August 1998 Bulletin

States approve 19 laws on scope of practice

Legislators introduce more than 60 bills

Nineteen scope of practice bills were signed into state laws in the first five months of this year.

The more than 60 bills introduced in this year ranged from proposed legislation that would allow chiropractors to be called "chiropractic physicians" to a bill in Vermont that would have expanded the scope of practice in podiatry to include diagnosis and treatment of ailments of the lower leg. The health care practitioners most often seeking to increase their scope of practice through legislation included advanced practice registered nurses, athletic trainers, chiropractors, physical therapists and podiatrists.

Here are some of the new scope of practice laws:

Arkansas. The governor signed legislation that allows direct access to chiropractors for patients in managed care plans without prior approval of a primary care physician or managed care plan.

Kansas. Chiropractors can now call themselves "chiropractic physicians."

New Mexico. Podiatrists are now permitted to use biomedical means to treat ailments to the foot and ankle.

Virginia. Licensed physical therapists can now practice without a referral when consulting with student athletes or employees about workplace ergonomics.

Bills still pending in New Jersey include AB 1207 which requires direct access to chiropractic services without medical referral to be included among health care services available in managed care plans and AB 411 which requires that any covered service within the scope of practice for a chiropractor be entitled to reimbursement at the same rate applied to licensed physicians and surgeons.

In New York, legislators were very active in the area of scope of practice, introducing 20 bills during the 1998 session. However, at the close of the second full session on June 30, the bills had not moved out of their respective committees. This lack of action effectively killed them until the 1999 legislative session.

"Both the orthopaedic society and the state medical society worked very hard to keep all of these extenders from passing to the floor," said Francis J. McKee, executive director of the New York State Society of Orthopaedic Surgeons. McKee said the society makes it position known to legislators through an annual visit to the state capital and, if necessary, testimony before committees. He said the society uses what little political action funds it garners to fight encroachment by the allied health professions by using the money to support legislators who support its positions.

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