WSR 04-20-051

PROPOSED RULES

DEPARTMENT OF HEALTH


(Board of Physical Therapy)

[ Filed October 1, 2004, 10:46 a.m. ]

Original Notice.

Preproposal statement of inquiry was filed as WSR 04-07-195.

Title of Rule and Other Identifying Information: WAC 246-915-040 Licensure by endorsement -- Applicants from approved schools, the proposed rule is required for housekeeping purposes. The current rule has not been updated in at least ten years. Currently, if a licensee has not worked in physical therapy in the last two years they may be granted licensure by endorsement under certain conditions. The proposed rule changes the length of time a physical therapist has not worked from two to three years. The three-year term is consistent with the language outlined in chapter 246-12 WAC, Administrative procedures and requirements for credentialed health care providers. The proposed rules also changes "continuing education" to "continuing competency." This language is consistent with current language outlined in WAC 246-915-085 Continuing competency.

Hearing Location(s): Department of Health, 310 Israel Road S.E., Room 152, Tumwater, WA 98501, on November 16, 2004, at 9:30 a.m.

Date of Intended Adoption: November 16, 2004.

Submit Written Comments to: Kris Waidely, Program Manager, 310 Israel Road S.E., Tumwater, WA 98501, e-mail kris.waidely@doh.wa.gov, fax (360) 664-9077, by November 5, 2004.

Assistance for Persons with Disabilities: Contact Kris Waidely, Program Manager, by November 5, 2004, (800) 833-6388 or (360) 236-4847.

Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The current rule includes language that states if a licensee has not worked in physical therapy in the last two years, the applicant may be granted licensure by endorsement under the following conditions. The proposed rule changes the length of time a physical therapist has not worked from two to three years. The proposed rule also changes the language for continuing education to continuing competency. The board would like the change made to be consistent with the language of WAC 246-915-085 which uses the continuing competency language rather than continuing education.

Reasons Supporting Proposal: The proposed changes extend physical therapy licensure eligibility requirements from two years to three years without employment and changes language from continuing education to continuing competency for consistency with WAC 246-915-085 Continuing competency.

Statutory Authority for Adoption: RCW 18.74.023.

Statute Being Implemented: RCW 18.74.023.

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

Name of Proponent: Department of Health, governmental.

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.

A small business economic impact statement has been prepared under chapter 19.85 RCW.

Small Business Economic Impact Statement

Proposed Amendatory Sections: WAC 246-915-040 Licensure by endorsement -- Applicants from approved schools, 246-915-050 Expired license, 246-915-100 Approved physical therapy schools, 246-915-105 Approved physical therapist assistant schools, and 246-915-180 Professional conduct principles.

1. Briefly Describe the Proposed Rule: The proposed rule amendments seek to increase the standards of appropriateness of physical therapy care in accordance with RCW 18.74.025.

Changes for Clarification:

Extend physical therapy licensure eligibility requirements from two years to three years without employment.

Change language from continuing education to continuing competency for board scrutiny of licensees that have not worked in physical therapy for three years.

Amend the title of WAC 246-915-050 from expired license to reinstatement. The change better describes the intent of the section.

Rephrase the reinstatement requirements for a practitioner whose license has been expired for over three years, and has not been in active practice in another United States jurisdiction. The change in language clarifies the authority of the board to decide on reexamination and/or other evidence necessary to ensure the applicant is professionally competent before returning to active practice in Washington state.

Recognize and clarify the role of the Commission on Accreditation in Physical Therapy Education, the division within the American Physical Therapy Association responsible for establishing educational standards and developing appropriate systems for outcome measurements within United States physical therapy education programs. The current rule adopts the educational standards for United States physical therapy programs established by the American Physical Therapy Association.

Recognize the role of the American Physical Therapy Association's Commission on Accreditation in Physical Therapy Education in establishing the education standards for physical therapist assistants. A board approved physical therapist assistant program shall mean a United States physical therapist assistant education program accredited by the American Physical Therapy Association's Commission on Accreditation in Physical Therapy Education's Commission on Accreditation in Physical Therapy Education or a United States military physical therapy technician program that is substantially equal to an accredited United States physical therapist assistant program. The regulation of physical therapist assistants is not authorized under chapter 18.74 RCW. While the supervising physical therapist is trained to provide the examination, evaluation, diagnosis, prognosis, and treatment plan, physical therapist assistants are considered paraprofessionals who work under the direction and supervision of the physical therapist and are trained to provide physical therapy interventions. Given that physical therapist assistants are not required to work under direct supervision and frequently work in unsupervised settings such as home health and public schools, this rule is necessary to establish that physical therapist assistants meet minimum educational qualifications in order to protect the public.

Changes Imposing Additional Requirements:

Prohibit physical therapists from receiving reimbursement for self evaluation and self directed treatment. The restriction is necessary to protect the public from excessive charging and an over utilization of physical therapy services.

Require physical therapists to only delegate physical therapy tasks to trained supportive personnel as defined in WAC 246-915-010 (4)(a) and (b). The amendment seeks to protect the public from the delegation of physical therapy services to untrained, unskilled, and unqualified individuals.

2. Is a Small Business Economic Impact Statement (SBEIS) Required for this Rule? No. Insurance companies spread the costs associated with self treatment among enrollees. Even though they use different methods of risk pooling to spread the extra costs, the share of the extra costs to small businesses do not seem to be significant.

The change of language in the reinstatement section (WAC 246-915-050) does not create any new requirements and there is no added financial impact to the approximately sixty-five reinstatement applicants each year. The associated costs for the proposed rule are zero because the change is for clarification.

The recognition of approved physical therapy schools (WAC 246-915-100) and approved physical therapist assistant schools (WAC 246-915-105) are meant to clarify the role of the Commission on Accreditation in Physical Therapy Education, the division within the American Physical Therapy Association responsible for establishing educational standards and developing appropriate systems for outcome measurements within United States physical therapy education programs and standards for physical therapist assistants. This rule amendment does not change current standards.

New requirements that prohibit physical therapists from receiving reimbursement for self evaluation and/or self directed treatment (WAC 246-915-180(10)) and the delegation of physical therapy tasks to trained personnel (WAC 246-915-180(11)) are meant to protect Washington state from excessive charging and overutilization of services. Only minimal costs will be generated for physical therapy practitioners who provide physical therapy services in a professional and ethical manner.

3. Which Industries Are Affected by this Rule? In preparing this small business economic impact statement (SBEIS), the Department of Health used the following SIC codes:

SIC Description Minor Impact Threshold ($)
8051 Skilled nursing care facilities 195.64
8052 Intermediate care facilities 66.10
8059 Nursing and personal care, nec 66.10
8062 General medical & surgical hospital 396.57
8069 Specialty hospitals exc. Psychiatric 237.94
8082 Home health care services 122.94
8093 Specialty outpatient clinic, nec 116.33
8099 Health and allied services, nec 66.10

4. How Are Small Businesses Involved in the Development of this Rule? During the comment period, town meetings were held and draft rules were sent to all Washington state licensed physical therapists and all known physical therapist assistants through the Physical Therapy Association of Washington.

A copy of the statement may be obtained by contacting Kris Waidely, P.O. Box 47868, Olympia, WA 98504-7868, phone (360) 236-4847, fax (360) 664-9077, e-mail kris.waidely@doh.wa.gov.

A cost-benefit analysis is required under RCW 34.05.328. A preliminary cost-benefit analysis may be obtained by contacting Kris Waidely, P.O. Box 47868, Olympia, WA 98504-7868, phone (360) 236-4847, fax (360) 664-9077, e-mail kris.waidely@doh.wa.gov.

October 1, 2004

Kris Waidely

Program Manager

OTS-7065.1


AMENDATORY SECTION(Amending Order 403B, filed 2/4/94, effective 3/7/94)

WAC 246-915-040   Licensure by endorsement -- Applicants from approved schools.   (1) Before licensure by endorsement is extended to any individual licensed to practice physical therapy under the law of another state, territory, or District of Columbia, the applicant shall have graduated from a board approved school, shall have taken the examination for physical therapy and shall have achieved a passing score approved by the board.

(2) If the decision to extend licensure by endorsement is based on an examination other than the examination approved in WAC 246-915-030(1), the board shall determine if such examination is equivalent to that required by the laws of this state.

(3) The board shall not recommend to the secretary that a person be licensed as a physical therapist under the licensure by endorsement provisions of RCW 18.74.060, unless said applicant shall have taken and passed the examination approved by the board, or other examination equivalent to that required by the laws of this state.

(4) If a licensee has not worked in physical therapy in the last ((two)) three years, the applicant may be granted licensure by endorsement under the following conditions:

(a) The board may require reexamination of an applicant who has not been actively engaged in lawful practice in another state or territory; or

(b) Waive reexamination in favor of evidence of continuing ((education)) competency satisfactory to the board.

[Statutory Authority: RCW 18.74.023. 94-05-014 (Order 403B), 246-915-040, filed 2/4/94, effective 3/7/94; 91-05-094 (Order 144B), 246-915-040, filed 2/20/91, effective 3/23/91; 91-02-011 (Order 103B), recodified as 246-915-040, filed 12/21/90, effective 1/31/91. Statutory Authority: Chapter 18.74 RCW. 90-16-070 (Order 074), 308-42-060, filed 7/30/90, effective 8/30/90. Statutory Authority: RCW 18.74.023. 86-19-063 (Order PM 619), 308-42-060, filed 9/16/86; 84-17-032 (Order PL 477), 308-42-060, filed 8/8/84. Statutory Authority: RCW 18.74.020. 83-05-032 (Order PL 426), 308-42-060, filed 2/10/83; 81-19-071 (Order PL 384), 308-42-060, filed 9/15/81; Order PL 191, 308-42-060, filed 5/29/75; Order 704207, 308-42-060, filed 8/7/70, effective 9/15/70.]

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