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 Constitution) is being amended, the text of the existing provision will appear in this style type, additions will appear in this style type, and deletions will appear in this style type.
Additions: Whenever a new statutory provision is being enacted (or a new constitutional provision adopted), the text of the new provision will appear in this style type. Also, the word NEW will appear in that style type in the introductory clause of each SECTION that adds a new provision to the Indiana Code or the Indiana Constitution.
Conflict reconciliation: Text in a statute in this style type or this style type reconciles conflicts between statutes enacted by the 2002 Regular or Special Session of the General Assembly.

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.