VIA EMAIL CORRESPONDENCE
Ms. Helen Drew
RI Department of Health – Legislative Liaison
3 Capitol Hill
Providence, RI 02908
Dear Ms. Drew:
On behalf of the National Association for the Advancement of Orthotics and Prosthetics (“NAAOP”), I am writing to support the efforts of the Rhode Island legislature to enact a strong state licensure bill to help ensure the quality of orthotic and prosthetic services provided to Rhode Island residents.
The National Association for the Advancement of Orthotics and Prosthetics (“NAAOP”) is a national non-profit association representing the collective interests of certain specialized clinicians, as well as the rehabilitation and disability communities they serve, who are concerned with the quality of orthotic and prosthetic (“O&P”) healthcare. Specifically, these highly trained and educated clinicians carefully evaluate both limb loss and limb or trunk dysfunction for the purpose of providing appropriate, custom designed and custom fit orthoses (orthopedic braces) and prostheses (artificial limbs).
NAAOP supports state licensure efforts for the provision of professional orthotic and prosthetic care. As such, we generally support H. 7103, introduced in the Rhode Island General Assembly on February 7, 2006. However, we would offer a small number of important amendments to make the licensure law as effective as possible in safeguarding the public health and ensuring the quality of orthotic and prosthetic services.
First, the bill should reflect a distinction between “off the shelf” and “pre-fabricated” orthoses. These are not synonymous terms as the bill clearly indicates in Section 5-59.1-3(14). Most pre-fabricated orthoses require varying degrees of clinical expertise and custom fitting to be safe, effective, and functional for the patient. Exemptions from orthotic licensure should apply to “off the shelf” orthoses only, which are generally regarded as being minimally complex and widely commercially available, and should not apply to pre-fabricated orthoses. This is particularly true when additional exemptions are explicitly recognized in the state licensure law that provide wide latitude to therapists and others to treat patients with devices such as “commercially available knee orthoses used following injury or surgery, spastic muscle-tone inhibiting orthoses….finger splints, hand splints, wrist gauntlets….fabric or elastic supports, corsets, low-temperature formed plastic splints, trusses, etc.” See, Section 5-59.1-3(11).
Most importantly, limiting exemptions of providers from orthotic licensure to off-the-shelf orthoses would be consistent with federal Medicare law. See, Section 427 of the Benefits Improvement and Protection Act of 2000 (“BIPA”). The distinction between off the shelf and prefabricated orthoses should be replicated consistently throughout Rhode Island’s orthotic and prosthetic licensure law.
Second, Section 5-59.1.3(3) of the bill should be amended to include “custom fit” orthoses, all of which require varying levels of clinical expertise to properly fit to the patient. This would be consistent with the previous points regarding prefabricated orthoses.
Finally, we understand that the physical therapists and occupational therapists are seeking at least two amendments to the “Exceptions” section of the bill, Section 5-59.1.8. The first amendment would apparently insert the words “or podiatrist” in the provision exempting physicians generally from the licensure statute. Section 5-59.1.8(a). We oppose this amendment because we view it as superfluous and might suggest that other physician specialties would not hold the same level of exemption from the licensure scheme as podiatrists.
The second amendment is far more problematic. We understand that the physical and occupational therapists are seeking to expand their exemption from this law from “providing patients with prefabricated or direct-form orthoses” (as the bill now reads) to all orthotic services and devices. This would be a substantial expansion of the types of orthotic care that PTs and OTs would be able to provide under this bill without obtaining the additional education and training necessary to provide quality orthotic care. In fact, this amendment, if adopted, would significantly expand the range of orthotic and prosthetic services currently permitted under the state’s PT and OT licensure laws. The provision of orthotics and prosthetics is not even addressed by the PT licensure law in Rhode Island (see,www.rules.state.ri.us/rules/released/pdf/DOH/DOH_2873.pdf [PDF]) and the OT licensure law only mentions “selected orthotic devices” and “training” for use of orthoses and prostheses (see, www.rules.state.ri.us/rules/released/pdf/DOH/DOH_2516.pdf [PDF]. We believe the current bill, as amended by the recommendations herein, would properly exempt “selected orthotic devices.”
The arguments being made by the physical and occupational arguments on this issue are not new. For many years, therapy organizations have attempted to expand their scope of practice through legislation rather than through additional clinical training in professional O&P care. To this day, no document exists that demonstrates that physical or occupational therapists are educated and trained, as a profession, to provide the degree of professional orthotic and prosthetic care that they apparently seek in this bill.
We firmly maintain that physical and occupational therapists do not possess the formal education, unique training, experience, broad knowledge base, ability and expertise necessary to prescribe, fabricate and provide to patients the full range of professional orthotic and prosthetic services. And we oppose any legislative effort that circumvents proper education and training requirements.
Thank you for your careful consideration of this matter. If you would like to discuss this issue directly, please call me at (800)220-6670.