RULES AND REGULATIONS
Title 49--PROFESSIONAL AND VOCATIONAL STANDARDS
STATE BOARD OF MEDICINE
STATE BOARD OF OSTEOPATHIC MEDICINE
[49 PA. CODE CHS. 16, 18 AND 25]
Athletic Trainers
[37 Pa.B. 3230]
[Saturday, July 14, 2007]The State Boards of Medicine and Osteopathic Medicine (Boards) amend Chapters 16, 18 and 25 to read as set forth in Annex A.
A. Effective Date
The final-form rulemaking will be effective upon publication in the Pennsylvania Bulletin.
B. Statutory Authority
Section 51.1(d) of the Medical Practice Act of 1985 (63 P. S. § 422.51a(d)) and section 7.1(d) of the Osteopathic Medical Practice Act (63 P. S. § 271.7a(d)) (medical practice acts) authorize the Boards to jointly promulgate regulations that establish approved education and training programs for certification of athletic trainers and define the circumstances and protocol under which a certified athletic trainer may perform athletic training services.
C. Background and Purpose
Under the Physical Therapy Practice Act (formerly 63 P. S. §§ 1301, 1310.1 and 1310.2), the State Board of Physical Therapy certified and regulated athletic trainers in this Commonwealth.
The acts of December 10, 2001 (P. L. 859, No. 92) and (P. L. 863, No. 93) (Acts 92 and 93) repealed these provisions insofar as they are inconsistent with the medical practice acts. Acts 92 and 93 added section 51.1(d) to the Medical Practice Act of 1985 and section 7.1(d) to the Osteopathic Medical Practice Act to provide for the certification and regulation of athletic trainers by the Boards. Acts 92 and 93, effective February 8, 2002, further provided that until the Boards adopt final-form regulations, the regulations of the State Board of Physical Therapy in Chapter 40, Subchapter B (relating to athletic trainers) govern the activities of athletic trainers, which are not inconsistent with amendments to the medical practice acts. The Boards are adopting these amendments to establish procedures for certification and protocols for the practice of athletic trainers.
D. Summary of Comments to Proposed Rulemaking and the Boards' Responses
The proposed rulemaking was published at 36 Pa.B. 1233 (March 18, 2006). The Boards entertained public comment for a period of 30 days, during which time the Boards received comments from the Pennsylvania Athletic Trainers' Society, Inc. (PATS), the Pennsylvania Physical Therapy Association (PPTA) and an individual certified athletic trainer. Following the close of the public comment period, the Boards received comments from the House Professional Licensure Committee (HPLC) and the Independent Regulatory Review Commission (IRRC). The following summarizes the comments received and provides the Boards' responses.
§ 16.61. Unprofessional and immoral conduct.
The HPLC noted that subsection (a)(18) makes it unprofessional conduct for a Board-regulated practitioner to fail to complete reports needed for reimbursement by an insurance company of the medical expenses of a patient. In light of the change in focus in this section from ''physicians'' to ''Board-regulated practitioners,'' the HPLC suggested this language be amended to refer to expenses that result from the practice of the healing arts. The State Board of Medicine had no objection to this suggestion and made the change to the final-form rulemaking.
§§ 18.502 and 25.702. Definitions.
The HPLC commented that there was a minor discrepancy in the definition of ''direction'' between the two Boards' versions in that § 18.502 used ''via'' while § 25.702 used ''by means of.'' The Legislative Reference Bureau corrected this situation when the proposed rulemaking was published so that both versions use the generally accepted ''by means of.''
The HPLC also noted that the word ''and'' appears in the definition of ''written protocol'' in § 18.502, but is absent from the same definition in § 25.702. This situation has been remedied by deleting it from § 18.502.
§§ 18.503 and 25.703. Certification requirement.
The HPLC sought clarification regarding the exceptions to the general rule that a person may not use the title of athletic trainer or perform athletic training services unless certified by the Board. The HPLC observed that the exceptions in subsection (b) seem to permit other types of licensees to call themselves athletic trainers. The intent of the exceptions was to permit other duly licensed practitioners of the healing arts to perform services within the scope of practice for which they were trained, not to permit them to call themselves athletic trainers. IRRC agreed that this section should be rewritten to clarify the Boards' intentions. In the final-form rulemaking, the Boards amended these sections to clarify their intent. Subsection (a) discusses the use of the title ''athletic trainer'' and subsection (b) discusses the general prohibition on the practice of athletic training unless certified, with the exceptions provided for other duly licensed practitioners of the various healing arts practicing within the scope of practice for which they were trained, athletic trainers licensed or certified in other jurisdictions who are employed by a visiting athletic team or organization, and students whose performance of athletic training services is coincidental to their education and training.
PPTA suggested adding a notice requirement for out-of-State athletic trainers who are required to be in this Commonwealth for an extended period of time. The Boards have elected not to adopt this suggestion.
The HPLC noted an inconsistency between §§ 18.503(c) and 25.703(c) regarding former certificateholders under the State Board of Physical Therapy. Section 18.503(c) has been amended to remedy the inconsistency.
§§ 18.504 and 25.704. Application for certification.
The HPLC noted that both Boards are setting a minimum age for certification as an athletic trainer at 20 years of age although the enabling acts are silent with regard to an age requirement. The Boards adopted the age limitation that had been established by the State Board of Physical Therapy, which has been in effect since 1987. Under this final-form rulemaking, an applicant shall complete an approved athletic training education program to be eligible for certification. These programs are available at the bachelor's degree and master's degree levels. Normally, an individual would be at least 20 years of age by the time they meet the educational requirements for certification. Therefore, the Boards find this age limitation reasonable. In addition, the Boards are not aware of a situation when the age limitation became a barrier to an applicant for certification since its original adoption by the State Board of Physical Therapy in 1987. The Boards may reevaluate this requirement if it proves to be an impediment to otherwise qualified applicants.
IRRC asked how the Boards intend to determine whether an applicant meets the requirement that ''an applicant may not be addicted to alcohol or hallucinogenic, narcotic or other drugs which tend to impair judgment or coordination.'' This requirement is standard language required for licensure or certification in the health-related professions in this Commonwealth. To enforce this provision, the Boards require applicants to certify that they are not addicted to drugs or alcohol. In addition, the Boards ask a number of questions on the licensure/certification applications that may indicate drug or alcohol related problems, such as prior convictions, disciplinary actions in other jurisdictions, loss of hospital privileges and so forth. If an applicant supplies an answer that indicates potential problems with drugs or alcohol, the application is reviewed by the Bureau of Professional and Occupational Affairs' (Bureau) Professional Health Monitoring Program. A false statement on an application subjects the applicant to criminal penalties under 18 Pa.C.S. § 4904 (relating to unsworn falsification to authorities) and to disciplinary action including the refusal or revocation of a license or certificate.
The HPLC also noted a typographical error in § 25.704(a)(4) which has been corrected in the final-form rulemaking.
§§ 18.505 and 25.705. Educational requirements.
The HPLC and IRRC asked for clarification of the educational requirements. Sections 18.505 and 25.705 require that an applicant for certification as an athletic trainer be a graduate of an accredited athletic training education program or hold and maintain current credentialing as a certified athletic trainer (ATC) by the Board of Certification, Inc. (BOC). Entry-level athletic training education programs are accredited by the Commission on Accreditation of Athletic Training Education (CAATE). CAATE and the National Athletic Trainers Association (NATA) accredit master's degree programs in athletic training. Accredited programs offer either a baccalaureate or master's degree in athletic training. Accredited programs generally include basic coursework in applied mathematics, biology, chemistry, psychology, communications and so forth, as well as courses in medical terminology, anatomy and physiology, kinesiology and biomechanics, therapeutic modalities, injury evaluation and prevention, strength and conditioning, rehabilitation sciences, exercise physiology and related courses. During their education, athletic training students participate in clinical education in a variety of practice settings such as high schools, colleges, universities, hospitals, physicians' offices and health care clinics. There are currently 19 accredited athletic training education programs operating at colleges and universities in this Commonwealth.
Currently, to obtain the ATC credential from the BOC, a candidate shall be a graduate of an entry-level athletic training education program accredited by CAATE. Prior to 2004, internship was an alternative route to BOC certification. The BOC has eliminated the internship route to BOC certification and new candidates shall now graduate from a CAATE-accredited program. To maintain BOC certification, an ATC shall adhere to the BOC Standards of Professional Practice, maintain certification in emergency cardiac care and complete 75 continuing education contact hours every 3 years. At the present time, the BOC is the only organization that offers this type of credential to athletic trainers. The regulations refer to ''another credentialing body approved by the Board'' to recognize that the profession is dynamic and there may be other organizations formed in the future for this purpose. If another credentialing body is approved by the Boards, the Boards will provide notice to certificateholders through the Boards' websites and newsletters. In addition, the application for certification will include all approved credentials accepted by the Boards.
The HPLC also asked whether the registered trademark symbol should be removed from ''ATC'' in paragraph (2). The Boards agree and deleted the symbol.
IRRC requested that these sections be amended to use the defined term ''approved athletic training education program'' in place of ''accredited educational program for athletic trainers'' and ''accredited education program.'' The Boards made the requested changes.
§§ 18.507 and 25.707. Temporary certification.
The HPLC noted that section 51.1(b) of the Medical Practice Act of 1985 and section 7.1(b) of the Osteopathic Medical Practice Act provide for temporary certification of athletic trainers who were previously certified by the State Board of Physical Therapy prior to the amendments made by Acts 92 and 93. However, §§ 18.507 and 25.707 appear to be creating another type of temporary certificate. Therefore, the HPLC requested an explanation of the effect of this provision.
To become certified as an athletic trainer, a graduate of an accredited athletic training education program shall pass the certification examination administered by the BOC. The BOC offers the examination several times throughout the year at approximately 16 locations across the United States. However, some applicants for examination may find the next test date at their chosen location is full and may have to wait until a subsequent administration of the examination or travel to another test site. The BOC will be transitioning to a computer-based examination that will eventually be offered at over 200 exam sites across the United States and Canada. Until then, the Boards felt it necessary to create a mechanism to provide graduates of accredited athletic education programs the ability to begin their athletic training careers under the direct onsite supervision of a certified athletic trainer until they have the opportunity to take the certification exam.
IRRC and PATS both suggested that the reference to the Commission for Accreditation of Allied Health Education Programs (CAAHEP) be deleted from this section. In light of the fact that CAATE now accredits athletic trainer education programs, and to avoid having to amend the regulations in the future should this organization again change, the Boards have adopted IRRC's suggestion and use the defined term ''approved athletic training education programs'' in these sections.
PATS suggested that temporary certificateholders be required to report to the Boards whether the temporary certificateholder had passed, failed or failed to take the certification examination within 30 days of the expiration of the temporary certification period. The Boards have elected not to adopt this recommendation believing it to be unnecessary. If a temporary certificateholder passes the examination, it is the temporary certificateholder's responsibility to report it to the Board to be certified. If no report is made to the Board within 1 year, the temporary certificate will expire and may not be renewed.
Additionally, the HPLC noted that § 25.707 included the additional statement that temporary certificates may not be renewed. This statement has been added to § 18.507 in the final-form rulemaking.
§ 18.508. Renewal of certification.
§ 25.708. Renewal of certificate.
The HPLC noted that the State Board of Medicine requires that continuing education certificates be maintained for 2 years, while the State Board of Osteopathic Medicine requires them to be maintained for 4 years. The difference is due to the different administrative capacities of the two Boards in conducting continuing education audits. These requirements were intended to be consistent within each Board, not between the two Boards. Acts 92 and 93 place jurisdiction over athletic trainers who are supervised by medical doctors with the State Board of Medicine and those supervised by doctors of osteopathic medicine with the State Board of Osteopathic Medicine. An athletic trainer who is supervised by more than one physician from both Boards could comply with both regulations simply by maintaining all continuing education certificates for 4 years.
In addition, the HPLC noted that with respect to §§ 18.508(d) and 25.708(d), the medical regulations provide for a $5 penalty fee for untimely renewals and the osteopathic medical regulations do not. The $5 late fee is provided for in section 225 of the Bureau of Professional and Occupational Affairs Fee Act (Fee Act) (63 P. S. § 1401-225) and applies to all of the board and commissions under the Bureau. The State Board of Medicine included it in the rulemaking to provide certificateholders with additional notice of the fee for late renewal. Therefore, § 25.708(d) is amended in the final-form rulemaking to likewise provide notice to athletic trainers certified by the State Board of Osteopathic Medicine. IRRC commented that a cross-reference to the Fee Act should be added to the final-form rulemaking. The Boards have done so.
IRRC suggested that subsection (e) be deleted from this section and a new section regarding continuing education be added. The Boards responded to this suggestion by adding §§ 18.511 and 25.711 (relating to continuing education).
One individual certified athletic trainer who was originally certified by the State Board of Physical Therapy in 1987 expressed concern about whether he would be able to comply with the BOC continuing education requirements because he is not certified by the BOC and is not eligible to take the BOC certification exam. Former certificateholders under the State Board of Physical Therapy are deemed certified under the regulations without further action. However, to renew their certificates, they will need to comply with the continuing education requirements. It is not the Board's intent to require certificateholders to become BOC certified. In addition, the BOC confirmed that one does not have to be an ATC to take continuing education courses from the BOC approved providers, colleges and universities. Therefore, current certificateholders will be able to comply with the continuing education requirements without becoming certified by the BOC.
§§ 18.509 and 25.709. Practice standards for athletic trainers.
The HPLC and IRRC asked whether a physically active person being referred by a podiatrist or dentist should have the results of the required medical exam reviewed by the dentist or podiatrist. The Boards note that this section is inconsistent with § 25.709, which includes review by a dentist or podiatrist. Therefore, § 18.509(a)(3) has been amended to include review by the referring dentist or podiatrist.
In addition, the HPLC noted that these sections permit a podiatrist or dentist to issue a standing written prescription or protocol. The HPLC noted that with respect to a protocol, both enabling acts only mention a physician. These sections have been amended to clarify that an athletic trainer must ensure that the physically active person have a referral or prescription for athletic trainer services from a physician, podiatrist or dentist, or be subject to a written protocol from a physician.
IRRC noted that the Pennsylvania Physical Therapists Association recommended that the review of the written protocol occur more frequently than annually and asked how the Boards determined that an annual review is appropriate. The Boards believe that an annual review of the written protocol is an appropriate standard within the profession. The regulations already provide for on-going communication between the athletic trainer and the supervising physician. In fact, the written protocol itself is required to describe the manner and frequency of communications between the athletic trainer and the supervising physician. However, the intent was to establish a minimum requirement. Therefore, the final-form rulemaking has been amended to require the review occur ''at least'' annually.
Finally, the HPLC noted that in the medical regulations, the responsibility is on the athletic trainer to obtain the standing written prescription or protocol, when the osteopathic physician regulations place the responsibility on the supervising physician, dentist or podiatrist to provide the standing written prescription or protocol. In recognition of the fact that this rulemaking is intended to regulate the conduct of athletic trainers, § 25.709(c) has been rewritten to mirror the language in § 18.509(c).
E. Description of the Amendments
With regard to the State Board of Medicine, § 16.1 (relating to definitions) is amended to define ''treatment regimen'' to describe the service provided by athletic trainers. This term is also of a broad enough nature that the clinical service provided by other State Board of Medicine-regulated practitioners could come under this umbrella term. It provides flexibility to the State Board of Medicine in regulating its licensees and certificateholders and ensures uniformity in regulation. Section 16.61 (relating to unprofessional and immoral conduct) is also amended by replacing the term ''physician'' with ''Board-regulated practitioner'' so that athletic trainers and other practitioners licensed by the State Board of Medicine would be subject to the regulation. At the request of the HPLC, § 16.61(a)(18) has been amended to refer to payment by a third party of the expenses of a patient that result from treatment of the healing arts.
The Boards are amending §§ 16.13 and 25.31 (relating to licensure, certification, examination and registration fees; and schedule of fees) to carry over the fees currently in place under the regulations of the State Board of Physical Therapy in § 40.5 (relating to fees).
The Boards are adding Chapter 18, Subchapter H and Chapter 25, Subchapter M (relating to athletic trainers) to provide for the certification and regulation of athletic trainers.
Sections 18.501 and 25.701 (relating to purpose) provide a general statement of the purpose of this final-form rulemaking. Sections 18.502 and 25.702 (relating to definitions) define key terms used throughout the subchapters. The definitions of ''direction'' and ''standing written prescription'' have been amended in the final-form rulemaking in response to the HPLC's observation that the legislation refers to the written protocol in conjunction with physicians only, not dentists or podiatrists.
Sections 18.503 and 25.703 (relating to certification requirements) set forth the requirement for certification of persons using the title of or performing athletic trainer services in this Commonwealth. The final-form rulemaking was amended in response to comments from the HPLC and IRRC. Subsection (a) was amended to refer solely to the use of the title. Subsection (b) now prohibits the practice of athletic training unless certified, with exceptions provided for licensed practitioners of the healing arts practicing within the scope of practice for which they are trained, a licensed or certified athletic trainer from another jurisdiction who is employed by a visiting athletic team or organization competing in this Commonwealth, and student athletic trainers whose practice of athletic training is coincidental to the student's education.
In addition, §§ 18.503(c) and 25.703(c) with regard to former athletic training certificateholders under the State Board of Physical Therapy have been amended in the final-form rulemaking to mirror each other.
Sections 18.504 and 25.704 (relating to application for certification) delineate the documentation and information required to apply for certification.
Sections 18.505 and 25.705 (relating to educational requirements) set forth the educational requirements for certification. The requisite education can met by having graduated from an approved athletic training education program or by holding a current credential as a certified athletic trainer from the BOC or another accrediting body approved by the Board.
Sections 18.506 and 25.706 (relating to examination requirement) provide that applicants shall achieve a passing score on the BOC examination or an equivalent examination approved by the Board.
Sections 18.507 and 25.707 (relating to temporary certification) provide for temporary certification for applicants who have completed their education and have applied to take the examination. An applicant may practice under a temporary certificate under the direct supervision of a certified athletic trainer for up to 1 year or until certification, whichever occurs first. Section 18.507 has been amended in the final-form rulemaking to delete the reference to the CAAHEP because athletic training programs are now accredited by the CAATE. To avoid the need to amend this section every time the accrediting body changes, the section now simply refers to ''approved athletic training education programs'' as suggested by IRRC. This section was also amended to mirror § 25.707 by adding the phrase ''and may not be renewed.''
Section 18.508 and 25.708 (relating to renewal of certification; and renewal of certificate) provide for biennial renewal of certificates. Section 25.708 has been amended in the final-form rulemaking to clarify that all athletic trainer certifications under both Boards must be renewed by December 31 of even-numbered years. At the suggestion of IRRC, a cross-reference to the Fee Act has been added. In addition, at the suggestion of IRRC, the continuing education requirements have been removed from these sections and §§ 18.511 and 25.711 have been added to the final-form rulemaking.
Sections 18.509 and 25.709 (relating to practice standards for athletic trainers) contain provisions regarding referrals and protocols for treatment, retention of records and circumstances under which consultation with or referral to a physician, dentist or podiatrist is required. Subsection (a) also makes these standards applicable to an athletic trainer certified by any other state, commonwealth, Canadian province or territory or the District of Columbia when providing services to a team or organization in this Commonwealth. These sections have been amended in the final-form rulemaking to clarify that an athletic trainer shall secure a written referral or prescription from a licensed physician, dentist or podiatrist, or shall be subject to a written protocol from a licensed physician. Sections 18.509(a)(3) and 25.709(a)(3) have been amended to require the referring physician, dentist or podiatrist to review the results of a recently performed medical diagnostic examination prior to treatment by an athletic trainer. Finally, §§ 18.509(c) and 25.709(c) have been amended to require the athletic trainer to obtain the protocol or standing written prescription from the supervising physician and to require review of the written protocol or standing written prescription at least annually.
Sections 18.510(a) and 25.710(a) (relating to refusal, suspension or revocation of certificate) authorize the Boards to impose disciplinary action against athletic trainers under section 41 of the Medical Practice Act of 1985 (63 P. S. § 422.41) as set forth in § 16.61, and section 15(b) of the Osteopathic Practice Act (63 P. S. § 271.15(b)). Subsection (b) provides for the applicability of 2 Pa.C.S. §§ 501--508 and 701--704 (relating to Administrative Agency Law) to the activities of and proceedings before the Boards regarding athletic trainers. The language is included to direct applicants and certificateholders to the procedural provisions that govern the Boards' actions.
Finally, §§ 18.511 and 25.711 have been added to the final-form rulemaking to provide for the continuing education of athletic trainers.
F. Fiscal Impact and Paperwork Requirements
The final-form rulemaking will have no adverse fiscal impact on the Commonwealth or its political subdivisions because the sole purpose of the amendments is to transfer regulatory authority over athletic trainers from the State Board of Physical Therapy to the Boards. For this reason also, the final-form rulemaking will impose no additional paperwork requirements on the public sector.
G. Sunset Date
The Boards continuously monitor the effectiveness of their regulations. Therefore, no sunset date has been assigned.
H. Regulatory Review
Under section 5(a) of the Regulatory Review Act (71 P. S. § 745.5(a)), on March 8, 2006, the Boards submitted a copy of the notice of proposed rulemaking, published at 36 Pa.B. 1233, to IRRC and the Chairpersons of the HPLC and the Senate Consumer Protection and Professional Licensure Committee (SCP/PLC) for review and comment.
Under section 5(c) of the Regulatory Review Act, IRRC, the HPLC and the SCP/PLC were provided with copies of the comments received during the public comment period, as well as other documents when requested. In preparing the final-form rulemaking, the Department has considered all comments from IRRC, the HPLC, the SCP/PLC and the public.
Under section 5.1(j.2) of the Regulatory Review Act (71 P. S. § 745.5a(j.2)), on May 23, 2007, this final-form rulemaking was approved by the HPLC. On June 6, 2007, the final-form rulemaking was deemed approved by the SCP/PLC. Under section 5.1(e) of the Regulatory Review Act, IRRC met on June 7, 2007, and approved the final-form rulemaking.
I. Contact Persons
Further information may be obtained by contacting Sabina I. Howell, Board Counsel, State Board of Medicine, or Beth Sender Michlovitz, Counsel, State Board of Osteopathic Medicine, P. O. Box 2649, Harrisburg, PA 17105-2649.
J. Findings
The Boards find that:
(1) Public notice of proposed rulemaking was given under sections 201 and 202 of the act of July 31, 1968 (P. L. 769, No. 240) (45 P. S. §§ 1201 and 1202) and the regulations promulgated thereunder, 1 Pa. Code §§ 7.1 and 7.2.
(2) A public comment period was provided as required by law and all comments were considered.
(3) This final-form rulemaking does not enlarge the purpose of proposed rulemaking published at 36 Pa.B. 1233.
(4) This final-form rulemaking is necessary and appropriate for administering and enforcing the authorizing acts identified in Part B of this preamble.
K. Order
The Boards, acting under their authorizing statutes, order that:
(a) The regulations of the Boards, 49 Pa. Code, Chapters 16, 18 and 25, are amended by amending §§ 16.1, 16.13 and 16.61 and 25.231 and by adding §§ 18.501--18.511 and 25.701--25.711 to read as set forth in Annex A, with ellipses referring to the existing text of the regulations.
(Editor's Note: The addition of §§ 18.511 and 25.711 was not included in the proposed rulemaking published at 36 Pa.B. 1233.)
(b) The Boards shall submit this order and Annex A to the Office of General Counsel and the Office of Attorney General as required by law.
(c) The Boards shall certify this order and Annex A and deposit them with the Legislative Reference Bureau as required by law.
(d) This order shall take effect on publication in the Pennsylvania Bulletin.
CHARLES D. HUMMER, Jr., M.D.,
Chairperson
State Board of MedicineCHARLES P. FASANO, D.O.,
Chairperson
State Board of Osteopathic Medicine(Editor's Note: For the text of the order of the Independent Regulatory Review Commission, relating to this document, see 37 Pa.B. 2909 (June 23, 2007).)
Fiscal Note: Fiscal Note 16A-4915 remains valid for the final adoption of the subject regulations.
Annex A
TITLE 49. PROFESSIONAL AND VOCATIONAL STANDARDS
PART I. DEPARTMENT OF STATE
Subpart A. PROFESSIONAL AND OCCUPATIONAL AFFAIRS
CHAPTER 16. STATE BOARD OF MEDICINE--GENERAL PROVISIONS
Subchapter A. BASIC DEFINITIONS AND INFORMATION § 16.1. Definitions.
The following words and terms, when used in this chapter and Chapters 17 and 18 (relating to State Board of Medicine--medical doctors; and State Board of Medicine--practitioners other than medical doctors), have the following meanings, unless the context clearly indicates otherwise:
* * * * * Treatment regimen--The provision of care and practice of a component of the healing arts by a Board-regulated practitioner.
* * * * *
Subchapter B. GENERAL LICENSE, CERTIFICATION AND REGISTRATION PROVISIONS § 16.13. Licensure, certification, examination and registration fees.
* * * * * (h) Athletic Trainer:
Application for certification $20 Biennial renewal $37 (i) Verification or Certification:
Verification of status $15 Certification of records $25 (j) Examination Fees:
The State Board of Medicine has adopted Nationally recognized examinations in each licensing class. Fees are established by the National owners/providers of the examinations and are indicated in the examination applications.
Subchapter E. MEDICAL DISCIPLINARY PROCESS AND PROCEDURES
COMPLAINTS § 16.61. Unprofessional and immoral conduct.
(a) A Board-regulated practitioner who engages in unprofessional or immoral conduct is subject to disciplinary action under section 41 of the act (63 P. S. § 422.41). Unprofessional conduct includes, but is not limited to, the following:
(1) Revealing personally identifiable facts, obtained as the result of a practitioner-patient relationship, without the prior consent of the patient, except as authorized or required by statute.
(2) Violating a statute, or a regulation adopted thereunder, which imposes a standard for the practice of the healing arts as regulated by the Board in this Commonwealth. The Board, in reaching a decision on whether there has been a violation of a statute, rule or regulation, will be guided by adjudications of the agency or court which administers or enforces the standard.
(3) Performing a medical act or treatment regimen incompetently or performing a medical act or treatment regimen which the Board-regulated practitioner knows or has reason to know that the practitioner is not competent to perform.
(4) Unconditionally guaranteeing that a cure will result from the performance of medical services or treatment regimen.
(5) Advertising of a medical business which is intended to or has a tendency to deceive the public.
(6) Practicing the healing arts fraudulently, or with reckless indifference to the interests of a patient on a particular occasion, or with negligence on repeated occasions.
(7) Practicing the healing arts while the ability to practice is impaired by alcohol, drugs or physical or mental disability.
(8) Knowingly permitting, aiding or abetting a person who is not licensed or certified, or exempt from license or certification requirements, to perform activities requiring a license or certification in a health care practice.
(9) Continuing to practice while the Board-regulated practitioner's license or certificate has expired, is not registered or is suspended or revoked.
(10) Impersonating another health-care practitioner.
(11) Possessing, using, prescribing for use or distributing a controlled substance or a legend drug in a way other than for an acceptable medical purpose. An acceptable experimental purpose is considered an acceptable medical purpose.
(12) Offering, undertaking or agreeing to cure or treat a disease by a secret method, procedure, treatment or medicine, or the treating, operating or prescribing for a human condition by a method, means or procedure which the licensee refuses to divulge to the Board upon demand of the Board.
(13) Charging a patient or a third-party payor for a medical service or treatment regimen not performed. This paragraph does not apply to charging for an unkept office visit.
(14) Delegating a medical responsibility to a person when the physician knows or has reason to know that the person is not qualified by training, experience, license or certification to perform the delegated task.
(15) Failing to exercise appropriate supervision over a person who is authorized to practice only under the supervision of the physician.
(16) Willfully harassing, abusing or intimidating a patient.
(17) Abandoning a patient. Abandonment occurs when a physician withdraws his services after a physician-patient relationship has been established, by failing to give notice to the patient of the physician's intention to withdraw in sufficient time to allow the patient to obtain necessary medical care. Abandonment also occurs when a physician leaves the employment of a group practice, hospital, clinic or other health-care facility, without the physician giving reasonable notice and under circumstances which seriously impair the delivery of medical care to patients.
(18) Failing to make available to the patient or to another designated health care practitioner, upon a patient's written request, the medical record or a copy of the medical record relating to the patient which is in the possession or under the control of the Board-regulated practitioner; or failing to complete those forms or reports, or components of forms or reports, which are required to be completed by the Board-regulated practitioner as a precondition to the reimbursement or direct payment by a third party of the expenses of a patient that result from the practice of the healing arts. Reasonable fees may be charged for making available copies, forms or reports. Prior payment for professional services to which the records relate--this does not apply to fees charged for reports--may not be required as a condition for making the records available. A Board-regulated practioner may withhold information from a patient if, in the reasonable exercise of his professional judgment, he believes release of the information would adversely affect the patient's health.
(19) Violating a provision of this chapter, Chapter 17 or Chapter 18 (relating to State Board of Medicine--medical doctors; or State Board of Medicine--practitioners other than medical doctors) fixing a standard of professional conduct.
(b) Immoral conduct includes, but is not limited to, the following:
(1) Misrepresentation or concealment of a material fact in obtaining a license or a certificate issued by the Board or a reinstatement thereof.
(2) The commission of an act involving moral turpitude, dishonesty or corruption when the act directly or indirectly affects the health, welfare or safety of citizens of this Commonwealth. If the act constitutes a crime, conviction thereof in a criminal proceeding is not a condition precedent to disciplinary action.
CHAPTER 18. STATE BOARD OF MEDICINE--PRACTITIONERS OTHER THAN MEDICAL DOCTORS
Subchapter H. ATHLETIC TRAINERS Sec.
18.501. Purpose. 18.502. Definitions. 18.503. Certification requirement. 18.504. Application for certification. 18.505. Educational requirements. 18.506. Examination requirement. 18.507. Temporary certification. 18.508. Renewal of certification. 18.509. Practice standards for athletic trainers. 18.510. Refusal, suspension or revocation of certificate. 18.511. Continuing education. § 18.501. Purpose.
This subchapter implements section 51.1 of the act (63 P. S. § 422.51a) to provide for the certification and practice standards of athletic trainers.
§ 18.502. Definitions.
The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise:
Approved athletic training education programs--An athletic training education program that is accredited by a Board-approved Nationally recognized accrediting agency.
Athletic training services--The management and provision of care of injuries to a physically active person, with the direction of a licensed physician.
(i) The term includes the rendering of emergency care, development of injury prevention programs and providing appropriate preventative and supportive devices for the physically active person.
(ii) The term also includes the assessment, management, treatment, rehabilitation and reconditioning of the physically active person whose conditions are within the professional preparation and education of a certified athletic trainer.
(iii) The term also includes the use of modalities such as: mechanical stimulation, heat, cold, light, air, water, electricity, sound, massage and the use of therapeutic exercise, reconditioning exercise and fitness programs.
(iv) The term does not include surgery, invasive procedures or prescription of any medication or controlled substance.
BOC--The Board of Certification, Inc., a National credentialing organization for athletic trainers.
Certified athletic trainer--A person who is certified to perform athletic training services by the Board or by the State Board of Osteopathic Medicine.
Direction--Supervision over the actions of a certified athletic trainer by means of referral by prescription to treat conditions for a physically active person from a licensed physician, dentist or podiatrist or written protocol approved by a supervising physician, except that the physical presence of the supervising physician, dentist or podiatrist is not required if the supervising physician, dentist or podiatrist is readily available for consultation by direct communication, radio, telephone, facsimile, telecommunications or by other electronic means.
Physically active person--An individual who participates in organized, individual or team sports, athletic games or recreational sports activities.
Referral--An order from a licensed physician, dentist or podiatrist to a certified athletic trainer for athletic training services. An order may be written or oral, except that an oral order must be reduced to writing within 72 hours of issuance.
Standing written prescription--A portion of the written protocol or a separate document from a supervising physician, which includes an order to treat approved individuals in accordance with the protocol.
Written protocol--A written agreement or other document developed in conjunction with one or more supervising physicians, which identifies and is signed by the supervising physician and the certified athletic trainer, and describes the manner and frequency in which the certified athletic trainer regularly communicates with the supervising physician and includes standard operating procedures, developed in agreement with the supervising physician and certified athletic trainer, that the certified athletic trainer follows when not directly supervised onsite by the supervising physician.
§ 18.503. Certification requirement.
(a) A person may not use the title ''athletic trainer'' or ''certified athletic trainer'' or use any abbreviation including ''A.T.,'' ''A.T.C.'' or ''C.A.T.'' or any similar designation to indicate that the person is an athletic trainer unless that person has been certified by the Board.
(b) Except as otherwise provided in this subsection, a person may not perform the duties of an athletic trainer unless that person is certified by the Board. This provision is not intended to prevent the following:
(1) A person trained and licensed or certified under any other law from engaging in the licensed or certified practice in which the person is trained.
(2) An athletic trainer from another state, province, territory or the District of Columbia, who is employed by an athletic team or organization that is competing in this Commonwealth only on a visiting basis, from providing athletic training services, provided the practice of the athletic trainer is limited to the members of the team or organization.
(3) An athletic training student practicing athletic training that is coincidental to required clinical education and is within the scope of the student's education and training.
(c) Former athletic training certificateholders certified under the Physical Therapy Practice Act (63 P. S. §§ 1301--1313) prior to July 14, 2007, are deemed certified by the Board.
(d) Athletic training certificateholders certified by the State Board of Osteopathic Medicine are deemed certified by the Board.
§ 18.504. Application for certification.
(a) The applicant shall submit the following on forms supplied by the Board:
(1) A completed application and the fee set forth in § 16.13 (relating to licensure, certification, examination and registration fees).
(2) Verification of professional education in athletic training in accordance with § 18.505 (relating to educational requirements).
(3) Documentation of passage of the National examination in accordance with § 18.506 (relating to examination requirement).
(4) Documentation of practice as an athletic trainer, if licensed or certified in another jurisdiction, and verification as to whether there has been disciplinary action taken in that jurisdiction.
(b) To qualify for certification, an applicant shall be at least 20 years of age and may not be addicted to alcohol or hallucinogenic, narcotic or other drugs which tend to impair judgment or coordination.
§ 18.505. Educational requirements.
An applicant for certification shall comply with one of the following:
(1) Be a graduate of an approved athletic training education program.
(2) Hold and maintain current credentialing as a certified athletic trainer (ATC) from the BOC or another credentialing body approved by the Board.
§ 18.506. Examination requirement.
An applicant for a certificate to practice as a certified athletic trainer shall submit to the Board written evidence that the applicant has passed the BOC certification examination for athletic trainers, or its equivalent as determined by the Board.
§ 18.507. Temporary certification.
An applicant who is a graduate of an approved athletic training education program and who has applied to take the certification examination may be granted a temporary certificate to practice athletic training under the onsite direct supervision of a certified athletic trainer. The temporary certification expires 1 year from issuance or upon certification as an athletic trainer by the Board, whichever comes first, and may not be renewed.
§ 18.508. Renewal of certification.
(a) A certification issued under this subchapter expires on December 31 of every even-numbered year unless renewed for the next biennium.
(b) Biennial renewal forms and other forms and literature to be distributed by the Board will be forwarded to the last mailing address given to the Board.
(c) To retain the right to engage in practice, the certificateholder shall renew certification in the manner prescribed by the Board and pay the required fee prior to the expiration of the next biennium.
(d) When a certification is renewed after December 31 of an even numbered year, a penalty fee of $5 for each month or part of a month of practice beyond the renewal date will be charged in addition to the renewal fee as set forth in section 225 of the Bureau of Professional and Occupational Affairs Fee Act (63 P. S. § 1401-225).
(e) As a condition of renewal, a certificateholder shall comply with the continuing education requirements in § 18.511 (relating to continuing education).
§ 18.509. Practice standards for athletic trainers.
(a) Athletic trainers certified by the Board or by the proper licensing authority of another state, province, territory or the District of Columbia shall comply with the following:
(1) Ensure that the physically active person has secured a written referral or prescription from a licensed physician, dentist or podiatrist or is subject to a written protocol for treatment by a certified athletic trainer from a licensed physician.
(2) Comply strictly with conditions or restrictions that may be placed on the course of athletic training services by the referring physician, dentist or podiatrist.
(3) Ensure that the physically active person has undergone a medical diagnostic examination or has had the results of a recently performed medical diagnostic examination reviewed by the referring physician, dentist or podiatrist.
(4) Keep a copy of the referral or prescription and the results of the medical diagnostic examination in the physically active person's file.
(5) Consult promptly with the referring physician, dentist or podiatrist regarding a new ailment or condition or a worsened ailment or condition of the physically active person.
(6) Consult with the referring physician, dentist or podiatrist upon request of either the referring physician, dentist or podiatrist or the physically active person.
(7) Refer a physically active person with conditions outside the scope of athletic training services to a licensed physician, dentist or podiatrist.
(b) Athletic trainers certified by the Board, or by the proper licensing authority of another state, province, territory or the District of Columbia who are working in a team setting, treating injuries which arise in the course of practices or team sports events, may treat the participant at the events under the conditions of the referral, or the standing written prescription or written protocol.
(c) An athletic trainer shall obtain the standing written prescription or protocol annually from the supervising physician and review it at least annually. The standing written prescription or written protocol shall be retained at or near the treatment location or facility. An individual referral or prescription from a referring physician, dentist or podiatrist is required in the absence of a standing written prescription or written protocol.
§ 18.510. Refusal, suspension or revocation of certificate.
(a) The Board may refuse to issue a certificate, and after notice and hearing, may suspend or revoke the certificate of a person who is subject to disciplinary action under section 41 of the act (63 P. S. § 422.41) as set forth in § 16.61 (relating to unprofessional and immoral conduct).
(b) Actions taken by the Board regarding the refusal, suspension or revocation of a certificate are taken subject to the right of notice, hearing and adjudication and appeal under 2 Pa.C.S. §§ 501--508 and 701--704 (relating to the Administrative Agency Law).
§ 18.511. Continuing education.
(a) Beginning with the biennial period commencing on the next biennial renewal period following July 14, 2007, athletic trainers shall complete the continuing education requirements prescribed by the BOC.
(b) Applicants for renewal of a certificate shall provide a signed statement verifying that the continuing education requirement has been met.
(c) Proof of completion of the required continuing education shall be retained for at least 2 years after completion.
CHAPTER 25. STATE BOARD OF OSTEOPATHIC MEDICINE
Subchapter F. FEES § 25.231. Schedule of fees.
An applicant for a license, certificate, registration or service shall pay the following fees at the time of application:
Application for unrestricted license to practice as osteopathic physician--original, reciprocal, boundary or by endorsement $45 Application for short-term camp license as osteopathic physician $30 Temporary training license or graduate training certificate $30 Annual renewal of temporary training license or graduate training certificate $25 Application for physician assistant certificate $30 Application for supervising physician $95 Uncertified verification of any license, certification or permit $15 Certification of any licenses, certifications, examination grades or hours $25 Application for athletic trainer certification $20 Biennial renewal--athletic trainer $37 Biennial renewal--physicians $440 Biennial renewal--physician assistants $10 Penalty for late biennial renewal--per month or part of month $5 Duplicate license or certificate $5 Application for radiology examinations $25 Application for acupuncturist registration $30 Biennial renewal--acupuncturists $25 Application for acupuncturist supervisor registration $30
Subchapter M. ATHLETIC TRAINERS Sec.
25.701. Purpose. 25.702. Definitions. 25.703. Certification requirement. 25.704. Application for certification. 25.705. Educational requirements. 25.706. Examination requirement. 25.707. Temporary certification. 25.708. Renewal of certificate. 25.709. Practice standards for athletic trainers. 25.710. Refusal, suspension or revocation of certificate. 25.711. Continuing education. § 25.701. Purpose.
This subchapter implements section 7.1 of the act (63 P. S. § 271.7a) to provide for the certification of athletic trainers.
§ 25.702. Definitions.
The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise:
Approved athletic training education programs--An athletic training education program that is accredited by a Board-approved Nationally recognized accrediting agency.
Athletic training services--The management and provision of care of injuries to a physically active person, with the direction of a licensed physician.
(i) The term includes the rendering of emergency care, development of injury prevention programs and providing appropriate preventative and supportive devices for the physically active person.
(ii) The term also includes the assessment, management, treatment, rehabilitation and reconditioning of the physically active person whose conditions are within the professional preparation and education of a certified athletic trainer.
(iii) The term also includes the use of modalities such as: mechanical stimulation, heat, cold, light, air, water, electricity, sound, massage, and the use of therapeutic exercise, reconditioning exercise and fitness programs.
(iv) The term does not include surgery, invasive procedures or prescription of any medication or controlled substance.
BOC--The Board of Certification, Inc., a National credentialing organization for athletic trainers.
Certified athletic trainer--A person who is certified to perform athletic training services by the Board or the State Board of Medicine.
Direction--Supervision over the actions of a certified athletic trainer by means of referral by prescription to treat conditions for a physically active person from a licensed physician, dentist or podiatrist or written protocol approved by a supervising physician, except that the physical presence of the supervising physician, dentist or podiatrist is not required if the supervising physician, dentist or podiatrist is readily available for consultation by direct communication, radio, telephone, facsimile, telecommunications or by other electronic means.
Physically active person--An individual who participates in organized, individual or team sports, athletic games or recreational sports activities.
Referral--An order from a licensed physician, dentist or podiatrist to a certified athletic trainer for athletic training services. An order may be written or oral, except that an oral order must be reduced to writing within 72 hours of issuance.
Standing written prescription--A portion of the written protocol or a separate document from a supervising physician, which includes an order to treat approved individuals in accordance with the protocol.
Written protocol--A written agreement or other document developed in conjunction with one or more supervising physicians, which identifies and is signed by the supervising physician and the certified athletic trainer, describes the manner and frequency in which the certified athletic trainer regularly communicates with the supervising physician and includes standard operating procedures, developed in agreement with the supervising physician and certified athletic trainer, which the certified athletic trainer follows when not directly supervised onsite by the supervising physician.
§ 25.703. Certification requirement.
(a) A person may not use the title of ''athletic trainer'' or ''certified athletic trainer'' or use any abbreviation including ''A.T.C.,'' ''C.A.T.,'' or ''A.T.'' or any similar designation to indicate that the person is an athletic trainer unless that person has been certified by the Board.
(b) Except as otherwise provided by this subsection, a person may not perform the duties of an athletic trainer unless that person has been certified by the Board. This provision is not intended to prevent the following:
(1) A person trained and licensed or certified under any other law from engaging in the licensed or certified practice in which the person is trained.
(2) An athletic trainer from another state, province, territory or the District of Columbia, who is employed by an athletic team or organization that is competing in this Commonwealth on a visiting basis, who provides athletic training services to the members of their respective athletic team or organization.
(3) An athletic training student who practices athletic training that is coincidental to required clinical education and is within the scope of the student's education and training.
(c) Former athletic training certificateholders under the Physical Therapy Practice Act (63 P. S. §§ 1301--1313) prior to July 14, 2007, are deemed certified by the Board.
(d) Athletic training certificateholders certified by the State Board of Medicine are deemed certified by the Board.
§ 25.704. Application for certification.
(a) The applicant shall submit the following on forms supplied by the Board:
(1) A completed application and the fee set forth in § 25.231 (relating to schedule of fees).
(2) Verification of professional education in athletic training in accordance with § 25.705 (relating to educational requirements).
(3) Documentation of passage of the National examination in accordance with § 25.706 (relating to examination requirement).
(4) Documentation of practice as an athletic trainer, if licensed or certified in another jurisdiction, and verification as to whether there has been disciplinary action taken in that jurisdiction.
(b) To qualify for certification, an applicant shall be at least 20 years of age and may not be addicted to alcohol or hallucinogenic, narcotic or other drugs which tend to impair judgment or coordination.
§ 25.705. Educational requirements.
An applicant for certification shall comply with one of the following:
(1) Be a graduate of an approved athletic training education program.
(2) Hold current credentialing as a Certified Athletic Trainer (ATC) from the BOC or another credentialing body approved by the Board.
§ 25.706. Examination requirement.
An applicant for a certificate to practice as a certified athletic trainer shall submit to the Board written evidence that the applicant has passed the BOC certification examination for athletic trainers or its equivalent, as determined by the Board.
§ 25.707. Temporary certification.
An applicant who is a graduate of an approved athletic training education program and who has applied to take the certification examination may be granted a temporary certificate to practice athletic training under the onsite direct supervision of a certified athletic trainer. The temporary certification expires 1 year from issuance or upon certification as an athletic trainer by the Board, whichever comes first, and may not be renewed.
§ 25.708. Renewal of certificate.
(a) A certificate issued under this subchapter shall be renewed biennially. An application form will be mailed to the most recent address of the certificateholder as it appears on the records of the Board. The certificateholder shall complete the renewal application and return it to the Board with a renewal fee before December 31 of the year in which the application was received. Certificates other than temporary certificates expire on December 31 of each even-numbered year. Upon receipt of an application and renewal fee, the Board will verify the accuracy of the application and issue to the applicant a certificate of renewal for the next biennial period.
(b) When a certification is renewed after December 31 of an even-numbered year, a penalty fee of $5 for each month or part of a month of practice beyond the renewal date will be charged in addition to the renewal fee, as set forth in section 225 of the Bureau of Professional and Occupational Affairs Fee Act (63 P. S. § 1401--225).
(c) As a condition of renewal, a certificateholder shall comply with the continuing education requirements in § 25.711 (relating to continuing education).
§ 25.709. Practice standards for athletic trainers.
(a) Athletic trainers certified by the Board or by the proper licensing or certification authority of another state, province, territory or the District of Columbia shall comply with the following:
(1) Ensure that the physically active person has secured a written referral or prescription from a licensed physician, dentist or podiatrist or is subject to a written protocol for treatment by a certified athletic trainer from a licensed physician.
(2) Comply strictly with conditions or restrictions that may be placed on the course of athletic training services by the referring physician, dentist or podiatrist.
(3) Ensure that the physically active person has undergone a medical diagnostic examination or has had the results of a recently performed medical diagnostic examination reviewed by the referring physician, dentist or podiatrist.
(4) Keep a copy of the referral or prescription and the results of the medical diagnostic examination in the physically active person's file.
(5) Consult promptly with the referring physician, dentist or podiatrist regarding a new ailment or condition or a worsened ailment or condition of the physically active person.
(6) Consult with the referring physician, dentist or podiatrist upon request of either the referring physician, dentist or podiatrist or the physically active person.
(7) Refer a physically active person with conditions outside the scope of athletic training services to a licensed physician, dentist or podiatrist.
(b) Athletic trainers certified by the Board or by the proper licensing authority of another state, province, territory or the District of Columbia who are working in a team setting, treating injuries which arise in the course of practices or team sports events, may treat the participant at the events under the conditions of the referral, the standing written prescription or written protocol.
(c) An athletic trainer shall obtain the standing written prescription or written protocol annually from the supervising physician and review it at least annually. This standing written prescription or protocol must be in writing and retained at or near the treatment location or facility. An individual referral or prescription from a referring physician, dentist or podiatrist is required in the absence of a written protocol.
§ 25.710. Refusal, suspension or revocation of certificate.
(a) The Board may refuse to issue a certificate, and after notice and hearing, may suspend or revoke the certificate of a person who is subject to disciplinary action under section 15(b) of the act (63 P. S. § 271.15(b)).
(b) Actions taken by the Board regarding the refusal, suspension or revocation of a certificate are taken subject to the right of notice, hearing and adjudication and appeal under 2 Pa.C.S. §§ 501--508 and 701--704 (relating to Administrative Agency Law).
§ 25.711. Continuing education.
(a) Beginning with the biennial period commencing on the next biennial renewal period following July 14, 2007, athletic trainers shall complete the continuing education requirements prescribed by the BOC.
(b) Applicants for renewal of a certificate shall provide a signed statement verifying that the continuing education requirement has been met.
(c) Proof of completion of the required continuing education shall be retained for 4 years after completion.
[Pa.B. Doc. No. 07-1232. Filed for public inspection July 13, 2007, 9:00 a.m.]
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