Hawaii 2022 Regular Session

Hawaii Senate Bill SB617 Compare Versions

Only one version of the bill is available at this time.

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1	1	THE SENATE S.B. NO. 617 THIRTY-FIRST LEGISLATURE, 2021 STATE OF HAWAII A BILL FOR AN ACT RELATING TO THE PHYSICAL THERAPY PRACTICE ACT. BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
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3	3	THE SENATE S.B. NO. 617
4	4	THIRTY-FIRST LEGISLATURE, 2021
5	5	STATE OF HAWAII
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7	7	THE SENATE
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9	9	S.B. NO.
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11	11	617
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13	13	THIRTY-FIRST LEGISLATURE, 2021
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17	17	STATE OF HAWAII
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31	31	A BILL FOR AN ACT
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37	37	RELATING TO THE PHYSICAL THERAPY PRACTICE ACT.
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43	43	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
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47	47	SECTION 1. The legislature finds that the Physical Therapy Practice Act was established in 1985, when health care was primarily focused on the curing of illness. Since that time, health care has evolved to place a greater focus on the overall wellness and prevention of illness and disability with the growth of evidence-based treatment intervention options for patients. The legislature further finds that dry needling is a therapeutic intervention tool that is used in conjunction with other physical therapy interventions in order to improve pain control, decrease muscle tension, accelerate active rehabilitation, facilitate normal movement, and return to function for overall better quality of life. Dry needling is recognized by the American Physical Therapy Association, American Academy of Orthopaedic Manual Physical Therapists, and Federation of State Boards of Physical Therapy and has been utilized effectively to treat neuromuscular pain in specific populations, such as acute and overuse sport injuries, post‑operative rehabilitative care, chronic pain, opioid dependence, work restrictions, and disability. Dry needling is allowed in all but seven states, one of the seven being Hawaii. Physical therapists practicing dry needling in federal facilities in Hawaii, as well as across the nation, have patients who have benefited from its use. However, civilian patients in Hawaii are denied access and choice of dry needling care from a physical therapist when appropriate. The legislature also finds that the American Physical Therapy Association endorses the professional liability insurance administered by the Healthcare Providers Service Organization and underwritten by American Casualty Company of Reading, Pennsylvania, a CNA company. A review of a CNA claim database from 2012 to 2017 reveals that of the total of 3,413 physical therapist claims, there were only thirty‑four physical therapy claims related to dry needling reported, representing less than one per cent of the total amount of claims against physical therapists and a total loss incurred of $341,290. The legislature further finds that the Federation of State Boards of Physical Therapy is an organization made up of fifty‑three physical therapy jurisdictions within the United States. The Federation of State Boards of Physical Therapy upholds a mission to protect the public by providing leadership that promotes safe and competent physical therapy services, including administration and maintenance of an examination, licensure, and disciplinary database. The Federation of State Boards of Physical Therapy commissioned the Human Resources Research Organization for the July 10, 2015, practice analysis of the competencies required of physical therapists to perform dry needling. These competencies can provide a strong foundation of professional standards, including education and training requirements, practice assessment, management, and regulation. In this practice analysis, the specific definition of competency, in terms of a physical therapist performing dry needling, was determined to be safe and effective for the patient and the physical therapist. The practice analysis further determined that eighty-six per cent of the knowledge requirements for dry needling competency is acquired during physical therapy basic entry level education and consists of knowledge related to evaluation, assessment, diagnosis, and plan of care development. The remaining fourteen per cent of the knowledge required for dry needling competency must be acquired through post-graduate education or specialized training in dry needling. The legislature further finds that the Hawaii Physical Therapy Practice Act, which is codified under chapter 461J, Hawaii Revised Statutes, establishes the board of physical therapy to provide licensing requirements for physical therapists and physical therapist assistants in the interest of safeguarding life and health. As such, the board of physical therapy is responsible for content standards of continuing competency related to the professional practice of physical therapy and patient or client management. Under existing law, physical therapists are prohibited from breaking or puncturing good skin integrity through surgery or injection. This prohibition was originally intended to ensure that physical therapists do not perform surgery and medical procedures outside the scope of practice and education of physical therapists. However, the existing law does not allow for modern techniques in physical therapy that are within the scope of physical therapy practice and education. Accordingly, the purpose of this Act is to: (1) Clarify the scope of practice for licensed physical therapists to include the practice of dry needling; (2) Require the board of physical therapy to issue dry needling certifications to qualified licensed physical therapists and designate the requirements for physical therapists related to dry needling; and (3) Allow the board of physical therapy to revoke or suspend a physical therapist's license for performing dry needling incorrectly, without proper training or certification, or in a manner that would likely harm a patient. SECTION 2. Section 461J-1, Hawaii Revised Statutes, is amended as follows: 1. By adding a new definition to be appropriately inserted and to read: ""Dry needling" means a skilled technique performed by a physical therapist using filiform needles to penetrate the skin or underlying tissues to affect change in body structures and functions for the evaluation and management of neuromusculoskeletal conditions, pain, movement impairments, and disability." 2. By amending the definition of "physical therapy" or "physical therapy services" to read: ""Physical therapy" or "physical therapy services" means the examination, treatment, and instruction of human beings to detect, assess, prevent, correct, alleviate, and limit physical disability, bodily malfunction, pain from injury, disease, and any other physical or mental condition as performed by a physical therapist appropriately licensed under this chapter. It includes but is not limited to: (1) Administration, evaluation, modification of treatment, and instruction involving the use of physical measures, activities, and devices, for preventive and therapeutic purposes; provided that should the care or treatment given by a physical therapist or physical therapist assistant contravene treatment diagnosed or prescribed by a medical doctor, osteopath, or as determined by the board, the physical therapist shall confer with the professional regarding the manner or course of treatment in conflict and take appropriate action in the best interest of the patient; and (2) The provision of consultative, educational, and other advisory services for the purpose of reducing the incidence and severity of physical disability, bodily malfunction, or pain[.], including the promotion and maintenance of fitness, health, and quality of life in all age populations." 3. By amending the definition of "practice of physical therapy" to read: ""Practice of physical therapy" includes, but is not limited to, the use of the following: (1) Physical agents, such as heat, cold, water, air, sound, compression, light, electricity, and electromagnetic radiation; (2) Exercise with or without devices, joint mobilization, mechanical stimulation; dry needling; biofeedback; postural drainage; traction; positioning, massage, splinting, training in locomotion, and other functional activities with or without assisting devices; and correction of posture, body mechanics, and gait; (3) Tests and measurements of: muscle strength, force, endurance, and tone; joint motion, mobility, and stability; reflexes and automatic reaction; movement skill and accuracy; sensation and perception; peripheral nerve integrity; locomotor skill, stability, and endurance; activities of daily living; cardiac, pulmonary, and vascular functions; the fit, function, and comfort of prosthetic, orthotic, and other assisting devices; posture and body mechanics; limb strength, circumference, and volume; thoracic excursion and breathing patterns; vital signs; nature and locus of pain and conditions under which pain varies; photosensitivity; and the home and work physical environments." SECTION 3. Section 461J-2.5, Hawaii Revised Statutes, is amended to read as follows: "[[]§461J-2.5[]] Prohibited practices. A physical therapist shall not use invasive procedures. For purposes of this section, an invasive procedure is the breaking or puncturing of a person's good skin integrity, for example, through surgery or injections[.], with the exception of dry needling." SECTION 4. Section 461J-6, Hawaii Revised Statutes, is amended to read as follows: "§461J-6 Permanent licenses[.]; dry needling certifications. (a) An applicant for a permanent license to practice as a physical therapist or physical therapist assistant shall submit proof of educational qualifications and any other information required by the board on an application form prescribed by the board. The board shall maintain a current list of schools of physical therapy that are approved by an agency recognized by the United States Department of Education or Council on Postsecondary Accreditation. In the case of foreign-trained persons, the board shall establish procedures for assessing the education and training to determine in each case whether it is equivalent to that of applicants trained in the United States. (b) Except as provided under section 461J-7, every applicant for a permanent license who meets the qualifications established by the board shall take an examination administered by the board or an examination administered by a testing agency selected by the board. The board shall establish the schedule for examinations, determine the passing score, and notify applicants of the results of examinations according to rules adopted by the board. (c) The board shall certify qualified licensed physical therapists to perform dry needling and shall designate the requirements for physical therapists related to dry needling, including but not limited to continuing competence requirements; provided that the board shall not certify a qualified licensed physical therapist to perform dry needling before January 1, 2022." SECTION 5. Section 461J-12, Hawaii Revised Statutes, is amended by amending subsection (a) to read as follows: "(a) In addition to any other actions authorized by law, any license issued under this chapter may be revoked or suspended by the board at any time for any cause authorized by law, including but not limited to the following: (1) Obtaining a fee on the assurance that a manifestly incurable disease can be permanently cured; (2) Wilfully betraying patient confidentiality; (3) Making an untruthful and improbable statement in advertising one's practice or business; (4) False, fraudulent, or deceptive advertising; (5) Being habituated to the excessive use of drugs or alcohol or being or having been addicted to, dependent on, or a habitual user of, a narcotic, barbiturate, amphetamine, hallucinogen, or other drug having similar effects; (6) Practicing physical therapy while the ability to practice is impaired by alcohol, drugs, or mental instability; (7) Procuring a license through fraud, misrepresentation, or deceit, or knowingly permitting an unlicensed person to practice physical therapy; (8) Performing dry needling incorrectly, without proper training or certification, or in a manner that would likely harm a patient; [(8)] (9) Professional misconduct, gross carelessness, or manifest incapacity in the practice of physical therapy; [(9)] (10) Conduct or practice contrary to the ethics of the profession of physical therapy in the United States; [(10)] (11) Violation of the conditions or limitations upon which a temporary license is issued or an exemption is granted; or [(11)] (12) Violation of this chapter or the rules adopted pursuant thereto." SECTION 6. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored. SECTION 7. This Act shall take effect upon its approval. INTRODUCED BY: _____________________________
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49	49	SECTION 1. The legislature finds that the Physical Therapy Practice Act was established in 1985, when health care was primarily focused on the curing of illness. Since that time, health care has evolved to place a greater focus on the overall wellness and prevention of illness and disability with the growth of evidence-based treatment intervention options for patients.
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51	51	The legislature further finds that dry needling is a therapeutic intervention tool that is used in conjunction with other physical therapy interventions in order to improve pain control, decrease muscle tension, accelerate active rehabilitation, facilitate normal movement, and return to function for overall better quality of life. Dry needling is recognized by the American Physical Therapy Association, American Academy of Orthopaedic Manual Physical Therapists, and Federation of State Boards of Physical Therapy and has been utilized effectively to treat neuromuscular pain in specific populations, such as acute and overuse sport injuries, post‑operative rehabilitative care, chronic pain, opioid dependence, work restrictions, and disability.
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53	53	Dry needling is allowed in all but seven states, one of the seven being Hawaii. Physical therapists practicing dry needling in federal facilities in Hawaii, as well as across the nation, have patients who have benefited from its use. However, civilian patients in Hawaii are denied access and choice of dry needling care from a physical therapist when appropriate.
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55	55	The legislature also finds that the American Physical Therapy Association endorses the professional liability insurance administered by the Healthcare Providers Service Organization and underwritten by American Casualty Company of Reading, Pennsylvania, a CNA company. A review of a CNA claim database from 2012 to 2017 reveals that of the total of 3,413 physical therapist claims, there were only thirty‑four physical therapy claims related to dry needling reported, representing less than one per cent of the total amount of claims against physical therapists and a total loss incurred of $341,290.
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57	57	The legislature further finds that the Federation of State Boards of Physical Therapy is an organization made up of fifty‑three physical therapy jurisdictions within the United States. The Federation of State Boards of Physical Therapy upholds a mission to protect the public by providing leadership that promotes safe and competent physical therapy services, including administration and maintenance of an examination, licensure, and disciplinary database.
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59	59	The Federation of State Boards of Physical Therapy commissioned the Human Resources Research Organization for the July 10, 2015, practice analysis of the competencies required of physical therapists to perform dry needling. These competencies can provide a strong foundation of professional standards, including education and training requirements, practice assessment, management, and regulation. In this practice analysis, the specific definition of competency, in terms of a physical therapist performing dry needling, was determined to be safe and effective for the patient and the physical therapist. The practice analysis further determined that eighty-six per cent of the knowledge requirements for dry needling competency is acquired during physical therapy basic entry level education and consists of knowledge related to evaluation, assessment, diagnosis, and plan of care development. The remaining fourteen per cent of the knowledge required for dry needling competency must be acquired through post-graduate education or specialized training in dry needling.
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61	61	The legislature further finds that the Hawaii Physical Therapy Practice Act, which is codified under chapter 461J, Hawaii Revised Statutes, establishes the board of physical therapy to provide licensing requirements for physical therapists and physical therapist assistants in the interest of safeguarding life and health. As such, the board of physical therapy is responsible for content standards of continuing competency related to the professional practice of physical therapy and patient or client management.
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63	63	Under existing law, physical therapists are prohibited from breaking or puncturing good skin integrity through surgery or injection. This prohibition was originally intended to ensure that physical therapists do not perform surgery and medical procedures outside the scope of practice and education of physical therapists. However, the existing law does not allow for modern techniques in physical therapy that are within the scope of physical therapy practice and education.
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65	65	Accordingly, the purpose of this Act is to:
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67	67	(1) Clarify the scope of practice for licensed physical therapists to include the practice of dry needling;
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69	69	(2) Require the board of physical therapy to issue dry needling certifications to qualified licensed physical therapists and designate the requirements for physical therapists related to dry needling; and
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71	71	(3) Allow the board of physical therapy to revoke or suspend a physical therapist's license for performing dry needling incorrectly, without proper training or certification, or in a manner that would likely harm a patient.
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73	73	SECTION 2. Section 461J-1, Hawaii Revised Statutes, is amended as follows:
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75	75	1. By adding a new definition to be appropriately inserted and to read:
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77	77	""Dry needling" means a skilled technique performed by a physical therapist using filiform needles to penetrate the skin or underlying tissues to affect change in body structures and functions for the evaluation and management of neuromusculoskeletal conditions, pain, movement impairments, and disability."
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79	79	2. By amending the definition of "physical therapy" or "physical therapy services" to read:
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81	81	""Physical therapy" or "physical therapy services" means the examination, treatment, and instruction of human beings to detect, assess, prevent, correct, alleviate, and limit physical disability, bodily malfunction, pain from injury, disease, and any other physical or mental condition as performed by a physical therapist appropriately licensed under this chapter. It includes but is not limited to:
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83	83	(1) Administration, evaluation, modification of treatment, and instruction involving the use of physical measures, activities, and devices, for preventive and therapeutic purposes; provided that should the care or treatment given by a physical therapist or physical therapist assistant contravene treatment diagnosed or prescribed by a medical doctor, osteopath, or as determined by the board, the physical therapist shall confer with the professional regarding the manner or course of treatment in conflict and take appropriate action in the best interest of the patient; and
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85	85	(2) The provision of consultative, educational, and other advisory services for the purpose of reducing the incidence and severity of physical disability, bodily malfunction, or pain[.], including the promotion and maintenance of fitness, health, and quality of life in all age populations."
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87	87	3. By amending the definition of "practice of physical therapy" to read:
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89	89	""Practice of physical therapy" includes, but is not limited to, the use of the following:
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91	91	(1) Physical agents, such as heat, cold, water, air, sound, compression, light, electricity, and electromagnetic radiation;
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93	93	(2) Exercise with or without devices, joint mobilization, mechanical stimulation; dry needling; biofeedback; postural drainage; traction; positioning, massage, splinting, training in locomotion, and other functional activities with or without assisting devices; and correction of posture, body mechanics, and gait;
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95	95	(3) Tests and measurements of: muscle strength, force, endurance, and tone; joint motion, mobility, and stability; reflexes and automatic reaction; movement skill and accuracy; sensation and perception; peripheral nerve integrity; locomotor skill, stability, and endurance; activities of daily living; cardiac, pulmonary, and vascular functions; the fit, function, and comfort of prosthetic, orthotic, and other assisting devices; posture and body mechanics; limb strength, circumference, and volume; thoracic excursion and breathing patterns; vital signs; nature and locus of pain and conditions under which pain varies; photosensitivity; and the home and work physical environments."
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97	97	SECTION 3. Section 461J-2.5, Hawaii Revised Statutes, is amended to read as follows:
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99	99	"[[]§461J-2.5[]] Prohibited practices. A physical therapist shall not use invasive procedures. For purposes of this section, an invasive procedure is the breaking or puncturing of a person's good skin integrity, for example, through surgery or injections[.], with the exception of dry needling."
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101	101	SECTION 4. Section 461J-6, Hawaii Revised Statutes, is amended to read as follows:
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103	103	"§461J-6 Permanent licenses[.]; dry needling certifications. (a) An applicant for a permanent license to practice as a physical therapist or physical therapist assistant shall submit proof of educational qualifications and any other information required by the board on an application form prescribed by the board. The board shall maintain a current list of schools of physical therapy that are approved by an agency recognized by the United States Department of Education or Council on Postsecondary Accreditation.
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105	105	In the case of foreign-trained persons, the board shall establish procedures for assessing the education and training to determine in each case whether it is equivalent to that of applicants trained in the United States.
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107	107	(b) Except as provided under section 461J-7, every applicant for a permanent license who meets the qualifications established by the board shall take an examination administered by the board or an examination administered by a testing agency selected by the board. The board shall establish the schedule for examinations, determine the passing score, and notify applicants of the results of examinations according to rules adopted by the board.
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109	109	(c) The board shall certify qualified licensed physical therapists to perform dry needling and shall designate the requirements for physical therapists related to dry needling, including but not limited to continuing competence requirements; provided that the board shall not certify a qualified licensed physical therapist to perform dry needling before January 1, 2022."
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111	111	SECTION 5. Section 461J-12, Hawaii Revised Statutes, is amended by amending subsection (a) to read as follows:
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113	113	"(a) In addition to any other actions authorized by law, any license issued under this chapter may be revoked or suspended by the board at any time for any cause authorized by law, including but not limited to the following:
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115	115	(1) Obtaining a fee on the assurance that a manifestly incurable disease can be permanently cured;
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117	117	(2) Wilfully betraying patient confidentiality;
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119	119	(3) Making an untruthful and improbable statement in advertising one's practice or business;
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121	121	(4) False, fraudulent, or deceptive advertising;
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123	123	(5) Being habituated to the excessive use of drugs or alcohol or being or having been addicted to, dependent on, or a habitual user of, a narcotic, barbiturate, amphetamine, hallucinogen, or other drug having similar effects;
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125	125	(6) Practicing physical therapy while the ability to practice is impaired by alcohol, drugs, or mental instability;
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127	127	(7) Procuring a license through fraud, misrepresentation, or deceit, or knowingly permitting an unlicensed person to practice physical therapy;
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129	129	(8) Performing dry needling incorrectly, without proper training or certification, or in a manner that would likely harm a patient;
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131	131	[(8)] (9) Professional misconduct, gross carelessness, or manifest incapacity in the practice of physical therapy;
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133	133	[(9)] (10) Conduct or practice contrary to the ethics of the profession of physical therapy in the United States;
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135	135	[(10)] (11) Violation of the conditions or limitations upon which a temporary license is issued or an exemption is granted; or
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137	137	[(11)] (12) Violation of this chapter or the rules adopted pursuant thereto."
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139	139	SECTION 6. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.
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141	141	SECTION 7. This Act shall take effect upon its approval.
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145	145	INTRODUCED BY: _____________________________
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147	147	INTRODUCED BY:
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181	181	Report Title: Dry Needling; Physical Therapists; Scope of Practice; Certification Description: Specifies that the scope of practice for licensed physical therapists to include the practice of dry needling. Requires the board of physical therapists to certify qualified licensed physical therapists to perform dry needling after 1/1/2022, and designate requirements to perform dry needling. Allows the board of physical therapists to revoke or suspend a physical therapist's license for performing dry needling incorrectly, without proper training or certification, or in a manner that would likely harm a patient. The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.
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187	187	Report Title:
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189	189	Dry Needling; Physical Therapists; Scope of Practice; Certification
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193	193	Description:
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195	195	Specifies that the scope of practice for licensed physical therapists to include the practice of dry needling. Requires the board of physical therapists to certify qualified licensed physical therapists to perform dry needling after 1/1/2022, and designate requirements to perform dry needling. Allows the board of physical therapists to revoke or suspend a physical therapist's license for performing dry needling incorrectly, without proper training or certification, or in a manner that would likely harm a patient.
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203	203	The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.