01-29 15:07 S.B. 196
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Physical Therapist Practice Amendments
2025 GENERAL SESSION
STATE OF UTAH
Chief Sponsor: Calvin R. Musselman
House Sponsor:
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LONG TITLE
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General Description:
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This bill addresses physical therapists and primary care providers.
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Highlighted Provisions:
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This bill:
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▸ expands the definition of primary health care to include the services of physical
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therapists;
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▸ recognizes that a health insurance policy has discretion to allow an insured to select a
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physical therapist as the insured's primary care provider for a musculoskeletal condition;
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and
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▸ makes conforming and technical changes.
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Money Appropriated in this Bill:
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None
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Other Special Clauses:
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None
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Utah Code Sections Affected:
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AMENDS:
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26B-4-301, as last amended by Laws of Utah 2024, Chapter 261
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31A-22-624, as last amended by Laws of Utah 2019, Chapter 349
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Be it enacted by the Legislature of the state of Utah:
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Section 1. Section 26B-4-301 is amended to read:
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26B-4-301 . Definitions.
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As used in this part:
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(1) "Committee" means the Primary Care Grant Committee described in Section 26B-1-410.
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(2) "Community based organization":
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(a) means a private entity; and
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(b) includes for profit and not for profit entities.
S.B. 196 S.B. 196 01-29 15:07
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(3) "Cultural competence" means a set of congruent behaviors, attitudes, and policies that
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come together in a system, agency, or profession and enables that system, agency, or
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profession to work effectively in cross-cultural situations.
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(4) "Emergency medical dispatch center" means a public safety answering point, as defined
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in Section 63H-7a-103, that is designated as an emergency medical dispatch center by
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the office.
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(5) "Health literacy" means the degree to which an individual has the capacity to obtain,
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process, and understand health information and services needed to make appropriate
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health decisions.
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(6) "Institutional capacity" means the ability of a community based organization to
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implement public and private contracts.
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(7) "Medically underserved population" means the population of an urban or rural area or a
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population group that the committee determines has a shortage of primary health care.
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(8) "Office" means the Office of Emergency Medical Services and Preparedness within the
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department.
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(9) "Pregnancy support services" means services that:
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(a) encourage childbirth instead of voluntary termination of pregnancy; and
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(b) assist pregnant women, or women who may become pregnant, to choose childbirth
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whether they intend to parent or select adoption for the child.
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(10) "Primary care grant" means a grant awarded by the department under Subsection
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26B-4-310(1).
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(11)(a) "Primary health care" means:
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(i) basic and general health care services given when a person seeks assistance to
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screen for or to prevent illness and disease, or for simple and common illnesses
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and injuries; and
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(ii) care given for the management of chronic diseases.
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(b) "Primary health care" includes:
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(i) services of physicians, nurses, physician's assistants, physical therapists, and
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dentists licensed to practice in this state under Title 58, Occupations and
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Professions;
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(ii) diagnostic and radiologic services;
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(iii) preventive health services including perinatal services, well-child services, and
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other services that seek to prevent disease or its consequences;
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(iv) emergency medical services;
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(v) preventive dental services; and
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(vi) pharmaceutical services.
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Section 2. Section 31A-22-624 is amended to read:
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31A-22-624 . Primary care physician, physician assistant, or physical therapist.
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An accident and health insurance policy that requires an insured to select a primary care
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physician to receive optimum coverage:
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(1) shall permit an insured to select a participating provider who:
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(a) is[ an]:
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(i) an obstetrician;
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(ii) a gynecologist;
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(iii) a pediatrician; or
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(iv) a physician assistant who works with a physician:
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(A) providing primary care; or
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(B) described in [Subsections] Subsection (1)(a)(i), (ii), or (iii); and
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(b) is qualified and willing to provide primary care services, as defined by the health
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care plan, as the insured's provider from whom primary care services are received;
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(2) may permit an insured to select a participating provider who is a physical therapist, if:
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(a) the insurance coverage for which the selection is made is for a musculoskeletal
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condition; and
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(b) the physical therapist meets the requirements of Subsection (1)(b);
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[(2)] (3) shall clearly state in literature explaining the policy the [option] options available to
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insureds under [Subsection (1)] Subsections (1) and (2); and
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[(3)] (4) may not impose a higher premium, higher copayment requirement, or any other
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additional expense on an insured because the insured selected a primary care physician
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in accordance with [Subsection (1)] this section.
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Section 3. Effective Date.
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This bill takes effect on May 7, 2025.
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