HB629 HD1

SECTION 1. 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. 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. This requirement creates barriers that hinder the department of education's ability to be reimbursed for the services provided.

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. These services enable students to participate more fully in educational and social activities and benefit more effectively from their learning environments.

Moreover, the legislature also finds that expanding the scopes of practice for licensed occupational therapists, physical therapists, and speech pathologists may facilitate the department of education's ability to obtain reimbursement. 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.

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.

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

"§457G-1.5 Practice of occupational therapy. (a) 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. It includes:

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

(A) 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;

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

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

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

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

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

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

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

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

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

(3) 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:

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

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

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

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

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

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

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

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

(I) 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;

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

(K) Low vision rehabilitation;

(L) Driver rehabilitation and community mobility;

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

(N) 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

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

(b) 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.

(c) 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.

(d) 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:

(1) 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

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

(e) 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.

(f) 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.

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. "Occupational therapy services" include but are not limited to:

(1) Evaluating students' needs and developing individualized treatment plans;

(2) Providing interventions to improve students' fine motor skills, gross motor skills, sensory processing, visual-motor integration, and cognitive skills;

(3) Adapting classroom environments and materials to facilitate students' participation in school activities;

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

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

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

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

"§461J-2 Practice of physical therapy; qualifications. (a) 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.

(b) 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.

(c) 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.

(d) 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.

(e) 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.

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

(1) Assessing students' physical abilities and limitations;

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

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

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

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

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

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

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

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

(1) 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;

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

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

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

(b) 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.

[~~(b)~~] (c) A person represents oneself to be an audiologist when the person:

(1) 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;

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

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

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

SECTION 6. This Act shall take effect on July 1, 3000.

HOUSE OF REPRESENTATIVES	H.B. NO.	629
THIRTY-THIRD LEGISLATURE, 2025		H.D. 1
STATE OF HAWAII