1      H. [
AMENDMENTS TO MENTAL HEALTH PRACTICES

             2     
LICENSING LAWS ] BIOFEEDBACK LICENSING AMENDMENTS .H

             3     
2012 GENERAL SESSION

             4     
STATE OF UTAH

             5     
Chief Sponsor: R. Curt Webb

             6     
Senate Sponsor: Allen M. Christensen

             7     
             8      LONG TITLE
             9      General Description:
             10          This bill amends the Physical Therapist Licensing Act, the Psychologist Licensing Act,
             11      and the Naturopathic Physician Licensing Act to clarify that a person does not have to
             12      be licensed as a psychologist, naturopathic physician, or physical therapist to use
             13      biofeedback.
             14      Highlighted Provisions:
             15          This bill:
             16          .    removes the word "biofeedback" from the definition of the practice of physical
             17      therapy, the practice of psychology, and the practice of naturopathic physical
             18      medicine to clarify that the use of biofeedback is not limited to those particular
             19      licensing acts.
             20      Money Appropriated in this Bill:
             21          None
             22      Other Special Clauses:
             23          None
             24      Utah Code Sections Affected:
             25      AMENDS:


             26          58-24b-102, as enacted by Laws of Utah 2009, Chapter 220
             27          58-61-102, as enacted by Laws of Utah 1994, Chapter 32
             28          58-71-102, as last amended by Laws of Utah 2010, Chapter 101
             29     
             30      Be it enacted by the Legislature of the state of Utah:
             31          Section 1. Section 58-24b-102 is amended to read:
             32           58-24b-102. Definitions.
             33          As used in this chapter:
             34          (1) "Animal physical therapy" means practicing physical therapy or physiotherapy on
             35      an animal.
             36          (2) "Board" means the Utah Physical Therapy Licensing Board, created in Section
             37      58-24b-201 .
             38          (3) "Consultation by telecommunication" means the provision of expert or professional
             39      advice by a physical therapist who is licensed outside of Utah to a licensed physical therapist or
             40      a health care provider by telecommunication or electronic communication.
             41          (4) "General supervision" means supervision and oversight of a person by a licensed
             42      physical therapist when the licensed physical therapist is immediately available in person, by
             43      telephone, or by electronic communication to assist the person.
             44          (5) "Licensed physical therapist" means a person licensed under this chapter to engage
             45      in the practice of physical therapy.
             46          (6) "Licensed physical therapist assistant" means a person licensed under this chapter
             47      to engage in the practice of physical therapy, subject to the provisions of Subsection
             48      58-24b-401 (2)(a).
             49          (7) "Licensing examination" means a nationally recognized physical therapy
             50      examination that is approved by the division, in consultation with the board.
             51          (8) "On-site supervision" means supervision and oversight of a person by a licensed
             52      physical therapist or a licensed physical therapist assistant when the licensed physical therapist
             53      or licensed physical therapist assistant is:
             54          (a) continuously present at the facility where the person is providing services;
             55          (b) immediately available to assist the person; and
             56          (c) regularly involved in the services being provided by the person.


             57          (9) "Physical impairment" means:
             58          (a) a mechanical impairment;
             59          (b) a physiological impairment;
             60          (c) a developmental impairment;
             61          (d) a functional limitation;
             62          (e) a disability;
             63          (f) a mobility impairment; or
             64          (g) a bodily malfunction.
             65          (10) "Physical therapy aide" means a person who:
             66          (a) is trained, on-the-job, by a licensed physical therapist; and
             67          (b) provides routine assistance to a licensed physical therapist or licensed physical
             68      therapist assistant, while the licensed physical therapist or licensed physical therapist assistant
             69      practices physical therapy, within the scope of the licensed physical therapist's or licensed
             70      physical therapist assistant's license.
             71          (11) (a) "Physical therapy" or "physiotherapy" means:
             72          (i) examining, evaluating, and testing an individual who has a physical impairment or
             73      injury;
             74          (ii) identifying or labeling a physical impairment or injury;
             75          (iii) formulating a therapeutic intervention plan for the treatment of a physical
             76      impairment, injury, or pain;
             77          (iv) assessing the ongoing effects of therapeutic intervention for the treatment of a
             78      physical impairment or injury;
             79          (v) treating or alleviating a physical impairment by designing, modifying, or
             80      implementing a therapeutic intervention;
             81          (vi) reducing the risk of an injury or physical impairment;
             82          (vii) providing instruction on the use of physical measures, activities, or devices for
             83      preventative and therapeutic purposes;
             84          (viii) promoting and maintaining health and fitness;
             85          (ix) the administration of a prescription drug pursuant to Section 58-24b-403 ;
             86          (x) subject to Subsection 58-28-307 (12)(b), engaging in the functions described in
             87      Subsections (11)(a)(i) through (ix) in relation to an animal, in accordance with the


             88      requirements of Section 58-24b-405 ; and
             89          (xi) engaging in administration, consultation, education, and research relating to the
             90      practices described in this Subsection (11)(a).
             91          (b) "Physical therapy" or "physiotherapy" does not include:
             92          (i) diagnosing disease;
             93          (ii) performing surgery;
             94          (iii) performing acupuncture;
             95          (iv) taking x-rays; or
             96          (v) prescribing or dispensing a drug, as defined in Section 58-37-2 .
             97          (12) "Recognized accreditation agency" means an accreditation agency that:
             98          (a) grants accreditation, nationally, in the United States of America; and
             99          (b) is approved by the division, in consultation with the board.
             100          (13) (a) "Testing" means a standard method or technique used to gather data regarding
             101      a patient that is generally and nationally accepted by physical therapists for the practice of
             102      physical therapy.
             103          (b) "Testing" includes measurement or evaluation of:
             104          (i) muscle strength, force, endurance, or tone;
             105          (ii) cardiovascular fitness;
             106          (iii) physical work capacity;
             107          (iv) joint motion, mobility, or stability;
             108          (v) reflexes or autonomic reactions;
             109          (vi) movement skill or accuracy;
             110          (vii) sensation;
             111          (viii) perception;
             112          (ix) peripheral nerve integrity;
             113          (x) locomotor skills, stability, and endurance;
             114          (xi) the fit, function, and comfort of prosthetic, orthotic, or other assistive devices;
             115          (xii) posture;
             116          (xiii) body mechanics;
             117          (xiv) limb length, circumference, and volume;
             118          [(xv) biofeedback;]


             119          [(xvi)] (xv) thoracic excursion and breathing patterns;
             120          [(xvii)] (xvi) activities of daily living related to physical movement and mobility;
             120a      H. [ and ] .H
             121          [(xviii)] (xvii) functioning in the physical environment at home or work, as it relates to
             122      physical movement and mobility H. ; and
             122a          (xviii) neural muscular responses .H .
             123          (14) "Therapeutic intervention" includes:
             124          (a) therapeutic exercise, with or without the use of a device;
             125          (b) functional training in self-care, as it relates to physical movement and mobility;
             126          (c) community or work integration, as it relates to physical movement and mobility;
             127          (d) manual therapy, including:
             128          (i) soft tissue mobilization;
             129          (ii) therapeutic massage; or
             130          (iii) joint mobilization, as defined by the division, by rule;
             131          (e) prescribing, applying, or fabricating an assistive, adaptive, orthotic, prosthetic,
             132      protective, or supportive device;
             133          (f) airway clearance techniques, including postural drainage;
             134          (g) integumentary protection and repair techniques;
             135          (h) wound debridement, cleansing, and dressing;
             136          (i) the application of a physical agent, including:
             137          (i) light;
             138          (ii) heat;
             139          (iii) cold;
             140          (iv) water;
             141          (v) air;
             142          (vi) sound;
             143          (vii) compression;
             144          (viii) electricity; and
             145          (ix) electromagnetic radiation;
             146          (j) mechanical or electrotherapeutic modalities;
             147          (k) positioning;
             148          (l) instructing or training a patient in locomotion or other functional activities, with or
             149      without an assistive device;


             150          (m) manual or mechanical traction; and
             151          (n) correction of posture, body mechanics, or gait.
             152          Section 2. Section 58-61-102 is amended to read:
             153           58-61-102. Definitions.
             154          In addition to the definitions in Section 58-1-102 , as used in this chapter:
             155          (1) "Board" means the Psychologist Licensing Board created in Section 58-61-201 .
             156          (2) "Client" or "patient" means an individual who consults or is examined or
             157      interviewed by a psychologist acting in his professional capacity.
             158          (3) "Confidential communication" means information, including information obtained
             159      by the psychologist's examination of the client or patient, which is:
             160          (a) (i) transmitted between the client or patient and a psychologist in the course of that
             161      relationship; or
             162          (ii) transmitted among the client or patient, the psychologist, and individuals who are
             163      participating in the diagnosis or treatment under the direction of the psychologist, including
             164      members of the client's or patient's family; and
             165          (b) made in confidence, for the diagnosis or treatment of the client or patient by the
             166      psychologist, and by a means not intended to be disclosed to third persons other than those
             167      individuals:
             168          (i) present to further the interest of the client or patient in the consultation,
             169      examination, or interview;
             170          (ii) reasonably necessary for the transmission of the communications; or
             171          (iii) participating in the diagnosis and treatment of the client or patient under the
             172      direction of the psychologist.
             173          (4) "Hypnosis" means, regarding individuals exempted from licensure under this
             174      chapter, a process by which one individual induces or assists another individual into a hypnotic
             175      state without the use of drugs or other substances and for the purpose of increasing motivation
             176      or to assist the individual to alter lifestyles or habits.
             177          (5) "Individual" means a natural person.
             178          (6) "Mental health therapist" means an individual licensed under this title as a:
             179          (a) physician and surgeon, or osteopathic physician engaged in the practice of mental
             180      health therapy;


             181          (b) registered psychiatric mental health nurse specialist;
             182          (c) psychologist qualified to engage in the practice of mental health therapy;
             183          (d) clinical social worker;
             184          (e) certified social worker;
             185          (f) marriage and family therapist; or
             186          (g) professional counselor.
             187          (7) "Mental illness" means a mental or emotional condition defined in an approved
             188      diagnostic and statistical manual for mental disorders generally recognized in the professions of
             189      mental health therapy listed under Subsection (6).
             190          (8) "Practice of mental health therapy" means the treatment or prevention of mental
             191      illness, including:
             192          (a) conducting a professional evaluation of an individual's condition of mental health,
             193      mental illness, or emotional disorder;
             194          (b) establishing a diagnosis in accordance with established written standards generally
             195      recognized in the professions of mental health therapy listed under Subsection (6);
             196          (c) prescribing a plan for the prevention or treatment of a condition of mental illness or
             197      emotional disorder; and
             198          (d) engaging in the conduct of professional intervention, including psychotherapy by
             199      the application of established methods and procedures generally recognized in the professions
             200      of mental health therapy listed under Subsection (6).
             201          (9) (a) "Practice of psychology" includes:
             202          (i) the practice of mental health therapy by means of observation, description,
             203      evaluation, interpretation, intervention, and treatment to effect modification of human behavior
             204      by the application of generally recognized professional psychological principles, methods, and
             205      procedures for the purpose of preventing, treating, or eliminating mental or emotional illness or
             206      dysfunction, the symptoms of any of these, or maladaptive behavior;
             207          (ii) the observation, description, evaluation, interpretation, or modification of human
             208      behavior by the application of generally recognized professional principles, methods, or
             209      procedures requiring the education, training, and clinical experience of a psychologist, for the
             210      purpose of assessing, diagnosing, preventing, or eliminating symptomatic, maladaptive, or
             211      undesired behavior and of enhancing interpersonal relationships, work and life adjustment,


             212      personal effectiveness, behavioral health, and mental health;
             213          (iii) psychological testing and the evaluation or assessment of personal characteristics
             214      such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological
             215      functioning;
             216          (iv) counseling, marriage and family therapy, psychoanalysis, psychotherapy, hypnosis,
             217      [biofeedback,] and behavior analysis and therapy;
             218          (v) diagnosis and treatment of mental and emotional disorders of disability, alcoholism
             219      and substance abuse, disorders of habit or conduct, and the psychological aspects of physical
             220      illness, accident, injury, or disability; and
             221          (vi) psychoeducational evaluation, therapy, remediation, and consultation.
             222          (b) An individual practicing psychology may provide services to individuals, couples,
             223      families, groups of individuals, members of the public, and individuals or groups within
             224      organizations or institutions.
             225          (10) "Unlawful conduct" is as defined in Sections 58-1-501 and 58-61-501 .
             226          (11) "Unprofessional conduct" is as defined in Sections 58-1-501 and 58-61-502 , and
             227      may be further defined by division rule.
             228          Section 3. Section 58-71-102 is amended to read:
             229           58-71-102. Definitions.
             230          In addition to the definitions in Section 58-1-102 , as used in this chapter:
             231          (1) "Administrative penalty" means a monetary fine imposed by the division for acts or
             232      omissions determined to constitute unprofessional or unlawful conduct, as a result of an
             233      adjudicative proceeding conducted in accordance with Title 63G, Chapter 4, Administrative
             234      Procedures Act.
             235          (2) "Acupuncture" has the same definition as in Section 58-72-102 .
             236          (3) "Board" means the Naturopathic Physicians Licensing Board created in Section
             237      58-71-201 .
             238          (4) "Diagnose" means:
             239          (a) to examine in any manner another person, parts of a person's body, substances,
             240      fluids, or materials excreted, taken, or removed from a person's body, or produced by a person's
             241      body, to determine the source, nature, kind, or extent of a disease or other physical or mental
             242      condition;


             243          (b) to attempt to conduct an examination or determination described under Subsection
             244      (4)(a);
             245          (c) to hold oneself out as making or to represent that one is making an examination or
             246      determination as described in Subsection (4)(a); or
             247          (d) to make an examination or determination as described in Subsection (4)(a) upon or
             248      from information supplied directly or indirectly by another person, whether or not in the
             249      presence of the person making or attempting the diagnosis or examination.
             250          (5) "Local anesthesia" means an agent, whether a natural medicine or prescription drug,
             251      which:
             252          (a) is applied topically or by injection in superficial tissues associated with the
             253      performance of minor office procedures;
             254          (b) has the ability to produce loss of sensation at the site of minor office procedures;
             255      and
             256          (c) does not cause loss of consciousness or produce general sedation.
             257          (6) "Medical naturopathic assistant" means an unlicensed individual working under the
             258      direct and immediate supervision of a licensed naturopathic physician and engaged in specific
             259      tasks assigned by the licensed naturopathic physician in accordance with the standards and
             260      ethics of the profession.
             261          (7) (a) "Minor office procedures" means:
             262          (i) the use of operative, electrical, or other methods for repair and care of superficial
             263      lacerations, abrasions, and benign lesions;
             264          (ii) removal of foreign bodies located in the superficial tissues, excluding the eye or
             265      ear; and
             266          (iii) the use of antiseptics and local anesthetics in connection with minor office surgical
             267      procedures.
             268          (b) "Minor office procedures" does not include:
             269          (i) general or spinal anesthesia;
             270          (ii) office procedures more complicated or extensive than those set forth in Subsection
             271      (7)(a);
             272          (iii) procedures involving the eye; or
             273          (iv) any office procedure involving tendons, nerves, veins, or arteries.


             274          (8) "Natural medicine" means:
             275          (a) food, food extracts, dietary supplements as defined by the federal Food, Drug, and
             276      Cosmetics Act, all homeopathic remedies, and plant substances that are not designated as
             277      prescription drugs or controlled substances;
             278          (b) over-the-counter medications;
             279          (c) other nonprescription substances, the prescription or administration of which is not
             280      otherwise prohibited or restricted under federal or state law;
             281          (d) prescription drugs:
             282          (i) that, except as provided in Subsection (8)(e), are not controlled substances as
             283      defined in Section 58-37-2 ;
             284          (ii) the prescription of which is consistent with the competent practice of naturopathic
             285      medicine; and
             286          (iii) the prescription of which is approved by the division in collaboration with the
             287      naturopathic formulary advisory peer committee; and
             288          (e) testosterone, if the testosterone is:
             289          (i) bio-identical;
             290          (ii) designed to be:
             291          (A) administered topically, for transdermal absorption; or
             292          (B) absorbed across the mucosal membranes of the mouth; and
             293          (iii) prescribed or administered, in accordance with the requirements of federal and
             294      state law, solely for the purpose of treating a patient with a low testosterone level in order to
             295      restore the patient to a normal testosterone level.
             296          (9) (a) "Naturopathic childbirth" means uncomplicated natural childbirth assisted by a
             297      naturopathic physician, and includes the use of:
             298          (i) natural medicines; and
             299          (ii) uncomplicated episiotomy.
             300          (b) "Naturopathic childbirth" does not include the use of:
             301          (i) forceps delivery;
             302          (ii) general or spinal anesthesia;
             303          (iii) caesarean section delivery; or
             304          (iv) induced labor or abortion.


             305          (10) "Naturopathic mobilization therapy":
             306          (a) means manually administering mechanical treatment of body structures or tissues
             307      for the purpose of restoring normal physiological function to the body by normalizing and
             308      balancing the musculoskeletal system of the body;
             309          (b) does not mean manipulation or adjustment of the joints of the human body beyond
             310      the elastic barrier; and
             311          (c) does not include manipulation as defined in Title 58, Chapter 73, Chiropractic
             312      Physician Practice Act.
             313          (11) "Naturopathic physical medicine" means the use of the physical agents of air,
             314      water, heat, cold, sound, light, and electromagnetic nonionizing radiation, and the physical
             315      modalities of electrotherapy, [biofeedback], acupuncture, diathermy, ultraviolet light,
             316      ultrasound, hydrotherapy, naturopathic mobilization therapy, and exercise. Naturopathic
             317      medicine does not include the practice of physical therapy or physical rehabilitation.
             318          (12) "Practice of naturopathic medicine" means:
             319          (a) a system of primary health care for the prevention, diagnosis, and treatment of
             320      human health conditions, injuries, and diseases that uses education, natural medicines, and
             321      natural therapies, to support and stimulate the patient's intrinsic self-healing processes:
             322          (i) using naturopathic childbirth, but only if:
             323          (A) the licensee meets standards of the American College of Naturopathic
             324      Obstetricians (ACNO) or its successor as determined by the division in collaboration with the
             325      board; and
             326          (B) the licensee follows a written plan for naturopathic physicians practicing
             327      naturopathic childbirth approved by the division in collaboration with the board, which
             328      includes entering into an agreement with a consulting physician and surgeon or osteopathic
             329      physician, in cases where the scope of practice of naturopathic childbirth may be exceeded and
             330      specialty care and delivery is indicated, detailing the guidelines by which the naturopathic
             331      physician will:
             332          (I) refer patients to the consulting physician; and
             333          (II) consult with the consulting physician;
             334          (ii) using naturopathic mobilization therapy;
             335          (iii) using naturopathic physical medicine;


             336          (iv) using minor office procedures;
             337          (v) prescribing or administering natural medicine;
             338          (vi) prescribing medical equipment and devices, diagnosing by the use of medical
             339      equipment and devices, and administering therapy or treatment by the use of medical devices
             340      necessary and consistent with the competent practice of naturopathic medicine;
             341          (vii) prescribing barrier devices for contraception;
             342          (viii) using dietary therapy;
             343          (ix) taking and using diagnostic x-rays, electrocardiograms, ultrasound, and
             344      physiological function tests;
             345          (x) taking of body fluids for clinical laboratory tests and using the results of the tests in
             346      diagnosis;
             347          (xi) taking of a history from and conducting of a physical examination upon a human
             348      patient; and
             349          (xii) prescribing and administering natural medicines and medical devices, except a
             350      naturopathic physician may only administer:
             351          (A) a prescription drug, as defined in Section 58-17b-102 , in accordance with
             352      Subsection (8)(d); and
             353          (B) local anesthesia that is not a controlled substance, and only in the performance of
             354      minor office procedures;
             355          (b) to maintain an office or place of business for the purpose of doing any of the acts
             356      described in Subsection (12)(a), whether or not for compensation; or
             357          (c) to use, in the conduct of any occupation or profession pertaining to the diagnosis or
             358      treatment of human diseases or conditions, in any printed material, stationery, letterhead,
             359      envelopes, signs, or advertisements, the designation "naturopathic physician," "naturopathic
             360      doctor," "naturopath," "doctor of naturopathic medicine," "doctor of naturopathy,"
             361      "naturopathic medical doctor," "naturopathic medicine," "naturopathic health care,"
             362      "naturopathy," "N.D.," "N.M.D.," or any combination of these designations in any manner that
             363      might cause a reasonable person to believe the individual using the designation is a licensed
             364      naturopathic physician.
             365          (13) "Prescribe" means to issue a prescription:
             366          (a) orally or in writing; or


             367          (b) by telephone, facsimile transmission, computer, or other electronic means of
             368      communication as defined by division rule.
             369          (14) "Prescription device" means an instrument, apparatus, implement, machine,
             370      contrivance, implant, in vitro reagent, or other similar or related article, and any component
             371      part or accessory, which is required under federal or state law to be prescribed by a practitioner
             372      and dispensed by or through a person or entity licensed under this chapter or exempt from
             373      licensure under this chapter.
             374          (15) "Prescription drug" means a drug that is required by federal or state law or rule to
             375      be dispensed only by prescription or is restricted to administration only by practitioners.
             376          (16) "Unlawful conduct" is as defined in Sections 58-1-501 and 58-71-501 .
             377          (17) "Unprofessional conduct" is as defined in Sections 58-1-501 and 58-71-502 , and
             378      as may be further defined by division rule.


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