of
expiration.
(c) An expired license or certificate may be reinstated by the
committee up to three (3) years after the expiration date if the holder
of the expired license or certificate:
(1) pays a penalty fee set by the board after consideration of
considering any recommendation of the committee; and
(2) pays the renewal fees for the biennium.
If more than three (3) years have elapsed since expiration of the license
or certificate, the holder may be reexamined by the committee. The
board may adopt, after consideration of considering any
recommendation of the committee, rules setting requirements for
reinstatement of an expired license.
(d) The committee may issue not more than two (2) temporary
permits to a physical therapist or physical therapist's therapist
assistant. A person with a temporary permit issued under this
subsection may practice physical therapy only under the direct
supervision of a licensed physical therapist who is responsible for the
patient. A temporary permit may be issued to any person who has paid
a fee set by the board after consideration of considering any
recommendation of the committee and who:
(1) has a valid license from another state to practice physical
therapy, or has a valid certificate from another state to act as a
physical therapist's therapist assistant; or
(2) has applied for and been approved by the committee to take
the examination for licensure or certification, has not previously
failed the licensure or certification examination in Indiana or any
other state, and has:
(A) graduated from a school or program of physical therapy;
or
(B) graduated from a two (2) year college level education
program for physical therapist's therapist assistants that meets
the standards set by the committee.
The applicant must take the examination within the time limits set by
the committee.
(e) A temporary permit issued under subsection (d) expires when
the applicant becomes licensed or certified, or approved for
endorsement licensing or certification by the committee, or when the
application for licensure has been disapproved, whichever occurs first.
An application for licensure or certification is disapproved and any
temporary permit based upon the application expires when the
applicant fails to take the examination within the time limits set by the
committee or when the committee receives notification of the
applicant's failure to pass any required examination in Indiana or any
other state.
(f) A holder of a license or certificate under this chapter who intends
to retire from practice shall notify the committee in writing. Upon
receipt of After receiving the notice, the committee shall record the
fact that the holder of the license or certificate is retired and release the
person from further payment of renewal fees. If a holder of the license
or certificate surrenders a license or certificate, reinstatement of the
license or certificate may be considered by the committee upon written
request. The committee may impose conditions it considers appropriate
to the surrender or reinstatement of a surrendered license or certificate.
A license or certificate may not be surrendered to the committee
without the written consent of the committee if any disciplinary
proceedings are pending against a holder of a license or certificate
under this chapter.
SOURCE: IC 25-27-1-9; (03)HB1174.1.11. -->
SECTION 11. IC 25-27-1-9 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2003]: Sec. 9. (a) The committee
may register and furnish a license
to or certify by endorsement any
applicant who presents evidence satisfactory to the committee of being
duly licensed to practice physical therapy or to act as a physical
therapist's therapist assistant in another state if the applicant is
otherwise qualified as required in section 6 of this chapter. However,
the committee shall register and furnish a license or certificate by
endorsement to any applicant who is licensed to practice physical
therapy or to act as a physical
therapist's therapist assistant in another
state if:
(1) the applicant is otherwise qualified as required under section
6(a) and 6(b) of this chapter; and
(2) the applicant has successfully passed a licensure examination
in another state equal to or exceeding the examination standards
of Indiana.
At the time of making an application, the applicant shall pay a fee
determined by the board after consideration of any recommendation of
the committee.
(b) The committee may license as a physical therapist or certify as
a physical
therapist's therapist assistant any person who has graduated
as a physical therapist or physical
therapist's therapist assistant,
whichever is appropriate, in a foreign country from an educational
program approved by the committee if the applicant presents
satisfactory evidence to the committee that the applicant:
(1) does not have a conviction for:
(A) an act that would constitute a ground for disciplinary
sanction under IC 25-1-9; or
(B) a crime that has a direct bearing on the applicant's ability
to practice competently; and
(2) has not been the subject of a disciplinary action initiated by
the licensing agency of another state or jurisdiction on the
grounds that the applicant was unable to practice as a physical
therapist or physical therapist's therapist assistant without
endangering the public;
and that the applicant has successfully passed the physical therapy
licensure or physical therapist's therapist assistant certification
examination provided for by this chapter. However, the committee, in
evaluating an educational program under this subsection, shall approve
at least three (3) credential evaluating agencies acceptable to the board
for the purpose of evaluating educational programs.
(c) At the time of making an application under subsection (b), the
applicant shall pay a fee determined by the board after consideration of
considering any recommendation of the committee.
SOURCE: IC 25-27-1-12; (03)HB1174.1.12. -->
SECTION 12. IC 25-27-1-12 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2003]: Sec. 12. A person who
violates this chapter commits a Class B misdemeanor. In addition, the
board may, in the name of the state, through the attorney general, apply
in any court to enjoin any person from practicing physical therapy or
acting as a physical
therapist's therapist assistant in violation of
IC 25-27-1-2. section 2 of this chapter.