RELATING TO THERAPY SERVICES.

HB1070

HOUSE OF REPRESENTATIVES

H.B. NO.

1070

THIRTY-THIRD LEGISLATURE, 2025

STATE OF HAWAII

A BILL FOR AN ACT

RELATING TO THERAPY SERVICES.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

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SECTION 1.
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The
legislature finds that amending Hawaii's occupational therapy, physical
therapy, and speech pathology laws is necessary to promote a more cost
effective model for delivering therapeutic services to students in the
department of education.
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Currently, the
department of education is unable to claim reimbursement unless licensed
occupational therapists, physical therapists, and speech pathologists employed
by or contracted with the department of education obtain a prescription from a
physician or other authorized health care provider before providing services to
students.
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This requirement creates
barriers that hinder the department of education's ability to be reimbursed for
the services provided.

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The legislature further finds that timely
access to occupational, physical, and speech therapy services is critical for
supporting students' development, particularly in physical, sensory, cognitive,
and communication skills.
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These services
enable students to participate more fully in educational and social activities
and to benefit more effectively from their learning environments.

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Moreover, the legislature finds that
expanding the scopes of practice for these licensed professionals may facilitate
the department of education's ability for reimbursement.
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By allowing occupational therapy, physical
therapy, and speech therapy services to be provided after a diagnosis of a
medical condition by these providers without a physician's diagnosis, the
department of education can more effectively bill for these services,
generating additional funding to support and enhance therapeutic resources for
students.

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The purpose of this Act is to expand the
scopes of practice for occupational therapists, physical therapists, and speech
pathologists employed by or contracted with the department of education to
diagnose students with a medical condition and treat them, thereby streamlining
service delivery.

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SECTION 2.
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Section 457G-1.5, Hawaii Revised Statutes, is amended to read as
follows:

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�457G-1.5
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Practice of
occupational therapy.

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(a)
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The practice of occupational therapy is the
therapeutic use of everyday life activities with individuals or groups for the
purpose of participation in roles and situations in home, school, workplace,
community, and other settings.
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It
includes:

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(1)
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Evaluation
of factors affecting activities of daily living, instrumental activities of
daily living, rest and sleep, education, work, play, leisure, and social
participation, including:

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(A)
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Client
factors, including body functions, such as neuromusculoskeletal,
sensory-perceptual, visual, mental, cognitive, and pain factors; body
structures, such as cardiovascular, digestive, nervous, integumentary,
genitourinary systems, and structures related to movement, values, beliefs, and
spirituality;

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(B)
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Habits,
routines, roles, rituals, and behavior patterns;

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(C)
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Occupational
and social environments, cultural, personal, temporal, and virtual contexts and
activity demands that affect performance; and

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(D)
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Performance
skills, including motor and praxis, sensory-perceptual, emotional regulation,
cognitive, communication, and social skills;

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(2)
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Methods
or approaches selected to direct the process of interventions, including:

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(A)
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Establishment,
remediation, or restoration of a skill or ability that has not yet developed,
is impaired, or is in decline;

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(B)
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Compensation,
modification, or adaptation of activity or environment to enhance performance
or prevent injuries, disorders, or other conditions;

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(C)
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Retention
and enhancement of skills or abilities without which performance in everyday
life activities would decline;

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(D)
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Promotion
of health and wellness, including the use of self-management strategies, to
enable or enhance performance in everyday life activities; and

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(E)
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Prevention
of barriers to performance and participation, including injury and disability
prevention; and

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(3)
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Interventions
and procedures to promote or enhance safety and performance in activities of
daily living, instrumental activities of daily living, rest and sleep,
education, work, play, leisure, and social participation, including:

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(A)
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Therapeutic
use of occupations, exercises, and activities;

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(B)
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Training
in self-care, self-management, health management and maintenance, home management,
community reintegration, work reintegration, school activities, and work
performance;

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(C)
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Development,
remediation, or compensation of neuromusculoskeletal, sensory-perceptual,
visual, mental, and cognitive functions; pain tolerance and management; and
behavioral skills;

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(D)
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Therapeutic
use of self, including one's personality, insights, perceptions, and judgments,
as part of the therapeutic process;

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(E)
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Education
and training of individuals, including family members, caregivers, groups,
populations, and others;

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(F)
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Care
coordination, case management, and transition services;

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(G)
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Consultative
services to groups, programs, organizations, or communities;

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(H)
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Modification
of environments, such as home, work, school, or community, and adaptation of
processes, including the application of ergonomic principles;

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(I)
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Assessment,
design, fabrication, application, fitting, and training in seating and
positioning; assistive technology; adaptive devices; orthotic devices; and
training in the use of prosthetic devices;

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(J)
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Assessment,
recommendation, and training in techniques to enhance functional mobility,
including management of wheelchairs and other mobility devices;

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(K)
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Low
vision rehabilitation;

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(L)
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Driver
rehabilitation and community mobility;

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(M)
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Management
of feeding, eating, and swallowing to enable eating and feeding performance;

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(N)
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Application
of physical agent modalities and use of a range of specific therapeutic
procedures, such as wound care management, interventions to enhance
sensory-perceptual and cognitive processing, and manual therapy, to enhance
performance skills; and

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(O)
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Facilitating
the occupational performance of groups, populations, or organizations through
the modification of environments and the adaptation of processes.

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(b)
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No
person shall engage in the practice of occupational therapy gratuitously or for
pay, offer to practice occupational therapy, offer occupational therapy, or
represent, advertise, or announce, either publicly or privately, that the
person is an occupational therapist, unless the person is appropriately
licensed under this chapter.

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(c)
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No person shall use, in connection with the
person's name or business, the words "occupational therapist
licensed", "registered occupational therapist", "licensed
occupational therapist", "occupational therapist", or
"doctor of occupational therapy", or the letters "OT",
"OTR", "OTD", "OT/L", "OTR/L", or
"OTD/L", or any other words, letters, abbreviations, or insignia
indicating or implying that the person is an occupational therapist unless the
person is appropriately licensed as an occupational therapist under this
chapter.

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(d)
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Effective January 1, 2017, except as otherwise
provided in this chapter, no person shall engage in the practice of
occupational therapy or represent the person's self as able to practice as an
occupational therapy assistant in the State unless:

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(1)
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The
practice is done under the supervision of and in partnership with an
occupational therapist who is licensed to practice occupational therapy in the
State; and

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(2)
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The
person possesses a valid license issued pursuant to this chapter to practice
occupational therapy as an occupational therapy assistant.

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(e)
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No person shall use the title
"occupational therapy assistant licensed", "licensed
occupational therapy assistant", the letters "OTA/L" or
"COTA/L", or any other words, letters, abbreviations, or insignia
indicating or implying that the person is an occupational therapy assistant
unless that person is appropriately licensed as an occupational therapy
assistant under this chapter.

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(f)
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A licensed occupational therapist employed by or contracted with the
department of education may diagnose medical conditions that can be treated by
occupational therapy services when providing occupational therapy services to
students of the department of education in an educational setting.

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For the purposes of this subsection,
"occupational therapy services" means the therapeutic use of everyday
life activities with students for the purpose of participation in roles and
situations in school, home, and community settings.
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These services include, but are not limited
to:

����
(1)
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Evaluating
students' needs and developing

individualized treatment plans;

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(2)
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Providing
interventions to improve students' fine

motor skills, gross motor
skills, sensory processing,
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visual-motor
integration, and cognitive skills;

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(3)
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Adapting
classroom environments and materials to

facilitate students'
participation in school

activities;

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(4)
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Training
teachers and parents on strategies to support students' occupational needs;

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(5)
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Recommending
assistive technology devices and adaptive equipment; and

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(6)
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Diagnosing
medical conditions that can be treated by occupational therapy.
"

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SECTION 3.
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Section 461J-2, Hawaii Revised Statutes, is
amended to read as follows:

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�461J-2
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Practice of physical therapy; qualifications.
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(a)
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No person shall practice physical therapy
gratuitously or for pay, offer to practice physical therapy, offer physical
therapy or physical therapy services, or represent, advertise, or announce,
either publicly or privately, that the person is a physical therapist or
physiotherapist, unless the person is appropriately licensed under this
chapter.

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(b)
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No person shall use, in connection with the
person's name or business, the words "licensed physical therapist",
"physical therapist", or "physiotherapist", or the letters
"RPT", "LPT", "DPT",

"PT", or
any other words, letters, abbreviations, or insignia indicating or implying
that the person is a physical therapist, unless the person is appropriately
licensed as a physical therapist

under this chapter.

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(c)
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No person shall use the title "physical
therapist assistant", the letters "PTA", or any other words,
abbreviations, or insignia in connection with that person's name to indicate or
imply, directly or indirectly, that the person is a physical therapist
assistant unless that person is appropriately licensed as a physical therapist
assistant under this chapter.

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(d)
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No person shall practice as a physical
therapist or as a physical therapist assistant, except as licensed pursuant to
this chapter and under the administrative rules determined by the board in
accordance with chapter 91.

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(e)
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A licensed physical therapist employed by or contracted with the
department of education may diagnose medical conditions that can be treated by
physical therapy services when providing physical therapy services to students
of the department of education in an educational setting.

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For the purposes of this subsection,
"physical therapy services" includes the following:

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(1)
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Assessing
students' physical abilities and
�

limitations;

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(2)
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Developing
and implementing individualized treatment plans to address students' physical
therapy needs;

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(3)
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Providing
interventions to improve students' strength, flexibility, range of motion,
balance, coordination, and mobility;

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(4)
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Adapting
physical education activities and school environments to meet the needs of
students with physical disabilities;

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(5)
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Educating
teachers, parents, and students on proper body mechanics and injury prevention;

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(6)
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Recommending
adaptive equipment to facilitate students' participation in school activities;
and

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(7)
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Diagnosing
medical conditions that can be treated by physical therapy.
"

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SECTION 4.
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Section 468E-3, Hawaii Revised Statutes, is amended
to read as follows:

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�468E-3
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Practice as speech pathologist or
audiologist; title or description of services.
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(a)
�
A
person represents oneself to be a speech pathologist when the person:

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(1)
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Holds
oneself out to the public by any title or description of services incorporating
the words
"speech pathologist", "speech pathology",
"speech therapy", "speech correction", "speech
correctionist", "speech therapist", "speech clinic",
"speech clinician", "language pathologist", "language
pathology", "logopedics", "logopedist",
"communicology", "communicologist",
"asphasiologist", "voice therapy", "voice
therapist", "voice pathology", or "voice pathologist",
"language therapist", or "phoniatrist", or any similar
titles;

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(2)
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Purports
to treat stuttering, stammering, or other disorders of speech;

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(3)
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Is
employed as a faculty member in speech pathology;

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(4)
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Is
employed as a speech pathologist by the State or any county agency.

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(b)
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A licensed speech pathologist employed by or contracted
with the department of education may diagnose medical conditions that can be
treated by speech pathology services when providing speech pathology services
to students of the department of education in an educational setting.

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[b]

(c)
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A person represents oneself to be an
audiologist when the person:

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(1)
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Holds
oneself out to the public by any title or description of services incorporating
the terms "audiology", "audiologist",
"audiological", "hearing clinic", "hearing clinician",
"hearing therapist", or any similar titles;

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(2)
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Is
employed as a faculty member in audiology;

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(3)
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Is
employed as an audiologist by the State or any county agency."

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SECTION 5.
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Statutory material to be repealed is bracketed
and stricken.
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New statutory material is
underscored.

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SECTION 6.
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This Act shall take effect upon its approval.

INTRODUCED BY:

_____________________________

BY REQUEST

Report Title:

DOE; Department of Commerce and Consumer Affairs;
Department of Human Services

Description:

Expands the scopes of practice for occupational
therapists, physical therapists, and speech pathologists to allow those
professionals working for or contracted by the Department of Education to
diagnose medical conditions that can be treated with their respective services.

The summary description
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not legislation or evidence of legislative intent.