Sunrise request of the Arizona Association for Home Care

              Arizona House of Representatives
House Majority Research
MEMORANDUM
Kristine Stoddard~
Assistant Legislative Research Analyst
( 602) 926- 5299
To: JOINT LEGISLATIVE AUDIT COMMITTEE
1700 w. Washington
Phoenix, AZ 85007- 2848
FJLK ( 602) 417- 3140
cc: Representative Rick Murphy, Chair
Senator Jim Waring, Vice- Chair
Re: Sunrise application of the Arizona Association for Home Care
Date: December 2, 2005
Attached is the final report ofthe sunrise request submitted by the Arizona Association for Home
Care, which was conducted by the Senate Health and House ofRepresentatives Health Committee
ofReference.
This report has been distributed to the following individuals and agencies:
Governor ofthe State ofArizona
The Honorable Janet Napolitano
President ofthe Senate
Senator Ken Bennett
Senate Members
Senator Jim Waring, Vice- Chair
Senator Carolyn Allen
Senator Marsha Arzberger
Senator Robert Cannell
Senator Barbara Leff
Arizona Association for Home Care
Department of Library, Archives & Public Records
Auditor General
Senate Republican Staff
Senate Research Staff
Senate Democratic Staff
Speaker ofthe House ofRepresentatives
Representative Jim Weiers
House Members
Representative Rick Murphy, Chair
Representative David Bradley
Representative Laura Knaperek
Representative Linda Lopez
Representative Doug Quelland
House Majority Staff
House Research Staff
House Democratic Staff
Senate Health and House ofRepresentatives Health
Committee ofReference Report
Sunrise Request ofthe Arizona Association for Home Care
Date: December 2, 2005
To: Joint Legislative Audit Committee
Representative Rick Murphy, Chair
Senator Jim Waring, Vice- Chair
Background
Pursuant to Arizona Revised Statutes ( ARS) § 32- 3104, the Joint Legislative Audit
Committee assigned a sunrise review for physical therapist assistants to the Senate Health
and House of Representatives Health Committee of Reference. Attached is a copy of the
application submitted by the Arizona Association for Home Care ( Association).
According to Arizona Revised Statutes ( ARS) § 32- 2001, a physical therapist assistant is
a person who is certified by the Arizona Board of Physical Therapy ( Board) and who
performs physical therapy procedures and related tasks. A physical therapist assistant is
selected and delegated tasks by a supervising physical therapist. The practice of physical
therapy means examining, evaluating and testing people who have mechanical,
physiological and developmental impairments, functional limitations and disabilities or
other health and movement related conditions in order to determine a diagnosis, a
prognosis and a plan of therapeutic intervention and to asses the ongoing effects of
intervention. The practice of physical therapy also includes alleviating impairments and
functional limitations by managing, designing, implementing and modifying therapeutic
interventions by using various techniques defined in statute.
According to ARS § 32- 2043, physical therapist assistants must function under the on- site
supervision of a licensed physical therapist. ARS § 32- 2001 defines on- site supervision
as the supervising physical therapist is on site and is present at the facility or on the
campus where the physical therapist assistant is performing services. The Arizona
Association for Home is requesting an increase in scope of practice because it believes
there is a lack of available physical therapists to serve the home health population. The
Association would like physical therapist assistants to conduct home health visits under
the general supervision of a licensed physical therapist instead of on- site supervision.
General supervision would allow physical therapist assistants to perform routinely
designated tasks in a home health setting, with the physical therapist available by
telephone for consultation.
Committee ofReference Sunrise Review Procedures
The Committee of Reference held one public meeting on November 8, 2005 to review the
Association's sunrise application as required by ARS § 32- 3104 and to hear public
testimony on the proposed changes.
Committee ofReference Recommendations
The Committee of Reference recommends that the Legislature expand the scope of
practice for licensed physical therapist assistants by allowing home health visits under the
general supervision of licensed physical therapists.
Attachments:
1. Sunrise application submitted by the Arizona Association for Home Care.
2. Meeting notice.
3. Minutes of the Committee of Reference meeting.
Arizona House of Representatives
House Majority Research
MEMORANDUM
1700 W. Washington
Phoenix, AZ 85007- 2848
FAX ( 602) 417- 3140
To: Members of the House and Senate Health Committees of Reference
Re: Sunrise Request of the Arizona Association for Home Care
Date: October 26, 2005
The following memo is background information regarding the request for an increase in the scope of
practice of physical therapist assistants. Also attached is a copy of the sunrise application submitted
by the Arizona Association for Home Care ( Association). A public meeting is scheduled for
November 8, 2005 to allow you to ask questions of the Association, take public testimony, and make
a fmal recommendation as to the Association's request. Ifyou have any questions or need additional
information, please feel free to contact me.
BACKGROUND
According to Arizona Revised Statutes ( ARS) § 32- 2001, a physical therapist assistant is a person
who is certified by the Arizona Board of Physical Therapy ( Board) and who performs physical
therapy procedures and related tasks. A physical therapist assistant is selected and delegated tasks by
a supervising physical therapist. The practice of physical therapy means examining, evaluating and
testing people who have mechanical, physiological and developmental impairments, functional
limitations and disabilities or other health and movement related conditions in order to determine a
diagnosis, a prognosis and a plan of therapeutic intervention and to asses the ongoing effects of
intervention. The practice of physical therapy also includes alleviating impairments and functional
limitations by managing, designing, implementing and modifying therapeutic interventions by using
various techniques defmed in statute.
October 26, 2005
To become certified as a physical therapist assistant in Arizona, a person must be of good moral
character, complete the application process, graduate from an accredited physical therapist assistant
education program, successfully pass a jurisprudence examination on the Board's statutes and rules
and pass the national examination. Currently, the Board certifies 423 physical therapist assistants.
SCOPE OF PRACTICE INCREASE
According to ARS § 32- 2043, physical therapist assistants must function under the on- site
supervision of a licensed physical therapist. ARS § 32- 2001 defines on- site supervision as the
supervising physical therapist is on site and is present at the facility or on the campus where the
physical therapist assistant is performing services. The physical therapist must be immediately
available to assistant the individual being supervised and must maintain continued involvement in the
aspects ofthe treatment session. Physical therapists are directly responsible for patient care given by
physical therapist assistants that are under their supervision, including accurate documentation and
billing of services provided and must verifY the qualifications of the physical therapist assistants
under their supervision. Physical therapists may delegate acts, tasks or procedures to physical
therapist assistants, but they must fall within the scope of physical therapy practice and must stay
within the boundaries ofphysical therapist assistant's education. On each date of services, a physical
therapist must provide and document all of the therapy that requires a physical therapist and must
determine how to use a physical therapist assistant to ensure the delivery of care that is safe.
The Arizona Association for Home Care is requesting an increase in scope of practice because it
believes there is a lack of available physical therapists to serve the home health population. The
Association would like physical therapist assistants to conduct home health visits under the general
supervision of a licensed physical therapist instead of on- site supervision, as required by the state
currently. General supervision would allow physical therapist assistant to perform routinely
designated tasks in a home health setting, with the physical therapist available by telephone for
consultation.
2
October 26, 2005
The Association is requesting physical therapist assistants to make home health care visits
independently, only after the physical therapist has conducted the initial patient visit and outlined the
plan of care to be performed physical therapist assistant. By allowing physical therapist assistants to
perform therapy in the home health setting, the Association believes the availability of physical
therapy treatments will increase. The Association feels that the public can be confident with
allowing physical therapist assistants operate under general supervision because only the location of
where they practice will change, not their regulated scope of practice. Physical therapist assistants
would still not be able to initiate care, make the initial patient visit unsupervised, make any changes
to the plan of care, or discharge patients. The physical therapist assistant would also be required to
have any chart notation signed off by the physical therapist. According to the Association, the
sunrise application is not a recommendation requesting a change in responsibility of physical
therapist assistants because the supervising physical therapist will still be responsible for the actions
ofthe assistant they are supervising, on or off site.
OTHER STATES
Several states including Arizona, Maryland, New Jersey and Pennsylvania do not allow general
supervision of physical therapist assistants. The remaining 46 states allow some form of direct
or general supervision, some more permissive than others. For example, Florida Statutes
§ 486.021 allow physical therapist assistants that are working for an orthopedic physician or a
physiatrist to practice under the general supervision of a physical therapist and on- site
supervision is not required. However, for all other health care practitioners, physical therapist
assistants must work with the on- site supervision of a physical therapist. Georgia requires that in
a home health setting, the physical therapist assistant and the supervising physical therapist meet
once a week and that the physical therapist make on- site visits no less than every sixth visit. The
following are examples of states that require general supervision.
3
October 26, 2005
GENERAL SUPERVISION
California - California Codes § 2655 authorizes physical therapist assistants to practice without
direct supervision of a physical therapist. However, according to California Code of Regulations
Title 16, Division 13.2, Article 4, § 1398.44, a licensed physical therapist must be responsible for all
physical therapy services provided by a physical therapist assistant. Additionally, the supervising
physical therapist must be readily available in person or by telecommunication to the physical
therapist assistant at all times while the physical therapist assistant is treating patients. The
supervising physical therapist must also provide periodic on- site supervision and observation of the
assigned patient care given by the physical therapist assistant.
Montana - Montana Code § 37- 11- 105 states that a physical therapist assistant must practice under
the supervision of a licensed physical therapist who is responsible for a patient's care. Supervision
meaning that the physical therapist must make on- site visits to patients at least once for every six
visits made by an assistant or at least once every two weeks, whichever occurs first.
South Carolina - South Carolina Code Title 40, Chapter 45, § 40- 45- 300 specifies that a physical
therapist assistant must function under the supervision of a licensed physical therapist and must only
perform duties after the evaluation of a patient is conducted by a licensed physical therapist. In
South Carolina, supervision means that a physical therapist must reevaluate a patient's plan of care
every eighth treatment or every sixty calendar days, whichever comes first.
4
• •
ARIZONA ASSOCIATION FOR HOME CARE
To: Joint Legislative Audit Committee
From: Arizona Association for Home Care
Re: Increasing the Scope of Practice of a Licensed. Physical Therapy
Assistant
Enclosure: Sunrise Application
To Whom It May Concern:
The Arizona Association for Home Care respectfully submits this Sunrise
Application to the Joint Legislative Audit Committee, and the Research Analysts
for both the House and Senate, to request a Sunrise Hearing on increasing the
scope of practice of a licensed physical therapy. assistant.
Page 1 Y! 1.. M.. -, .
~
ARIZONA ASSOCIATION FOR HOME CARE
Table of Contents:
Background Information Page 3
Application , , , , Page 6
Appendix A Page 9
Association Contact Information
Appendix B , , , '" ., , : , Page 11
Arizona Association for Home Care Informal Survey Results
Appendix C Page 12
Arizona Association for Home Care/ Arizona Physical Therapy Association
On- line Survey Results
Appendix D , , , ." , Page 13
Research synopsis to date, including a State Supervision Matrix
Appendix E Page 14
Language the Arizona Association for Home Care Supports:
North Dakota
New York
Page 2
Backgroundlnformafion
This section is intended to provide the Joint Legislative Audit Committee, Senate
and House of Representatives staff, Elected Officials and the general public with
information on the steps thatthe Arizona Association for Home Care ( AAHC) has
taken to date in an attempt to alleviate the physical therapy shortage, prior to
requesting legislative change.
• This issue was brought to the forefront during an AAHC Legislative Affairs
Committee meeting in fall of 2004. AAHC decided the first step was to
meet with the Arizona Chapter of the American Physical Therapy
Association ( AZPTA), and legislators to discern a reaction to the idea of
allowing a licensed physical therapy assistant ( PTA) to make home health
visits under the general supervision of a licensed physical therapist ( PT).
Current Arizona statutes specify that a PTA must be under the direct
supervision of a PT.
• After several attempts, AAHC was able to schedule an initial meeting on
January 18, 2005 with representatives fromAZPTA. During this brief
meeting, AZPTA agreed to take the issue back: to their Board of Directors
and return with feedback and comments. Hearing no response from
AZPTA, AAHC next met with legislators and staff to discuss our issue.
• AAHC met with Representative Doug Quelland ( R- 10), Chairman of the
House Health Committee, and staff and were advised that to proceed with
this statutory change, AAHC would need to submit a sunrise application.
• AAHC then went before the Arizona State Board of Physical Therapy ( PT
Board) during the January 25, 2005 meeting. The PT Board
recommended working with AZPTA and obtaining statistical data from
home care agencies on the lack of availability of home health physical
therapists. For results, please ~ ee Appendix S, page 10. Mr. Robert
Direnfeld, President of the AZPTA, went on record stating that AZPTA was
against allowing PTAs to make home health visits, but that they would be
willing to work with AAHC to research alternative solutions.
• AAHC invited AZPTA and the PT Board to a working meeting on June 2,
2005, where several alternatives to legislative change were discussed.
Some of those include the following:
o AZPTA including an article in their July newsletter written by a PT
encouraging the practice of physical therapy in the home health
industry.
Page 3
o A survey was created and sponsored by both the AZPTA and
AAHC with the intention of gathering information on the physical
therapists knowledge, as well as aversion to or · interest towards
working in the home health arena. Physical therapists were then
asked if they had ever worked in a State that utilized physical
therapy assistants as an integral part of their health care system.
Additionally, participants were provided an opportunity to enter their
personal information if they would like the option of contracting with
a home health care agency to work additional cases according to
their specified schedule and geographic location. For results,
please see Appendix C, page 12.
o AZPTA and AAHC had originally scheduled a follow- up meeting for
August 9, 2005, but due to unavoidable circumstances, AAHC re­scheduled
that meeting to August 25,2005.
• The follow- up meeting took place on August 25,2005. This was a shorter
re- cap meeting, with only a few items at the table for discussion. Please
note, there were representatives from both AAHC and AZPTA present, but
the PT Board was not at the meeting. AAHC notified the PT Board ( via e­mail)
of the outcome.
o The results of the co- sponsored survey were discussed. It was
determined that the results are not statistically valid, since only 33
responses were gathered from the approximately 1,000 physical
therapists that received the survey. Being cognizant of the
AZPTA's position on increasing the scope of practice of a PTA, but
in the effort to obtain more relevant data for our cause, the AAHC
has decided to create an independent survey, which will be mailed
out to every licensed physical therapist in the state.
o Also discussed was the opportunity of collaborating on an
education course, where physical therapists could attend a
workshop on physical therapy practice in the home health arena,
and earn continuing education credits.
o AAHC expressed their concern that while the steps taken to date
have been helpful, they are not truly addressing our concerns with
the shortage of physical therapists. Mr. Direnfeld explained that we
are not the only industry currently experiencing a shortage, and that.
they are going through a " hiccup" in the system. The number of
physical therapy students is growing, and we should be out of a
shortage in 2- 3 years. AAHC stills feels urgency, as Arizona's older
population is also growing, and there is a continuing demand for
physical therapy services, which cannot be met. Therefore, the
Page 4
MHC decided to submit a sunrise application in order to take this
issue one step further.
AAHC has contacted interested stakeholders, and conducted several meetings in
an attempt to find a suitable solution to the inability to provide the necessary
physical therapy services for home health patients. Still faced with opposition,
and rapidly approaching the deadline for the Sunrise Application, AAHCdecided
to submit this application, in the hopes that with legislator guidance and approval,
AAHC and the AZPTA can come to consensus to help resolve the shortage of
physical therapists to meet the needs of home bound patients.
Page 5
Application
1.) Define the problem, and why an increased scope of practice is
necessary, including consumers need and benefits, if an increase is
granted .
There is a lack of available physical therapists to serve the home
health patient population. An informal survey of the MHC agency
members revealed that approximately 32% of physical therapy patients
referred to home health agencies ( in February 2005) were denied care
due to lack of available physical therapists. After several meetings and
brainstorming sessions with stakeholders ( please see Background,
page 3), AAHC has determined that increasing the scope of practice of
a licensed physical therapy assistant is the most logical solution to
relieve the inability to serve our homebound patient population.
We propose that the Arizona Revised Statutes be amended to allow
physical therapy assistants to conduct home health visits for an
Arizona Medicare licensed home care agency under the general
supervision of a licensed physical therapist. Currently, a physical
therapy assistant is required to practice under the " on- site supervision
of a licensed physical therapist." CA. R. S. 32- 2043)
On- site supervision is defined in State Statute · as follows: the
" supervising physical therapist is on site and present at the facility or
on the campus where the assistive personnel or holder of an interim
permit is performing services, is immediately available to assist the
person being supervised in the services being performed and
maintains continued involvement in appropriate aspects of each
treatment session in which a component of treatment is delegated."
( A. R. S. 32- 2001)
AAHC recommends that physical therapy assistants be allowed to
perform routinely designated tasks in the home health setting, while
the physical therapist is available by telephone for consultation.
Allowing physical therapy assistants to perform therapy for home
bound patients under the indirect supervision of a licensed physical
therapist will increase the availability of physical therapy treatments,
that have been determined necessary by the physical therapist as
ordered by the physician.
Page 6
2.) The extent to which the public can be confidant that qualified
practitioners are competent
Currently, physical therapy assistants are required to complete the
following education requirements:
• . Must complete a two- year education program, typically offered by
a community college or a junior college, and receive an
associate's degree
• In Arizona, physical therapy assistants are required to be
graduates of an education program accredited by a national
accreditation agency approved by the PT Board, and pass the
national examination approved by the PT Board in order to be
certified to practice.
The. public can be confident that the physical therapy assistants are
competent because the currently regulated scope of practice would
not be altered, only the location where they can practice. Physical
therapy assistants would not be allowed to initiate care, make the
initial patient visit unsupervised, make any changes to the plan of
care, or discharge patients. Ideal legislation would allow physical
therapy assistant's to make a visit independently, after the physiCal
therapist has already conducted the initial patient visit, and outlined
the plan of care to the assistant. The physical therapy assistant
would be required to have any chart notation signed off by the
physical therapist, and the physical therapist would be required to
make a recurring visit as needed or specified by statute.
3.) The extent to which an increased scope of practice may harm the
public
Increasing the scope of practice of a licensed physical therapy
assistant will not endanger the public. The home care agency and the
many existing regulatory bodies will continue to monitor the actions of
the physical therapist and the physical therapy assistant. For example,
the Arizona Department of Health Services regularly conducts frequent
and unannounced lengthy surveys of home health agencies, during
which home care visits are conducted ( with licensed staff). In addition,
patient charts are reviewed, employee files are examined, and staff
and patients are interviewed, all to ensure that home health agencies
are maintaining quality care of their patients.
Page 7
Licensed physical therapists are currently regulated in this manner and
licensed physical therapy assistants would fall under this same review
schedule. This sunrise application is not a recommendation
requesting a change in responsibility; the supervising physical therapist
will still be responsible for the actions of the assistant they are
supervising, on or off site. The same safeguards currently in practice
to protect the public will remain in place.
In researching other states, AAHC has determined that there is a trend
to allow indirect supervision. Research in some states ( namely
California) also revealed that the number of PTA complaints is not
higher in states where indirect supervision is allowed, as compared to
states where indirect supervision is not allowed.
4.) The estimated cost to the state and the general public of
implementing the proposed increase in scope of practice
Any cost that is incurred in implementing physical therapy assistants
into the home setting would be absorbed by the individual licensed
home care agency. There will be no additional cost to the State or the
general public. There is a potential reduction in the cost of physical
therapy treatments for homebound residents as physical therapy
assistants are paid at a lower rate than physical therapists.
Page 8
Appendix A
Contact Information
Suzanne B. Gilstrap
Government Affairs, AAHC
Capitol Consulting, LLC
2302 N. Third Street
Phoenix, AZ 85004
602- 712- 1121
Suzanne@ capitolconsultingaz. com
Michelle Hindman
Capitol Consulting, LLC
2302 N. Third Street
Phoenix, AZ 85004
602- 712- 1121
Miche! le@ capitolconsultingaz. com
. Marie Fredette
Administrator
Arizona Association for Home Care
2302 N. Third Street
Phoenix, AZ 85004
602- 712- 9822
Marie@ capitolconsuitinqaz. com
Karen Jeselun
President, AAHC
4615 South 33rd Place
Phoenix, AZ 85040 .
602- 252- 5000 ext 202
karen@ azhomecare. com
Jane Irvine
President Elect, AAHC
Hospice of the Valley
1510 E. Flower Street
Phoenix, AZ 85014
602- 287- 7050
iirvine@ hov. org
Page 9
Mike Savastio
Legislative Affairs Chair, AAHC
All At Home Health Care
3295 N. Drinkwater Blvd., Ste. 1
Scottsdale, AZ 85251
480- 970- 3700
mike@ allathome. org
Robert B. Direnfeld, PT
President, Arizona Physical Therapy Association
2001 W Orange Grove Rd., Ste. 114
Tucson, AZ 85704
520- 297- 8842
rbdpt1@ aol. com
Susie Stevens
Stevens & Stevens, P. C.
2700 N. Central, Ste. 100
602- 265- 4370
Susie@ stevensandstevenslaw. com
Jeff Baxter
Stevens & Stevens, P. C.
2700 N. Central, Ste. 100
602- 265- 4370
Jeff@ stevensandstevenslaw. com
Heidi Herbst- Paakkonen
Executive Director, Arizona State Board of Physical Therapy
1400 W. Washington, Ste. 230
Phoenix, AZ 85007
602- 542- 3095
heidi. herbst- paakkonen@ ptboard. state. az. us
Page 10
Appendix B
Arizona Association for Home Care Informal Survey Results
Survey Period:
Title:
Purpose:
Scope:
February 2005
PHYSICAL THERAPY SURVEY
Provide AAHC Liaison to the Legislative Affairs Committee
with statistical data to document the shortage of physical
therapy providers in the home health field resulting in the
inability to provide necessary services to homebound
patients, both adults and children.
To track the number of patients referred and denied physical
therapy care during the month of February. -
Participating agencies:
Correctly completed surveys:
Percentage of AAHC agency members participating:
Results of correctly completed surveys:
Number of patients denied physical therapy due to lack of staff:
Total number of patients referred:
Percentage of denied patients:
Page 11
8
7
20.5%
273
868
31.5%
Appendix C
Arizona Association for HomeCare/ Arizona Physical Therapy Association
. On- line Survey Results
Please see attached
* Please note, this survey was conducted on www. surveymonkey. com. and is still
active. These are the responses collected to date.
Page 12
Survey Summary
1. How many years have you; practiced as a Physical Therapist?
( 3 Privacy ~ Contact Us 0< Logout
Response Response
Percent Total
Less than 1 f4i'rf
1- 3 •
6.1%
3%
90.9%
2
1
30
Total Respondents 33
( skipped this question) 0
2. Do you have experience in any of the following areas? ( Please check all that apply)
Long Tenn Care Facility ~ 1T!!? if~'"
Skilled Nursing Fadlity W: rt! t'Ff'~-= T'E= Hr......"'.': « TN
Inpatient Rehab w, r · · .,."'* fe- sr
" . i; · i
Other ( please specify) i:~~
Response Response
Percent Total
71.9% 23
43.8% 14
62.5% · 20
50% 16
68.8% 22
12.5% 4
62.5% 20
25% 8
Total Respondents 32
( skipped this question) 1
3. If you haven't had previous experience in Home Health, what inhibits your practice in this area of care?
( Please check all that apply)
Travel TIme F"" W"
Pay.-
Working Alone ""'"
Paperwork & l! PitF~~ W
Uability "' a1"~
Level of Care
Personal Costs ( i. e. cellphone, fax, i~",,~ p.:>~ Ji
etc.. )
I currently work in the Home He;~~~ r= T~~-
Response Response
Percent Total ·
16% 4
4% 1
12% 3
40% 10
12% 3
0% 0
16% 4
36% 9
24% 6
Total Respondents 25
( rlrin. no< rI ~ hic: nnp. c:: tion \ 8
4. What would entice you into the Home Health Reid? ( Please check all that apply)
Response Response
Percent Total
37.5% 9
45.8% 11
29.2% 7
54.2% 13
37.5% 9
16; 7%. 4
70; 8% 17
29.2% 7
66.7% 16
70.8% 17
37.5% 9
20.8% 5
16.7% 4
Total Respondents 24
( skipped this question) 9
Weekend Only work rr¥,? f:!" p" TW
CEU Expenses Paid · """' i'ft! f! ff1f' 1T! aI'i! 1 Tlm.,,- · · ' f
Cellphone ifi" fWjjJf'~' I! pn!,
Paid TIme Off ~ 1f!!'! ff
Aexibile Schedule flffflm"? rW..... 1 ..._
Geographic Location of Choice f.,. ttfffk!! 1" rF~= r
Weekend Differential """"""" fi!!!! l
5. What do you think the annual income is of a Home Health Physical Therapist?
0- 45,000
45,000- 55,000 r
75,000+ iff" fl!? t'tfj'ff! f! li
Other ( please spedfy) III
Response Respons
Percent Total
0% 0
6.5% 2
38.7% 12
25.8% 8
22.6% 7
6.5% 2
Total Respondents 31
( skipped this question) 2
6. Would you be interested in learning more about the Home Health industry in a wo~ kshop setting if CEU's
were offered?
Response Response
Percent Total
Otner ( please spedfy)
69%
31%
0%
20
9
o
Total Respondents 29
( skipped this question) 4
7. Have you ever practiced physical therapy in a state where the use of physical therapy assistants to make
generalfy supervised home health visits was an integral part of the system?
Response Response
Percent Total
Yes iWfifftp- g;
No~~"' B¥ W;:
Other ( please specify) iI
jQ i!
18.8%
78.1%
3.1%
6
25
1
Total Respondents . 32
( skipped this question) 1
8. Would you be interested in having your contact · information available on a password protected Homecare
Web site so Home Health Agencies in need of PT services could contact you directly? By answering yes f you
will be prompted to enter your name and e- mail address for further contact. By answering no, the survey is
complete. Thank you for your participation.
Response Response
Percent Total
. Other ( please specify) 11III
45.5%
51.5%
9.1%
15
17
3
9. Please enter your name below
10. Please enter your e- mail address below
Total Respondents 33
( skipped this question) 0
IVI~ J Total Respondents 17
( skipped this question) 16
[ Vi! biJ Total Respondents 17
( skipped this question) 16
Appendix D
Research Synopsis:
In addition to the attached matrix, please refer to the points below, which
highlight additional research conducted on behalf of AAHC:
• Nebraska has the following provision in section 71- 2811 of their State
statutes:
o Physical therapist assistant; perform physical therapy services;
requirements
• Any physical therapist assistant certified under section 71­2808
to 71- 2822 to perform physical therapy services may
perform those services only:
• In the office of the physical therapist to whom the
physical therapist assistant is assigned
• When the physical therapist to whom he or she is
assigned is present or providing supervision
• In a hospital, with the approval of the appropriate
authority of such hospital, where the physical
- therapist to whom he or she is assigned is a member
of the staff, or .
• On calls outside the office of the physical therapist
when the assigned patients and the place of practice
of the physical therapist assistant are identical to that
of the primary care supervisory physical therapist to
whom he or she is assigned. A satellite office staffed
solely by a physical therapist assistant is prohibited.
State Supervision Matrix
Please See Attached
Page 13
StateSupervision Comparison
Arizona Association for Home Care
I General ~ up~ rvision or I PT/ PTA I I
PT's - 7 1,600 IPT must provide direction to a PTA and
Alabama National oversee their activities on a regularly
" DlrectIOn" PTA's - 7 1,300
scheduled basis.
Outlines specific duties of a PT vs.
PTA, for example, that the supervising
Alaska I General Supervision I PT I National I ??? I PT make an on site visit at least once a
month, and be available for consultation
with the PTA by telephone, verbally, or
in writing.
Arizona I Direct On- Site I PT/ PTA I National I
PT's - 7 3,034 IPTA's shall perfonn designated routine
Supervision PTA's - 7 395
tasks under the on- site supervision ofa
PT.
Allows a PTA to operate under the
supervision of a PT; supervision is
defined as the PT " retains moral, ethical
Arkansas I General Supervision IPT/ PTA I National I ?? 7 I and legal responsibi~ ity for patient care
and is readily available for
consultation... the supervising PT is not
required to' be ' on- site, but must be at
least available by teleconununication.
PT's must be available telephonically to
PT's - 7 over PTA's at all times, after they have
California I General, unles. s have \ PT/ PTA \ National \ 30,000 received their license. Before they are
not completed llcensure PTA's - 7 around licensed, PTA's require on- site
7,000 supervision. Scope determined by
supervising PT and Board Rules.
Permits PTA's to be under the
responsible direction and supervision of
Colorado I General Supervision I PT I National I ??? I a PT. No reference to direct
supervision, although it is defined in
statute as on- site suvervision
Supervision is defined as the
" overseeing of or the participation in the
workof a PTA bya licensed PT
including but not limited to continuous
Connecticut I General Supervision I PT/ PTA I National I 777 I availability or directcommunication
between the PT and the PTA, and the
availability of a PT to review on a
regular basis the practice of a PTA and
support the PTA in the perfonnance of
their services;
Allows indirect supervision if the PTA
has had one year or more ofwork
experience, and requires on- site face to
face supervision at least once every fifth
Delaware I General Supervision I PT I National I 777 I treatment day or once every three
weeks, whichever occurs first. Requires
the PT to be available and accessible by
telecommunications to the PTA during
all working hours of the PTA.
Specifies under which cases a PIA may
Florida I Allo,: s both Gen~ r~ l I PTIPTA I National I 777 I practice under the general supervision .
and Dlfect SupervlSlon of a PT, and when they must practice
under the onwsite supervision of a PT.
Allows a PTA to practice " lmder the
general supervision and direction of a
PT, iftheir license is in " good
standing." Has specific provisions for
the home health setting, including
Georgia I General Supervision I PT/ PTA I National I 777 I requiring a consult with the PTA the PT
is supervising at least once a week,
chart documentation requirements, and
requiring the PT to make an on- site visit
to the patient no less than every sixth
visit.
Difficult to determine, outlines the
Hawaii I ?? 7 I PT/ PTA I National I 777 I duties ofthe supervising PI in statute,
but makes no reference to requiring on-site
01' general supervision.
PTA's are allowed to practice under the
Idaho I General Supervision I PT/ PTA I National I 777 I general supervision of a PT, requiring
the PT to be available by means of
telecommunications.
The PTA may perform patient care
activities under the general supervision
of a PT, and the PT must maintain
Illinois I General Supervision I PT/ PTA I National I 777 I continual contact with the PTA
including periodic personal supervision
and instmction to insure the safety and
welfare of the oatient.
Page 3
Indiana
Iowa
Off- Site Direct
Supervision by a
Physical Therapist or a
Physician
Both General and On­site
Supervision
PT/ PTA
PT/ PTA
National.
National
Pl" rT~ 4
777
777
Requires a daily communication with
the supervisingPT or physician, but
allows the PTA to perform services off
site. Requires the supervising PT or
physician to make a patient examination
every 14 days for patients ina hospital,
every 90 days or 6 physical therapy
visits for patients in a facility for the
mentally retarded or developmentally
disabled, and every 30 days or 15
physical therapy visits for all other
patients. Requires the daily
communication to be via
telecommunications, if not face to face.
Allows a PTA to work in varyiilg
settings with varying supervision
requirements. For example, a PTA
working in the home health setting is
required to have a PT visit every 4
patient visits or 9 consecutive calenda~'
days, while a PTA working in a hospital
acute care is required to have a PTvisit
every 3 patient visits or 2 consecutive
calendar days. All other supervision is
on- site. Statue also outlines the specific
tasks of a PT and a PTA.
Allows a PTA to work under the
" direction" ofaPT, anddirection is
defined as the PT seeing allpatients
initially and evaluating the periodically
Kansas I General Supervision I PT/ PTA I National I 777 I except in those cases in a hospital
setting when the PT is not immediately
available, the PTA may initiate patient
care after telephone contact with the PT
for documented instruction.
Allows general supervision of a
licensed PTA by a licensed PT, who is
readily available and accessible by
Kel1tucky I General Supervision I PT/ PTAI National I 777 I telecommunications during the working
hours of the PTA. Outlines the
respective duties of both the PT and the
PTA.
In the home health setting, the
Depends on the setting, supervising PT must be readily
General Off- Site accessible by beeper or mobile phone,
Louisiana I Supei: vision allowed in PT/ PTA National 777 and conduct a once weekly face- to- face
the Home Health patient care conference with each PTA
Setting to review progress and modification of
treatment for all patients.
Requires a PTA to be under the
direction of a PT, and defines direction
as
Maine I General Supervision I PT/ PTA I National I 777 I continuing verbal and written contact by
a PT with a PTA including periodic on-site
supervision adequate to ensure the
. safety and welfare of the patient.
Page 5
A licensed PTA may practice only
under the direction of a licensed PT
Maryland I Direct Supervision I PT/ PTA I National I 777 I who gives ongoing onsite supervision
and instruction that is adequate to
ensure the safety and welfare of the
atient.
Allows for the general supervision of a
Massachusetts , General Supervision I PT/ PTA I National I 777 I licensed PTA, and outlines specific
duties they can and cannot perfonTI.
Michiflan I - 777 I PT I National I PT's~ 6,765 No mention ofPTA's in statute.
Minnesota I General Supervision PT/ PTA National 777 Allows a licensed PTA to practice under
, the general supervision of aPT.
Mississivvi I Direct Sunervision PT National 777 Requires direct on- site supervision
" A licensed PT shall direct and
supervise a PTA at all times ... no PT
Missouri I Direct Supervision I PT/ PTA I National I 777 I may establish a treating office in which
the PTA is the primary care provider, no
licensed PT shall have under their direct
supervision more than four PTAs."
Montana' I General Supervision I PTIPTA I National I 777 IAllows a licensed PTA to practice under
the Ileneral sunervision of a PT.
Pl'lae 6
Supervision means responsible
supervision andcontrol when a licensed
PT assumes legal liability for the
services ofaPTA. Except in cases of
emergency or when appropriate duties
Direct Supervision, and protocols have been outlined in the
Nebraska I except in specifically PT National ??? initial application and approved by the
defined circumstances board, supervision shall require that the
PT be present on the premises of the
practice site for consultation and
direction of the actions of the PTA.
Prohibits the use of a satellite office
staffed solely by a PTA.
PTA's are required to be supervised on~
site until they have worked 2,000 hours,
I General, after the PTA _\ PT/ PTAI I PT's ~ 972 Iand then ( with the sponsorshipofaPT)
Nevada National
PTA's ~ 278
they can be under " general
has worked 2,000 hours
supervision." Scope determined by
supervising PT and Board Rules and
Regulations
Allows a licensed PTA to practice under
New I \ PT/ PTA \ National
\
???
I the general supervision of a Ucensed
Hampshire
General Supervision PT, requiring the PT to be available via
telecommunications for PTA
consultation.
Direct onsite supervision is required of
New Jersey I Direct Supervision I PT/ PTA I National I ??? I PTA's. However, the laws are
sunsetting, and are currently under
review.
Page 7
PTis responsible for a written plan of
care, arid may assign responsibilities to
thePTA as defined in the Accreditation
New Mexico I General Supervision I PT/ PTA I National I PT's 7 1,160 I Handbook, the American Physical
PTA's -) 236 Therapy Association. The PTA may
not make changes to a plan of care, and
must have daily notes co- signed by the
supervising PT.
Continuous ( general)
New Y() rk allows " continuous
New York I
Supervision in the
PT
supervision," but not specifically on- site
Horne Health Setting National 777 or direct supervision of a PTA who is
Allowed
assisting in the home care services
setting.
Allows a PTA to engage in off- site
patient related activities that are
North Carolina I General Supervision I PT/ PTA I National I 777 I appropriatefor the PTA's qualifications
and the status of the patient, and may
document C8Je provided without the
cosignatme ofthe supervising PT.
Allows general supervision specifically
General supervision,
in the home health, long term care and
school settings. Requires on- site
North Dakota I with specific provisions PT National ? 7? supervision in hospitals and other
re: home health clinical settings. Additionally allows a
PTA to document care provided without
thecosignature of the supervising PT.
The PT shall select the appropriate
portions of the patient treatment/ plan of
Ohio I General Supervision I PTIPTA I NationallLicensme I PT's -) 6,288 I care tobe delegated to the PTA. Any
by Examination PTA's 7 4,216 reports completed by the PTA to be
included in the patient's record shall be
co- signed by the suoervisinQ: PT.
. Page 8
General supervision is defined as " the
responsible supervision and control of
the practice of the licensed PTA by the
Oklahoma I General Supervision I PT/ PTA I National I ? 7? I PT." When non on- site, the PT must be
on- call or readily available either
physically of through direct
telecommunication.
Provides that a PTA may provide
treatment only when a PT is available.
Available is defined as " readily
Oregon I General Supervision I PT/ PTA I National I ? 7? I accessible for consultation with the
assistant, either in person or by means
of telecommlmications." Also outlines
duties that a PTA may not perform.
Pennsylvania I Direct Supervision I PT/ PTA I National I 777 I Requires the direct on premise
supervision of a physical therapist.
Allows a PTA to be the on- site
supervisor for both physical therapist
assistant students, and additional
Rhode Island I General allowed, in I PT/ PTA \ National I ??? \ supportive persOlmeL Requires a PT to
certain settings be available via telecommunications to
the PTA at all times during treatment.
Outlines the respective responsibilities
of a PT/ PTA.
Allows general supervision of a
licensed PTA, unlicensed PTA's or
South Carolina I General Supervision I PT/ PTA I National I 7?? , students must be under the on- site
supervision of a licensed PT or a
licensed PTA.
Page 9
Supervision is defined as " the
responsibility ofthe PT to observe,
direct, and review the work, records,
and practice... to ensure the patient, the
South Dakota I General Supervision I PT I National I 777 I PT and the PTA that good and safe
treatment is rendered." Requires the PT
to be available telephonically, and that
the PTA's first patient visit be ajoint
visit with the supervising PI.
Statute outlines the responsibilities of
the supervising PI, and states that a
licensed PI may not supervise a PIA
that is working at a site further than 60
Tennessee I General Supervision I PT/ PTA I National I . 777 I miles or one hour from the PI's
primary practice address, and must be
available by telephone Or other means
when the PIA is off- site delivering
services.
State Statute does · not limit the number
of assistants/ aides that Can. be
PT's~ 8,686
. supervised. Requires a PI to be on call
Texas I General Supervision I PI/ PIA I National · I I and. readily ~ vailable when service~ are PTA's~ 3,784 bemg prOVIded, and may only assIgn
responsibilities based on aPTA's
training.
Utah I General Supervision I PI I National I 777 I Activities must be directed and
aooroved bv the suoervisi11l1 PT.
Page 10
The PT must make regular visits at
reasonable frequency to the place where
the PTA is providing service. Also
Vermont I General Supervision I PTIPTA I National I 777 I describes duties of the PT and PTA, and
requires the PT to make a recuning visit
every 5th visit or 30 days, whichever
occurs first.
Code outlines the tasks that can be
performed by a PT as well as a PTA.
Virginia I General Supervision I PT/ PTA I National I 777 I PT has full responsibility for all
assistive persollile1. PT's can directly
supervise no more than 3 assistive
ersol1l1el at a time. +
PT is responsible for patient care given
Washington I A! lo:" s both dire. c: and I PT/ PTA IBoardapproved PTA I 777
I by any staff under their supervision, and
State Code specifies the duties that can
md1rect superv1siOn program.
only be performed by a PT. Requires a
PT to make a recurring visit.
Supervision~ " authoritative procedural
guidance by a licensed PT for the
accomplishment of a function or
West Virginia I General Supervision I PT/ PTA I National I 777 I activity with initial direction and
periodic inspection on a regular basis by
a PT of the actual act of accomplishing
the function or activity."
Licensed PTA'smay practice under the
Wisconsin I General Supervision I PTIPTA I National I 777 I general supervision of a licensed PT.
Wisconsin Statute outlines the duties
that both aPT and aPTA may perform.
I PT/ PTA I NationallR~ gistration
RegisteredPT's and PTA's may both
Wyoming I General Supervision 777 delegate duties and activities to be
Requued
erformed b " assistive persollilel."
Page 11
Appendix E
Examples of other States supervision statutes
North Dakota § 61. S- QS- 01- 02
• Service in home health, long- term care, and school settings
o A qualified physical therapist must be accessible bycommunication
to the physical therapist assistant at all times while the physical
therapist assistant is treating the patient.
o An initial visit must be made by a qualified physical therapist for
evaluation of the patient and establishment of a plan of care.
o A joint visit by the physical therapist and the. physical therapist
assistant or a conference between the physical therapist and
physical therapist assistant must be made prior to or on the first
physical therapist assistant visit to the patient. The physical
therapist must complete the initial evaluation
o . At least once every sixth physical therapist assistant visit or at least
once every thirty- calendar days, whichever occurs first, the physical
therapist must visit the patient. Following each onsite visit by a
physical therapist, the medical/ education record must reflect a
documented conference with the physical therapist assistant
outlining treatment goals and program modification. · The physical
therapist must make the final visit to terminate the plan of care.
o A supervisory onsite visit must include
• An onsite functional assessment
• Review of activities with appropriate revisions or termination
of plan of care
• Assessment of utilization of outside resources.
Page 14
New York § 6738
• For the purposes of the provision of physical therapist assistant services in
a home care services setting.... whether such services are provided by a
home care services agency or under the supervision of a physical
therapist licensed pursuant to this article, continuous supervision of a
physical therapist assistant, who has had direct clinical experience for a
period of not less than two years, by a licensed physical therapist shall not
be construed as requiring the physical presence of such licensed physical
therapist at the same time and place where such services are performed.
Also limits the number of physical therapist assistant's supervised in the
home care services setting by a licensed physical therapist to not exceed
the ratio of two physical therapist assistants to one licensed physical
, therapist.
o Continuous supervision shall be deemed to include:
• The licensed physical, therapist's setting of goals,
establishing a plan of care and determining whether the
patient is appropriate to receive the services of a physical
therapist assistant subject to the licensed physical therapist's
evaluation
• An initial joint visit with the patient by the supervising
licensed physical therapist and the physical therapist
assistant
• Periodic treatment and evaluation of the patient by he
supervising licensed physical therapist, as indicated in the
plan of care and as determined in accordance with patient
need, but in no instance shall the interval between such
treatment exceed every six patients v. isits or thirty days,
whichever occurs first
• A final evaluation by the supervising licensed physical
therapist to determine if the plan of care shall be terminated.
Page 15
Interim agendas can be obtained via the Internet at http:// www. azleg. state. az. us/ lnterimCommittees. asp
ARIZONA STATE LEGISLATURE
INTERIM MEETING NOTICE
OPEN TO THE PUBLIC
SENATE HEALTH AND HOUSE OF REPRESENTATIVES HEALTH
COMMITTEE OF REFERENCE FOR THE:
SUNSET OF THE HEALTH FACILITIES AUTHORITY
SUNSET OF THE MEDICAL RADIOLOGIC TECHNOLOGY BOARD OF EXAMINERS
SUNSET OF THE NURSING CARE INSTITUTION ADMINISTRATION AND ASSISTED LIVING
SUNSET OF THE BOARD OF HOMEOPATHIC MEDICAL EXAMINERS
SUNRISE REQUEST OF THE ARIZONA ASSOCIATION FOR HOME CARE
SUNRISE REQUEST OF THE ARIZONA MIDWIFERY INSTITUTE
SUNRISE REQUEST OF THE ARIZONA ALLIANCE OF SURGICAL SPECIALISTS
Date:
Time:
Place:
Tuesday, November 8,2005
9: 00 a. m.
House Hearing Room 1
AGENDA
1. Call to Order - Opening Remarks
2. Health Facilities Authority
• Presentation by the Health Facilities Authority
• Public Testimony
• Discussion and Recommendations by Committee of Reference
3. Medical Radiologic Technology Board of Examiners
• Presentation by the Medical Radiologic Technology Board of Examiners
• Public Testimony
• Discussion and Recommendations by Committee of Reference
4. Nursing Care Institution Administration and Assisted Living Facility Managers Board
• Presentation by the Nursing Care Institution Administration and Assisted Living
Facility Managers Board
• Public Testimony
• Discussion and Recommendations by Committee of Reference
5. Board of Homeopathic Medical Examiners
• Presentation by the Board of Homeopathic Medical Examiners
• Public Testimony
• Discussion and Recommendations by Committee of Reference
6. Arizona Alliance of Surgical Specialists
• Presentation by the Arizona Alliance of Surgical Specialists
• Public Testimony
• Discussion and Recommendations by Committee of Reference
7. Arizona Association for Home Care
• Presentation by the Arizona Association for Home Care
• Public Testimony
• Discussion and Recommendations by Committee of Reference
8. Arizona Midwifery Institute
• Presentation by the Arizona Midwifery Institute
• Public Testimony
• Discussion and Recommendations by Committee of Reference
9. Adjourn
Members:
Senator Jim Waring, Co- Chair
Senator Carolyn Allen
Senator Marsha Arzberger
Senator Robert Cannell
Senator Barbara Leff
10/ 31/ 05
jmb
Representative Rick Murphy, Co- Chair
Representative David Bradley
Representative Laura Knaperek
Representative Linda Lopez
Representative Doug Quelland
People with disabilities may request reasonable accommodations such as interpreters,
alternative formats, or assistance with physical accessibility. If you require accommodations,
please contact the Chief Clerk's Office at ( 602) 926- 3032, TOO ( 602) 926- 3241.
ARIZONA STATE LEGISLATURE
SENATE HEALTH AND HOUSE OF REPRESENTATIVES HEALTH COMMITTEE OF
REFERENCE FOR THE:
SUNSET OF THE HEALTH FACILITIES AUTHORITY
SUNSET OF THE MEDICAL RADIOLOGIC TECHNOLOGY BOARD OF EXAMINERS
SUNSET OF THE NURSING CARE INSTITUTION ADMINISTRATION AND
. ASSISTED LIVING
SUNSET OF THE BOARD OF HOMEOPATHIC MEDICAL EXAMINERS
SUNRISE REQUEST OF THE ARIZONA ASSOCIATION FOR HOME CARE
SUNRISE REQUEST OF THE ARIZONA MIDWIFERY INSTITUTE .
SUNRISE REQUEST OF THE ARIZONA ALLIANCE OF SURGICAL SPECIALISTS
Minutes of the Meeting
Tuesday, November 8, 2005 .
9: 00 a. m;, House Hearing Room 1
Members Present:
Senator Jim Waring, Co- Chair
Senator Carolyn Allen
Senator Marsha Arzberger
Senator Robert Cannell
Senator Barbara Leff .
Members Absent:
Representative David Bradley
Staff:
Beth Kohler, Senate Health Research Analyst
Elizabeth Baskett, House Health Research Analyst
Representative Rick Murphy, Co- Chair
Representative Laura Knaperek
Representative Linda Lopez
Representative Doug Quelland
Co- chairman Murphy called the meeting to order at 9: 12 a. m. and attendance was
noted. .
Presentation by the Health Facilities Authority
Blaine Sandi, Executive Director, Health Facilities Authority ( HFA), stated that his
organization was established in 1977 to issue bonds exempt from income tax on the
Authorities interest which enables them to get lower interest rates. He explained that the
Authority would then loan their proceeds to health care facilities at lower rates than the
healthcare facilities would receive from banks. Mr. Bandi remarked that the Authority
provided low cost loans for rural and underserved healthcare facilities.
He stated that rural communities that have benefited from the program included:
• Flagstaff
• Kingman
• Prescott
• Wickenburg
• Douglas
• Springerville
• Page
• Bisbee
• Camp Verde
• Fort Mojave
• Peach Springs
• Sacaton
• Elfrida
• Morenci
• Ajo
• St. Michaels
Mr. Bandi remarked that the Health Facilities Authority was not a regulatory agency and
that it existed solely to improve the health care for the residents ofArizona through the
financing of critical health care projects. He remarked that failure to continue the
Authority would deprive the State's health care providers of a needed source of tax
exempt financing. He respectfully requested the Committee of Reference recommend
the Arizona Health Facilities Authority be continued for ten years.
In response to Senator Cannell's question about the possibility of a hospital not paying
their loan back, Mr. Bandi told the Committee that since the inception of the HFA in
1977, this had only occurred once. He remarked that payments by that hospital were
still being made to HFA. Mr. Bandi added that the residents of the State have no legal
obligation to back up those bonds because they were issued solely on the credit of the
institution.
Representative Knaperek asked Mr. Bandi to list the seven directors for HFA and he did
so as follows:
1. Bruce Gulledge, health care underwriter who does financing for health
care institutions across the country.
2. Donald Shropshire, former hospital administrator; Tucson Medical
Center.
3. Jennifer Ryan, community health center director from Southern Arizona.
4. Rufus Glasper, Chancellor of the Maricopa County Community College
District.
SENATE HEALTH AND HOUSE HEALTH COMMIITEE
OF REFERENCE
Tuesday, November 8, 2005
Page 2
5. William Emerson, City Attorney for the City of Peoria.
6. Susan Straussner, Community Health Nurse from Parnell County.
7. Steven Russo, Sond Attorney based in Tucson.
In response to Representative Knaperek's question about funding, Mr. Sandi told the
Committee that the HFA's annual budget was approximately $ 300,000 per year and that
revenues to the Authority were generated throug h bond financing activities. He stated
that when the HFA approved bonds, applicants are paying one basis point, which is .01
of one percent of total financing. He remarked that additionally applicants paid 7.5 basis
points which was equal to .075 percent. Mr. Sandi told the Committee that the HFA
brought in between $ 300,000 to one million dollars per year, a five year cycle with one
million dollars every fifth year. He added that the extra money was used for loans to
other healthcare facilities in underserved parts of the State. Mr. Sandi told the
Committee that the credit rate was predicated on a number of things, the most
prominent being the credit worthiness of the applicant and also on the term and purpose
of th~ loan. He remarked that he had seen the interest rates in the range of about four
.:<' percent up to about seven percent.
Representative Knaperek asked the amount of savings in interest rates there was for
people who used the HFA services. Mr. Sandi responded that historically, the industry
used a figure of 15 percent savings going to tax exempt financing versus taxable
financing. He stated that today, when interest rates are lower, that 15 percent figure
would be closer to 10 or 11 percent.
In response to Representative Quelland, Mr. Sandi stated that the title holder on any
property in which the HFA loaned money is going to be that non- profit corporation. He
remarked that the HFA had liens on record for every loan they do. Mr. Sandi explained
that the bond financing has specific guidelines and rules the HFA must follow in the
event of a default.
In response to Senator Left, Mr. Sandi told the Committee that HFA hired a lobbyist
solely from lack of experience with legislative scenarios and to help the organization
navigate through the process.
Representative Quelland moved that the Senate Health and House
Health Committee of Reference recommend to continue the Health
Facilities Authority Board for ten years. By voice vote, the motion
CARRIED.
Presentation by the Medical Radiologic Technology Board of Examiners
Aubrey Godwin, Director, Radiation Regulatory Agency, told the Committee that the
Medical Radiologic Technology Board of Examiners ( MRTBE) was created in 1977 by
SENATE HEALTH AND HOUSE HEALTH COMMITTEE
OF REFERENCE
Tuesday. November 8,2005
Page 3
legislation due to the large number of unqualified technicians in the State. He stated that
the role of MRTBE was to make sure that technicians or people applying ionizing
radiation to a human being had been properly trained. He remarked that the type of
technologist observed by MRTBE were X- ray, therapy, nuclear medicine and
mammography technologists. Mr. Godwin pointed out that nuclear medicine technology
had been added recently to MRTBE's certification program. He stated that MRTBE
presently had approximately 9,000 certificate holders, some of whom hold dual
certification. Mr. Godwin pointed out that most of the MRTBE cases dealing with
disciplinary matters were related to failure to pay dues or questionable certifications
since their last sunset review.
In response to Senator Allen, Mr. Godwin explained that drug treatment was made
available through MRTBE for certified technicians who may need it and failure to
successfully complete these proceedings would result in termination of certification.
In response to Senator Cannell, Mr. Godwin said that most of the drug related issues
with technicians took place in larger institutions such as hospitals as opposed to private
physician offices. He stated that if the institution where a troubled technician worked
had a drug treatment program, MRTBE would direct the technician to utilize that
program and if not, the technician would attend an independent drug program paid for
by the technician.
In response to Senator Arzberger, Mr. Godwin remarked that due to the different State
requirements for technician certification, out of town applicants must be certified in
Arizona before working in this State.
In response to Representative Knaperek, Mr. Godwin told the Committee that there
were both nationally certified and non- nationally certified radiological technician schools
in Arizona. He stated that the vacancy on MRTBE had been available for less than one
year.
In response to Representative Murphy, Mr. Godwin told the Committee that he looked
forward to finding a citizen to fill the vacancy on the MRTBE.
In response to Representative Knaperek, Mr. Godwin remarked that due to the shortage
of technicians in the State, Arizona has experienced an influx of out of State
technicians.
In response to Senator Allen, John Gray, Program Manager, MRTBE, informed the
Committee that a high school graduate could enter into the field of radiological
technology either through community college or privately funded programs. He added
that private school training took two years or less.
In response to Senator Leff, Mr. Godwin stated that there was a continuing education
requirement in place for the field of radiological technology due to- changing technology.
SENATE HEALTH AND HOUSE HEALTH COMMITIEE
OF REFERENCE
Tuesday, November B, 2005
Page4
Public Testimony
Jerry High, Arizona State Society of Radiologic Technologists, told the Committee
that out of concern for public safety, he was glad that certification was required before
becoming a technician.
In response to Senator Left, Mr. Hyde said that passing the " Registry," a test sponsored
by the American Association of Radiologic Technology ( AART) was very difficult, yet
allowed him to be nationally certified.
In response to Senator Left, Mr. Godwin told the Committee that radiologic
technologists were certified professionals, not licensed professionals.
Stephen Sapareto, Director of Medical Physics, Banner Good Samaritan Hospital,
stated that he was the boss of the technologists at his facility and expressed the
importance of technologists to be certified. He pointed out that another group certified
by MRTBE were radiologic therapists, who administered ongoing care such as
chemotherapy, and that it was especially important for these therapists to be certified.
In reiPonse to Senator Left, Mr. · Safereto explained that radiologic technologists and
therapists had a chief technologist or therapist supervising them, followed by a chain of
command that ultimately led to a physician at his facility.
Jeff Siupik, Director of Radiation Services, MRTBE told ~ he Committee that being a
director of technologists, he is concerned about the shortage of technologists in the
State due to strict standards by the MRTBE on non- local technologist operating
machinery in a crisis situation.
Senator Left opined that two weeks, the time it takes for MRTBE to certify a non- local
technician, was not a long period of time.
Representative Quelland moved that the Senate Health and House
Health Committee of Reference recommend to continue · the Medical
Radiologic Technology Board of Examiners for ten years. The motion
CARRIED by voice vote.
Presentation by the Board of Examiners of Nursing Care Institution
Administrators and Assisted Living Facility Managers
Allen Imig, Executive Director, Board of Examiners of Nursing Care Institution
Administrators and Assisted Living Facility Managers ( B. ENCIAIALFM), informed
the Committee that the Board was created in 1975 to protect the public's health and
welfare by regulating and licensing nursing care institution administrators. He stated that
in 1990, the board statutes were amended to add the responsibility of certifying and
regulating adult home care managers and renamed in 1998 to Assisted Living Facility
Managers. The mission of the Board was to protect the health, welfare and safety of its
SENATE HEALTH AND HOUSE HEALTH COMMITIEE
OF REFERENCE
Tuesday. November B, 2005
Page 5
citizens, to seek and institute the use of services of nursing care institution
administrators and assisted living facility managers. Mr. Imig said that the Board's
procedures helped ensure quality and competency standards were met by
administrators and managers. In addition, the Board approves continuing education
courses to make sure quality and useful education is being taught. He explained that
since June of 2005, the Board had undergone an " extreme makeover" with virtually all
new members being appointed. This reduced the back log of uninvestigated complaints
significantly. Mr. Imig told the Committee that the Board had reduced their staff from five
to three, leaving an executive director, investigator and a licensing coordinator. He
encouraged the Committee to continue the BENCIAIALFM.
In response to Senator Allen, Mr. Imig said that the Board consisted of five managers,
two public members and the remaining members were administrators.
Senator Allen opined that home care nursing staff deserved better pay.
In response to Senator Waring, Mr. Imig stated that the changes made to the Board has
helped, but not solved its financial problems.
In response to Senator Arzberger, Mr. Imig said that his Board investigated complaints
from citizens regarding private care nurses and administrators as well as complaints
filed by the Department of Health Services.
In response to Senator Waring, Mr. Imig told the Committee that the Board's website
contained information regarding decisions on disciplinary action.
In response to Senator Allen, Mr. Imig explained that out of the last renewal period for
managers, 2,000 of 2,500- 2,600 renewal notices sent were renewed, causing 578
expired notices to be sent by the Board.
In response to Senator Leff, Mr. Imig opined that his Board received between 60 and 70
complaints a year, mainly not health care related but administrative related.
In response to Senator Waring, Mr. Imig stated that with the current staff, the Board
should catch up on its back log of complaints by January 2006.
In response to Representative Quelland, Mr. Imig remarked that the Board was actively
seeking replacements for the three vacancies on the Board.
Senator Leff suggested that the Committee send a letter to the Governor encouraging
her to appoint the three positions.
In response to Representative Quelland, Mr. Imig opined that he would like to see a five
year continuation be given to the Board.
SENATE HEALTH AND HOUSE HEALTH COMMITTEE
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Tuesday, November 8,2005
Page 6
Representative Knaperek remarked that time elected to the Board would reflect
concerns with term limits and not reflect faith in Mr. Imig.
Public Testimony
Robert Frechettee, President, Arizona Health Care Association ( AHCA), told the
Committee that on behalf of his Board, he would like to offer support in the continuation
of the BENCIAIALFM. He opined that the efforts implemented by the new staff showed
that the Board was very serious about suggestions and concerns brought forth by the
Legislature.
In response to Senator Waring, Mr. Bruschette stated that the AHCA was seen as the
organization that represented the for profit facilities, containing some non- profit facilities
and representing assisted living communities and independent full service communities.
He said that Assisted liVing Federation represents assisted living centers in homes and
the Arizona Association of Homes for the Aging represents a number of facilities seen
as non- profit businesses.
In re~ ponse to Senator Cannell, Mr. Bruschette opined that if fee increases were
nece~ ary to fund the continuation of the Board, that it would be supported by AHCA.
Senator Leff stated that if the Committee made a five year recommendation at this
meeting and the audit comes out in December and is changed, the legislation coming
out in January does not have to be the same as the recommendation.
Representative Knaperek told the Committee that Mr. Imig had a good work history as a
Director in other fields.
In response to Representative Knaperek, Beth Kohler, Senate Health Research Analyst,
stated that the first audit of the Board would take place approximately six months after
nomination adding an 18 month follow up audit, only if the requirements and
recommendations made by the report were not met.
Representative Quelland moved that the Senate Health and House
Health Committee of Reference recommend that the Board of
Examiners of Nursing Care Institution Administrators and Assisted
Living Facility Managers be continued for two years. The motion
FAILED.
Representative QOelland moved that the Senate Health and House
Health Committee of Reference recommend that the Board of
Examiners Nursing Care Institution Administrators and Assisted
Living Facility Managers be continued for five years pending the
findings of the Auditor General's report due in December of 2005.
The motion CARRIED.
SENATE HEALTH AND HOUSE HEALTH COMMITTEE
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Tuesday, November 8,2005
Page 7
Presentation by the Board of Homeopathic Medical Examiners
Chris Springer, Executive Director, Homeopathic Board, told the Committee that
she had worked for the Board of Homeopathic Medical Examiners ( BHME) since 1999.
She complimented appointments made to the Board by all of the Governors on both the
Democrat and Republican side. She opined that the laws governing the licensing of
homeopathic physicians set forth by the State had been upheld. Ms. Springer stated
that a potential audit could be helpful in improving procedures and welcomed the
process of an impartial audit. She said that the Board currently has 117 licensed
homeopathic physicians.
Senator Leff opined that it was nice to hear Ms. Springer suggest an audit of the Board
and noted that BHME had gone approximately 20 years without an audit.
Senator Allen opined that she would like to see an audit of the BHME as well. She
added that in no way did legislation intend to do away with the homeopathic form of
medicine.
In response to Representative Lopez, Ms. Springer stated that a licensed homeopathic
physician could only continue to practice inane state after receiving disciplinary ac, tion
in another state for less than one year, due to the Board's annual renewal application
required of all homeopathic physicians, which would discover the violation in the other
state. .
In response to Representative Murphy, Ms. Springer said that there was the possibility
of a physician being dishonest about any past disciplinary action, however, there is a
standard penalty in place for such an event.
In response to Senator Waring, Ms. Springer told the Committee that there was not an
easily accessible data base of criminal background checks for physicians and added
that the fee to search names on the federal data base was $ 3.75 per name.
Senator Leff opined that being dishonest on an application should have strong
consequences for any physician when dealing with the subject matter of past
disciplinary action.
Dr. Charles Schwengel, President of the Homeopathic Medical Licensing Board,
told the Committee that being dishonest on an application was the most egregious of
unprofessional conduct that could happen.
In response to Representative Knaperek, Ms; Springer stated that a physician lying on
the application was discovered once and a letter of concern was issued.
Representative Knaperek opined that there should be a certain amount of consideration
afforded to the applicant on whether the incident was an issue of forgetfulness or
deliberate intent.
SENATE HEALTH AND HOUSE HEALTH COMMITTEE
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Tuesday, November 8, 2005
Page 8
In response to Senator Cannell, Ms. Springer stated that setting aside funds to check
each individual physician's background would be a step in the right direction.
Senator Allen remarked that the concerns stated today could be addressed in the
forthcoming audit.
In response to Representative Quelland, Ms. Springer told the Committee that some
traditional doctors became homeopathic physicians, and then dropped their traditional
medical license.
In response to Representative Quelland's comments on a medical doctor dropping their
license to pursue homeopathy due to decreased chances of medical malpractice
occuring, Dr. Schwengel remarked that he could not comment on the personal reasons
a physician might do this.
In response to Representative Murphy, Ms. Springer stated that the percentage of
homeopathic physicians who were previously licensed as medical doctors was very low.
Representative Murphy told the Committee that some physicians may choose to not
carry medical malpractice insurance to avoid becoming a target for medical malpractice.
Senator Cannell opined that there was a fear with physicians of becoming a target for
medical malpractice by carrying medical malpractice insurance.
In response to Senator Waring, Ms. Springer stated that BHME kept records indefinitely
of reported complaints against homeopathic physicians. She told the Committee that in
her opinion, the BHME should only keep records for up to five years similar to other
medical boards.
In response to Senator Waring, Ms. Springer remarked that she felt it necessary to keep
records of complaints for longer than five years, only if they were substantiated.
In response to Senator Allen suggesting that more public members should be on the
BHME, Ms. Springer said that additional public members on the Board would be a good
idea.
Public Testimony
Dr. Kathleen Fry, dually licensed by the Arizona Medical Board and Arizona
Homeopathic Medical Board, told the Committee that she had gathered a large
amount of important information pertaining to the BHME that she would like to share
with the Legislature and the Office of the Auditor General. She stated that she had been
committed to the practice of homeopathic and alternative medicine for twenty years in
Scottsdale, Arizona. She remarked that it was not her intent to keep patients from
receiving homeopathic care. Dr. Fry opined that the BHME had been grossly negligent
SENATE HEALTH AND HOUSE HEALTH COMMITTEE
OF REFERENCE
Tuesday, November 8,2005
Page 9
in its spiritual, moral and judicial responsibilities to protect the public from unscrupulous
physicians by licensing felons, failing to adequately discipline physicians who had
harmed patients, failing to adequately file complaints against other board members and
by giving licenses to physicians who could not pass a basic oral examination of
homeopathy. She stated that when she was recruited to the BHME in 1994, she was
informed by the Board that her dues were necessary to keep the Board in existence and
to allow her to continue to practice homeopathic medicine. Dr. Fry remarked that the
dues for the Association were $ 1000 per year in addition to the $ 500 per year licensing
fee and the $ 150 dispensing fee. She explained that if a homeopathic physician in
Arizona lost their M. D. license in another state, they could still practice homeopathy
here in Arizona which gives that physician the power to write prescriptions for all
classes of drugs, conduct minor surgery in their office, perform acupuncture and various
other medical techniques. In conclusion, Dr. Fry told the Committee that the
homeopathic license gives the physician a much broader range of modalities that they
can use with much less scrutiny and training.
In response to Senator Waring, Dr. Fry stated that in theory, physicians who had marks
on their records in other states should be rehabilitated in that state before being allowed
a license in Arizona, but that had not always been the case.
In response to Representative Knaperek, Dr. Fry remarked that transcripts from board
meetings that she had obtained from Ms. Springer, were public record. .
In response to Senator Left, Dr. Fry explained that a device called a sputnik originated
in Russia and is swallowed by a patient and designed to kill parasites by radiation. She
told the committee that a physician sold the device to a patient in Florida over the
phone, and that upon taking this device orally, the patient developed a bowel
obstruction resulting in the removal of several feet of her intestine. She added that the
said physician, being one of the originators of the BHME, only received a letter of
concern and an apology by the Board for placing that letter in the physicians file.
In response to Senator Waring, Dr. Springer told the Committee that she disagreed with
Ms. Fry's perception of the Board.
Dr. Todd Rowe, Homeopathic and Integrative Medical Physician, Desert Institute
of Classical Homeopathy, dually licensed, told the Committee that he had been
practicing homeopathic medicine for over twenty years. He urged the Committee to
continue the BHME. He remarked that after attending several meetings over the years
of the BHME, he had found most of what Dr. Fry said to be untrue.
In response to Senator Cannell, Dr. Rowe stated that the number of out- of- state
homeopathic physicians licensed in Arizona was very small. He explained that Arizona
was one of only three states who had homeopathy boards and that this was another
reason for an increase in out- of- state applicants in this State.
SENATE HEALTH AND HOUSE HEALTH COMMITIEE
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Tuesday, November 8, 2005
Page 10
In response to Senator Left, Dr. Rowe said that his homeopathy school had a 1,000
hour program for homeopathy; with plans on expanding that program to 4,000 hours
within the next few years.
In response to Senator Left, Dr. Rowe stated that the qualifications for a license for
homeopathy consisted of either 40 hours of class of homeopathy, in addition to 300
hours of alternative medicine, or 90 hours of class for homeopathy. He opined that this
met the minimum requirements to become a homeopathic physician and commented on
the fact that some applicants were already licensed medical doctors.
Lee Bakunin, practicing attorney in Arizona for 36 years, representing self, told the
committee that he had spent the last eleven years of his life studying homeopathy. He
explained that after the required 90 hours, there was no continuing education required
to continue practicing homeopathy. Mr. Bakunin said that the Auditor General may
come across the problem of incomplete records of past BHME meetings.
In response to Representative Quelland, Mr. Bakunin said that he currently had studied
about 2,000 hours of homeopathy.
Gladys Conroy, patient of homeopathy, representing self stated that homeopathy
had saved her life. She told the Committee that standard medication caused her great
danger.
Clifford Heinrich, practicing family physician for alternative medicines, opined that
no alternative medical board should be able to have jurisdiction over the spiritual
practice of homeopathy. He added that he had obtained over 1,200 hours of
homeopathy. Dr. Heinrich told the Committee that he had a petition with 200 signatures
recognizing homeopathy as a spiritual practice. He stated that he had an additional
petition to request the Legislature audit the BHME for " reasons previously addressed in
the meeting."
In response to Senator Allen, Dr. Heinrich opined that · homeopathy was being
misrepresented by the BHME from its original spiritual foundation, causing the public to
believe they were receiving homeopathic care when in fact, they were not.
In response to Representative Knaperek question about the spiritual aspect of
homeopathy, Dr. Heinrich explained that a nonmaterial substance was one that had
been diluted to a point where the original property is no longer there, leaving only the
essence of that object.
In response to Representative Murphy, Dr. Heinrich told the Committee that he wanted
the separation between homeopathy and alternative medicines distinguished by the
State.
Amanya Jacobs, Director of Evolution of Self/ Soul School Homeopathy, remarked
that she was deeply committed to making homeopathy available to all citizens in the
SENATE HEALTH AND HOUSE HEALTH COMMITTEE
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Tuesday, November 8, 2005
Page 11
State. She said that the Board regulated activities that it deemed homeopathy which
were totally unrelated to that area of medicine. Ms. Jacobs stated that she was in favor
of an audit of the BHME.
Linda Heming, Arizona Homeopathic and Integrative Medical Association, told the
committee that western medicine could not help her and homeopathy saved her life.
Senator Leff remarked that the open meeting law stated that recordings and minutes
must be kept by the open body and must be accurate and open for inspection three
days after the meeting, with no language about whether or not they could be destroyed
at any time period.
Russell Olinsky, patient of homeopathy, spoke in favor of the BHME.
Cynthia MacLuskie, patient of homeopathy, told the Committee that all homeopathy
medicines were not available at health food stores and that prescriptions were the only
way to obtain some of these medicines.
Lisa Platt, Arizona Homeopathic and Integrative Medical Association, speaking on
behalf of the BHME, remarked that BHME was not recruiting felons. She stated that a
number of patients had told her how homeopathy had saved their lives.
Senator Allen moved that the Senate Health and House Health
Committee of Reference recommend that the Board of Homeopathic
Medical Examiners continue for two years, adding the request for an
audit addressing the concerns covered in today's committee.
Representative Quelland explained his vote. He said that although he did not have an
educational background in homeopathy, the homeopathic physicians had a certain
amount of disagreement and confusion among themselves. He reminded the
Committee that this was just a recommendation and that someone was going to create
a bill and that bill would be voted on, making today's vote not a guarantee that the
Board will continue, and he voted " aye."
Senator Cannell explained his vote. He said that although he advocated homeopathy
and the continuation of the Board, that the BHME had suffered a " major black eye"
today. He opined that the director and the president of the boards had not changed their
attitudes and that they should consider their Board a precious commodity by not diluting
their group of good physicians with out of state applicants with questionable credentials
and he voted " aye."
Senator Leff explained her vote. She requested the Auditor General to do both a
financial and performance audit. She remarked that the people who came forward today
against the Board should feel free to do so without retaliation and she voted " aye."
SENATE HEALTH AND HOUSE HEALTH COMMITTEE
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Tuesday, November 8, 2005
Page 12
Senator Waring explained his vote. He said that he was very frustrated with the Board,
and that he would be the first to vote " no" on a bill in the following session if changes
weren't made, but since today's vote was merely a recommendation, he would vote
" aye."
Representative Murphy explained his vote. He said that he shared many of the
concerns voiced by the Committee members today and looked forward to hearing what
the Auditor General had to say and he voted " aye."
The motion CARRIED by a roll call vote of 9- 0- 1 ( Attachment 1).
Representative Murphy RECESSED the meeting at 1: 35 p. m. to the sound of the gavel.
Representative Murphy RECONVENED the meeting at 2: 30 p. m.
Presentation by the Arizona Midwifery Institute
Marinah Valenzuela Farrell, President of the Arizona Midwifery Institute ( AMI),
submitted handouts ( Attachment A) and ( Attachment B) to the Committee. She told the
Co~ mittee that as midwives, their main concern was for safe outcomes of mothers and
babies. She remarked that midwives chose home birth because they believe that birth is
a natural and safe event in the life of a woman. Ms. Farrell explained that in the 1970' s,
midwifery became licensed in the State, yet because of medical liability issues,
midwives had experienced difficulty in consults with physicians and access to items to
assist in home birth. .
In response to Senator Allen, Ms. Farrell stated that midwife licensing exams were very
tough and that she had received specialized intravenous training in New Mexico through
the local hospital.
In response to Senator Cannell, Ms. Farrell told the Committee that licensing of
midwives was dependent upon number of hours of experience in child birth delivery with
that applicant. She stated that there were also schools available to midwives that
involved intense clinical training. Ms. Farrell said that a surveyor in the Department of
Special Licensure administered a national exam to applicants in which upon passing,
the applicant must then go through an oral board and upon passing this, must complete
a practical exam which is overseen by the surveyor and · other midwives. She told the
Committee that midwives were trained in resuscitating babies.
In response to Senator Leff, Ms. Farrell stated that the midwives were requesting that a
physician not be required to sign off on supplies.
Representative Lopez opined that her own personal experience of giving birth to her last
two children at home from midwives was a wonderful experience.
SENATE HEALTH AND HOUSE HEALTH COMMITTEE
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Tuesday, November 8, 2005
Page 13
Representative Quelland informed the Committee that Arizona had 53 licensed
midwives with 22 of them located in Maricopa County and that there were 343 midwife
births in the home in 2004 in the State.
In response to Representative Quelland, Ms. Farrell remarked that none of the 343
reported midwife births reported in 2004 resulted in any problems. She stated that
although medical malpractice and liability insurance was available to midwives, the
majority refused it due to its cost in proportion to their pay. She told the Committee that
the Arizona Health Care Cost Containment System ( AHCCCS) discontinued the
payment for midwife delivery two years ago due to midwives not carrying medical
malpractice and liability insurance which could possibly put AHCCCS at risk for such
claims.
Senator Leff stated that midwives dealt mostly with low- risk births and that she would
like to see the issue of AHCCCS discontinuing payment for midwife births examined.
Senator Cannell opined that the Committee should hear from AHCCCS because they
obviously found midwifery funds a financial risk for some legitimate reason.
Ms. Farrell told the Committee that mothers who chose home births mainly did 30, not
for financial reasons, but because of belief that the hospital environment was just one
intervention leading to another.
Public Testimony
Rory Hays, Arizona Nurses Association, said that the items asked for by the AMI
were appropriate, if accompanied by more training. She stated that she opposed
expanding prescription privileges for anything requiring a Drug Enforcement Agency
number.
In response to Representative Quelland, Ms. Hays said that certification would be
appropriate for midwives.
Ms. Farrell stated that the only thing midwives were requesting was the power to obtain
items already in their reach through a physician, without that physician's pre- approval
and that the laws were already in place on limitations for uses with these items.
Representative Quelland moved that the Senate Health and House
Health Committee of Reference recommend that the Legislature
expand the scope of practice for Arizona's licensed midwives by
allowing procurement, possession, and administration of various
medical devices and medications which will be named in the bill. The
motion was CARRIED by voice vote.
SENATE HEALTH AND HOUSE HEALTH COMMITTEE
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Tuesday, November 8, 2005
Page 14
Senator Allen opined that midwifery was a choice to be made by the citizen and she
hoped that fatalities did not occur due to the choice of using such a method.
Presentation by the Arizona Association for Home Care
Suzanne Gilstrap, representing the patients for the Arizona Association for Home
Care ( AAHC), stated that AAHC was founded in 1983 with a mission to advance quality
home care as an integral component of the health care delivery system. She told the
Committee that she believed in continuing education for home care providers. She
remarked that AAHC had discussed having a joint workshop with the Physical Therapy
Association ( PTA) but never actually initiated these workshops. Ms. Gilstrap requested
that the Committee grant an expansion to allow physical therapy assistants to work
under general supervision of a physical therapist as opposed to direct supervision. She
told the Committee that the AAHC respectfully requested the joint Committee
recommend that physical therapy assistants be allowed to practice in the home health
care setting and only in that setting under the following conditions:
• The supervising physical therapist shall be solely responsible for
evaluating the patient and determining a plan of care.
• The supervising physical therapist shall be available at all times via
telecommunication while the physical therapist assistant is providing
treatment interventions.
• The supervising physical therapist supervises no more than two physical
therapy assistants. .
• The supervising physical therapist shall see the patient and revise the plan
of care no less than every 21 days.
• The supervising physical therapist not assign responsibilities to the
physical therapy assistants that in any way allow them to provide
evaluation services for procedures.
• Continuing education requirements should be added to the statute as well.
• The physical therapist would be the one responsible for final evaluation
and discharge of the patient.
In response to Senator Arzberger, Ms. Gilstrap said that proposing a mileage limit would
be a good idea in reference to a physical therapist along with the constant
telecommunication contact. She stated that it was not unusual to recommend that the
practice of home care be extended to other areas outside of the home such as
hospitals.
SENATE HEALTH AND HOUSE HEALTH COMMITTEE
OF REFERENCE
Tuesday, November 8, 2005
Page 15
In response to Senator Left, Ms. Gilstrap remarked that the AAHC was not intending to
mandate what physical therapists do, but to enable legislation that would allow them to
choose.
In response to Representative Murphy, Ms. Gilstrap stated that home care therapist
assistants were well schooled for their job no matter what setting, with the exception of
no clinical experience required of the physical therapist.
In response to Senator Waring, Ms. Gilstrap remarked that in all fields of medicine,
health care providers were experiencing an inability to serve patients.
Representative Lopez opined that an outside organization should not be directing
physical therapists on how to conduct their practice.
In response to Senator Allen, Ms. Gilstrap told the Committee that currently more than
45 states allow general supervision in the home health care setting and that the only
two states that do not allow it are Pennsylvania and Arizona.
Public Testimony
Karen Jeselun, President of the Arizona Association for Home Care, stated that
even if there were no home care physical therapist available at the time, a patient could.
still be released from the hospital even though they required home care to continue
recovery. Ms. Jeselun compared the relationship between a physical therapist and a
physical therapist assistant to that of a registered nurse and a licensed practical nurse.
She told the Committee that all of their home care providers go through an interview
process, a mandatory criminal background check and participate in orientation often
with preceptors.
In response to Representative Knaperek, Ms. Jeselun stated that Medicare currently
paid home health agencies on an episode basis, meaning for every 60 Qays of time that
patient is in the care of a home health provider, the home care provider gets a lump
sum. She opined that she was hoping to serve more patients with no increase in cost.
Susie Stevens, representing the Arizona Physical Therapy Association ( AZPTA),
informed the Committee that the definitions of general supervision and direct
supervision needed to be reviewed. She stated that she was there in opposition to the
sunrise request.
Heidi Herbst Paakkonen, Executive Director of the Arizona Board of Physical
Therapy ( ABPT), told the Committee that the ABPT regulates about 3,200 physical
therapists and 434 physical therapist assistants. She said that due to lack of detailed
information at this time, she would encourage the Board to oppose the Sunrise
Application oftheAAHC.
SENATE HEALTH AND HOUSE HEALTH COMMITTEE
OF REFERENCE
Tuesday, November 8, 2005
Page 16
In response to Representative Knaperek, Ms. Paakkonen remarked that there were
exactly 3,268 licensed in the State but not all of them worked in Arizona. She told the
Committee that approximately 2,800 physical therapists listed Arizona addresses. She
stated that there were 434 physical therapy assistants and that approximately 396
reside in Arizona and that it was ABPT's estimate that 350 of them were currently
working in the field of physical therapy.
In response to Representative Quelland, Ms. Paakkonen stated that the ABPT was
required by statute to have three physical therapists and two public members, but no
physical therapist assistants.
In response to Senator Leff, Ms. Paakkonen told the Committee that the ABPT does
and has disciplined physical therapist assistants.
Bob Direnfeld, President of the Arizona Physical Therapy Association ( AZPTA),
remarked that his organization was the only one in the State representing physical
therapists. He told the Committee that his association opposed the idea of general
supervision. Mr. Direnfeld said that patients were getting discharged from the hospital
too early in most cases compared to years ago, which cause a greater need for these
home care physicians. He remarked that a therapist was ultimately responsible foc
anything the physical therapy assistant does which puts the physical therapist's license
on the line.
In response to Representative Murphy, Mr. Direnfeld opined that passing legislation
supporting general care could potentially decrease an even larger amount of physical
therapists.
In response to Senator Cannell, Mr. Direnfeld stated that he was not sure that there was
a shortage in home health care providers. He also remarked that setting a parameter or
definition of a home care patient, would cut down on the patient load.
Representative Knaperek opined that physical therapist assistants should have more of
a vote on the Board.
Peter Zawicki, in favor of the sunrise recommendation, told the Committee that
physical therapists and physical therapist assistants were trained at community colleges
and technical schools across the country. He opined that it was critical that there be
communication between the physical therapist and the physical therapist assistant in all
patient care.
In response to Senator Cannell, Mr. Zawicki stated that physical therapist assistants
were under direct supervision during the education process.
In response to Representative Murphy, Mr. Zawicki remarked that to be able to perform
in public health care, it would be helpful if a physical therapist assistant had a certain
amount or certain type of training.
SENATE HEALTH AND HOUSE HEALTH COMMITTEE
OF REFERENCE
Tuesday, November 8, 2005
Page 17
Senator Leff opined that home health patients are the most vulnerable patients and she
felt uncomfortable " experimenting" with the care of those patients.
Kerry Halcomb, Physical Therapy on Wheels, representing AAHC, opined that he
did not believe that a physical therapist could adequately supervise a physical therapist
assistant.
Gayle Haas, physical therapist, representing AAHC, remarked that a physical
therapist and a physical therapist assistant can work together for years and develop a
relationship which allowed for better understanding and communication skills with one
another.
Deborah Bornmann, physical therapist, stated that she did not feel represented by
her own board. She opined that it was great for an outside organization to try to help
physical therapists.
Representative Quelland moved that the Senate Health and House
Health Committee of Reference recommend that the Legislature
expand the scope of practice for licensed physical therapist
assistants by allowing home health visits under the general
. supervision of licensed physical therapists. The motion was
CARRIED by voice vote.
Senator Waring stated that although he was unhappy with what he had heard
today, he hoped discussions were started to improve the situation.
Representative Knaperek remarked that she hoped they could work out their
differences for the benefit of the State.
Senator Arzberger opined that changes do need to be made and issues need to
be addressed.
Representative Murphy stated that hopefully, this would get people back into
discussions.
There being no further business, the meeting was adjourned at 5: 12 p. m.
Respectfully submitted,
Jeff Turner
Committee Secretary
( Tapes and attachments on file in the Secretary of the Senate's Office/ Resource Center, Room 115.)
SENATE HEALTH AND HOUSE HEALTH COMMITTEE
OF REFERENCE
Tuesday, November 8,2005
Page 18
Senate Health and House of Representatives Health Committee
of Reference
ARIZONA STATE LEGISLATURE
FORTY- FIFTH LEGISLATURE - ROLL CALL VOTE
Recommendation: ' Tt± P( f " lH- t; ' 13 of\ BP 0 F \+ CM£ O? fr1}- rJ'
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Rep. Bradley
Rep. Knap~ erek
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Rep. Lopez
Rep. Quelland
Senator Allen
Senator Arzberger
Senator Cannell
Senator Left
Senator Waring, CoChair
Rep. Murphy, CoChair
Committee Secretary j- fPf=-; = r0 ~ t; r2- Date \ I- O~ '" dOo<)
Attachment~
November B. 2005