WSR 04-20-053

PROPOSED RULES

DEPARTMENT OF HEALTH


(Board of Physical Therapy)

[ Filed October 1, 2004, 10:50 a.m. ]

Original Notice.

Preproposal statement of inquiry was filed as WSR 04-07-173.

Title of Rule and Other Identifying Information: WAC 246-915-100 Approved physical therapy schools, RCW 18.74.030 directs that applicants hold a baccalaureate degree in physical therapy from a school that has been approved by the board. The current rule adopts the educational standards for United States physical therapy programs established by the American Physical Therapy Association and has been in effect since the inception of the American Physical Therapy Association's accreditation process in 1985. The proposed rule is required to 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.

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, TTY (800) 833-6388 or (360) 236-4847.

Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: Physical therapy education and scopes of practice within countries outside the United States and Canada are significantly more restrictive and most often require the direct supervision of a physician. By recognizing the educational standards established by the American Physical Therapy Association, an organization responsible for the development of appropriate standards for the various elements of physical therapy practice within the United States, the board believes the goals and objectives for RCW 18.74.030 and 18.74.060 have been met. All known United States physical therapy education programs currently hold accreditation status with the American Physical Therapy Association's Commission on Accreditation in Physical Therapy Education. Consumers of physical therapy services will only benefit from the licensure of qualified physical therapists whose level of training has been proven to be consistent with the functions and services that fall within the physical therapy scope of practice in this state. There are currently more than two hundred physical therapy programs in this country. The board reviews and acts on approximately six hundred physical therapy applications each year. In the absence of a rule establishing the standards adopted by the American Physical Therapy Association's Commission on Accreditation in Physical Therapy Education, the board could potentially be faced with the review of more than two hundred physical therapy education programs every five years. According to the American Physical Therapy Association's Commission on Accreditation in Physical Therapy Education, this process utilizes the expertise of hundreds of academicians and clinical instructors across the United States and can take up to six months. The Board of Physical Therapy is made up of four physical therapists and one consumer member, all essentially volunteers. Both the time factor and prohibitive costs involved in this process would make this alternative impossible to implement and would create lengthy, unreasonable delays in the application process. This would result in limited access to physical therapy services throughout the state.

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 not required under RCW 34.05.328. This rule change only clarifies existing standards. The rule does not impose any new standards.

August 30, 2004

Kris Waidely

Program Manager

OTS-7067.1


AMENDATORY SECTION(Amending Order 103B, filed 12/21/90, effective 1/31/91)

WAC 246-915-100   Approved physical therapy schools.   The board adopts the standards of the American Physical Therapy Association's Commission on Accreditation in Physical Therapy Education for the approval of physical therapy schools. Individuals who have a baccalaureate degree in physical therapy or who have a baccalaureate degree and a certificate or advanced degree from an institution of higher learning accredited by the American Physical Therapy Association's Commission on Accreditation in Physical Therapy Education will be considered qualified under RCW 18.74.030(2).

[Statutory Authority: RCW 18.74.023. 91-02-011 (Order 103B), recodified as 246-915-100, filed 12/21/90, effective 1/31/91; 85-10-002 (Order PL 525), 308-42-122, filed 4/18/85.]

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