SF 3083

as introduced - 92nd Legislature (2021 - 2022) Posted on 02/18/2022 09:52am

A bill for an act
relating to health occupations; modifying provisions governing the practice or
provision of physical therapy; amending Minnesota Statutes 2020, sections 148.65,
subdivisions 1, 5, 6; 148.706; 148.75; 148.76; repealing Minnesota Statutes 2020,
sections 148.65, subdivision 9; 148.77.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

Minnesota Statutes 2020, section 148.65, subdivision 1, is amended to read:

Subdivision 1.

Physical therapy.

As used in sections 148.65 to 148.78 the term "physical
therapy" means the evaluation or treatment or both of any person by the employment of
physical measures and the use of therapeutic exercises and rehabilitative procedures, with
or without assistive devices, for the purpose of preventing, correcting, or alleviating a
physical or mental disability. Physical measures shall include but shall not be limited to
heat or cold, air, light, water, electricity, and sound. Physical therapy includes evaluation,
diagnosis other than medical diagnosis, treatment planning, treatment, documentation,
performance of appropriate tests and measurement, interpretation of orders or referrals,
instruction, consultative services, and supervision of supportive personnel, and prevention,
wellness, fitness, health promotion, and education in populations of all ages. "Physical
therapy" does not include the practice of medicine as defined in section 147.081, or the
practice of chiropractic as defined in section 148.01.

Sec. 2.

Minnesota Statutes 2020, section 148.65, subdivision 5, is amended to read:

Subd. 5.

Student physical therapist.

"Student physical therapist" means a person in a
professional educational program, approved by the board under section 148.705, who is
satisfying supervised clinical education requirements by performing physical therapy under
the on-site supervision of a licensed physical therapist. "On-site supervision" means the
physical therapist is easily available for instruction to the student physical therapist. The
physical therapist shall have direct contact with the patient during at least every second
treatment session by the student physical therapist. Telecommunications, except within the
facility, does not meet the requirement of on-site supervision.

Sec. 3.

Minnesota Statutes 2020, section 148.65, subdivision 6, is amended to read:

Subd. 6.

Student physical therapist assistant.

"Student physical therapist assistant"
means a person in a physical therapist assistant educational program accredited by the
Commission on Accreditation in Physical Therapy Education (CAPTE) or a recognized
comparable national accrediting agency approved by the board. The student physical therapist
assistant, under the direct on-site supervision of the physical therapist, or the direct on-site
supervision of the physical therapist and physical therapist assistant team, performs physical
therapy interventions and assists with coordination, communication, documentation, and
patient-client-related instruction. "Direct "On-site supervision" means the physical therapist
or physical therapist assistant is physically present and immediately easily available to
provide instruction to the student physical therapist assistant. Telecommunications, except
within the facility, does not meet the requirement of on-site supervision.

Sec. 4.

Minnesota Statutes 2020, section 148.706, is amended to read:

148.706 PHYSICAL THERAPIST ASSISTANTS, AIDES, AND STUDENTS.

Subdivision 1.

Supervision.

(a) Every physical therapist who uses the services of a
physical therapist assistant or physical therapy aide for the purpose of assisting in the practice
of physical therapy is responsible for functions performed by the assistant or aide while
engaged in such assistance. The physical therapist shall delegate direct duties to the physical
therapist assistant and assign tasks to the physical therapy aide in accordance with subdivision
2.

(b) A licensed physical therapist may supervise no more than two physical therapist
assistants at any time. A physical therapist supervising physical therapist assistants is not
required to be on site, but must be easily available by telecommunications.

(c) Physical therapists who instruct student physical therapists and student physical
therapist assistants are responsible for the functions performed by the students and shall
supervise the students as provided under section 148.65, subdivisions 5 and 6. A licensed
physical therapist may supervise no more than two physical therapist assistants at any time.
A physical therapist supervising a student physical therapist shall have direct contact with
the patient during at least every second treatment session by the student physical therapist.
A physical therapist or physical therapist assistant supervising a student physical therapist
assistant shall have direct contact with the patient during at least every second treatment
session by the student physical therapist assistant.

Subd. 2.

Delegation Direction of duties.

The physical therapist may delegate is
authorized to direct patient treatment procedures only to a physical therapist assistant who
has sufficient didactic and clinical preparation. The physical therapist may not delegate
direct the following activities to the a physical therapist assistant or to other supportive
personnel: initial patient examination and evaluation, treatment planning, initial treatment,
change of treatment, development and modification of the plan of care, and initial or final
documentation.

Subd. 3.

Observation of Collaboration with physical therapist assistants.

When a
physical therapist directs components of a patient's treatment are delegated to a physical
therapist assistant, a physical therapist must provide on-site observation of the treatment
and documentation of its appropriateness at least every six treatment sessions. The physical
therapist is not required to be on site, but must be easily available by telecommunications.:

(1) have a real-time, collaborative treatment session, that takes place in person or remotely
via telehealth, with the physical therapist assistant; and

(2) document the continued appropriateness of the plan of care at least every six treatment
sessions.

Subd. 4.

Observation of physical therapy aides.

The physical therapist must observe
the patient's status before and after the treatment administered by a physical therapy aide.
The physical therapy aide may perform tasks related to preparation of patient and equipment
for treatment, housekeeping, transportation, clerical duties, departmental maintenance, and
selected treatment procedures. The tasks must be performed under the direct supervision
of a physical therapist who is readily available for advice, instruction, or immediate
assistance.

Sec. 5.

Minnesota Statutes 2020, section 148.75, is amended to read:

148.75 DISCIPLINARY ACTION.

(a) The board may impose disciplinary action specified in paragraph (b) against an
applicant or licensee whom the board, by a preponderance of the evidence, determines:

(1) has violated a statute, rule, order, or agreement for corrective action that the board
issued or is otherwise authorized or empowered to enforce;

(2) is unable to practice physical therapy with reasonable skill and safety by reason of
any mental or physical illness or condition, including deterioration through the aging process
or loss of motor skills, or use of alcohol, drugs, narcotics, chemicals, or any other type of
material;

(3) has been convicted of or has pled guilty or nolo contendere to a felony or other crime,
an element of which is dishonesty or fraud, or has been shown to have engaged in acts or
practices tending to show that the applicant or licensee is incompetent or has engaged in
conduct reflecting adversely on the applicant's or licensee's ability or fitness to engage in
the practice of physical therapy;

(4) has been convicted of violating any state or federal narcotic law;

(5) has obtained or attempted to obtain a license or approval of continuing education
activities, or passed an examination, by fraud or deception;

(6) has engaged in unprofessional conduct or any other conduct which has the potential
for causing harm to the public, including any departure from or failure to conform to the
minimum standards of acceptable and prevailing practice without actual injury having to
be established;

(7) has engaged in gross negligence in the practice of physical therapy as a physical
therapist or in providing physical therapy as a physical therapist assistant;

(8) has treated human ailments by physical therapy after an initial 90-day period of
patient admittance to treatment has lapsed, except by the order or referral of a person licensed
in this state in the practice of medicine as defined in section 147.081, the practice of
chiropractic as defined in section 148.01, the practice of podiatry as defined in section
153.01, or the practice of dentistry as defined in section 150A.05, or the practice of advance
practice nursing as defined in section 148.171, subdivision 3, when orders or referrals are
made in and whose license is in collaboration with a physician, chiropractor, podiatrist, or
dentist, and whose license is in good standing; or when a previous diagnosis exists indicating
an ongoing condition warranting physical therapy treatment, subject to periodic review
defined by board of physical therapy rule. The 90-day limitation of treatment by a physical
therapist without an order or referral does not apply to prevention, wellness, education, or
exercise;

(9) for a physical therapist licensed less than one year, has treated human ailments,
without referral, by physical therapy treatment without first having practiced one year in
collaboration with a physical therapist with more than one year of experience or under a
physician's orders or referrals as verified by the board's records;

(10) has failed to consult with the patient's licensed health care provider, or licensed
health care professional, who prescribed the physical therapy treatment if the treatment is
altered by the physical therapist from the original written order. The provision does not
include written orders to "evaluate and treat";

(11) (8) has inappropriately delegated directed components of a patient's treatment to a
physical therapist assistant or inappropriately assigned tasks to an aide, or inadequately
supervised a student physical therapist, physical therapist assistant, student physical therapist
assistant, or a physical therapy aide;

(12) (9) has practiced as a physical therapist performing medical diagnosis, the practice
of medicine as defined in section 147.081, or the practice of chiropractic as defined in
section 148.01;

(13) (10) has failed to comply with a reasonable request to obtain appropriate clearance
for mental or physical conditions that would interfere with the ability to practice physical
therapy, and that may be potentially harmful to patients;

(14) (11) has divided fees with, or is paying or promising to pay a commission or part
of the fee to, any person who contacts the physical therapist for consultation or sends patients
to the physical therapist for treatment;

(15) (12) has engaged in an incentive payment arrangement, other than that prohibited
by clause (14) (11), that tends to promote physical therapy overuse, that allows the referring
person or person who controls the availability of physical therapy services to a client to
profit unreasonably as a result of patient treatment;

(16) has failed to refer to a licensed health care professional a patient whose medical
condition has been determined by the physical therapist to be beyond the scope of practice
of a physical therapist;

(17) (13) has failed to report to the board other licensees who violate this section;

(18) (14) has engaged in the practice of physical therapy under lapsed or nonrenewed
credentials;

(19) (15) has had a license, certificate, charter, registration, privilege to take an
examination, or other similar authority denied, revoked, suspended, canceled, limited,
reprimanded, or otherwise disciplined, or not renewed for cause in any jurisdiction; or has
surrendered or voluntarily terminated a license or certificate during a board investigation
of a complaint, as part of a disciplinary order, or while under a disciplinary order;

(20) (16) has been subject to a corrective action or similar action in another jurisdiction
or by another regulatory authority; or

(21) (17) has failed to cooperate with an investigation of the board, including responding
fully and promptly to any question raised by or on behalf of the board relating to the subject
of the investigation, executing all releases requested by the board, providing copies of patient
records, as reasonably requested by the board to assist it in its investigation, and appearing
at conferences or hearings scheduled by the board or its staff.

(b) If grounds for disciplinary action exist under paragraph (a), the board may take one
or more of the following actions:

(1) deny the application for licensure;

(2) deny the renewal of the license;

(3) revoke the license;

(4) suspend the license;

(5) impose limitations or conditions on the licensee's practice of physical therapy,
including the: (i) limitation of scope of practice to designated field specialties; (ii) imposition
of retraining or rehabilitation requirements; (iii) requirement of practice under supervision;
or (iv) conditioning of continued practice on demonstration of knowledge or skills by
appropriate examination, monitoring, or other review of skill and competence;

(6) impose a civil penalty not to exceed $10,000 for each separate violation, the amount
of the civil penalty to be fixed so as to deprive the physical therapist of any economic
advantage gained by reason of the violation charged, to discourage similar violations, or to
reimburse the board for the cost of the investigation and proceeding including, but not
limited to, fees paid for services provided by the Office of Administrative Hearings, legal
and investigative services provided by the Office of the Attorney General, court reporters,
witnesses, reproduction of records, board members' per diem compensation, board staff
time, and travel costs and expenses incurred by board staff and board members;

(7) order the licensee to provide unremunerated service;

(8) censure or reprimand the licensee; or

(9) any other action as allowed by law and justified by the facts of the case.

(c) A license to practice as a physical therapist or physical therapist assistant is
automatically suspended if (1) a guardian of the licensee is appointed by order of a court
pursuant to sections 524.5-101 to 524.5-502, for reasons other than the minority of the
licensee; or (2) the licensee is committed by order of a court pursuant to chapter 253B. The
license remains suspended until the licensee is restored to capacity by a court and, upon
petition by the licensee, the suspension is terminated by the Board of Physical Therapy after
a hearing.

Sec. 6.

Minnesota Statutes 2020, section 148.76, is amended to read:

148.76 PROHIBITED CONDUCT.

Subdivision 1.

Licensure required.

(a) No person shall:

(1) provide physical therapy unless the person is licensed as a physical therapist or
physical therapist assistant under sections 148.65 to 148.78;

(2) use the title of physical therapist without a license as a physical therapist or use the
title physical therapist assistant without a license as a physical therapist assistant issued
under sections 148.65 to 148.78;

(3), in any manner hold out as a physical therapist or as a provider of physical therapy,
or use in connection with the person's name the words or letters Physical Therapist, Doctor
of Physical Therapy, Physiotherapist, Physical Therapy Technician, Registered Physical
Therapist, Licensed Physical Therapist, PT, DPT, PTT, RPT, LPT, or any letters, words,
abbreviations or insignia indicating or implying that the person is a physical therapist,
without a license being licensed as a physical therapist issued under sections 148.65 to
148.78. To do so is a gross misdemeanor;

(4) (3) use the title of physical therapist assistant, in any manner hold out as a physical
therapist assistant, or use in connection with the person's name the words or letters Physical
Therapist Assistant, P.T.A., or any letters, words, abbreviations, or insignia indicating or
implying that the person is a physical therapist assistant, without a license being licensed
as a physical therapist assistant under sections 148.65 to 148.78. To do so is a gross
misdemeanor; or

(5) (4) employ fraud or deception in applying for or securing a license as a physical
therapist or physical therapist assistant.

(b) No person, business entity, or an employee, agent, or representative of a business
entity shall use in connection with that person's name or with the activity of the business,
the words physical therapy or physiotherapy or any other words, abbreviations, or insignia
indicating or implying, directly or indirectly, that physical therapy is provided or supplied,
unless the services are provided by or under the direction and supervision of a person licensed
as a physical therapist under sections 148.65 to 148.78. No person or business entity shall
advertise or otherwise promote another person as being a physical therapist or physiotherapist
unless the person who is advertised or promoted is licensed as a physical therapist under
sections 148.65 to 148.78. A person or business entity that offers, provides, or bills any
other person for services shall not characterize the services as physical therapy or
physiotherapy unless the services are provided by or under the direction and supervision of
a person licensed as a physical therapist under sections 148.65 to 148.78.

(c) Nothing in sections 148.65 to 148.78 prohibits a person licensed or registered in this
state under another law from carrying out the therapy or practice for which the person is
duly licensed or registered.

Subd. 2.

Prohibitions Prohibition.

(a) No physical therapist may:

(1) treat human ailments by physical therapy after an initial 90-day period of patient
admittance to treatment has lapsed, except by the order or referral of a person licensed in
this state to practice medicine as defined in section 147.081, the practice of chiropractic as
defined in section 148.01, the practice of podiatry as defined in section 153.01, the practice
of dentistry as defined in section 150A.05, or the practice of advanced practice nursing as
defined in section 62A.15, subdivision 3a, when orders or referrals are made in collaboration
with a physician, chiropractor, podiatrist, or dentist, and whose license is in good standing;
or when a previous diagnosis exists indicating an ongoing condition warranting physical
therapy treatment, subject to periodic review defined by Board of Physical Therapy rule.
The 90-day limitation of treatment by a physical therapist without an order or referral does
not apply to prevention, wellness, education, or exercise;

(2) use any chiropractic manipulative technique whose end is the chiropractic adjustment
of an abnormal articulation of the body; and

(3) treat human ailments other than by physical therapy unless duly licensed or registered
to do so under the laws of this state.

(b) No physical therapist licensed less than one year may treat human ailments, without
referral, by physical therapy treatment without first having practiced one year in collaboration
with a physical therapist with more than one year of experience or under a physician's orders
or referrals as verified by the board's records.

Subd. 3.

Violations.

(a) A person or business entity that violates this section is guilty
of a gross misdemeanor.

(b) The board may impose a civil penalty, not to exceed $10,000 for each separate
violation, against any person or business entity that violates subdivision 1. In addition, the
board may seek an injunction against conduct that violates subdivision 1 in any court of
competent jurisdiction. For purposes of this paragraph, in seeking an injunction, the board
need only show that the defendant violated subdivision 1 to establish irreparable injury or
a likelihood of a continuation of the violation.

Sec. 7. REPEALER.

Minnesota Statutes 2020, sections 148.65, subdivision 9; and 148.77, are repealed.

APPENDIX

Repealed Minnesota Statutes: 22-05581

148.65 DEFINITIONS.

Subd. 9.

Licensed health care professional or licensed health care provider.

"Licensed health care professional" or "licensed health care provider" means a person licensed in good standing in Minnesota to practice medicine, osteopathic medicine, chiropractic, podiatry, dentistry, or advanced practice nursing.

148.77 VIOLATIONS.

Any person violating the provisions of section 148.76 is guilty of a gross misdemeanor.