Original Notice.

     Preproposal statement of inquiry was filed as WSR 98-13-104.

     Title of Rule: WAC 246-915-010 Definitions, 246-915-078 Interim permits, 246-915-140 Personnel Identification, and 246-915-160 Responsibilities of supervision.

     Purpose: The proposed rules protect the public by assuring that physical therapy services will only be provided by skilled professionals and that only qualified, appropriately supervised support staff are providing their care.

     Statutory Authority for Adoption: RCW 18.74.023 (3), (6) and (7).

     Summary: The proposed rules require physical therapists to perform specific tasks and only utilize physical therapist assistants and physical therapy aides who meet specific criteria. The proposed rules reemphasize the intent of the rules and further enhance their importance and relevance to the practice of physical therapy.

     Reasons Supporting Proposal: There is potential for significant patient harm due to inadequate training, incompetence or negligence in the supervision of physical therapist assistants or physical therapy aides for which there is no licensure requirement; or for graduate physical therapists under an interim permit who have little or no professional experience. The proposed rules address these issues.

     Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Kris Waidely, Program Manager, 310 Israel Road S.E., Tumwater, WA 98501, (360) 236-4847.

     Name of Proponent: Department of Health, governmental.

     Rule is not necessitated by federal law, federal or state court decision.

     Explanation of Rule, its Purpose, and Anticipated Effects: The proposed rules require physical therapists to perform specific tasks and only utilize physical therapist assistants and physical therapy aides who meet specific criteria. The proposed rules protect the public by assuring that physical therapy services are only provided by skilled professionals and that only qualified, appropriately supervised support staff are providing their care. There is potential for significant patient harm due to inadequate training, incompetence or negligence in the supervision of physical therapist assistants or physical therapy aides for which there is no licensure requirement; or for graduate physical therapists under an interim permit who have little or no professional experience. The proposed rules address these issues.

     Proposal Changes the Following Existing Rules: WAC 246-915-078 Interim permits.

     No small business economic impact statement has been prepared under chapter 19.85 RCW. A small business economic impact statement is not required because the cost to implement the proposed rules does not exceed the threshold. The more than minimum cost threshold from "804 Office of Clinics and Other Healthcare Practitioners" is set at $110.00.

     RCW 34.05.328 applies to this rule adoption. WAC 246-915-078 is legislatively significant because the proposal may be used to impose a penalty if violated.

     Hearing Location: Yakima Regional Medical Center, Building St. Ez Hall, Room Auditorium, 110 South 9th Avenue, Yakima, WA 98902, on May 18, 2004, at 9:15 - 9:45 a.m.

     Assistance for Persons with Disabilities: Contact Kris Waidely by May 7, 2004, TDD (800) 833-6388 or (360) 236-4847.

     Submit Written Comments to: Department of Health, Kris Waidely, P.O. Box 47868, Olympia, WA 98504-7868, fax (360) 664-9077, by May 7, 2004.

     Date of Intended Adoption: May 18, 2004.

March 12, 2004

Kris Waidely

Program Manager

OTS-6904.2

AMENDATORY SECTION(Amending WSR 98-05-060, filed 2/13/98, effective 3/16/98)

WAC 246-915-010   Definitions.   For the purposes of this chapter and administering chapter 18.74 RCW, the following ((terms are to be construed as set forth herein)) words and phrases have the following meanings:

     (1) The "performance of tests of neuromuscular function" includes the performance of electroneuromyographic examinations.

     (2) "Consultation" means a communication regarding a patient's evaluation and proposed treatment plan with an authorized health care practitioner.

     (3) "Supervisor" ((shall)) means the licensed physical therapist.

     (4) (("Physical therapist assistant" shall mean a graduate of an approved school of physical therapy who is eligible for licensure but has not been licensed to practice physical therapy in Washington state, or an individual who has received an associate degree as a physical therapist assistant from an approved school.

     (5) "Physical therapist aide" shall mean an individual who shall have received on-the-job training from a physical therapist.

     (6) "Immediate supervision" shall mean the supervisor is in audible or visual range of the patient and the person treating the patient.

     (7))) "Trained supportive personnel" as described in RCW 18.74.010(3) means:

     (a) "Physical therapist assistant." An individual who has successfully completed a board approved physical therapist assistant program; or

     (b) "Physical therapy aide." An individual who is involved in direct physical therapy patient care who does not meet the definition of a physical therapist or physical therapist assistant and receives ongoing on-the-job training.

     (5) "Direct supervision" ((shall)) means the supervisor is on the premises, is quickly and easily available and the patient has been examined by the physical therapist at such time as acceptable physical therapy practice requires, consistent with the delegated health care task.

     (((8))) (6) "Indirect supervision" ((shall)) means the supervisor is not on the premises, but has given either written or oral instructions for treatment of the patient and the patient has been examined by the physical therapist at such time as acceptable health care practice requires, and consistent with the particular delegated health care task.

     (((9))) (7) "Acquired immunodeficiency syndrome" or "AIDS" means the clinical syndrome of HIV-related illness as defined by the board of health by rule.

     (((10))) (8) "Office on AIDS" means ((that)) the section within the department of social and health services or any successor department with jurisdiction over public health matters as defined in chapter 70.24 RCW.

     (((11))) (9) "Spinal manipulation" or "manipulative mobilization" ((is defined as)) means movement beyond the normal physiological range of motion.

[Statutory Authority: RCW 43.70.280. 98-05-060, § 246-915-010, filed 2/13/98, effective 3/16/98. Statutory Authority: RCW 18.74.023. 92-08-039 (Order 259B), § 246-915-010, filed 3/24/92, effective 4/24/92; 91-05-094 (Order 144B), § 246-915-010, filed 2/20/91, effective 3/23/91; 91-02-011 (Order 103B), recodified as § 246-915-010, filed 12/21/90, effective 1/31/91. Statutory Authority: RCW 18.74.023(3). 89-21-007, § 308-42-010, filed 10/6/89, effective 11/6/89; 88-23-014 (Order PM 789), § 308-42-010, filed 11/7/88. Statutory Authority: RCW 18.74.023. 84-13-057 (Order PL 471), § 308-42-010, filed 6/19/84; Order PL 191, § 308-42-010, filed 5/29/75; Order 704207, § 308-42-010, filed 8/7/70, effective 9/15/70.]

     (1) Payment of the application fee ((and interim permit fee));

     (2) Evidence of having obtained a physical therapy degree from a board approved school;

     (3) Completed a physical therapy license application on which the applicant:

     (a) ((Requests to be scheduled for the first examination for which he or she is eligible no later than sixty days before the date of the examination;

     (b))) Requests to receive an interim permit;

     (((c))) (b) Provides the name, location and telephone number of his or her place of employment;

     (((d))) (c) Provides the name and license number of his or her licensed supervising physical therapist; and

     (((e))) (d) Provides written confirmation from the licensed supervising physical therapist attesting that he or she will:

     (i) Ensure that a licensed physical therapist will remain on the premises at all times to provide "graduate supervision" as specified in RCW 18.74.075;

     (ii) Report to the board any change in supervision or any change in location where services are ((to be)) provided;

     (iii) Ensure that the holder of the interim permit wears ((a badge identifying)) identification showing his or her clinical title and/or role in the facility as a graduate physical therapist; and

     (iv) Ensure that the holder of the interim permit ceases practice immediately upon notification of examination failure; or

     (v) Ensure that the holder of the interim permit obtains his or her physical therapy license immediately upon notification of having passed the examination.

[Statutory Authority: RCW 18.74.023. 94-05-014 (Order 403B), § 246-915-078, filed 2/4/94, effective 3/7/94.]

     (8) Provide discharge planning.)) (1) Each person shall wear identification showing his or her clinical title, and/or role in the facility as a physical therapist, a physical therapist assistant, a physical therapy aide, or a graduate physical therapist as appropriate. Supportive personnel may not use any term or designation which indicates or implies that he or she is licensed as a physical therapist in the state of Washington.

     (2) The licensee must post the license or interim permit, or a certified copy of the license or interim permit, in a safe, conspicuous location at the licensee's work site. The licensee may block out his or her address before posting the license or interim permit.

[Statutory Authority: RCW 18.74.023. 94-05-014 (Order 403B), § 246-915-140, filed 2/4/94, effective 3/7/94; 91-05-094 (Order 144B), § 246-915-140, filed 2/20/91, effective 3/23/91; 91-02-011 (Order 103B), recodified as § 246-915-140, filed 12/21/90, effective 1/31/91; 84-17-032 (Order PL 477), § 308-42-135, filed 8/8/84.]

     (2) The license or interim permit[,] or a certified copy of the license or interim permit shall be posted in a safe, conspicuous location at the licensee's work site. The licensee's address may be blocked out before posting the license or interim permit.)) A physical therapist is professionally and legally responsible for patient care given by supportive personnel under his or her supervision. If a physical therapist fails to adequately supervise patient care given by supportive personnel, the board may take disciplinary action against the physical therapist.

     (1) Regardless of the setting in which physical therapy services are provided, only the licensed physical therapist may perform the following responsibilities:

     (a) Interpretation of referrals.

     (b) Initial examination, problem identification, and diagnosis for physical therapy.

     (c) Development or modification of a plan of care that is based on the initial examination and includes the goals for physical therapy intervention.

     (d) Determination of which tasks require the expertise and decision-making capacity of the physical therapist and must be personally rendered by the physical therapist, and which tasks may be delegated.

     (e) Assurance of the qualifications of all assistive personnel to perform assigned tasks through written documentation of their education or training that is maintained and available at all times.

     (f) Delegation and instruction of the services to be rendered by the physical therapist, physical therapist assistant or physical therapy aide, including, but not limited to, specific tasks or procedures, precautions, special problems and contraindicated procedures.

     (g) Timely review of documentation, reexamination of the patient and revision of the plan of care when indicated.

     (h) Establishment of a discharge plan.

     (2) Supervision requires that the patient reevaluation is performed:

     (a) Every fifth visit, or if treatment is performed more than five times per week, reevaluation must be performed at least once a week;

     (b) When there is any change in the patient's condition not consistent with planned progress or treatment goals.

     (3) Supervision of supportive personnel means:

     (a) Physical therapist assistants may function under direct or indirect supervision;

     (b) Physical therapy aides shall function under direct supervision;

     (c) The physical therapist may supervise a total of two supportive personnel at any one time.

[Statutory Authority: RCW 18.74.023. 94-05-014 (Order 403B), § 246-915-160, filed 2/4/94, effective 3/7/94; 91-05-094 (Order 144B), § 246-915-160, filed 2/20/91, effective 3/23/91; 91-02-011 (Order 103B), recodified as § 246-915-160, filed 12/21/90, effective 1/31/91; 84-13-057 (Order PL 471), § 308-42-140, filed 6/19/84.]

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