RULES AND REGULATIONS
STATE BOARD OF PHYSICAL THERAPY
[49 PA. CODE CH. 40]
General Provisions
[34 Pa.B. 4697] The State Board of Physical Therapy (Board) amends Chapter 40 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
The final-form rulemaking is adopted by the Board under the authority of section 3(a) of the Physical Therapy Practice Act (act) (63 P. S. § 1303(a)) and section 812.1 of The Administrative Code of 1929 (71 P. S. § 279.3a).
C. Background and Purpose
The final-form rulemaking was proposed because the regulations had not been amended since the mid-1980s. As a result, many of the Board's current provisions are either unnecessary or require clarification. Also, the educational requirements for physical therapists (PT) need to be updated to conform to National standards. The Board also recognizes the need to refine and clarify activities the performance of which may not be delegated to a PT assistant or to supportive personnel.
D. Summary of Comments and Responses on Proposed Rulemaking
Notice of the proposed rulemaking was published at 33 Pa.B. 1715 (April 5, 2003). The Board received public comments from 128 individuals, the Pennsylvania Physical Therapy Association, the Pennsylvania Affiliate Special Interest Group (PASIG) Officers, the Pennsylvania Chiropractic Association (PCA), Chambersburg Hospital, Allied Services and the Pennsylvania Association of Rehabilitation Facilities (PARF). The Independent Regulatory Review Commission (IRRC) and the House Professional Licensure Committee submitted comments under the Regulatory Review Act (HPLC). The Senate Consumer Protection and Professional Licensure Committee (SCP/PLC) did not comment. Responses to these comments are organized by subject as follows.
§ 40.11. License by examination; requirements for examination.
IRRC identified an inconsistency in paragraph (1) in that the first sentence required applicants for licensure by examination to complete ''an accredited physical therapy course approved by the American Physical Therapy Association . . . '' and the second sentence required an applicant to graduate from a Commission on Accreditation in Physical Therapy Education (CAPTE) accredited program. IRRC suggested that the Board revise the first sentence to reflect the CAPTE accreditation requirement. The Board agreed with this suggestion and deleted the first sentence of paragraph (1). Also, because all physical therapy programs are currently accredited by the CAPTE, the Board deleted the 6-month effective date and will require compliance immediately. IRRC also suggested that paragraph (2) be deleted since the requirement of completion of an accredited program is already required under paragraph (1). The Board also deleted a reference to 120 semester hours because, as the HPLC pointed out in its comments, all CAPTE accredited programs are at least 120 semester hour programs.
§ 40.17. Foreign-educated physical therapists applying to take the licensure examination and pursue a clinical experience.
The Board has reworked this section in final-form rulemaking. In particular, the Board looked to a later revision of the Coursework Evaluation Tool for Foreign Educated Physical Therapists (tool) published by the Federation of State Boards of Physical Therapy (FSBPT) in January 2003. The tool reflects the content included in the first professional degree required of a CAPTE accredited program and required of a PT who wish to pursue licensure to practice in the United States. The FSBPT recommends that a foreign-educated applicant have a minimum of 120 semester credit hours with a minimum of 42 semester credit hours in general education courses and a minimum of 69 semester credit hours in professional education courses. The FSBPT also suggests that specific coursework or content be required to satisfy the minimum credit hour requirement in areas of general and professional education. The Board's revisions reflect the FSBPT recommendations as set forth in the tool.
In final-rulemaking, the Board also deleted specific references to the passing score requirements of the College Level Examination Program (CLEP) general examination subjects and CLEP subject examination subjects because the CLEP sets the passing scores and can change them at any time.
§ 40.32. Functions of supportive personnel.
A commentator suggested that paragraph (6) be revised to make it clear that supportive personnel are performing a clerical function of recording information rather than inferring that supportive personnel are engaged in the treatment of patients. The Board agreed with this comment and amended the language accordingly.
§ 40.51. Administration of electroneuromyography (EMG) and nerve conduction velocity (NCV) tests.
§ 40.51a. Transdermal administration of drugs.
In the proposed rulemaking, the Board had combined the administration of EMG and NCV tests and transdermal administration of drugs into one section. Upon further review, the Board has determined that these procedures should be separated into two sections.
With respect to EMG and NVC tests, some commentators questioned the use of the word ''administer'' in proposed subsection (a). In reviewing this section, the Board decided to retain current subsection (a).
With respect to transdermal administration of drugs, the HPLC questioned why the storage requirement is included in the regulation if the drugs are to be disposed of or returned to the patient. IRRC also addressed this concern and commented that it is their understanding that the disposal provision is intended to allow the PT to store the medication between treatment sessions and also require the PT to return the medication or dispose of it after the patient is discharged from treatment. IRRC suggested that the handling of medication should be clarified in the final-form rulemaking. The Board took this advice and explained that between treatment sessions, drugs must be properly stored in a manner consistent with pharmaceutical practice and that after the patient is discharged, the remaining drugs must be disposed of by the PT or returned to the patient.
§ 40.52 . Unprofessional conduct; physical therapists.
The Board received comments on proposed § 40.52(12) requiring that patient records include a discharge plan including results of intervention and sufficient information to identify the patient. The commentators expressed a concern that physical therapy services are provided in a variety of settings and documentation standards are site-specific and driven by the setting. Discharge summaries may not be feasible in some settings due to the quick pace of discharges from the facility, such as in acute care settings. In those settings, to be in compliance, the PT would have to retrieve medical records solely to write discharge notes. This would be unduly burdensome and unnecessary. The Board agrees with this concern and has agreed to delete the requirement that patient records include a discharge plan including results of intervention.
§ 40.53. Nondelegable activities; accountability.
IRRC, the PCA and others commented that the definition of ''mobilization'' in subsection (b)(7) is inconsistent with the statutory definition in section 2 of the act (63 P. S. § 1302). The Board agrees with this comment and has amended the definition to be consistent with section 2 of the act.
Many commentators also objected to the Board's proposal to prohibit delegating mobilization to physical therapist assistants (PTAs). They stated that many PTAs receive formal training in mobilization as part of their educational requirements and that those who do not receive training are offered the opportunity to develop these skills by attending continuing education courses. Others commented that, although it would be appropriate to permit experienced and skilled PTAs to perform mobilization, entry level PTAs should not be permitted to perform mobilization. The Board, in considering these comments, recognizes that the performance of mobilization requires significant skill, training and education. The Board believes it is in the interest of public safety to limit the performance of mobilization to PTs. As explained in the proposed rulemaking, a PT may still delegate to a PTA gross passive movement throughout normal planes of joint motions. The Board notes that its regulation will not prohibit a PT from delegating to a PTA the performance of range of motion or the performance of exercises to restore the functional motion of the joint.
IRRC and the HPLC pointed out that the services included in proposed subsection (e) are duplicative of some of the services in subsection (b) and suggested that the Board consider deleting subsection (e) and including a comprehensive list of services in subsection (b). The Board has agreed with these suggestions and has deleted subsection (e) and added ''the performance of consultations'' to subsection (b).
Many commentators objected to the requirement in subsection (d) that when PTAs are providing patient-care services, PTs reevaluate and adjust the patient plan of care at intervals not to exceed 14 days. These commentators wrote that the 14-day period was overly restrictive. They stated that there are many instances where a patient may be progressing steadily and on course with the timeframes and plan of care established and to require a formal reevaluation realistically will limit time spent providing patient treatment and negatively impact a patient's progression. Commentators noted in other instances, particularly in outpatient settings, patients may be receiving care one time a week under physician orders and to reevaluate formally would be unwarranted and excessive after only two treatment sessions. The Board agrees with this sentiment. Accordingly, the Board has amended this provision to require a PT to document reevaluations and adjustments to a patient plan of care and goals at least every 30 calendar days or when there is a significant change in patient status warranting an earlier patient evaluation.
The PARF commented that subsection (f) would unduly restrict a qualified and competent PTA and would limit accessibility to care. However, the Board has determined that the procedures outlined in subsection (f) pertaining to screening require the skill and knowledge of a PT to evaluate the need for further intervention by a PT. For this reason, the Board believes that a PT cannot delegate the evaluation of a patient to a PTA or supportive personnel.
Miscellaneous issues
IRRC referred to the HPLC question as to why the word ''district'' was being deleted in § 40.16(a)(1) (relating to licensure by endorsement) when the same section previously refers to the ''District of Columbia.'' The Board deleted this in error and has rectified it in the final-form rulemaking.
IRRC questioned whether the reference in § 40.16(a)(2) to section 6(d)(2) of the act (63 P. S. § 1306(d)(2)) is necessary since section (d) has been deleted. The Board does not believe the reference is necessary and has deleted it.
IRRC questioned the necessity of the word ''in'' in § 40.22(b) (relating to temporary license) which appears after ''or'' and before ''6 months.'' The Board has agreed to delete it.
The PASIG Officers expressed its objection to the use of the definition of ''direct on-premises supervision'' in § 40.1 (relating to definitions) and to the reference to that term at all. It asked to have the requirement of ''direct on-premises supervision'' deleted from home health care and school based therapy services. In addition, Allied Services asked the Board to redefine the term to clarify whether it means that a PT must be in the same room as the PTA. The Board notes that section 9.1(c) of the act (63 P. S. § 1309.1(c)) requires a PTA to work under the ''direct on-premises supervision'' of a licensed PT. Section 9.1(c) of the act also defines the term ''direct on-premises supervision.'' Section 40.1 reflects the statutory definition of the term.
IRRC noted that § 40.16(b)(1) requires an applicant for licensure by endorsement to submit ''evidence'' of authorization to practice without limitation in the country where the professional education occurred. Also, IRRC noted that § 40.17(1)--(4) requires a foreign educated PT applying to take the licensure examination to submit ''evidence'' or ''written proof'' of meeting certain conditions. IRRC asked that the Board specify what constitutes acceptable ''evidence'' in § 40.17(1)--(4). The Board has clarified this by requiring that the applicant submit written documentation to meet these requirements.
The Board recognizes a need to have PTs, PTAs and supportive personnel who provide care to patients identify themselves to the patient. Accordingly, the Board has added §§ 40.31a, 40.55 and 40.161(d) (relating to identification of supportive personnel; identification of physical therapists; and registration of physical therapist assistants; practice; exceptions) to provide for identification of supportive personnel, PTs and PTAs to the patient.
IRRC notes in its comments that the Board considered precluding delegation of wound care to PTAs, but decided this is a properly delegable service. The HPLC requested an explanation of the education and training of PTAs regarding wound care. In particular, IRRC and the HPLC requested information on the type of wound care activities PTAs are qualified to perform, whether there are aspects of wound care that only PTs are authorized to perform and if there are elements of wound care that a PT cannot delegate to a PTA.
In determining that wound care is a properly delegable function, the Board looked to the Evaluative Criteria for Accreditation of Education Programs for the Preparation of Physical Therapist Assistants (Evaluative Criteria) published by the Commission of Accreditation in Physical Therapy Education (CAPTE). The role of the CAPTE is to assure that accreditation criteria for judging education programs incorporate the education and training necessary for graduates to be effective as contemporary practitioners. The Evaluative Criteria, for purposes of accreditation, requires that the PTA comprehensive curriculum include many elements of wound care procedures. These elements include infection control procedures such as isolation techniques and sterile techniques. The curriculum must also include physical agents and mechanical agents including hydrotherapy (that is, whirlpools which are often used to cleanse and debride a wound) and superficial and deep thermal agents. Wound management including the application and removal of dressing or agents and the identification of precautions for dressing removal is also required. The PTA program curriculum must include data collection skills essential for carrying out the plan of care. In terms of integumentary integrity (that is, skin), the data collection skills include the following: recognizing absent or altered sensation; recognizing normal and abnormal integumentary changes; recognizing activities, positioning and postures that aggravate or relieve pain or altered sensations or that can produce associated skin trauma; and recognizing viable versus nonviable tissue. In consideration of the requirements for curricula for accreditation of PTA education and training programs, the Board believes that a PTA is adequately trained and educated to perform wound care services delegated by a PT and performed under the direct on-premise supervision of the PT.
E. Fiscal Impact and Paperwork Requirements
There should be no adverse fiscal impact or additional paperwork requirements incurred by the Board, political divisions or the private sector.
F. Sunset Date
The Board continuously monitors its regulations. Therefore, no sunset date has been assigned.
G. Regulatory Review
Under section 5(a) of the Regulatory Review Act (71 P. S. § 745.5(a)), on April 5, 2003, the Board submitted a copy of the notice of proposed rulemaking, published at 33 Pa.B. 1715, to IRRC and the Chairpersons of the HPLC and the SCP/PLC for review and comment.
Under section 5(c) of the Regulatory Review Act, IRRC and the Committees 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 House and Senate Committees and the public.
Under section 5.1(j.2) of the Regulatory Review Act (71 P. S. § 745.5a(j.2)), on May 26, 2004, the final-form rulemaking was approved by the HPLC. On July 28, 2004, the final-form rulemaking was deemed approved by the SCP/PLC. Under section 5.1(e) of the Regulatory Review Act, IRRC met on July 29, 2004, and approved the final-form rulemaking.
H. Contact Person
Interested persons can obtain information regarding the final-form rulemaking by writing to Robert Kline, Board Administrator, State Board of Physical Therapy, P. O. Box 2649, 2601 North 3rd Street, Harrisburg, PA 17105-2649.
I. Findings.
The Board finds 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) The amendments to the final-form rulemaking do not enlarge the purpose of proposed rulemaking published at 33 Pa.B. 1715.
(4) The final-form rulemaking is necessary and appropriate for administration and enforcement of the authorizing act identified in Part B of this preamble.
J. Order.
The Board, acting under its authorizing statute, orders that:
(a) The regulations of the Board, 49 Pa. Code Chapter 40, are amended by amending §§ 40.1, 40.4, 40.11, 40.14--40.17, 40.22, 40.32, 40.52, 40.53, 40.161, 40.163 and 40.164; by adding §§ 40.31a, 40.51a and 40.55; and by deleting §§ 40.18, 40.21, 40.23 and 40.24 to read as set forth in Annex A.
(Editor's Note: The proposal to amend § 40.51, included in the proposal at 33 Pa.B. 1715, has been withdrawn by the Board.)
(b) The Board shall submit this order and Annex A to the Office of General Counsel and to the Office of Attorney General as required by law.
(c) The Board 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 upon publication in the Pennsylvania Bulletin.
JAMES J. IRRGANG,
Chairperson(Editor's Note: For the text of the order of the Independent Regulatory Review Commission, relating to this document, see 34 Pa.B. 4528 (August 14, 2004).)
Fiscal Note: Fiscal Note 16A-659 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 40. STATE BOARD OF PHYSICAL THERAPY
Subchapter A. PHYSICAL THERAPISTS
GENERAL PROVISIONS § 40.1. Definitions.
The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise:
Act--The Physical Therapy Practice Act (63 P. S. §§ 1301--1313).
Board--The State Board of Physical Therapy.
Direct on-premise supervision--The physical presence of a physical therapist on the premises where the physical therapist assistant or the supportive personnel is providing patient-care services, so that the physical therapist is immediately available to provide supervision, direction and control.
Physical therapist--A person licensed under the act and this chapter to provide physical therapy services without restriction in this Commonwealth.
Supportive personnel--Persons other than physical therapist assistants who aid and assist a physical therapist but whose activities do not require the formal education or knowledge of a physical therapist or physical therapist assistant. The term does not include secretarial, administrative and other personnel who are not involved in direct patient care.
§ 40.4. Admission to practice of physical therapy.
Admission to the practice of physical therapy in this Commonwealth will be granted by the Board as follows:
(1) By the issuance of a license to an applicant who meets the requirements for licensure as set forth in sections 5 and 6 of the act (63 P. S. §§ 1305 and 1306).
(2) By the issuance of a license by endorsement to an applicant who is educated in another state or territory of the United States and who meets the licensing requirements in section 6 of the act (63 P. S. § 1306) and who holds a valid license by examination in another state or territory of the United States, providing the requirements were, at the time of receiving the license, substantially equal to the requirements as set forth in the act.
(3) By the issuance of a temporary license to an applicant who meets the licensing requirements as set forth in section 6 of the act.
(4) By the issuance of a license to an applicant educated in a jurisdiction other than a state or territory of the United States who meets the licensing requirements as set forth in sections 5 and 6(f) of the act.
(5) By the issuance of a license by endorsement to an applicant who is educated in a foreign country and who is authorized to practice as a physical therapist without limitations in the country where the professional education occurred and who holds a valid license by examination in another state or territory of the United States providing the requirements were, at the time of receiving the license, substantially equivalent to the requirements as set forth in the act.
LICENSURE § 40.11. License by examination; requirements for examination.
An applicant for license by examination shall have graduated from a physical therapy program accredited by the Commission on Accreditation in Physical Therapy Education (CAPTE) which has provided adequate instruction in basic sciences, clinical science and physical therapy theory and procedures.
§ 40.14. Examination; failure; reexamination.
(a) Applicants shall successfully pass, to the satisfaction of the Board, the examination approved by the Board. In cases of failure at the first examination, the applicant shall have, after the expiration of 6 months and within 2 years from the date of the first failure, the privilege of a second examination, with the payment of an additional examination fee charged by the vendor.
(b) After a second or successive failure to pass the examination, an applicant desiring to take a third or successive examination shall make a new application within the meaning of section 5 of the act (63 P. S. § 1305) within 6 months from the date of the last failure. However, prior to filing a new application for examination, the Board may require evidence of additional training. If the Board determines that the applicant will be permitted to take a third or successive examination, the Board may authorize in connection with a written examination an oral or practical examination, or both, to test the knowledge and competence of the applicant.
(c) The granting of permission by the Board to take a third or successive examination is at all times subject to the applicant otherwise qualifying under the requirements in force at the time permission to take the examination is sought.
§ 40.15. Examinations.
(a) An application for licensure by examination may be obtained from the State Board of Physical Therapy, Post Office Box 2649, Harrisburg, Pennsylvania, 17105-2649.
(b) An applicant may not be admitted to examination who is unable to present, at the time of application, the required credentials of professional education from an approved institution.
§ 40.16. Licensure by endorsement.
(a) An applicant for licensure by endorsement who is educated in another state or territory of the United States is required to submit the professional credentials in § 40.11 (relating to license by examination; requirements for examination), and comply with the following:
(1) Submit a written application on forms provided by the Board, together with evidence satisfactory to the Board that the applicant is licensed or otherwise registered as a physical therapist in another state or territory of the United States, or in the District of Columbia, if the requirements for licensure or registration in the state, territory or district were, at the date of licensure or registration, substantially equal to the requirements for licensure or registration in this Commonwealth under the act.
(2) A fee prescribed in § 40.5 (relating to fees) must accompany each application for licensure by endorsement.
(b) An applicant for licensure by endorsement who received education in a country outside of the United States is required to meet the educational requirements as set forth in § 40.17(5) and (6) (relating to foreign-educated physical therapists applying to take the licensure examination and pursue a clinical experience) and comply with the following:
(1) The applicant shall submit documentary evidence that the applicant is authorized to practice as a physical therapist without limitation in the country where the professional education occurred.
(2) The applicant shall hold a valid license by examination in another state or territory of the United States providing the requirements were, at the time of receiving the license, substantially equivalent to the requirements as set forth in the act.
§ 40.17. Foreign-educated physical therapists applying to take the licensure examination and pursue a clinical experience.
To be eligible to take the examination for licensure, foreign-educated applicants for licensure shall comply with the following conditions:
(1) The applicant shall submit evidence, satisfactory to the Board, indicating that the applicant has met the requirements stated in § 40.12(a)(1)--(3) (relating to application for licensure).
(2) The applicant shall provide written documentation that the school of physical therapy is recognized by the authorizing agency or entity of the jurisdiction in which the school is situated.
(3) The applicant shall provide written documentation of authorization to practice as a physical therapist without limitations in the country where the professional education took place.
(4) The applicant shall provide documentation of legal authorization to seek employment in the United States or its territories.
(5) The applicant shall meet educational requirements by securing a credentials evaluation from a recognized and accredited evaluation agency approved by the Board. The credentials evaluation must demonstrate that the applicant has met the requirement of at least 120 semester credit hours of which at least 42 credit hours must be in general education subjects and 69 credit hours must be in professional education subjects. If an applicant has deficiencies in general education or professional education, the applicant can correct the deficiencies as follows:
(i) General education. A minimum of one semester course must be successfully completed in each of the following areas of general education unless otherwise noted:
(A) Humanities.
(B) Physical science (two courses each in chemistry and physics including laboratory sessions).
(C) Biological science.
(D) Social science.
(E) Behavioral science.
(F) Mathematics.
(ii) Professional education. The applicant shall complete 69 credit hours of professional education the content of which includes:
(A) Basic health science including:
(I) Human anatomy (specific to physical therapy).
(II) Human physiology (specific to physical therapy).
(III) Neuroscience.
(IV) Kinesiology or functional anatomy.
(V) Pathology.
(B) Medical and clinical science coursework including the following:
(I) Clinical medicine pertinent to physical therapy including:
(-a-) Neurology.
(-b-) Orthopedics.
(-c-) Pediatrics.
(-d-) Geriatrics.
(-e-) Cardiopulmonary.
(-f-) Pharmacology.
(II) Physical therapist coursework must include:
(-a-) Examination, evaluation and intervention pertaining to the integumentary system.
(-b-) Examination, evaluation and intervention pertaining to the musculoskeletal system.
(-c-) Examination, evaluation and intervention pertaining to the neuromuscular system.
(-d-) Examination, evaluation and intervention pertaining to the cardiopulmonary system.
(iii) Clinical education. Clinical education must include physical therapist-supervised application of physical therapy theory, examination, evaluation and intervention. The applicant shall have a minimum of two full-time clinical internships of at least 800 hours total, which are supervised by a physical therapist. The maximum number of full-time clinical education credits is 23.
(iv) Related professional coursework. Content is required in the following nine areas:
(A) Professional behaviors.
(B) Administration.
(C) Community health.
(D) Research and clinical decision making.
(E) Educational techniques.
(F) Medical terminology.
(G) Communication (related to client/patient care).
(H) Legal and ethical aspects of physical therapy practice.
(I) Psychosocial aspects in physical therapy practice.
(6) General educational deficiencies. The applicant may correct general educational deficiencies in the areas specified in paragraph (5)(i) by either:
(A) Pursuing studies in an accredited college or university. Upon completion of studies, the applicant shall submit an official transcript to the Board.
(B) Attaining college credit through successful completion of the following examinations offered by the College Level Examination Program (CLEP). No more than 30 credits may be obtained through CLEP.
(I) The CLEP General Examination may be used to satisfy the requirements in paragraph (5)(i) for credit hours if passing scores are received in the following subjects:
General Examination College Level Credit English Composition with Essay 6 Mathematics 3 Humanities 6 Natural Sciences Biological Sciences (subscore) 3 Physical Sciences (subscore) 3 Social Sciences 6 (II) The CLEP Subject Examination may be used to satisfy the requirements in paragraph (5) for credit hours if passing scores are received in the following subjects:
Subject Examination College Level Credit Analysis and Interpretation of Literature 3 College Algebra 3 English Literature 3 Foreign Language French--Levels I and II 6 German--Levels I and II 6 Spanish--Levels I and II 6 Freshman English 3 English Composition 4 General Biology 3 General Chemistry 3 General Psychology 2 Human Growth & Development 2 Introduction to Management 2 Introduction to Sociology 2 Statistics 2 Trigonometry 2 Western Civilization 3 (III) The applicant is responsible for directing that CLEP report his examination scores to the Board.
(7) Clinical experience. The applicant shall complete, at the Board's discretion, up to 1 year of supervised clinical experience in the United States, as approved by the Board.
(i) To apply for approved supervised clinical experience the applicant shall:
(A) Submit a notarized application signed by the sponsoring physical therapist who will supervise the applicant in the institution in which the applicant will be pursuing the clinical experience.
(B) Arrange for and have a personal interview with a member of the Board and have the application forms signed and approved by the Board member.
(C) Submit a passport-size photograph for the purpose of identification. The applicant and a sponsor shall both sign either the photograph or the paper on which the photograph is mounted.
(ii) The applicant may obtain the required clinical experience while pursuing studies to correct educational deficiencies in the areas specified in paragraph (5).
(iii) The applicant shall submit a letter from the supervising physical therapist in the institution where the supervised clinical experience was completed, certifying the applicant's clinical competence.
§ 40.18. (Reserved).
TEMPORARY LICENSES § 40.21. (Reserved).
§ 40.22. Temporary license.
(a) An applicant for temporary license under section 6(g) of the act (63 P. S. § 1306(g)) shall apply to the Board on forms provided by the Board and meet the following requirements:
(1) Fulfill to the satisfaction of the Board the requirements set forth under section 6(a) of the act.
(2) Have made application to take the examination set forth in section 6(b) of the act or have taken the examination and be awaiting the results of the examination.
(3) Received the temporary license from the Board, work only under the direct on premises supervision of a licensed physical therapist with at least 2 years of experience.
(b) A temporary license issued under 6(g) of the act must be surrendered to the Board immediately upon the failure of the first examination or 6 months after the date of issuance, whichever occurs first.
§ 40.23. (Reserved).
§ 40.24. (Reserved).
SUPPORTIVE PERSONNEL § 40.31a. Identification of supportive personnel.
Supportive personnel shall identify themselves to patients as supportive personnel.
§ 40.32. Functions of supportive personnel.
(a) The physical therapist may only allow supportive personnel to perform patient-related activities which do not require the formal education or training and the skill and knowledge of a physical therapist or physical therapist assistant, and only while the supportive personnel are under the direct on-premise supervision of a physical therapist.
(b) The physical therapist may not permit supportive personnel to provide physical therapy services. The physical therapist may permit supportive personnel to perform the following:
(1) Patient assistance in preparation for treatment, as necessary during treatment and at the conclusion of treatment.
(2) Application of superficial heat or cold as an adjunct to the treatment program.
(3) Assembly, disassembly and maintenance of equipment and accessories.
(4) Transportation of patients.
(5) Assistance to patients with nontreatment aspects of activities and attending the personal needs of patients.
(6) Recording information through the use of flow sheets and checklists which identify activities performed by the patient.
(c) The physical therapist may not permit supportive personnel to interpret referrals, perform evaluation procedures, conduct tests, initiate or adjust treatment programs, assume responsibility for patient care or document physical therapy treatment.
SCOPE OF PRACTICE § 40.51a. Transdermal administration of drugs.
A physical therapist may perform transdermal administration of drugs through the use of modalities such as ultrasound and electrical stimulation. If a prescriptive medication is used, the medication must be prescribed by the referring physician and dispensed in the name of the patient by the referring physician or pharmacist. Between treatment sessions, drugs must be properly stored in a manner consistent with pharmaceutical practice. After the patient is discharged, the remaining drugs must be disposed of by the physical therapist or returned to the patient.
§ 40.52. Unprofessional conduct; physical therapists.
A physical therapist who engages in unprofessional conduct is subject to disciplinary action under section 11(a)(6) of the act (63 P. S. § 1311(a)(6). Unprofessional conduct includes the following:
(1) Harassing, abusing or intimidating a patient.
(2) Revealing information obtained as a result of the therapist-patient relationship to a third party who is not involved in the patient's care, without the prior written consent of the patient, except as authorized or required by statute.
(3) Failing to exercise appropriate supervision over a person who is authorized to render services only under the supervision of the physical therapist.
(4) Accepting a patient for treatment or continuing treatment if benefit cannot reasonably be expected to accrue to the patient, or misleading a patient as to the benefits to be derived from physical therapy.
(5) Unconditionally guaranteeing the results of physical therapy treatment.
(6) Practicing physical therapy while the ability to practice is impaired by alcohol, drugs or a physical or mental disability.
(7) Charging a patient or a third-party payor for a physical therapy service which is not performed.
(8) Receiving a fee for referring a patient to a third person.
(9) Advertising physical therapy services in a false, misleading or deceptive manner.
(10) Assigning or delegating to physical therapist assistants or supportive personnel activities prohibited from assignment or delegation under §§ 40.32, 40.53 and 40.171 (relating to functions of supportive personnel; nondelegable activities; accountability; and functions of physical therapist assistants).
(11) Violating a provision of the act or this chapter which establishes a standard of conduct.
(12) Failure to maintain adequate patient records. Adequate patient records include at a minimum sufficient information to identify the patient, a summary of the findings of the examination, an evaluation, a diagnosis, the plan of care including desired outcomes, and the treatment record.
§ 40.53. Nondelegable activities; accountability.
(a) A physical therapist may delegate to a physical therapist assistant or supportive personnel that which he is educated to perform subject to the limitations in this section.
(b) A physical therapist may not assign or delegate to physical therapist assistants or supportive personnel functions which require the formal education or training and the skill and knowledge of a licensed physical therapist, including the following functions:
(1) Interpretation of referrals.
(2) Initial evaluation or reevaluation.
(3) Determination or modification of a patient plan of care.
(4) Final discharge assessment/evaluation or establishment of discharge plan.
(5) Therapeutic techniques and procedures beyond the skill and knowledge of the physical therapist assistant.
(6) Duties, the delegation of which is inconsistent with minimum standards of acceptable physical therapy practice embraced by the physical therapy community in this Commonwealth.
(7) Mobilization. Mobilization is defined as a group of techniques comprising a continuum of skilled passive movements to the joints or related soft tissues, or both, throughout the normal physiological range of motion that are applied at varying speeds and amplitudes, without limitation.
(8) The performance of consultations.
(c) A physical therapist may not assign or delegate to supportive personnel activities which require the formal education or training and skill and knowledge of a licensed physical therapist or registered physical therapist assistant.
(d) When patient-care services are provided by the physical therapist assistant, the physical therapist shall document reevaluations and adjustments to a patient plan of care and goals at least every 30 calendar days or when there is a significant change in patient status warranting an earlier patient evaluation.
(e) A physical therapist may not assign or delegate to a physical therapist assistant or supportive personnel screenings to determine the need for the following:
(1) Primary, secondary or tertiary services.
(2) Further examination or intervention.
(3) Consultation by a physical therapist.
(4) Referral to another health care practitioner.
(f) For purposes of this section, screening is defined as determining the need for further examination or intervention, or both, by a physical therapist or for referral to another health professional.
§ 40.55. Identification of physical therapists.
Physical therapists shall identify themselves to patients as physical therapists.
Subchapter C. PHYSICAL THERAPIST ASSISTANTS
REGISTRATION § 40.161. Registration of physical therapist assistants; practice; exceptions.
(a) A person may not perform or hold himself out as being able to perform as a physical therapist assistant in this Commonwealth unless the person is registered by the Board under section 9.1 of the act (63 P. S. § 1309.1) and this subchapter or exempted under this section.
(b) A person or business entity may not use in connection with a business name or activity the words ''physical therapist assistant,'' the letters ''P.T.A.'' or similar words and related abbreviations to imply that physical therapist assistant services are being provided, unless the services are provided by a physical therapist assistant registered under the act and this subchapter.
(c) This subchapter does not prohibit physical therapist assistant students from assisting a physical therapist licensed to practice without restriction in this Commonwealth under the direct on-premises supervision of the physical therapist as is incidental to their course of study in a program which has been approved for the education and training for physical therapist assistants by the Commission on Accreditation in Physical Therapy Education (CAPTE).
(d) Physical therapist assistants shall identify themselves to patients as physical therapist assistants.
§ 40.163. Requirements for registration.
(a) Under section 9.1(a) of the act (63 P. S. § 1309.1(a)), an applicant for registration by examination shall submit evidence of the following:
(1) Graduation from a physical therapist assistant program which has been approved for the education and training for physical therapist assistants by the Commission on Accreditation in Physical Therapy Education (CAPTE).
(2) A passing grade on the physical therapist assistant registration examination.
(b) Under section 6(d.1) of the act (63 P. S. § 1306(d.1)), an applicant for reciprocal registration shall submit evidence of a valid license, certificate or registration as a physical therapist assistant issued by another state, territory or the District of Columbia, where the requirements for licensure, certification or registration were on the date of issuance substantially the same as those required by this Commonwealth, and which accords similar privileges to persons registered as physical therapist assistants in this Commonwealth.
§ 40.164. Physical therapist assistant registration examination.
(a) Application procedure. An applicant applying for registration by examination shall take the physical therapist assistant registration examination. The applicant who is taking the examination within this Commonwealth shall comply with the following:
(1) The applicant shall complete application forms for admission to the examination obtained from the Board and return the completed form with a check or money order for the appropriate fee.
(2) The applicant shall present the required credentials of professional education at the time of application.
(b) Failure and reexamination. In the case of failure of examination, the following apply:
(1) After failing the first examination, the applicant has, after the expiration of 6 months and within 2 years of the date of the first failure, the privilege of a second examination upon the filing of a new application under subsection (a) and upon payment of the appropriate fee.
(2) After a second or successive failure to pass the examination, an applicant desiring to take a third or successive examination shall file a new application. The Board may require evidence of additional training prior to allowing a candidate to take a third or successive examination.
(3) The granting of permission to take a third or successive examination is subject to:
(i) Authorization by the Board at its discretion to include an oral or practical examination, or both, in connection with the written examination to further test the knowledge, skills and competence of the applicant.
(ii) The applicant otherwise qualifying under requirements in force at the time that permission to take the examination is sought.
[Pa.B. Doc. No. 04-1592. Filed for public inspection August 27, 2004, 9:00 a.m.]
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