S.F. 364 Section 1. Section 147.1, subsections 3 and 6, Code 2011, 1 are amended to read as follows: 2 3. “Licensed” or “certified” , when applied to a physician 3 and surgeon, podiatric physician, osteopathic physician and 4 surgeon, physician assistant, psychologist, chiropractor, 5 nurse, dentist, dental hygienist, dental assistant, 6 optometrist, speech pathologist, audiologist, pharmacist, 7 physical therapist, physical therapist assistant, occupational 8 therapist, occupational therapy assistant, orthotist, 9 prosthetist, pedorthist, respiratory care practitioner, 10 practitioner of cosmetology arts and sciences, practitioner 11 of barbering, funeral director, dietitian, marital and 12 family therapist, mental health counselor, social worker, 13 massage therapist, athletic trainer, acupuncturist, nursing 14 home administrator, hearing aid dispenser, or sign language 15 interpreter or transliterator means a person licensed under 16 this subtitle. 17 6. “Profession” means medicine and surgery, podiatry, 18 osteopathic medicine and surgery, practice as a physician 19 assistant, psychology, chiropractic, nursing, dentistry, 20 dental hygiene, dental assisting, optometry, speech pathology, 21 audiology, pharmacy, physical therapy, physical therapist 22 assisting, occupational therapy, occupational therapy 23 assisting, respiratory care, cosmetology arts and sciences, 24 barbering, mortuary science, marital and family therapy, mental 25 health counseling, social work, dietetics, massage therapy, 26 athletic training, acupuncture, nursing home administration, 27 hearing aid dispensing, or sign language interpreting or 28 transliterating , orthotics, prosthetics, or pedorthics . 29 Sec. 2. Section 147.2, subsection 1, Code 2011, is amended 30 to read as follows: 31 1. A person shall not engage in the practice of medicine 32 and surgery, podiatry, osteopathic medicine and surgery, 33 psychology, chiropractic, physical therapy, physical 34 therapist assisting, nursing, dentistry, dental hygiene, 35 -1- SF 364 (4) 84 jr/nh 1/ 11

S.F. 364 dental assisting, optometry, speech pathology, audiology, 1 occupational therapy, occupational therapy assisting, 2 orthotics, prosthetics, pedorthics, respiratory care, 3 pharmacy, cosmetology arts and sciences, barbering, social 4 work, dietetics, marital and family therapy or mental health 5 counseling, massage therapy, mortuary science, athletic 6 training, acupuncture, nursing home administration, hearing aid 7 dispensing, or sign language interpreting or transliterating, 8 or shall not practice as a physician assistant, unless the 9 person has obtained a license for that purpose from the board 10 for the profession. 11 Sec. 3. Section 147.13, Code 2011, is amended by adding the 12 following new subsection: 13 NEW SUBSECTION . 24. For orthotics, prosthetics, and 14 pedorthics, the board of podiatry. 15 Sec. 4. Section 147.14, subsection 1, paragraph s, Code 16 2011, is amended to read as follows: 17 s. For podiatry, five members licensed to practice podiatry , 18 two members licensed to practice orthotics, prosthetics, or 19 pedorthics, and two members who are not so licensed to practice 20 podiatry and who shall represent the general public. 21 Sec. 5. Section 147.74, Code 2011, is amended by adding the 22 following new subsection: 23 NEW SUBSECTION . 24. a. An orthotist licensed under chapter 24 148F may use the words “licensed orthotist” after the person’s 25 name or signify the same by the use of the letters “L.O.” after 26 the person’s name. 27 b. A pedorthist licensed under chapter 148F may use the 28 words “licensed pedorthist” after the person’s name or signify 29 the same by the use of the letters “L.ped.” after the person’s 30 name. 31 c. A prosthetist licensed under chapter 148F may use the 32 words “licensed prosthetist” after the person’s name or signify 33 the same by the use of the letters “L.P.” after the person’s 34 name. 35 -2- SF 364 (4) 84 jr/nh 2/ 11

S.F. 364 Sec. 6. NEW SECTION . 148F.1 Title and purpose. 1 1. This chapter may be cited and referred to as the 2 “Orthotics, Prosthetics, and Pedorthics Practice Act” . 3 2. The purpose of this chapter is to provide for the 4 regulation of persons offering orthotic, prosthetic, and 5 pedorthic services to the public in order to safeguard the 6 public health, safety, and welfare. 7 Sec. 7. NEW SECTION . 148F.2 Definitions. 8 As used in this chapter: 9 1. “Board” means the board of podiatry. 10 2. “Orthosis” means a custom-fabricated or custom-fitted 11 brace or support designed to provide for alignment, correction, 12 or prevention of neuromuscular or musculoskeletal dysfunction, 13 disease, injury, or deformity. “Orthosis” does not include 14 fabric or elastic supports, corsets, arch supports, low 15 temperature plastic splints, trusses, elastic hoses, canes, 16 crutches, soft cervical collars, dental appliances, or other 17 similar devices carried in stock and sold as “over-the-counter” 18 items by a drug store, department store, corset shop, or 19 surgical supply facility. 20 3. “Orthotic and prosthetic education program” means a 21 course of instruction accredited by the national commission on 22 accreditation of allied health education programs, consisting 23 of both of the following: 24 a. A basic curriculum of college level instruction in math, 25 physics, biology, chemistry, and psychology. 26 b. A specific curriculum in orthotic or prosthetic courses, 27 including but not limited to: 28 (1) Lectures covering pertinent anatomy, biomechanics, 29 pathomechanics, prosthetic-orthotic components and materials, 30 training and functional capabilities, prosthetic or orthotic 31 performance evaluation, prescription considerations, etiology 32 of amputations and disease processes necessitating prosthetic 33 or orthotic use, and medical management. 34 (2) Subject matter related to pediatric and geriatric 35 -3- SF 364 (4) 84 jr/nh 3/ 11

S.F. 364 problems. 1 (3) Instruction in acute care techniques, such as immediate 2 and early post-surgical prosthetics and fracture bracing 3 techniques. 4 (4) Lectures, demonstrations, and laboratory experiences 5 related to the entire process of measuring, casting, fitting, 6 fabricating, aligning, and completing prostheses or orthoses. 7 4. “Orthotic and prosthetic scope of practice” means a 8 list of tasks, with relative weight given to such factors as 9 importance, criticality, and frequency, based on nationally 10 accepted standards of orthotic and prosthetic care as 11 outlined by the American board for certification in orthotics, 12 prosthetics, and pedorthics. 13 5. “Orthotics” means the science and practice of evaluating, 14 measuring, designing, fabricating, assembling, fitting, 15 adjusting, or servicing an orthosis under an order from a 16 licensed physician or podiatric physician for the correction or 17 alleviation of neuromuscular or musculoskeletal dysfunction, 18 disease, injury, or deformity. 19 6. “Orthotist” means a health care professional, 20 specifically educated and trained in orthotic patient care, 21 who measures, designs, fabricates, fits, or services orthoses 22 and may assist in the formulation of the order and treatment 23 plan of orthoses for the support or correction of disabilities 24 caused by neuromusculoskeletal diseases, injuries, or 25 deformities. 26 7. “Pedorthic device” means therapeutic shoes, such as 27 diabetic shoes and inserts, shoe modifications made for 28 therapeutic purposes, below-the-ankle partial foot prostheses, 29 and foot orthoses for use at the ankle or below. The term also 30 includes subtalar-control foot orthoses designed to manage the 31 function of the anatomy by controlling the range of motion of 32 the subtalar joint. Excluding pedorthic devices which are 33 footwear, the proximal height of a custom pedorthic device 34 does not extend beyond the junction of the gastrocnemius and 35 -4- SF 364 (4) 84 jr/nh 4/ 11

S.F. 364 the Achilles tendon. “Pedorthic device” does not include 1 nontherapeutic inlays or footwear regardless of method of 2 manufacture; unmodified, nontherapeutic over-the-counter shoes; 3 or prefabricated foot care products. 4 8. “Pedorthic education program” means an educational 5 program accredited by the American board for certification in 6 orthotics, prosthetics, and pedorthics consisting of all of the 7 following: 8 a. A basic curriculum of instruction in foot-related 9 pathology of diseases, anatomy, and biomechanics. 10 b. A specific curriculum in pedorthic courses, including 11 lectures covering shoes, foot orthoses, and shoe modifications, 12 pedorthic components and materials, training and functional 13 capabilities, pedorthic performance evaluation, prescription 14 considerations, etiology of disease processes necessitating 15 use of pedorthic devices, medical management, subject matter 16 related to pediatric and geriatric problems, and lectures, 17 demonstrations, and laboratory experiences related to the 18 entire process of measuring and casting, fitting, fabricating, 19 aligning, and completing pedorthic devices. 20 9. “Pedorthic scope of practice” means a list of tasks 21 with relative weight given to such factors as importance, 22 criticality, and frequency based on nationally accepted 23 standards of pedorthic care as outlined by the American board 24 for certification in orthotics, prosthetics and pedorthics. 25 10. “Pedorthics” means the science and practice of 26 evaluating, measuring, designing, fabricating, assembling, 27 fitting, adjusting, or servicing a pedorthic device under an 28 order from a licensed physician or podiatric physician for the 29 correction or alleviation of neuromuscular or musculoskeletal 30 dysfunction, disease, injury, or deformity. 31 11. “Pedorthist” means a health care professional, 32 specifically educated and trained in pedorthic patient 33 care, who measures, designs, fabricates, fits, or services 34 pedorthic devices and may assist in the formulation of the 35 -5- SF 364 (4) 84 jr/nh 5/ 11

S.F. 364 order and treatment plan of pedorthic devices for the support 1 or correction of disabilities caused by neuromusculoskeletal 2 diseases, injuries, or deformities. 3 12. “Prosthesis” means an artificial medical device that 4 is not surgically implanted and that is used to replace a 5 missing limb, appendage, or any other external human body part 6 including an artificial limb, hand, or foot. 7 13. “Prosthetics” means the science and practice of 8 evaluating, measuring, designing, fabricating, assembling, 9 fitting, adjusting, or servicing a prosthesis under an order 10 from a licensed physician. 11 14. “Prosthetist” means a health care professional, 12 specifically educated and trained in prosthetic patient care, 13 who measures, designs, fabricates, fits, or services prostheses 14 and may assist in the formulation of the order and treatment 15 plan of prostheses for the replacement of external parts of the 16 human body lost due to amputation or congenital deformities or 17 absences. 18 15. “Resident” means a person who has completed an education 19 program in either orthotics or prosthetics and is continuing 20 the person’s clinical education in a residency accredited by 21 the American board for certification in orthotics, prosthetics 22 and pedorthics. 23 16. “Residency” means an approved supervised program of 24 a minimum duration of one year to acquire practical clinical 25 training in orthotics or prosthetics in a patient care setting. 26 Sec. 8. NEW SECTION . 148F.3 Duties of the board. 27 The board shall administer this chapter. The board’s duties 28 shall include but are not limited to the following: 29 1. Adoption of rules to administer and interpret this 30 chapter, chapter 147, and chapter 272C with respect to the 31 education and licensing of orthotists, prosthetists, and 32 pedorthists. 33 2. Adoption of rules to establish accepted standards of 34 orthotic and prosthetic scope of practice, including the 35 -6- SF 364 (4) 84 jr/nh 6/ 11

S.F. 364 classification of devices and supervision of nonlicensed 1 caregivers. 2 3. Adoption of rules relating to professional conduct and 3 licensing and the establishment of ethical and professional 4 standards of practice. 5 4. Acting on matters concerning licensure and the process 6 of applying for, granting, suspending, imposing supervisory 7 or probationary conditions upon, reinstating, revoking, or 8 renewing a license. 9 5. Establishing and collecting licensure fees as provided 10 in section 147.80. 11 6. Developing continuing education requirements as a 12 condition of license renewal. 13 7. Evaluating requirements for licensure in other states to 14 determine if reciprocity may be granted. 15 8. Adoption of rules providing temporary licensing for 16 persons providing orthotic, prosthetic, and pedorthic care 17 in this state prior to the effective date of this Act. A 18 temporary license is good for no more than one year. 19 Sec. 9. NEW SECTION . 148F.4 Persons and practices not 20 affected. 21 This chapter does not prevent or restrict the practice, 22 services, or activities of any of the following: 23 1. A person licensed in this state by any other law from 24 engaging in the profession or occupation for which the person 25 is licensed, including but not limited to persons set out in 26 section 147.1, subsections 3 and 6. 27 2. A person employed as an orthotics, prosthetics, or 28 pedorthics practitioner by the government of the United States 29 if that person practices solely under the direction or control 30 of the organization by which the person is employed. 31 3. A person pursuing a course of study leading to a degree 32 or certificate in orthotics, prosthetics, or pedorthics in an 33 educational program accredited or approved according to rules 34 adopted by the board, if the activities and services constitute 35 -7- SF 364 (4) 84 jr/nh 7/ 11

S.F. 364 a part of a supervised course of study and the person is 1 designated by a title which clearly indicates the person’s 2 status as a student, resident, or trainee. 3 Sec. 10. NEW SECTION . 148F.5 Qualifications for licensure 4 as orthotist, prosthetist, or pedorthist. 5 1. To qualify for a license to practice orthotics or 6 prosthetics, a person shall meet the following requirements: 7 a. Possess a baccalaureate degree from a college or 8 university. 9 b. Have completed the amount of formal training, including 10 but not limited to an orthotic and prosthetic education 11 program, and clinical practice established and approved by the 12 board. 13 c. Complete a clinical residency in the professional area 14 for which a license is sought in accordance with standards, 15 guidelines, or procedures for residencies established and 16 approved by the board. The majority of training must be 17 devoted to services performed under the supervision of a 18 licensed practitioner of orthotics or prosthetics or a person 19 certified as a certified orthotist, certified prosthetist, 20 or certified prosthetist orthotist whose practice is located 21 outside the state. 22 d. Pass all written, practical, and oral examinations that 23 are required and approved by the board. 24 e. Be qualified to practice in accordance with accepted 25 standards of orthotic and prosthetic care as established by the 26 board. 27 2. To qualify for a license to practice pedorthics, a person 28 shall meet the following requirements: 29 a. Submit proof of a high school diploma or its equivalent. 30 b. Have completed the amount of formal training, including 31 but not limited to a pedorthic education program, and clinical 32 practice established and approved by the board. 33 c. Complete a qualified work experience program or 34 internship in pedorthics that has a minimum of one thousand 35 -8- SF 364 (4) 84 jr/nh 8/ 11

S.F. 364 hours of pedorthic patient care experience in accordance 1 with any standards, guidelines, or procedures established 2 and approved by the board. The majority of training must 3 be devoted to services performed under the supervision of a 4 licensed practitioner of pedorthics or a person certified as 5 a certified pedorthist whose practice is located outside the 6 state. 7 d. Pass all examinations that are required and approved by 8 the board. 9 e. Be qualified to practice in accordance with accepted 10 standards of pedorthic care as established by the board. 11 3. The standards and requirements for licensure established 12 by the board shall be substantially equal to or in excess of 13 standards commonly accepted in the professions of orthotics, 14 prosthetics, or pedorthics, as applicable. The board shall 15 adopt rules as necessary to set the standards and requirements. 16 4. A person may be licensed in more than one discipline. 17 Sec. 11. NEW SECTION . 148F.6 Assistants and technicians. 18 1. a. A person shall not work as an assistant to an 19 orthotist or prosthetist or provide patient care services or 20 fabrication of orthoses or prostheses, unless the work is 21 performed under the supervision of a licensed orthotist or 22 prosthetist. 23 b. An assistant may perform orthotic or prosthetic 24 procedures and related tasks in the management of patient care. 25 An assistant may also fabricate, repair, and maintain orthoses 26 and prostheses. 27 2. A technician may assist a person licensed under this 28 chapter with fabrication of orthoses, prostheses, or pedorthic 29 devices but shall not provide direct patient care. 30 Sec. 12. NEW SECTION . 148F.7 Limitation on provision of 31 care and services. 32 A licensed orthotist, prosthetist, or pedorthist may provide 33 care or services only if the care or services are provided 34 pursuant to an order from a licensed physician, a licensed 35 -9- SF 364 (4) 84 jr/nh 9/ 11

S.F. 364 podiatric physician, an advanced registered nurse practitioner 1 who has a written collaborative agreement with a collaborating 2 physician or podiatric physician that specifically authorizes 3 ordering the services of an orthotist, prosthetist, or 4 pedorthist, an advanced registered nurse practitioner who 5 practices in a hospital or ambulatory surgical treatment center 6 and possesses clinical privileges to order services of an 7 orthotist, prosthetist, or pedorthist, or a physician assistant 8 who has been delegated the authority to order the services of 9 an orthotist, prosthetist, or pedorthist by the assistant’s 10 supervising physician. A licensed podiatric physician or an 11 advanced registered nurse practitioner collaborating with a 12 podiatric physician may only order care or services concerning 13 the foot from a licensed pedorthist or orthotist. 14 Sec. 13. NEW SECTION . 148F.8 Penalties. 15 1. If any person, company, or other entity violates a 16 provision of this chapter, the attorney general may petition 17 for an order enjoining the violation or for an order enforcing 18 compliance with this chapter. Upon the filing of a verified 19 petition in court, the court may issue a temporary restraining 20 order, without notice or bond, and may preliminarily and 21 permanently enjoin the violation. If it is established 22 that the person, company, or other entity has violated or is 23 violating the injunction, the court may punish the offender 24 for contempt of court. Proceedings under this section shall 25 be in addition to, and not in lieu of, all other remedies and 26 penalties provided in this chapter. 27 2. If a person practices as an orthotist, prosthetist, 28 or pedorthist or represents the person as such without being 29 licensed under the provisions of this chapter, then any other 30 licensed orthotist, pedorthist, or prosthetist, any interested 31 party, or any person injured by the person may petition for 32 relief as provided in subsection 1. 33 3. If a company or other entity holds itself out to provide 34 orthotic, prosthetic, or pedorthic services without having 35 -10- SF 364 (4) 84 jr/nh 10/ 11

S.F. 364 an orthotist, prosthetist, or pedorthist licensed under the 1 provisions of this chapter on its staff to provide those 2 services, then any other licensed orthotist, prosthetist, 3 or pedorthist or any interested party or injured person may 4 petition for relief as provided in subsection 1. 5 Sec. 14. FUNDING. There is appropriated from the general 6 fund of the state to the board of podiatry for the fiscal year 7 beginning July 1, 2011, and ending June 30, 2012, the following 8 amount, or so much thereof as is necessary, to be used for the 9 purposes designated: 10 For salaries, support, maintenance, and miscellaneous 11 purposes related to the licensure of persons offering orthotic, 12 prosthetic, or pedorthic services: 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 40,000 14 Notwithstanding section 8.33, moneys appropriated in this 15 section that remain unencumbered or unobligated at the close of 16 the fiscal year shall not revert but shall remain available for 17 expenditure for the purposes designated until the close of the 18 succeeding fiscal year. 19 -11- SF 364 (4) 84 jr/nh 11/ 11