How Assembly Bill 1000 Will Affect Your Practice

How Assembly Bill 1000 Will Affect Your Practice

On October 7, 2013, Governor Brown approved Assembly Bill 1000.  This new law, effective January 1, 2014, will likely benefit both physical therapists and patients seeking physical therapy treatment.

Allow Patients to Directly Access Physical Therapy

The most important aspect of AB 1000 is that it allows patients direct access to physical therapy without first obtaining a referral from a physician. [1] Prior to AB 1000, patients could only see a physical therapist for an evaluation, fitness and wellness services, and treatment for a condition that had been the subject of a medical evaluation.  Individuals seeking relief from pain and injuries were required to get a physician diagnosis and referral before a physical therapist could treat them.  Effective January 1, 2014, patients can obtain treatment directly through a physical therapist, rather than having to first see a physician.

However, there are several limitations to AB 1000. First, patients who receive direct treatment from a physical therapist are limited to 45 calendars days or 12 visits of treatment, whichever occurs first.  Once the 45 days or 12 visits are exhausted, the physical therapist must notify the patient’s physician (not including chiropractors) that the physical therapist is treating the patient.  The written disclosure must be in 14- point font, delineate the time period, plan of care and include the patient’s written authorization.  Approval of the physical therapist’s plan of care must include an in-person patient examination and evaluation of the patient’s condition and, if indicated, testing by the physician.  Patients who see a physical therapist for wellness services or who already have obtained a medical diagnosis are excluded from this limitation.

Additionally, if the physical therapist has reason to believe the patient has a condition requiring treatment or services beyond the physical therapist’s scope of practice, or if the patient is not progressing toward documented treatment goals, the physical therapist must refer the patient to another specified healing-arts practitioner.

Further, when a person initiates physical therapy treatment services directly, the physical therapist must first provide the following notice to the patient, orally and in writing, in at least 14-point type:

Direct Physical Therapy Treatment Services.  You are receiving direct physical therapy treatment services from an individual who is a physical therapist licensed by the Physical Therapy Board of California.  Under California law, you may continue to receive direct physical therapy treatment services for a period of up to 45 calendar days or 12 visits, whichever occurs first, after which time a physical therapist may continue providing you with physical therapy treatment services only after receiving, from a person holding a physician and surgeon’s certificate issued by the Medical Board of California or by the Osteopathic Medical Board of California, or from a person holding a certificate to practice podiatric medicine from the California Board of Podiatric Medicine and acting within his or her scope of practice, a dated signature on the physical therapist’s plan of care indicating approval of the physical therapist’s plan of care and that an in-person patient examination and evaluation was conducted by the physician and surgeon or podiatrist.

The physical therapist must obtain the patient’s signature acknowledging receipt of the notice.

Physical Therapy Corporations/Expansion of Physical Therapists Into Multi-Disciplinary Practices.

Prior to AB 1000, the California Physical Therapy Board took the position that physical therapists could not work for medical doctors or other healthcare practitioners. AB 1000 amends Section 13401.5 of the Corporations Code to authorize the organization of physical therapy corporations. Effective January 1, 2014, physical therapists must practice in one of the types of professional corporations identified in section 13401.5 if they practice in a corporate form. If you are a physical therapist currently working in a general business corporation, we recommend you amend your Articles of Incorporation and convert your corporation into a physical therapy corporation.

AB 1000 permits physical therapists to be shareholders, directors and officers of certain specified professional corporations. [2] It also allows certain other types of professionals to be officers, directors, and shareholders of physical therapy corporations. [3] Notably, chiropractors and chiropractic corporations are excluded from these lists. At the same time, the bill provides “This section does not limit employment by a professional corporation designated in this section of only those licensed professionals listed under each subdivision.” Thus, while they may not be shareholders, officers or directors, physical therapists may be employees of chiropractic corporations. Similarly, while chiropractors may not be shareholders, officers or directors, chiropractors may be employees of physical therapy corporations.

As with all other multi-disciplinary professional corporations in California, there are limitations and restrictions that must be followed when forming such a practice. Look for our upcoming article detailing how physical therapists may participate in multi-disciplinary professional corporations.

Referrals By Other Providers

AB 1000 seeks to reduce concerns regarding referrals by providers who refer individuals to services and facilities in which they have an ownership interest. The new law adds Section 2406.5 to the Business and Professions Code, and requires that practitioners provide verbal and written disclosure of such referral, informing the patient of his or her right to obtain physical therapy from a physical therapist of his or her choice; and of any financial interest the referring practitioner may have in treating or referring the patient. Such written disclosure must be in at least 14-point font and signed by the patient.

If you have questions about physical therapy corporations or the employment of physical therapists, please contact one of the attorneys at Carlson & Jayakumar.

[1] See Business and Professions Code §2620.1.
[2] Physical therapists may be employed by the following types of corporations: medical, podiatric medical, and naturopathic.
[3] The following types of professionals may be employees, shareholders, officers, and directors of a physical therapy corporation : physicians and surgeons, doctors of podiatric medicine, acupuncturists, naturopathic doctors, occupational therapists, licensed speech-language therapists, licensed audiologists, registered nurses, licensed psychologists, land licensed physician assistants.

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