The Legislature declares that in order to safeguard the health, safety, and welfare of the people of Alabama against the unauthorized, unqualified, and improper administration of prosthetic and orthotic care, it is necessary to provide for the licensing and regulation of persons offering prosthetic and orthotic services to the public.

There is established a separate special revenue trust fund in the State Treasury to be known as the Alabama State Board of Orthotists and Prosthetists Fund. All receipts and administrative fines collected by the board pursuant to this chapter shall be deposited in the fund and used only to implement and administer this chapter. The receipts shall be disbursed only by warrant of the state Comptroller, upon itemized vouchers approved by the executive director, if one is provided, otherwise by the chairperson of the board. Funds shall be withdrawn or expended pursuant to Sections 41-4-80 to 41-4-96, inclusive, and 41-19-1 to 41-19-12, inclusive, and only in amounts as stipulated in the general appropriations bill or other appropriations bills.

(a) The board shall issue an orthotic, prosthetic, or prosthetic/orthotic license or an orthotic supplier registration to any person who meets the qualifications required by this chapter and who pays the respective fees fixed by the board.

(b) Any person who is issued a license as an orthotic, prosthetic, or prosthetic/orthotic practitioner or orthotic assistant, prosthetic assistant, or prosthetic/orthotic assistant under this chapter may use the words licensed orthotist, licensed prosthetist, licensed prosthetist/orthotist, licensed orthotist assistant, licensed prosthetist assistant, or licensed prosthetist/orthotist assistant, or the letters 'L.O.,' 'L.P.,' 'L.P.O.,' 'L.O.A.,' 'L.P.A.,' or 'L.P.O.A.' in connection with his or her name to denote his or her licensure. Any person issued registration as an orthotic supplier under this chapter may use the words registered orthotic supplier or the letters 'R.O.S.' in connection with his or her name to denote his or her registration.

(c) A license or registration issued under this chapter shall be subject to annual or semiannual renewal as prescribed by rule or regulation duly promulgated and published by the board.

The board shall promulgate rules and regulations for all licensure fees, registration fees, and accreditation fees. The application fee for licensure as an orthotist, prosthetist, orthotist assistant, prosthetist assistant, or prosthetist/orthotist shall not exceed two hundred fifty dollars ($250) and the application fee for registration as an orthotic supplier shall not exceed one hundred fifty dollars ($150). The application fee for accreditation shall not exceed three hundred fifty dollars ($350) per facility. The licensure fee shall not exceed nine hundred fifty dollars ($950) per discipline per term of license. The accreditation fee shall not exceed nine hundred fifty dollars ($950) per term for each accredited facility. Registration fees shall not exceed three hundred fifty dollars ($350) per term of registration or renewal, and all other associated assistant fees shall not exceed five hundred dollars ($500) per term of license.

Any person who violates this chapter shall be fined no more than one thousand dollars ($1,000) per violation or be imprisoned for not more than six months per violation, or both, by the board in a disciplinary action or by a court of competent jurisdiction in the State of Alabama.

(a) The members of the board and all employees of the board shall be subject to the State Ethics Law, Sections 36-25-1 to 36-25-30, inclusive.

(b) The board shall be subject to the Alabama Sunset Law of 1981, and shall be classified as an enumerated agency pursuant to Section 41-20-3. The board shall automatically terminate on October 1, 2006, unless continued as therein provided and, if continued, the board shall be reviewed every four years thereafter.

This chapter shall be known as the Prosthetics and Orthotics Act.

As used in this chapter, the following terms shall have the following meanings:

(1) ACCREDITED FACILITY. A facility where prosthetic, orthotic, or prosthetic and orthotic care is provided to patients needing such care and has met the requirements of the board for such designation. The board shall require that all accredited facilities meet the requirements of a nationally recognized certifying board in prosthetics and orthotics accredited by the National Commission for Certifying Agencies (NCCA) in the discipline or disciplines for which the application is made. The board shall allow existing facilities to become accredited until July 1, 2004. During this allowed period, facilities may be the site of activity covered by this chapter. If an existing facility is not accredited under this chapter by July 1, 2004, all prosthetic and orthotic care in that facility must cease.

(2) AUTHORIZED HEALTH CARE PRACTITIONER. A physician licensed to practice medicine or a person licensed or authorized to practice podiatry pursuant to Article 6 of Chapter 24.

(3) BOARD. The Alabama State Board of Prosthetists and Orthotists.

(4) CHIROPRACTOR. A person licensed and acting within the definition as found in Section 34-24-120.

(5) OCCUPATIONAL THERAPIST/OCCUPATIONAL THERAPIST ASSISTANT/OCCUPATIONAL THERAPIST AIDE. A person who is licensed as an Occupational Therapist, or Occupational Therapist Assistant, or Occupational Therapist Aide as defined in Section 34-39-3.

(6) ORTHOSIS. A custom-fabricated, definitive brace or support that is designed for long-term use. Custom-fabricated orthoses, also known as custom-made orthoses, are devices designed and made from raw materials or commercially available components for a specific patient and require the generation of an image, form, or mold that replicates the patient's body or body segment and involves the rectification of dimensions, contours, and volumes to achieve proper fit, comfort, and function for that specific patient. Except for the treatment of scoliosis, orthosis does not include prefabricated or direct-formed orthotic devices, as defined in this subdivision and does not include any of the following items: Commercially available knee orthoses used following injury or surgery; upper extremity adaptive equipment; finger splints; leather wrist gauntlets; face masks used following burns; wheelchair seating that is an integral part of the wheelchair and not worn by the patient independent of the wheelchair; fabric or elastic supports; corsets; arch supports, also known as non-custom or prefabricated orthotics; low-temperature formed plastic splints; trusses; elastic hose; canes; crutches; cervical collars; dental appliances, and other similar devices as determined by the board, such as those commonly carried in stock by a pharmacy, hospital, rehabilitation facility, department store, corset shop, or surgical supply facility. Prefabricated orthoses, also known as custom-fitted or off-the-shelf, are devices that are manufactured as commercially available items for no particular patient. Direct-formed orthoses are devices formed or shaped during the molding process directly on the patient's body or body segment.

(7) ORTHOTICS. The science and practice of evaluating, measuring, designing, fabricating, assembling, fitting, adjusting, or servicing, as well as providing the initial training necessary to accomplish the fitting of, an orthosis for the support, correction, or alleviation of neuromuscular or musculoskeletal dysfunction, disease, injury, or deformity. The practice of orthotics encompasses evaluations and consultation and continuing care, with basic observational gait and posture analysis. Orthotists assess the need for and measure, design, manufacture, and fit orthoses to maximize function and provide not only the support but the alignment necessary to either prevent or correct deformity or to improve the safety and efficiency of mobility or locomotion, or both. Orthotic practice includes periodic evaluation and consultation to assess its effect on the patient's tissue and assure proper fit and function of the orthotic device.

(8) ORTHOTIC SUPPLIER. A person registered with the board who is employed by or has a contractual relationship with a manufacturer of orthoses or orthosis components and who has complied with the registration requirements of the board.

(9) ORTHOTIST. A person licensed to practice orthotics under this chapter.

(10) ORTHOTIST ASSISTANT. A person licensed under terms to be defined by the board.

(11) PHYSICAL THERAPIST/PHYSICAL THERAPIST ASSISTANT/PHYSICAL THERAPIST TECHNICIAN. A person who is licensed to practice as defined in Section 34-24-191.

(12) PHYSICIAN. A person who is a doctor of medicine or a doctor of osteopathy licensed to practice.

(13) PODIATRIST. A person licensed or authorized to practice podiatry pursuant to Article 6 of Chapter 24.

(14) PROSTHESIS. A definitive artificial limb that is alignable or articulated or, in lower extremity applications, capable of bearing weight. Prosthesis means an artificial medical device that is not surgically implanted and that is used to replace a missing limb, appendage, or other external human body part and that includes an artificial limb, hand, or foot. The term does not include artificial eyes, ears, dental appliances, ostomy products, devices such as artificial breasts or eyelashes, wigs, or other devices as determined by the board that do not have a significant impact on the musculoskeletal functions of the body.

(15) PROSTHETICS. The science and practice of evaluating, measuring, designing, fabricating, assembling, fitting, aligning, adjusting, or servicing, as well as providing the initial education necessary to accomplish the wearing and use of a prosthesis, through the replacement of external parts of a human body lost due to amputation or congenital deformities or absences. The practice of prosthetics also includes the generation of an image, form, or mold that replicates the patient's body or body segment and that requires rectification of dimensions, contours, and volumes for use in the design and fabrication of a socket to accept a residual limb to create an artificial appendage that is designed either to support body weight or to improve or restore function or cosmesis, or both. Involved in the practice of prosthetics is observational gait analysis and clinical assessment of the requirements necessary to refine and mechanically fix the relative position of various parts of the prosthesis to maximize the function, stability, and safety of the patient. The practice of prosthetics includes evaluation, consultation, and providing continuing patient care in order to assess the effect of the prosthetic device on the patient's tissues and to assure proper fit and function of the prosthetic device.

(16) PROSTHETIST. A person who is licensed to practice prosthetics under this chapter.

(17) PROSTHETIST ASSISTANT. A person licensed under terms to be defined by the board.

(18) PROSTHETIST/ORTHOTIST. A person licensed to practice prosthetics and orthotics under this chapter.

(a) A licensed prosthetist, licensed orthotist, or licensed prosthetist/orthotist may provide services utilizing new prostheses or orthoses for which he or she is licensed and only under a written order from an authorized health care practitioner. A consultation with and periodic review by an authorized health care practitioner is not required for the evaluation, repair, adjusting, or servicing of a prosthesis by a licensed prosthetist, or licensed prosthetist/orthotist and for the evaluation, repair, adjusting or servicing of an orthosis by a licensed orthotist, or licensed prosthetist/orthotist; nor is an order from an authorized health care practitioner required for maintenance or replacement of an orthosis or prosthesis to the level of its original prescription for an indefinite period of time if the original order remains appropriate for the patient's medical needs.

(b) Prosthetists and orthotists must refer persons receiving service to authorized health care practitioners if they have reasonable cause to believe symptoms or conditions are present that require services beyond the scope of their practice or for which the prescribed prosthetic or orthotic service is contraindicated.

(c) An orthotic supplier may engage in one or more of the following: Evaluating, measuring, designing, fabricating, assembling, fitting, adjusting, servicing, repairing, replacing, or delivering orthoses. An orthotic supplier may provide orthoses in hospitals, rehabilitation facilities, physician's offices, physician's clinics, or other sites as required. An orthotic supplier shall provide orthoses based on a written prescription from an authorized health care practitioner and under the supervision of such authorized health care practitioner.

(a) Except as provided in subsection (g) or (h), no person shall administer prosthetic or orthotic care in this state unless licensed or registered to do so in accordance with this chapter. The board shall issue approved forms for application prior to January 1, 2003.

(b) In order to obtain a license as a prosthetist, orthotist, or prosthetist/orthotist in this state, an applicant must do the following:

(1) File a written application on forms to be developed and approved by the board. The applicant must meet at least one of the following requirements after a one-year grandfather period:

a. The applicant must possess a baccalaureate degree in orthotics and prosthetics from a college or university accredited by a regional accrediting agency and complete 1,900 hours per discipline sought of directed employment under the supervision of a certified/licensed prosthetist, a certified/licensed orthotist or a certified/licensed prosthetist/orthotist in an accredited facility, and be certified as a prosthetist, orthotist, or prosthetist/orthotist by a nationally recognized certifying board in orthotics and prosthetics accredited by the National Commission for Certifying Agencies (NCCA), or such other national agency as approved by the board, in the discipline or disciplines for which the application is made.

b. The applicant must possess a baccalaureate degree from a regionally accredited college or university and have successfully completed a post-baccalaureate certificate course approved by the board and completed 1,900 hours of directed employment per discipline in which license is sought under the supervision of a certified/licensed prosthetist, a certified/licensed orthotist, or a certified/licensed prosthetist/orthotist in an accredited facility, and be certified by a nationally recognized certifying board in prosthetics or orthotics accredited by the National Commission for Certifying Agencies (NCCA), or such other national agency as approved by the board, in the discipline or disciplines for which application is made.

c. The applicant must possess an associates degree from a regionally accredited college or university, junior college, or community college and have successfully completed postsecondary coursework in anatomy, physiology, physics, biology, chemistry, algebra, and calculus and have worked under the supervision of a certified/licensed prosthetist, a certified/licensed orthotist, or a certified/licensed prosthetist/orthotist for not less than four consecutive years of the past six years in an accredited facility, and be certified by a nationally recognized certifying board in prosthetics or orthotics accredited by the National Commission for Certifying Agencies (NCCA), or such other national agency as may be approved by the board.

d. The applicant must have successfully completed postsecondary coursework in anatomy, physiology, physics, biology, chemistry, algebra, and calculus and have worked under the supervision of a certified/licensed prosthetist, a certified/licensed orthotist, or a certified/licensed prosthetist/orthotist for not less than eight years of the last 12 years and be certified as a prosthetist, orthotist, or prosthetist/orthotist by a nationally recognized board accredited by the National Commission for Certifying Agencies (NCCA), or such national agency as may be approved by the board, in the discipline or disciplines for which application is made.

(2) Any applicant after the first year following the board's issuance of applications not meeting the aforesaid conditions shall be required to successfully complete an examination as prescribed by the board prior to receiving a license as a prosthetist, an orthotist, or a prosthetist/orthotist.

(3) An applicant failing to achieve a required passing grade on his or her first examination may reapply, upon repayment of the application fee as set by the board. Applicants may take the examination no more than three times in four consecutive years following the initial application for licensure and upon payment of the examination fee in each instance.

(c) In order to obtain registration as an orthotic supplier, an applicant must do the following:

(1) File a written application on forms to be developed and approved by the board. Such forms shall require personal information such as full name, current address, educational status and history, and work history for the last five years of employment.

(2) The application forms shall be accompanied, when submitted, by attestation of employment by or contractual relationship with a manufacturer of orthoses or orthosis components whether registered with the United States Food and Drug Administration or not. Attestation shall be by notarized statement signed by the president, chief operating officer, or other designated corporate official of the employing company.

(d) The board shall grant a license without an examination for those qualified applicants who apply within one year of the issuance of application forms by the board. For purposes of this subsection, qualified applicants are those which meet either of the following requirements:

(1) The applicant shall possess current credentials as a Certified Prosthetist, Certified Orthotist, or Certified Prosthetist/Orthotist issued by the American Board for Certification in Orthotics and Prosthetics, Incorporated, or the Board for Orthotist/Prosthetist Certification as a prosthetist, orthotist, or prosthetist/orthotist.

(2) The applicant has practiced full time as a prosthetist, orthotist, or prosthetist/orthotist for five of the six years prior to July 1, 2002, and has provided comprehensive prosthetic, orthotic, or prosthetic/orthotic care, as defined by the board in a facility that meets the requirements of the board for accreditation.

(e) The board may issue a 12-month temporary license as a prosthetist, an orthotist, or a prosthetist/orthotist to persons who have applied for licensure and are awaiting examination. The temporary license is renewable once for a six month period if the applicant fails to pass the examination at the first sitting.

(f) The board shall grant a license as a prosthetist, an orthotist, or a prosthetist/orthotist to an applicant in possession of a current license as a prosthetist, orthotist, or prosthetist/orthotist in another state or territory of the United States without examination if the board determines that the credentialing standards set by the other state or territory are substantially equivalent to the standards set by the board for this state.

(g) No person may represent himself or herself as a licensed prosthetist, licensed orthotist, or licensed prosthetist/orthotist, use a title or description of services, or engage in the practice of prosthetics or orthotics without applying for licensure, meeting the required qualifications, and being licensed by the board unless otherwise exempted by this chapter. A person not licensed with the board may not represent himself or herself as being so licensed and may not use, in connection with his or her name, the words licensed orthotist, orthotist, licensed prosthetist, prosthetist, licensed prosthetist/orthotist, prosthetist/orthotist, or letters 'L.O.,' 'L.P.,' 'L.P.O.,' 'L.O.A.,' 'L.P.A.,' or 'L.P.O.A.,' or other letters, words, signs, numbers, or insignia indicating or implying that he or she is either a licensed prosthetist, a licensed orthotist, or a licensed prosthetist/orthotist in the State of Alabama without first having a valid license. The license shall be posted in a conspicuous location at the person's work site.

(h) Nothing in this chapter shall be construed to prohibit or restrict the following:

(1) The practice of prosthetics or orthotics by individuals authorized and performing services within their authorized scopes of practice as adopted by the State of Alabama Legislature including, but not limited to, authorized health care practitioners, doctors of podiatry, chiropractors, physical therapists, and occupational therapists licensed in this state.

(2) The practice of prosthetics or orthotics by an individual employed by, or in the service of the government of the United States of America while engaged in the performance of duties prescribed by the laws of the United States of America.

(3) The practice of prosthetics or orthotics by any person not licensed as a prosthetist, orthotist, or prosthetist/orthotist in accordance with this chapter who is employed in a diagnostic laboratory, hospital, rehabilitation facility, or authorized health care practitioner's office or as a medical lab technician or technologist whose function is to administer treatment or perform diagnostic procedures confined to that laboratory or office under the direction of an authorized health care practitioner.

(4) The practice of prosthetics or orthotics by a person who is a regular or full-time student in a prosthetic or orthotic educational program approved by the board, and whose designated status is student or trainee.

(5) A person fulfilling the supervised residency or internship experience requirements described in this chapter.

(6) A person who meets the qualifications listed in paragraphs a, b, c, and d of subdivision (1) of subsection (b) from performing prosthetic or orthotic services in this state, provided the services are not performed for more than 60 days per 12-month period, after notification to the board.

(a) The board may refuse to renew a license or registration, may suspend or revoke a license or registration, may impose probationary conditions, or may impose an administrative fine not exceeding one thousand dollars ($1,000) per violation as disciplinary actions if a licensee or registrant or applicant for licensure or registration has been found guilty of unprofessional conduct that has endangered or is likely to endanger the health, welfare, or safety of the public. Unprofessional conduct includes the following:

(1) Obtaining a license or registration by means of fraud, misrepresentation, or concealment of facts.

(2) Being found guilty of unprofessional conduct, as defined by the policies of the board, or the code of ethics adopted and published by the American Board for Certification in Orthotics and Prosthetics, or its successor organization, provided that such code of conduct and code of ethics shall not include education and training requirements not otherwise required by this chapter.

(3) Conviction of a crime, determined by the board to be other than a minor offense, in any court if the offense has a direct bearing on whether the person should be entrusted to serve the public in the capacity of a prosthetic or orthotic practitioner or as a registered orthotic supplier.

(b) The board may, after a hearing, exercise the disciplinary actions authorized in this section.

The board shall perform all the following duties:

(1) Establish and publish continuing education requirements such that a licensed orthotist or a licensed prosthetist is required to complete 15 hours of continuing education and a licensed prosthetist/orthotist is required to complete 20 hours of continuing education in each year of a license renewal period.

(2) Examine for, approve, deny, revoke, suspend, and renew licensure or registration of duly qualified applicants.

(3) Receive applications, issue licenses or registrations to applicants who have met the requirements for licensure or registration, and deny licenses or registration to applicants who do not meet the minimum qualifications, except that proceedings with the denial or revocation of licensure or registration based upon findings of unprofessional conduct or impairment are governed by the Uniform Disciplinary Act.

(4) Hire administrative, clerical, investigative, and other staff as needed to implement this chapter and hire individuals licensed under this chapter to serve as examiners for any practical examinations required by the board either within the state classified service or not within it.

(5) Promulgate and publish rules and regulations in accordance with the Administrative Procedure Act to administer this chapter. Any rule or regulation defining the scope of practice or permissible activities of a licensed orthotist, licensed prosthetist, or a licensed prosthetist/orthotist or a registered orthotic supplier shall be published jointly with the State Board of Medical Examiners.

(6) Develop and promulgate requirements and establish fees for the licensure of orthotic assistants, prosthetic assistants, or prosthetic/orthotic assistants. Such licenses shall be regulated and issued by the board.

(7) Conduct hearings on charges calling for the denial, suspension, or revocation of an issued license or registration, or for the refusal to renew a license or registration.

(8) Prepare and administer, or approve the preparation and administration of, examinations for applicants for licensure.

(a) The Alabama State Board of Prosthetists and Orthotists is created to administer this chapter and shall be composed of 11 members as provided in this section who shall be compensated at the rate of one hundred dollars ($100) per day plus travel expenses for each day they perform their duties. The board membership shall reflect the racial, gender, geographic, urban and rural, and economic diversity of the state. The Attorney General of the state shall act as legal advisor of the board and shall render such legal assistance as may be necessary in carrying out the provisions of this chapter.

(b) The board shall consist of six persons who are members of the Alabama Prosthetic and Orthotic Association and licensed or eligible for licensure pursuant to this chapter as an orthotist, a prosthetist, or a prosthetist/orthotist selected from a list of 10 applicants presented by the Alabama Prosthetic and Orthotic Association. There shall be one private citizen who is a consumer of orthotic or prosthetic services in the State of Alabama, one licensed chiropractor, one representative of the National Orthotics Manufacturers Association, one podiatrist whose application shall be presented directly to the Speaker of the House of Representatives, and one physician licensed to practice in the State of Alabama, whose application for appointment shall be presented directly to the Governor.

(c) Members shall be appointed as follows:

(1) Four by the Governor of the State of Alabama, one of whom shall be certified by the American Board for Certification in Orthotics and Prosthetics, Inc., one of whom shall be certified by the Board of Orthotic Certification; one of whom shall be a private citizen of the State of Alabama who is a consumer of orthotic or prosthetic services; and one of whom shall be a physician licensed to practice in the State of Alabama.

(2) Three by the Lieutenant Governor of the State of Alabama, two of whom shall be certified by the American Board for Certification in Orthotics and Prosthetics, Inc., and one of whom shall be certified by the Board of Orthotic Certification.

(3) Three by the Speaker of the House of Representatives of the State of Alabama, one of whom is a licensed chiropractor from the list presented by the Alabama State Chiropractic Association, one of whom is a registered orthotics supplier who is a representative of the National Orthotics Manufacturers Association from a list which may be submitted by the association, and one of whom is a licensed podiatrist.

(4) One by the President Pro Tempore of the Senate of the State of Alabama, who is certified by the Board of Orthotic Certification, from the list presented by the Alabama Prosthetic and Orthotic Association.

(d) All initial appointments to the board shall be made no later than 60 days after July 1, 2002.

(e) The Alabama Prosthetic and Orthotic Association shall submit its list of nominees for initial appointments to the Governor, the Speaker of the House of Representatives, and the President Pro Tempore of the Senate no later than 15 days after July 1, 2002. Applications from private citizens who are consumers of orthotic or prosthetic care and from authorized health care practitioners must be submitted to the appointing authorities within 30 days of July 1, 2002.

(a) Initial appointments shall be staggered such that two members are appointed for one year, two members are appointed for two years, and three members appointed for three years. The Governor shall appoint two members for one year and two members for three years, the Lieutenant Governor shall appoint one member for three years and the Speaker of the House of Representatives and the President Pro Tempore of the Senate shall each appoint one member for two years. Members shall serve until their successors are appointed and qualified, provided, no member shall serve more than eight consecutive years or two consecutive terms, whichever is greater.

(b) Upon the expiration of the initial terms and all terms of office thereafter, the appointing authorities shall appoint successors for terms of four years each. The board shall follow Robert's Rules of Order in the conduct of its affairs.

(c) The board may employ an executive director and such other officers and employees it deems necessary, with or without regard to the state Merit System, and may set the salary and terms of employment for such officers and employees.