26B-2-801 (Effective 05/06/26).

Definitions for part.

As used in this part:

(1) "Adult" means an individual who is:

(a) at least 18 years old;

or (b) under 18 years old and is emancipated.

(2) "APRN" means an individual who is:

(a) certified or licensed as an [advance] advanced practice registered nurse under Subsection [58-31b-301(2)(e)] 58-31b-301(2);

(b) an independent practitioner;

and (c) acting within the scope of practice for that individual, as provided by law, rule, and specialized certification and training in that individual's area of practice.

(3) "Capacity" means the same as that term is defined in Section 75A-9-101.

(4) "Emergency medical services provider" means a person that is licensed, designated, or - 4 - Enrolled Copy S.B.

31 certified under Title 53, Chapter 2d, Emergency Medical Services Act.

(5) "Health care" means the same as that term is defined in Section 75A-9-101.

(6) "Health care provider" means the same as that term is defined in Section 78B-3-403, except that "health care provider" does not include an emergency medical services provider.

(7)(a) "Life sustaining care" means any medical intervention, including procedures, administration of medication, or use of a medical device, that maintains life by sustaining, restoring, or supplanting a vital function.

(b) "Life sustaining care" does not include care provided for the purpose of keeping an individual comfortable.

(8) "Minor" means an individual who:

(a) is under 18 years old;

and (b) is not emancipated.

(9) "Order for life sustaining treatment" means an order related to life sustaining treatment, on a form designated by the Department of Health and Human Services under Section 26B-2-802, that gives direction to health care providers, health care facilities, and emergency medical services providers regarding the specific health care decisions of the individual to whom the order relates.

(10) "Parent" means the same as that term is defined in Section 75-1-201.

(11) "Physician" means a physician and surgeon or osteopathic surgeon licensed under Title 58, Chapter 67, Utah Medical Practice Act or Chapter 68, Utah Osteopathic Medical Practice Act.

(12) "Physician assistant" means an individual licensed as a physician assistant under Title 58, Chapter 70a, Utah Physician Assistant Act.

(13) "Sign" means the same as that term is defined in Section 75-1-201.

(14) "Substituted judgment" means the standard to be applied by a surrogate when making a health care decision for an adult who previously had the capacity to make health care decisions, which requires the surrogate to consider:

(a) specific preferences expressed by the adult:

(i) when the adult had the capacity to make health care decisions;

and (ii) at the time the decision is being made;

(b) the surrogate's understanding of the adult's health care preferences;

(c) the surrogate's understanding of what the adult would have wanted under the circumstances;

and - 5 - S.B.

31 Enrolled Copy (d) to the extent that the preferences described in Subsections (14)(a) through (c) are unknown, the best interest of the adult.

(15) "Surrogate" means the same as that term is defined in Section 75A-9-101.

Section 2.

Section 26B-4-203 is amended to read:

26B-4-203 (Effective 05/06/26).

Qualifying condition.

(1) By designating a particular condition under Subsection (2) for which the use of medical cannabis to treat symptoms is decriminalized, the Legislature does not conclusively state that:

(a) current scientific evidence clearly supports the efficacy of a medical cannabis treatment for the condition;

or (b) a medical cannabis treatment will treat, cure, or positively affect the condition.

(2) For the purposes of this part, each of the following conditions is a qualifying condition:

(a) HIV or acquired immune deficiency syndrome;

(b) Alzheimer's disease;

(c) amyotrophic lateral sclerosis;

(d) cancer;

(e) cachexia;

(f) persistent nausea that is not significantly responsive to traditional treatment, except for nausea related to:

(i) pregnancy;

(ii) cannabis-induced cyclical vomiting syndrome;

or (iii) cannabinoid hyperemesis syndrome;

(g) Crohn's disease or ulcerative colitis;

(h) epilepsy or debilitating seizures;

(i) multiple sclerosis or persistent and debilitating muscle spasms;

(j) post-traumatic stress disorder that is being treated and monitored by a licensed mental health therapist, as that term is defined in Section 58-60-102, and that:

(i) has been diagnosed by a health care provider or mental health provider employed or contracted by the United States Veterans Administration, evidenced by copies of medical records from the United States Veterans Administration that are included as part of the recommending medical provider's pre-treatment assessment and medical record documentation;

or (ii) has been diagnosed or confirmed, through face-to-face or telehealth evaluation of the patient, by a provider who is:

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31 (A) a licensed board-eligible or board-certified psychiatrist;

(B) a licensed psychologist with a master's-level degree;

(C) a licensed clinical social worker with a master's-level degree;

(D) a licensed advanced practice registered nurse who is qualified to practice within the psychiatric mental health nursing specialty and who has completed the clinical practice requirements in psychiatric mental health nursing, including in psychotherapy[, in accordance with Subsection 58-31b-302(5)(g)];

or (E) a licensed physician assistant who is qualified to specialize in mental health care under Section 58-70a-501.1;

(k) autism;

(l) a terminal illness when the patient's remaining life expectancy is less than six months;

(m) a condition resulting in the individual receiving hospice care;

(n) a rare condition or disease that:

(i) affects less than 200,000 individuals in the United States, as defined in Section 526 of the Federal Food, Drug, and Cosmetic Act;

and (ii) is not adequately managed despite treatment attempts using:

(A) conventional medications other than opioids or opiates;

or (B) physical interventions;

(o) pain lasting longer than two weeks that is not adequately managed, in the recommending medical provider's opinion, despite treatment attempts using:

(i) conventional medications other than opioids or opiates;

or (ii) physical interventions;

(p) pain that is expected to last for two weeks or longer for an acute condition, including a surgical procedure, for which a medical professional may generally prescribe opioids for a limited duration, subject to Subsection 26B-4-213(5)(c);

and (q) a condition that the Compassionate Use Board approves under Section 26B-1-421, on an individual, case-by-case basis.

Section 3.

Section 26B-8-201 is amended to read:

26B-8-201 (Effective 05/06/26).

Definitions.

As used in this part:

(1) "Dead body" means the same as that term is defined in Section 26B-8-101.

(2)(a) "Death by violence" means death that resulted by the decedent's exposure to physical, mechanical, or chemical forces.

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31 Enrolled Copy (b) "Death by violence" includes death that appears to have been due to homicide, death that occurred during or in an attempt to commit rape, mayhem, kidnapping, robbery, burglary, housebreaking, extortion, or blackmail accompanied by threats of violence, assault with a dangerous weapon, assault with intent to commit any offense punishable by imprisonment for more than one year, arson punishable by imprisonment for more than one year, or any attempt to commit any of the foregoing offenses.

(3) "Health care professional" means any of the following while acting in a professional capacity:

(a) a physician licensed under Title 58, Chapter 67, Utah Medical Practice Act, or Title 58, Chapter 68, Utah Osteopathic Medical Practice Act;

(b) a physician assistant licensed under Title 58, Chapter 70a, Utah Physician Assistant Act;

or (c) an advanced practice registered nurse licensed under Subsections 58-31b-301(2)(a) through (c).

(4) "Immediate relative" means an individual's spouse, child, parent, sibling, grandparent, or grandchild.

[(4) "Health care professional" means any of the following while acting in a professional capacity:] [(a) a physician licensed under Title 58, Chapter 67, Utah Medical Practice Act, or Title 58, Chapter 68, Utah Osteopathic Medical Practice Act;] [(b) a physician assistant licensed under Title 58, Chapter 70a, Utah Physician Assistant Act;

or] [(c) an advance practice registered nurse licensed under Subsection 58-31b-301(2)(e).] (5) "Medical examiner" means the state medical examiner appointed pursuant to Section 26B-8-202 or a deputy appointed by the medical examiner.

(6) "Medical examiner record" means:

(a) all information that the medical examiner obtains regarding a decedent;

(b) reports that the medical examiner makes regarding a decedent;

and (c) all administrative forms and correspondence related to a decedent's case.

(7) "Regional pathologist" means an American Board of Pathology certified pathologist licensed to practice medicine and surgery in the state, appointed by the medical examiner pursuant to Subsection 26B-8-202(3).

(8) "Sudden death while in apparent good health" means apparently instantaneous death - 8 - Enrolled Copy S.B.

31 without obvious natural cause, death during or following an unexplained syncope or coma, or death during an acute or unexplained rapidly fatal illness.

(9) "Sudden unexpected infant death" means the death of a child who was thought to be in good health or whose terminal illness appeared to be so mild that the possibility of a fatal outcome was not anticipated.

(10) "Suicide" means death caused by an intentional and voluntary act of an individual who understands the physical nature of the act and intends by such act to accomplish self-destruction.

(11) "Unattended death" means a death that occurs more than 365 days after the day on which a health care professional examined or treated the deceased individual for any purpose, including writing a prescription.

(12)(a) "Unavailable for postmortem investigation" means that a dead body is:

(i) transported out of state;

(ii) buried at sea;

(iii) cremated;

(iv) processed by alkaline hydrolysis;

or (v) otherwise made unavailable to the medical examiner for postmortem investigation or autopsy.

(b) "Unavailable for postmortem investigation" does not include embalming or burial of a dead body pursuant to the requirements of law.

(13) "Within the scope of the decedent's employment" means all acts reasonably necessary or incident to the performance of work, including matters of personal convenience and comfort not in conflict with specific instructions.

Section 4.

Section 58-1-401 is amended to read:

58-1-401 (Effective 05/06/26).

Grounds for denial of license -- Disciplinary proceedings -- Time limitations -- Sanctions.

(1) The division shall refuse to issue a license to an applicant and shall refuse to renew or shall revoke, suspend, restrict, place on probation, or otherwise act upon the license of a licensee who does not meet the qualifications for licensure under this title.

(2) The division may refuse to issue a license to an applicant and may refuse to renew or may revoke, suspend, restrict, place on probation, issue a public reprimand to, or otherwise act upon the license of a licensee for the following reasons:

(a) subject to the provisions of Subsection (7), the applicant or licensee has engaged in unprofessional conduct, as defined by statute or rule under this title;

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31 Enrolled Copy (b) the applicant or licensee has engaged in unlawful conduct as defined by statute under this title;

(c) the applicant or licensee has been determined to be mentally incompetent by a court of competent jurisdiction;

or (d) subject to Subsections [58-31b-401(7)] 58-31b-401(6), 58-60-108(2), 58-61-401(2), 58-67-401(2), 58-68-401(2), 58-70a-401(2), and Section 58-81-105, the applicant or licensee is unable to practice the occupation or profession with reasonable skill and safety because of illness, drunkenness, excessive use of drugs, narcotics, chemicals, or other type of material, or as a result of a mental or physical condition, when the condition demonstrates a threat or potential threat to the public health, safety, or welfare.

(3) A licensee whose license to practice an occupation or profession regulated by this title has been suspended, revoked, placed on probation, or restricted may apply for reinstatement of the license at reasonable intervals and upon compliance with conditions imposed upon the licensee by statute, rule, or terms of the license suspension, revocation, probation, or restriction.

(4) The division may issue cease and desist orders to:

(a) a licensee or applicant who may be disciplined under Subsection (1) or (2);

(b) a person who engages in or represents that the person is engaged in an occupation or profession regulated under this title;

and (c) a person who otherwise violates this title or a rule adopted under this title.

(5) The division may impose an administrative penalty in accordance with Section 58-1-502.

(6)(a) The division may not take disciplinary action against a person for unprofessional or unlawful conduct under this title, unless the division enters into a stipulated agreement or initiates an adjudicative proceeding regarding the conduct within four years after the conduct is reported to the division, except under Subsection (6)(b).

(b)(i) The division may not take disciplinary action against a person for unprofessional or unlawful conduct more than 10 years after the occurrence of the conduct, unless the proceeding is in response to a civil or criminal judgment or settlement and the proceeding is initiated within one year following the judgment or settlement.

(ii) Notwithstanding Subsection (6)(b)(i), the division may refuse to issue a license due to unprofessional or unlawful conduct that occurred more than 10 years before a request or application for licensure is made.

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31 (7) When the division is determining whether to refuse to issue a license to an applicant, or to refuse to renew the license of a licensee, based solely on the criminal conviction of an applicant or licensee, the division shall:

(a) provide individualized consideration to the applicant or licensee;

(b) determine whether the criminal conviction bears a substantial relationship to the applicant's or licensee's ability to safely or competently practice the occupation or profession;

and (c) consider the applicant's or licensee's current circumstances, which may include any of the following:

(i) the age of the applicant or licensee when the applicant or licensee committed the offense;

(ii) the time that has elapsed since the applicant or licensee committed the offense;

(iii) whether the applicant or licensee has completed the applicant's or licensee's criminal sentence;

(iv) whether the applicant has completed or is actively participating in rehabilitative drug or alcohol treatment;

(v) any testimonials or recommendations from other individuals provided by the applicant or licensee, including a progress report from the applicant's or licensee's probation or parole officer;

(vi) other evidence of rehabilitation provided by the applicant or licensee;

(vii) the education and training of the applicant or licensee;

(viii) the employment history of the applicant or licensee;

and (ix) other relevant information provided by the applicant or licensee.

Section 5.

Section 58-1-510 is amended to read:

58-1-510 (Effective 05/06/26).

Anesthesia and sedation requirements -- Unprofessional conduct -- Whistleblower protection.

(1) As used in this section:

(a) "Anesthesia or sedation provider" means an individual who is licensed:

(i) under Chapter 5a, Podiatric Physician Licensing Act;

(ii) under Subsection [58-31b-301(2)(e)] 58-31b-301(2)(b);

(iii) under Chapter 67, Utah Medical Practice Act;

(iv) under Chapter 68, Utah Osteopathic Medical Practice Act;

or (v) as a dentist under Chapter 69, Dentist and Dental Hygienist Practice Act, and who has obtained the appropriate permit established by the division under Subsection - 11 - S.B.

31 Enrolled Copy 58-69-301(4).

(b) "Deep sedation" means a drug-induced depression of consciousness where an individual:

(i) cannot be easily aroused;

(ii) responds purposefully following repeated or painful stimulation;

(iii) may not be able to independently maintain ventilatory function;

(iv) may require assistance in maintaining a patent airway;

and (v) usually maintains cardiovascular function.

(c) "General anesthesia" means a drug-induced loss of consciousness where an individual:

(i) cannot be aroused, even by painful stimulation;

(ii) is often unable to maintain ventilatory function;

(iii) often requires assistance in maintaining a patent airway and positive pressure ventilation may be required because of depressed spontaneous ventilation or drug-induced depression of neuromuscular function;

and (iv) may not be able to maintain cardiovascular function.

(d) "General anesthetic" means a drug identified as a general anesthetic by the federal Food and Drug Administration.

(e) "Minimal sedation" means a drug-induced state where an individual:

(i) responds normally to verbal commands;

(ii) may have reduced cognitive function and physical coordination;

and (iii) maintains airway reflexes, ventilatory function, and cardiovascular function.

(f) "Moderate sedation" means a drug-induced depression of consciousness where an individual:

(i) responds purposefully to verbal commands, either alone or accompanied by light tactile stimulation;

(ii) maintains a patent airway;

(iii) maintains spontaneous ventilation;

and (iv) usually maintains cardiovascular function.

(2) An anesthesia or sedation provider may not cause a patient to undergo moderate sedation, deep sedation, or general anesthesia, in an outpatient setting that is not an emergency department without:

(a) first providing the following information in writing and verbally:

(i) the level of anesthesia or sedation being administered;

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31 (ii) the identity, type of license, and training of the provider who is performing the procedure for which the anesthesia or sedation will be administered;

(iii) the identity, type of license, and a description of the training described in Subsection (4) of the anesthesia or sedation provider who will be administering the anesthesia or sedation;

and (iv) a description of the monitoring that will occur during the sedation or anesthesia, including descriptions related to the monitoring of the patient's oxygenation, ventilation, and circulation;

(b) after complying with Subsection (2)(a), obtaining the patient's written and verbal consent regarding the procedure;

(c) having the training described in Subsection (4);

(d) directly supervising the patient;

(e) if the patient is a minor, having a current pediatric advanced life support certification;

(f) if the patient is an adult, having a current advanced cardiovascular life support certification or perioperative resuscitation and life support certification;

(g)(i) having at least one individual in the procedure room who has advanced airway training and the knowledge and skills to recognize and treat airway complications and rescue a patient who entered a deeper than intended level of sedation;

or (ii) if the anesthesia or sedation provider is administering ketamine for a non-anesthetic purpose, having at least one individual on site and available who has advanced airway training and the knowledge and skills to recognize and treat airway complications and rescue a patient who entered a deeper than intended level of sedation;

(h) having access during the procedure to an advanced cardiac life support crash cart in the office with equipment that:

(i) is regularly maintained according to guidelines established by the American Heart Association;

and (ii) includes:

(A) a defibrillator;

(B) administrable oxygen;

(C) age appropriate airway equipment;

(D) positive pressure ventilation equipment;

and (E) unexpired emergency and reversal medications including naloxone for opioid sedation and flumazenil for benzodiazepine sedation;

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31 Enrolled Copy (i) using monitors that meet basic standards set by the American Society of Anesthesiologists and continually monitoring ventilatory function with capnography unless precluded or invalidated by the nature of the patient, procedure, or equipment;

and (j) entering appropriate information into the patient's chart or medical record, which shall include:

(i) the patient's name;

(ii) the route and site the anesthesia or sedation was administered;

(iii) the time of anesthesia or sedation administration and the dosage;

(iv) the patient's periodic vital signs during the procedure;

and (v) the name of the individual who monitored the patient's oxygenation and ventilation.

(3)(a) An anesthesia or sedation provider who violates Subsection (2) or [any] a rule [ created by the division] the division makes in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, to implement this section commits unprofessional conduct.

(b) An individual commits unprofessional conduct if the individual administers anesthesia or sedation for which the individual is not appropriately trained.

(4)(a) In accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, the division shall make rules to create training and safety standards regarding the inducing of general anesthesia, deep sedation, and moderate sedation:

(i) for each license described in Subsection (1)(a);

(ii) that are based on standards created by nationally recognized organizations, such as the American Society of Anesthesiologists, the American Dental Association, or the American Association of Oral and Maxillofacial Surgeons;

and (iii) that include safety standards for general anesthetic use that are consistent with federal Food and Drug Administration guidance.

(b) For making rules described in Subsection (4)(a), the division shall consult with the applicable licensing boards and a board described in Sections 58-67-201, [58-68-201, ] and 58-69-201.

(5) The requirements of Subsection (2) do not apply to the practice of inducing minimal sedation.

(6) An employer may not take an adverse employment action against an employee if:

(a) the employee notifies the division of:

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31 (i) a violation of this section;

or (ii) a violation of [any rule created by the division to implement this section] a rule the division makes in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, to implement this section;

and (b) the employment action is based on the individual notifying the division of the violation.

Section 6.

Section 58-1-602 is amended to read:

58-1-602 (Effective 05/06/26).

Auricular detoxification certification.

(1) As used in this section:

(a) "Health care provider" means an individual who is licensed under:

(i) Subsection [58-31b-301(2)(a), (b), (d), or (e)] 58-31b-301(2)(a), (2)(b), (2)(c), (2)(d), (2)(f), or (2)(g);

(ii) Chapter 60, Mental Health Professional Practice Act;

(iii) Chapter 61, Part 3, Licensing;

or (iv) Chapter 70a, Utah Physician Assistant Act.

(b)(i) "NADA protocol" means:

(A) a protocol developed by the National Acupuncture Detoxification Association;

and (B) an adjunctive therapy using one to five invariant ear acupuncture or acupressure points for the adjunctive treatment and prevention of substance use disorders or to provide support for individuals who have experienced physical or emotional trauma.

(ii) "NADA protocol" does not include the stimulation of other auricular or distal acupuncture points.

(2) A health care provider may perform the NADA protocol if the health care provider:

(a) obtains a certification from the National Acupuncture Detoxification Association to perform the NADA protocol;

and (b) provides the division proof of obtaining the certification.

(3) A health care provider may perform a protocol substantially similar to the NADA protocol if:

(a) the division has determined the protocol is substantially similar to the NADA protocol;

and (b) the individual has met each requirement the division has created to perform the protocol.

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31 Enrolled Copy (4) In accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, the division may make rules for implementing Subsection (3).

Section 7.

Section 58-1-603 is amended to read:

58-1-603 (Effective 05/06/26).

Hormonal transgender treatment on minors -- Requirements.

(1) As used in this section:

(a) "Approved organization" means an organization with expertise regarding transgender health care for minors that is approved by the division.

(b) "Biological sex at birth" means an individual's sex, as being male or female, according to distinct reproductive roles as manifested by sex and reproductive organ anatomy, chromosomal makeup, and endogenous hormone profiles.

(c) "Disorder of sexual development" means a sexual development disorder where an individual:

(i) is born with external biological sex characteristics that are irresolvably ambiguous;

(ii) is born with 46, XX chromosomes with virilization;

(iii) is born with 46, XY chromosomes with undervirilization;

(iv) has both ovarian and testicular tissue;

or (v) has been diagnosed by a physician, based on genetic or biochemical testing, with abnormal:

(A) sex chromosome structure;

(B) sex steroid hormone production;

or (C) sex steroid hormone action for a male or female.

(d) "Health care provider" means:

(i) a physician;

(ii) a physician assistant licensed under Chapter 70a, Utah Physician Assistant Act;

or (iii) an advanced practice registered nurse licensed under [Subsection 58-31b-301(2)(e)] Subsections 58-31b-301(2)(a) through (c).

(e)(i) "Hormonal transgender treatment" means administering, prescribing, or supplying for effectuating or facilitating an individual's attempted sex change:

(A) to an individual whose biological sex at birth is female, a dose of testosterone or other androgens at levels above those normally found in an individual whose biological sex at birth is female;

(B) to an individual whose biological sex at birth is male, a dose of estrogen or a synthetic compound with estrogenic activity or effect at levels above those - 16 - Enrolled Copy S.B.

31 normally found in an individual whose biological sex at birth is male;

or (C) a puberty inhibition drug.

(ii) "Hormonal transgender treatment" does not include administering, prescribing, or supplying a substance described in Subsection (1)(e)(i) to an individual if the treatment is medically necessary as a treatment for:

(A) precocious puberty;

(B) endometriosis;

(C) a menstrual, ovarian, or uterine disorder;

(D) a sex-hormone stimulated cancer;

or (E) a disorder of sexual development.

(f) "Mental health professional" means any of the following:

(i) a physician who is board certified for a psychiatry specialization recognized by the American Board of Medical Specialists or the American Osteopathic Association's Bureau of Osteopathic Specialists;

(ii) a psychologist licensed under Chapter 61, Psychologist Licensing Act;

(iii) a clinical social worker licensed under Chapter 60, Part 2, Social Worker Licensing Act;

(iv) a marriage and family therapist licensed under Chapter 60, Part 3, Marriage and Family Therapist Licensing Act;

or (v) a clinical mental health counselor licensed under Chapter 60, Part 4, Clinical Mental Health Counselor Licensing Act.

(g) "Minor" means an individual who is less than 18 years old.

(h) "Physician" means an individual licensed under:

(i) Chapter 67, Utah Medical Practice Act;

or (ii) Chapter 68, Utah Osteopathic Medical Practice Act.

(i) "Puberty inhibition drug" means any of the following alone or in combination with aromatase inhibitors:

(i) gonadotropin-releasing hormone agonists;

or (ii) androgen receptor inhibitors.

(j) "Transgender treatment certification" means a certification described in Subsection (2).

(2)(a) The division shall create a transgender treatment certification on or before July 1, 2023.

(b) The division may issue the transgender treatment certification to an individual if the individual:

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31 Enrolled Copy (i) is a health care provider or a mental health professional;

and (ii) has completed at least 40 hours of education related to transgender health care for minors from an approved organization.

(c) The division may renew a transgender treatment certification:

(i) at the time an individual renews the individual's license;

and (ii) if the individual has completed at least 20 hours of continuing education related to transgender health care for minors from an approved organization during the individual's continuing education cycle.

(d) Beginning January 1, 2024, providing a hormonal transgender treatment to a minor without a transgender treatment certification is unprofessional conduct.

(3)(a) A health care provider may provide a hormonal transgender treatment to a minor only if the health care provider has been treating the minor for gender dysphoria for at least six months.

(b) Beginning July 1, 2023, before providing a hormonal transgender treatment to a minor described in Subsection (3)(a), a health care provider shall:

(i) determine if the minor has other physical or mental health conditions, identify and document any condition, and consider whether treating those conditions before treating the gender dysphoria would provide the minor the best long-term outcome;

(ii) consider whether an alternative medical treatment or behavioral intervention to treat the minor's gender dysphoria would provide the minor the best long-term outcome;

(iii) document in the medical record that:

(A) the health care provider has complied with Subsections (3)(b)(i) and (ii);

and (B) providing the hormonal transgender treatment will likely result in the best long-term outcome for the minor;

(iv) obtain written consent from:

(A) the minor;

and (B) the minor's parent or guardian unless the minor is emancipated;

(v) discuss with the minor:

(A) the risks of the hormonal transgender treatment;

(B) the minor's short-term and long-term expectations regarding the effect that the hormonal transgender treatment will have on the minor;

and (C) the likelihood that the hormonal transgender treatment will meet the short-term and long-term expectations described in Subsection (3)(b)(v)(B);

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31 (vi) unless the minor is emancipated, discuss with the minor's parent or guardian:

(A) the risks of the hormonal transgender treatment;

(B) the minor's short-term and long-term expectations regarding the effect that the hormonal transgender treatment will have on the minor;

(C) the parent or guardian's short-term and long-term expectations regarding the effect that the hormonal transgender treatment will have on the minor;

and (D) the likelihood that the hormonal transgender treatment will meet the short-term and long-term expectations described in Subsections (3)(b)(vi)(B) and (C);

(vii) document in the medical record that the health care provider has provided the information described in Subsections (3)(b)(viii) and (ix);

(viii) provide the minor the following information if providing the minor a puberty inhibition drug:

(A) puberty inhibition drugs are not approved by the FDA for the treatment of gender dysphoria;

(B) possible adverse outcomes of puberty blockers are known to include diminished bone density, pseudotumor cerebri and long term adult sexual dysfunction;

(C) research on the long-term risks to children of prolonged treatment with puberty blockers for the treatment of gender dysphoria has not yet occurred;

and (D) the full effects of puberty blockers on brain development and cognition are unknown;

(ix) provide the minor the following information if providing a cross-sex hormone as described in Subsection (1)(e)(i)(A) or (B):

(A) the use of cross-sex hormones in males is associated with risks that include blood clots, gallstones, coronary artery disease, heart attacks, tumors of the pituitary gland, strokes, elevated levels of triglycerides in the blood, breast cancer, and irreversible infertility;

and (B) the use of cross-sex hormones in females is associated with risks of erythrocytosis, severe liver dysfunction, coronary artery disease, hypertension, and increased risk of breast and uterine cancers;

and (x) upon the completion of any relevant information privacy release, obtain a mental health evaluation of the minor as described in Subsection (4).

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31 Enrolled Copy (4) The mental health evaluation shall:

(a) be performed by a mental health professional who:

(i) beginning January 1, 2024, has a current transgender treatment certification;

and (ii) is not the health care provider that is recommending or providing the hormonal transgender treatment;

(b) contain a determination regarding whether the minor suffers from gender dysphoria in accordance with the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders;

(c) confirm that the minor and the mental health professional have had at least three therapy sessions;

and (d) document all of the minor's mental health diagnoses and any significant life events that may be contributing to the diagnoses.

(5) A violation of Subsection (3) is unprofessional conduct.

Section 8.

Section 58-24b-102 is amended to read:

58-24b-102 (Effective 05/06/26).

Definitions.

As used in this chapter:

[(1) "Animal physical therapy" means practicing physical therapy or physiotherapy on an animal.] [(2)] (1) "Board" means the Physical Therapies Licensing Board, created in Section 58-24b-201.

[(3)] (2) "Consultation by telecommunication" [means the provision of expert or professional advice by a physical therapist who is licensed outside of Utah to a licensed physical therapist or a health care provider by telecommunication or electronic communication] means a health care provider, as that term is defined in Section 58-1-501.8, receiving professional advice through electronic communication from a physical therapist who is licensed outside of the state.

(3) "Dry needling" means a skilled intervention using a filiform needle to penetrate the skin and underlying tissue for the evaluation, management, or prevention of a disability, a movement impairment, a neuromusculoskeletal condition, or pain.

(4) "General supervision" means supervision and oversight of an individual by a licensed physical therapist when the licensed physical therapist is immediately available in person, by telephone, or by electronic communication to assist the individual.

(5) "Licensed physical therapist" means an individual licensed under this chapter to engage in the practice of physical therapy.

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31 (6) "Licensed physical therapist assistant" means an individual licensed under this chapter to engage in the practice of physical therapy, subject to the provisions of Subsection 58-24b-401(2)(a).

(7) "Licensing examination" means a nationally recognized physical therapy examination that [is approved by the division, in consultation with the board] the division approves by rule the division makes in consultation with the board and with Title 63G, Chapter 3, Utah Administrative Rulemaking Act.

(8) "On-site supervision" means supervision and oversight of an individual by a licensed physical therapist or a licensed physical therapist assistant when the licensed physical therapist or licensed physical therapist assistant is:

(a) continuously present at the facility where the individual is providing services;

(b) immediately available to assist the individual;

and (c) regularly involved in the services being provided by the individual.

(9) "Physical impairment" means:

[(a) a mechanical impairment;] [(b) a physiological impairment;] [(c) a developmental impairment;] [(d) a functional limitation;] [(e) a disability;] [(f) a mobility impairment;

or] [(g) a bodily malfunction.] (a) a bodily malfunction;

(b) a developmental impairment;

(c) a disability;

(d) a functional limitation;

(e) a mechanical impairment;

(f) a mobility impairment;

or (g) a physiological impairment.

(10)(a) "Physical therapy" [or "physiotherapy" means:] means examining, evaluating, and testing an individual who has a physical impairment or injury.

[(i) examining, evaluating, and testing an individual who has a physical impairment or injury] (b) "Physical therapy" includes:

(i) ordering imaging in accordance with Section 58-54-303;

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31 Enrolled Copy (ii) identifying or labeling a physical impairment or injury;

(iii) formulating a therapeutic intervention plan for the treatment of a physical impairment, injury, or pain;

(iv) assessing the ongoing effects of therapeutic intervention for the treatment of a physical impairment or injury;

(v) treating or alleviating a physical impairment by designing, modifying, or implementing a therapeutic intervention;

(vi) reducing the risk of an injury or physical impairment;

(vii) providing instruction on the use of physical measures, activities, or devices for preventative and therapeutic purposes;

(viii) promoting and maintaining health and fitness;

(ix) [the administration of ] administering a prescription drug [pursuant to] in accordance with Section 58-24b-403;

(x) applying dry needling to enhance a client's physical performance if the physical therapy practitioner has the necessary training the division requires by rule the division makes in consultation with the board and in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act;

[(x)] (xi) subject to Subsection 58-28-307(12)(b), engaging in the functions described in Subsections [(10)(a)(i) through (ix)] (10)(b)(i) through (ix) in relation to an animal, in accordance with the requirements of Section 58-24b-405;

or [(xi)] (xii) [engaging in administration, consultation, education, and research relating to ] administering, consulting, educating, and researching the practices described in [ this Subsection (10)(a);

or] Subsection (10).

[(xii) applying dry needling to enhance an individual's physical performance if the physical therapy practitioner has received the necessary training as determined by division rule in collaboration with the board.] [(b)] (c) "Physical therapy" [or "physiotherapy" ]does not include:

[(i) diagnosing disease;] [(ii) performing surgery;] [(iii) performing acupuncture;] [(iv) taking x-rays;

or] [(v) prescribing or dispensing a drug, as defined in Section 58-37-2.] (i) diagnosing a disease;

(ii) dispensing or prescribing a drug as defined in Section 58-37-2;

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31 (iii) performing acupuncture;

(iv) performing surgery;

or (v) taking x-rays.

(11) "Physical therapy aide" means an individual who:

(a) [is trained, on-the-job, by] receives on-the-job training from a licensed physical therapist;

and (b) provides routine assistance to a licensed physical therapist or licensed physical therapist assistant, while the licensed physical therapist or licensed physical therapist assistant practices physical therapy[, within the scope of the licensed physical therapist's or licensed physical therapist assistant's license].

(12) "Recognized accreditation agency" means an accreditation agency that[:] the division approves in consultation with the board.

[(a) grants accreditation, nationally, in the United States of America;

and] [(b) is approved by the division, in consultation with the board.] (13)(a) "Testing" means a standard method or technique used to gather data regarding a patient that is generally and nationally accepted by physical therapists for the practice of physical therapy.

(b) "Testing" includes measurement or evaluation of:

(i) muscle strength, force, endurance, or tone;

(ii) cardiovascular fitness;

(iii) physical work capacity;

(iv) joint motion, mobility, or stability;

(v) reflexes or autonomic reactions;

(vi) movement skill or accuracy;

(vii) sensation;

(viii) perception;

(ix) peripheral nerve integrity;

(x) locomotor skills, stability, and endurance;

(xi) the fit, function, and comfort of prosthetic, orthotic, or other assistive devices;

(xii) posture;

(xiii) body mechanics;

(xiv) limb length, circumference, and volume;

(xv) thoracic excursion and breathing patterns;

(xvi) activities of daily living related to physical movement and mobility;

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31 Enrolled Copy (xvii) [functioning] physical movement and mobility functions in the physical environment at home or work[, as it relates to physical movement and mobility];

and (xviii) neural muscular responses.

[(14)(a) "Trigger point dry needling" means the stimulation of a trigger point using a dry needle to treat neuromuscular pain and functional movement deficits.] [(b) "Trigger point dry needling" does not include the stimulation of auricular or distal points.] [(15)] (14) "Therapeutic intervention" includes:

(a) therapeutic exercise, with or without the use of a device;

(b) [functional training in] physical movement and mobility training for functional self-care[, as it relates to physical movement and mobility];

(c) physical movement and mobility for community or work integration[, as it relates to physical movement and mobility];

(d) manual therapy, including:

(i) soft tissue mobilization;

(ii) therapeutic massage;

or (iii) joint mobilization, as [defined by the division, by rule] the division defines by rule the division makes in consultation with the board and in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act;

(e) [prescribing, applying, or fabricating an assistive, adaptive, orthotic, prosthetic, protective, or supportive device] prescription, application, fabrication, or training for an assistive technology, an adaptive device, an orthotic device, or a prosthetic device;

(f) prescription of durable medical equipment to a patient with or without requesting a prescription from a licensed physician;

[(f)] (g) airway clearance techniques, including postural drainage;

[(g)] (h) integumentary protection and repair techniques;

[(h)] (i) wound debridement, cleansing, and dressing;

[(i)] (j) the application of a physical agent, including:

(i) light;

(ii) heat;

(iii) cold;

(iv) water;

(v) air;

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31 (vi) sound;

(vii) compression;

(viii) electricity;

and (ix) electromagnetic radiation;

[(j)] (k) mechanical or electrotherapeutic modalities;

[(k)] (l) positioning;

[(l)] (m) instructing or training a patient in locomotion or other functional activities, with or without an assistive device;

[(m)] (n) manual or mechanical traction;

[(n)] (o) correction of posture, body mechanics, or gait;

and [(o)] (p) trigger point dry needling, under the conditions described in Section 58-24b-505.

Section 9.

Section 58-24b-402 is amended to read:

58-24b-402 (Effective 05/06/26).

Patient care and management.

(1) [In practicing physical therapy, a ] A licensed physical therapist shall:

(a) manage [all aspects of ]the physical therapy of a patient under the licensed physical therapist's care;

(b) perform the initial evaluation and documentation for each patient;

(c) perform periodic reevaluation and documentation for each patient;

(d) perform a physical therapy [interventions] intervention that [require] requires immediate and continuous [examination and ]evaluation throughout the intervention;

(e) perform on a patient all therapeutic intervention [on a patient ]that is outside of the [ standard ]scope of practice of a licensed physical therapist assistant or a physical therapy aide;

(f) determine the therapeutic intervention [to be performed by ]a licensed physical therapist assistant [under the on-site supervision or general supervision of the licensed physical therapist] performs while under the licensed physical therapist's on-site supervision or while the licensed physical therapist is immediately available in person, by telephone, or by electronic communication to ensure that the therapeutic intervention is safe, effective, efficient, and within the scope of practice of the licensed physical therapist assistant;

(g) conduct the discharge of each patient and document [for each patient,] each patient's response to therapeutic intervention at the time of discharge[, the patient's response to therapeutic intervention];

and (h) provide accurate documentation of the billing and services provided.

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31 Enrolled Copy (2) A licensed physical therapist assistant or a physical therapy aide may not:

(a) perform a physical therapy evaluation or assessment;

(b) identify or label a physical impairment or injury;

(c) design a plan of care for a patient;