HB141 By Representatives Treadaway, Mooney and Drake RFD Boards, Agencies and Commissions Rd 1 04-FEB-20

SYNOPSIS: Under existing law, the Alabama Board of Athletic Trainers is responsible for the regulation and licensing of athletic trainers in the state.

This bill would provide further for the licensing and regulation of athletic trainers to treat athletic injuries sustained by physically active individuals.

This bill would provide further for the formal professional relationship between an athletic trainer and a supervising or referring physician.

This bill would also provide for the membership and duties of the Advisory Council of the State Board of Medical Examiners and the Alabama Board of Athletic Trainers.

A BILL TO BE ENTITLED AN ACT

Relating to the Alabama Board of Athletic Trainers; to amend Sections 34-40-2, 34-40-3, 34-40-5, 34-40-6, 34-40-9, 34-40-10, 34-40-15, and 34-40-16, Code of Alabama 1975, to further provide for the licensing and regulation of athletic trainers; and to add Section 34-40-3.2 to the Code of Alabama 1975, to establish and provide for the membership and duties of the Advisory Council of the State Board of Medical Examiners and the Alabama Board of Athletic Trainers.

BE IT ENACTED BY THE LEGISLATURE OF ALABAMA:Section 1. Sections 34-40-2, 34-40-3, 34-40-5, 34-40-6, 34-40-9, 34-40-10, 34-40-15, and 34-40-16 of the Code of Alabama 1975, are amended to read as follows:

§34-40-2.

"As used in this chapter, the following words and phrases terms shall have the following meanings, respectively, unless the context clearly indicates otherwise:

"(1) APPRENTICE ATHLETIC TRAINER. A person who assists in the duties usually performed by an athletic trainer and who works under the direct supervision of a licensed athletic trainer.

"(2) ATHLETE. A person who participates in an athletic activity being conducted by an educational institution, professional athletic organization, or a board sanctioned amateur athletic organization.

"(1) ADVISORY COUNCIL. The Advisory Council of the State Board of Medical Examiners and the Alabama Board of Athletic Trainers created pursuant to Section 34-40-3.2.

"(3)(2) ATHLETIC INJURY. An injury or condition sustained received by an athlete as a result of, or limiting the preparation for or participation of the athlete in, an athletic activity exercise, sport, game, recreational activity, or any other activity that requires a level of strength, endurance, flexibility, or agility that is comparable to the level of strength, endurance, flexibility, or agility required for an exercise, sport, game, or recreational activity; or any injury that a physician deems would benefit from athletic training services.

"(4)(3) ATHLETIC TRAINER. A person An individual licensed by the Alabama Board of Athletic Trainers as an athletic trainer and who practices athletic training on an athlete under the direction or referral, or both, of a licensed physician after meeting the requirements of this chapter and rules and regulations promulgated pursuant to this chapter.

"(5)(4) ATHLETIC TRAINING PRACTICE. Practice by an athletic trainer under physician supervision of any of the following:

"a. Under physician direction or referral, or both, the prevention of athletic injuries The application of care for an athletic injury, including the application or provision of any of the following:

"1. Principles, methods, and procedures of recognition, examination, assessment, clinical evaluation, prevention, management, emergency care, disposition, or rehabilitation and reconditioning of athletic injuries.

"2. Appropriate preventive and supportive devices.

"3. Treatment using physical modalities such as heat, cold, light, mechanical devices, electric stimulation, manual therapy techniques, aquatic therapy, sound, or therapeutic exercise.

"4. Any other physical agent that is included within the written protocols allowed by the State Board of Medical Examiners and prescribed by a physician.

"b. The organization and administration of athletic training programs, including health care administration and professional responsibility.

"c. Athletic counseling The provision of athletic training, education, and guidance and the education of athletes regarding athletics and athletic training to physically active individuals, coaches, medical personnel, and the community in the prevention and care of athletic injuries.

"d. Under physician direction and referral, the rehabilitation and reconditioning of an athlete The recognition of potential illnesses and referrals to a physician for diagnosis and treatment.

"e. Under physician supervision, the evaluation, the recognition, and management of athletic injuries The provision of injury prevention services developed for physically active individuals.

"(6)(5) BOARD. The Alabama Board of Athletic Trainers.

"(6) INJURY PREVENTION. Care and guidance related to risk management, including biomechanics, conditioning, flexibility, nutrition, strength training, and fitness.

"(7) PHYSICAL THERAPIST. A physical therapist licensed by the Alabama State Board of Physical Therapy.

"(8) PHYSICIAN. A physician licensed by the Medical Licensure Commission of Alabama.

"(9) PHYSICIAN SUPERVISION. a. An A licensed athletic trainer acting under the supervision of a physician if:

"a.1. The activities are undertaken pursuant to a verbal or written order of the physician who has evaluated the injured athlete physically active individual; and or

"b.2. The activity is undertaken in accordance with a written protocol signed by the physician which that describes the athletic injury encountered and directs appropriate medical interventions consistent with the qualification, training, and experience of the licensed athletic trainer. The State Board of Medical Examiners shall establish minimum medical criteria for any protocol used by athletic trainers and shall specify those conditions and circumstances which that require referral to the physician for further evaluation.

"b. Physician supervision establishes a formal relationship between an athletic trainer and a physician under which the athletic trainer is authorized to practice as evidenced by a written protocol approved by the State Board of Medical Examiners and requires professional oversight and direction pursuant to the rules of the State Board of Medical Examiners and the Alabama Board of Athletic Trainers as recommended by the advisory council. No rule adopted pursuant to this paragraph shall be effective without the approval of both the State Board of Medical Examiners and the board.

§34-40-3.

"(a) The Alabama Board of Athletic Trainers shall be composed of nine members who shall serve four-year terms. Members may not serve more than three consecutive four-year terms. Three members shall be Black a member of a minority class, one of whom shall be a physician member. The composition of the board shall be as follows:

"(1) Six members who are athletic trainers, appointed by the Alabama Athletic Trainers Trainers' Association in accordance with subsection (b), one of whom shall also be an athletic trainer who is a licensed a physical therapist.

"(2) Three physicians licensed to practice medicine actively engaged in the treatment of athletes and athletic injuries or illnesses, appointed by the Medical Association of the State of Alabama.

"(3) The President of the Alabama Athletic Trainers Trainers' Association who shall serve as an ex officio member of the board and whose term of office shall be yearly to coincide with his or her term as President of the Alabama Athletic Trainers Trainers' Association.

"(b) The six athletic trainers shall be appointed by the The Alabama Athletic Trainers Trainers' Association. The association shall conduct an annual meeting at which all athletic trainers holding a current license as identified under this chapter shall have the right to attend, nominate, and vote for the athletic trainer members of the board. The association shall regulate and prescribe the date, hour, and place of the meeting, the method of nomination, and the manner of voting. At least 30 days prior to the meeting, the board shall mail send notices to each current licensee at the address shown on the current registration notifying of the exact date, hour, and place of the meeting, the purpose of the meeting, and of the right to attend and vote. To qualify as a board member pursuant to this subsection, a person shall be a citizen of the United States and a resident of this state and have acted as an athletic trainer for three years within this state immediately preceding appointment.

"(c) In making the initial appointments, the Alabama Athletic Trainers Trainers' Association shall appoint one athletic trainer whose term will expire in 1994, two athletic trainers whose terms will expire in 1995, and one athletic trainer whose term will expire in 1996, and two athletic trainers whose terms will expire in 1997. The Medical Association of the State of Alabama shall appoint one physician whose term will expire in 1994, one physician whose term will expire in 1995, and one physician whose term will expire in 1996. All appointments expire on December 31 of the year specified.

"(d) Each appointee to the board shall qualify by taking an oath of office within 15 days from the date of the appointment. In the event of death, resignation, or removal of any member, except for physician members, the vacancy of the unexpired term shall be filled by the board.

"(e) The board shall elect a chair, a vice-chair, and secretary from its members for a term of one year and may appoint any committees and formulate any rules it considers necessary to carry out its duties pursuant to this chapter. The board shall meet at least twice each year. Additional meetings may be held on the call of the chair or at the written request of any two members of the board. The secretary shall keep a record of the proceedings of the board. The board may promulgate and adopt rules and regulations consistent with this chapter which are necessary for the performance of its duties. The board may employ an executive secretary and any officers and employees as may be necessary to carry out the duties of the board. The State Board of Medical Examiners and the Alabama Board of Athletic Trainers shall jointly approve any rule, regulation, or policy that interprets, explains, or enumerates the permissible acts, functions, or services rendered by an athletic trainer or apprentice athletic trainer as those acts, functions, and services are defined in Section 34-40-2. Any rule, regulation, or policy adopted in violation of this requirement is invalid. The board shall prescribe methods and forms for license applications, license certificate, license renewal, verification of license, continuing education verification, and any forms for information required from licensees to carry out the duties of the board. The board shall adopt an official seal and a license certificate of suitable design.

"(f) Members of the board shall receive fifty dollars ($50) one hundred dollars ($100) for every day actually spent in the performance of their duties and in addition thereto shall be reimbursed according to the state travel policy for other expenses in the same amounts and under the same conditions as state employees are reimbursed.

"(g) It shall be the duty of the The board to shall pass upon the qualifications of applicants for licensure as an athletic trainer, and to issue licenses and annual renewals to athletic trainers. The board shall be responsible for fixing fix fees for such applications, licenses, renewals, verification of licensure, replacement of licenses, name changes on of licensees, publication fees, or other administration fees deemed necessary to carry out the provisions of this chapter.

§34-40-5.

"(a) Any person seeking licensure as an athletic trainer shall be a citizen of the United States or, if not a citizen of the United States, a person who is legally present in the United States with appropriate documentation from the federal government, and meet at least one of the following requirements:

"(1) Satisfactory completion of all of the National Athletic Trainers' Association (NATA) Board of Certification, Inc., or its successor organization, qualifications and; certification as an athletic trainer in good standing by the National Athletic Trainers' Association Board of Certification, Inc.; and eligibility for a National Provider Identifier.

"(2) Licensure by reciprocity. The board shall grant, without examination, licensure to any qualified athletic trainer holding a license certificate or registration in another state if that state maintains licensure qualifications which that are substantially equivalent to those required in this state, and gives similar reciprocity to licensees of this state.

"(b) Any person desiring to be licensed, desiring a renewal of an existing license, desiring verification of licensure, reinstatement of a license, replacement of a license, or name changes for a licensee as an athletic trainer in this state shall make and file with the board, not less than 30 days prior to any regular meeting thereof, a written application on a form or request as prescribed by the board. The application shall be accompanied by the payment of a fee, as set by the board, to include publication fees or other administrative fees deemed necessary to carry out the provisions of this chapter, in accordance with subsection (g) of Section 34-40-3. Any licensee who fails to renew his or her license within 90 days following expiration of the previous license shall be required to file a new application and pay an application fee with the board.

§34-40-6.

"An athletic trainer, as a qualified health care professional, functioning under the supervision of a physician, may use therapeutic exercise and modalities for the treatment of athletic injuries for which he or she has received appropriate training or education.

§34-40-9.

"(a) Nothing in this chapter shall be construed as preventing or restricting any of the following persons from engaging in the profession or occupation for which they are licensed, certified, or registered in Alabama as follows:

"(1) Physicians and surgeons licensed by the Medical Licensure Commission of Alabama.

"(2) Dentists licensed by the State Board of Dental Examiners.

"(3) Optometrists licensed by the State Board of Optometry.

"(4) Nurses licensed by the Alabama Board of Nursing.

"(5) Chiropractors licensed by the State Board of Chiropractic Examiners.

"(6) Podiatrists licensed by the State Board of Podiatry.

"(7) Physical therapists licensed by the State Board of Physical Therapy.

"(8) Occupational therapists licensed by the State Board of Occupational Therapy.

"(9) Emergency medical technicians licensed by the State Department of Public Health.

"(10) Physician assistants licensed by the State Board of Medical Examiners.

"(11) Massage therapists licensed by the Alabama Board of Massage Therapy.

"(b) This chapter shall not apply to the following persons:

"(1) Coaches and physical education instructors in the performance of their duties.

"(2) Apprentice athletic trainers who confine themselves to the duties prescribed in this chapter.

"(3)(2) Athletic trainers from other nations, states, or territories performing their duties for their respective teams or organizations and only during the course of their team's or organization's stay in this state.

"(4)(3) A person who performs any of the services set forth in this chapter as long as the person does not violate this chapter.

§34-40-10.

"The board may refuse to issue a license certificate to any person and, after notice and hearing pursuant to its regulations and rules, may suspend or revoke the license certificate of any person who has done does any of the following:

"(1) Practiced Practices athletic training other than under the direction or referral, or both, supervision of a physician licensed to practice medicine or surgery.

"(2) Uses drugs or intoxicating liquors to an extent which affects professional competency.

"(3) Obtained or attempted Obtains or attempts to obtain a license by fraud or deception.

"(4) Been Is found to be grossly negligent in the practice of athletic training.

"(5) Been Is adjudged mentally incompetent by a court of competent jurisdiction.

"(6) Been Is found to be guilty of conduct detrimental to the best interest of the public.

"(7) Has Is or has been imprisoned for violating any state or federal controlled substance law.

"(8) Treated Is treating or has undertaken to treat human ailments otherwise than by athletic training and according to standards established by the board.

"(9) Advertised Advertises unethically according to standards as set by the board.

"(10) Failed or refused Fails or refuses to obey any lawful order or regulation rule of the board.

"(11) Unlawful Engages in the unlawful invasion of the field of practice of any other profession.

§34-40-15.

"Nothing in this chapter shall authorize an athletic trainer or apprentice athletic trainer to engage in the practice of medicine; to diagnose, treat, or cure any human disease, illness, ailment, infirmity, pain, or other condition which that is not an athletic injury; to perform surgery of any type or description; or to prescribe any drug or medical device.

§34-40-16.

"An athletic trainer employed in a physical therapy clinic shall work under the administrative supervision of a licensed physical therapist in the context of an employer/employee relationship. The authority of the physical therapist may not supersede the authority of the physician regarding treatment, in accordance with physician supervision of the athletic trainer."

Section 2. Section 34-10-3.2 is added to the Code of Alabama 1975, to read as follows:

§34-10-3.2.

(a) There is created the Advisory Council of the State Board of Medical Examiners and the Alabama Board of Athletic Trainers. The membership of the advisory council shall include all of the following:

(1) Three physicians, appointed by the State Board of Medical Examiners.

(2) Three athletic trainers appointed by the board.

(b) In order to stagger the terms of office, the three physician members of the advisory council shall serve initial terms of one, two, and three years, as determined by the State Board of Medical Examiners, and terms of three years thereafter, and the three athletic trainer members of the advisory council shall serve initial terms of one, two, and three years, as determined by the board, and terms of three years thereafter. Should a vacancy occur on the advisory council, a successor shall be appointed by the original appointing authority to serve the remainder of the unexpired term.

(c) The advisory council shall meet annually, or more frequently if agreed by both the State Board of Medical Examiners and the board. During the annual meeting, the membership of the advisory council shall select one of its members to serve as chair for a term of one year. The office of chair shall alternate between a physician member and an athletic trainer member.

(d) Members of the advisory council shall receive per diem at a rate of one hundred dollars ($100) per day or any portion thereof that the advisory council member is attending an official meeting or function of the advisory council. In addition, each member of the advisory council shall receive reimbursement for subsistence and travel in accordance with state law as provided for state employees, for each day actively engaged in the duties of the office. Compensation of the members of the advisory council shall be paid by the appointing authority, and the appointing authorities shall furnish necessary clerical and administrative support for the operation of the advisory council.

(e) Any provision of this chapter to the contrary notwithstanding, the advisory council shall recommend model practice protocols to be used by athletic trainers, subject to approval by both the State Board of Medical Examiners and the board. The advisory council shall be limited to voting on new standard protocols, adding or deleting existing protocols, and amending existing protocols. The advisory council may recommend rules establishing the ratio of physicians to athletic trainers and the manner in which a supervising physician may designate an alternate supervising physician when temporarily unavailable as the supervising physician. The advisory council may not grant deviations from protocol. No rule or protocol shall be effective until approved by both the State Board of Medical Examiners and the board.

Section 3. This act shall become effective on the first day of the third month following its passage and approval by the Governor, or its otherwise becoming law.

Athletic Trainers, Board of

Boards and Commissions

Physicians

Medical Examiners, State Board of

Professional Licensing Boards

Code Added

Code Amended