DEPARTMENT OF HEALTH

(Board of Physical Therapy)

[Filed October 22, 2024, 2:50 p.m.]

Preproposal statement of inquiry was filed as WSR 23-24-101.

Title of Rule and Other Identifying Information: Physical therapists and physical therapist assistants; reducing licensure barriers. The board of physical therapy (board) is proposing amendments to WAC 246-915-030, 246-915-040, 246-915-085, and 246-915-120 in order to comply with section 8 of 2SHB 1724 (chapter 425, Laws of 2023), codified as RCW 18.130.077, and to make general and housekeeping updates to these sections. Additionally, the board is proposing amendments to WAC 246-915-040 to further expand upon the endorsement pathway required under 2SHB 1724 and amendments to WAC 246-915-120 to streamline the foreign educated applicant application process.

Hearing Location(s): On December 9, 2024, at 10:00 a.m., at Washington State Labor and Industries, Room S119, 7273 Linderson Way S.W., Tumwater, WA 98501; or virtual. Microsoft Teams meeting https://teams.microsoft.com/dl/launcher/launcher.html?url=%2F_%23%2Fl%2Fmeetup-join%2F19%3Ameeting_YjlkYTg0NTMtMTgxZC00MzFiLWFjZDctNzkxOTY0NTQ3MWNh%40thread.v2%2F0%3Fcontext%3D%257b%2522Tid%2522%253a%252211d0e217-264e-400a-8ba0-57dcc127d72d%2522%252c%2522Oid%2522%253a%2522b0a413cc-861e-438f-ad33-52df6d9a4283%2522%257d%26anon%3Dtrue&type=meetup-join&deeplinkId=47fb7984-3add-4c15-a935-9bd8ba2e745b&directDl=true&msLaunch=true&enableMobilePage=true&suppressPrompt=true, Meeting ID 256 753 416 51, Passcode 9EZj3m; or call in (audio only) +1 564-999-2000,,75167904# United States, Olympia, 833-322-1218,,75167904# United States (toll-free), Phone Conference ID 751 679 04#. The public hearing will be hybrid. You may attend virtually or in person. You may also submit comments in writing.

Date of Intended Adoption: December 9, 2024.

Submit Written Comments to: Allyson McIver, Department of Health, P.O. Box 47852, Olympia, WA 98504-7582 [7852], email https://fortress.wa.gov/doh/policyreview, physical.therapy@doh.wa.gov, beginning the day and time of this filing, by December 2, 2024, at 11:59 p.m.

Assistance for Persons with Disabilities: Contact Allyson McIver, phone 360-236-2878, TTY 711, email physical.therapy@doh.wa.gov, by November 22, 2024.

Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The board is proposing revisions to existing rules to waive education, training, experience, and examination requirements for applicants that qualify for licensure by endorsement to implement RCW 18.130.077. Specifically, the board is proposing to:

Additional proposed amendments to WAC 246-915-040 add a new a licensure by endorsement pathway for applicants who have been actively licensed for less than two years in a state or states with substantially equivalent standards to Washington. The board is also proposing further amendments to the foreign educated applicants section to clarify the requirements in WAC 246-915-120.


•	Remove unnecessary language in WAC 246-915-030.
•	Amend WAC 246-915-040 to create a faster pathway to licensure for out-of-state physical therapists and physical therapy assistants that have been credentialed in another state or states with substantially equivalent standards for two years or more, with no interruption in licensure for longer than 90 days, provided that they also meet the requirements in RCW 18.130.077(3).
•	Remove the jurisprudence examination requirement in WAC 246-915-120.
•	Amend the continuing education (CE) requirements in WAC 246-915-085 to add the jurisprudence examination as free CE hour that must be completed within their first full CE cycle after initial licensure.

Reasons Supporting Proposal: Under RCW 18.130.077, all disciplining authorities shall waive education, training, experience, and exam requirements for applicants who have been credentialed in another state or states with substantially equivalent standards for at least two years immediately preceding their application with no interruption in licensure for longer than 90 days. The statute also allows disciplining authorities to choose to waive education, training, experience, and exam requirements for applicants who have achieved the national credential for their profession. However, the physical therapy professions do not have a national certification that the board could consider as a pathway to licensure.

The intent of the statute is to make disciplining authorities review and adjust licensure requirements to remove barriers to entering and remaining in the health care workforce and shorten the credentialing process.

The board is proposing to move the jurisprudence requirement from initial licensure requirements to a CE. The jurisprudence exam is training that is Washington state specific. The board believes it is important that all physical therapy credential holders new to the state are aware of Washington's laws and rules pertaining to their profession. While it may not be necessary to have the education prior to being licensed in Washington state, by having all providers take the jurisprudence examination within the first full CE cycle, all providers will have knowledge of where to find laws and rules regarding their professions.

Establishing expedited pathways to Washington licensure for out-of-state professionals meets the intent of RCW 18.130.077 by reducing barriers for out-of-state health care professionals seeking certification in Washington, to expand the availability of qualified providers, and streamline the credentialing process.

The proposed amendments go beyond the requirements of RCW 18.130.077 by creating a faster pathway to licensure for applicants who have been practicing less than two years in a state with substantially equivalent standards.

These proposed amendments would create consistency throughout the chapter, provide faster pathways to licensure, and ease the burden on licensees and applicants while still maintaining sufficient standards of training and care. Rule making is necessary to amend licensure requirements throughout chapter 246-828 WAC to align with RCW 18.130.077 and create enforceable licensing standards.

Statutory Authority for Adoption: RCW 18.74.023 and 2SHB 1724 (chapter 425, Laws of 2023), codified as RCW 18.130.077.

Statute Being Implemented: RCW 18.130.077.

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

Name of Proponent: Board of physical therapy, governmental.

Name of Agency Personnel Responsible for Drafting, Implementation, and Enforcement: Allyson McIver, Program Manager, 111 Israel Road S.W., Tumwater, WA 98501, 360-236-2878.

A school district fiscal impact statement is not required under RCW 28A.305.135.

A cost-benefit analysis is required under RCW 34.05.328. A preliminary cost-benefit analysis may be obtained by contacting Allyson McIver, Department of Health, P.O. Box 47852, Olympia, WA 98504-7852, phone 360-236-2878, TTY 711, email physical.therapy@doh.wa.gov.

This rule proposal, or portions of the proposal, is exempt from requirements of the Regulatory Fairness Act because the proposal:

Is exempt under RCW 19.85.025(4).

Explanation of exemptions: The proposed amendments impact rules regulating individual professional licenses, not businesses.

Scope of exemption for rule proposal:

Kathryn Dale, PT, DSc, Chair

Board of Physical Therapy

AMENDATORY SECTION(Amending WSR 18-15-067, filed 7/17/18, effective 8/17/18)

WAC 246-915-030Examination.

The examination acceptable and approved for use under the provisions of RCW 18.74.035 is the NPTE.

(1) For a physical therapist a passing score is considered to be one of the following:

(a) Beginning November 8, 1995, the criterion referenced passing point shall be set to equal a scaled score of ((six hundred))600 based on a scale ranging from ((two hundred to eight hundred))200 to 800.

(b) Beginning February 28, 1991, through July 12, 1995, not less than ((sixty-eight))68 percent of the raw score.

(2) For a physical therapist assistant a passing score is considered to be one of the following:

(b) Prior to November 8, 1995, a passing score is answering correctly ((seventy))70 percent of the total number of questions.

(3) If a physical therapist or physical therapist assistant candidate fails to receive a passing score, he or she will be required to retake the NPTE.

(4) ((The department will issue a license by endorsement to an applicant who is currently licensed as a physical therapist or physical therapist assistant under the laws of another state provided the requirements for registration or licensure under the appropriate category in that state, including minimal education and passing score on the NPTE, were substantially equal to the requirements in force in this state on the date of the applicant's initial licensure in the other state.

(5))) An applicant may take the NPTE a maximum of six times, except that applicants who receive two very low scores on the exam will not be allowed to test again. A very low score is defined as performing at or below chance level (scale score ((four hundred))400 and below).

AMENDATORY SECTION(Amending WSR 18-15-067, filed 7/17/18, effective 8/17/18)

WAC 246-915-040Licensure by endorsement.

(((1) An applicant for licensure as a physical therapist or physical therapist assistant who is currently registered, certified, or licensed under the laws of another state or territory, or the District of Columbia, with substantially equal requirements of this chapter shall file an application and submit to the department:

(a) Documentation verifying graduation from a board approved school as described in WAC 246-915-100 and 246-915-105; and

(b) Verification of passing NPTE scores as described in WAC 246-915-030.

(2) If the applicant took an examination other than the NPTE, the board shall determine if such examination is equivalent to that required by the laws of this state.

(3) If an applicant has not been actively engaged in lawful practice in another state, territory, or District of Columbia in the last three years, the applicant may be granted licensure by endorsement under the following conditions:

(a) The board may require the applicant to retake and pass the NPTE; or

(b) The board may waive reexamination in favor of evidence of continuing competency satisfactory to the board.

(4) If the applicant has not been actively engaged in lawful practice in another state, territory, or District of Columbia in the last five years or longer, the applicant may be granted licensure by endorsement under the following conditions:

(a) The applicant completes the continuing competency requirements found in WAC 246-915-085; and

(b) The applicant retakes and passes the NPTE.))

(1) A physical therapist or physical therapist assistant applicant who has been licensed for two years or longer may qualify for licensure by endorsement providing the applicant meets the requirements in RCW 18.130.077 (1) and (3). A physical therapist or physical therapist assistant who applies for licensure by endorsement shall submit:

(a) A completed application on forms provided by the department;

(b) The application fee required under WAC 246-915-990 or 246-915-99005; and

(c) Proof of licensure under the laws of another state that the board has deemed to have substantially equivalent licensure requirements.

(2) A physical therapist or physical therapist assistant applicant who has been actively licensed for less than two years in a state that the board has deemed to have substantially equivalent licensure requirements may qualify for licensure by endorsement providing the applicant:

(a) Is not subject to denial of a license or issuance of a conditional license;

(b) Has not been subject to disciplinary action for unprofessional conduct or impairment in any jurisdiction during the time of licensure including the pendency of their application;

(d) Has no interruption in licensure lasting longer than 90 days;

(e) Submits the following to the department:

(i) A completed application on forms provided by the department;

(ii) Proof of active licensure under the laws of another jurisdiction that the board has deemed to have substantially equivalent licensure requirements;

(iii) A signed attestation verifying the applicant graduated from a board approved school as described in WAC 246-915-100 or 246-915-105;

(iv) A signed attestation verifying the applicant took and passed the National Physical Therapy Examination;

(v) An employer verification form signed by their employer attesting that the applicant has been actively engaged in lawful practice in the state where the applicant is licensed for at least 200 hours within the last two years immediately preceding an application; and

(vi) The application fee required under WAC 246-915-990 or 246-915-99005.

(3) An applicant who does not meet the requirements of this section shall follow the requirements under WAC 246-915-030, and either WAC 246-915-100 or 246-915-105, and follow the initial eligibility and application procedure under WAC 246-915-039.

AMENDATORY SECTION(Amending WSR 23-21-075, filed 10/13/23, effective 11/13/23)

WAC 246-915-085Continuing competency.

(1) Every two years, a physical therapist (PT) shall complete 32 hours of continuing education (CE) through any of the following means:

	CE Type	Maximum Hours Allowed	Documentation Requirements
a.	Participation in a course, live or online, including recorded.	No limit	Keep certificates of completion for each course, and, if not contained in the certificate of completion, information describing the course sponsors, the goals and objectives of the course, the credentials of the presenter as a recognized authority on the subject presented, dates of attendance, and total hours for all continuing education courses being reported.
b.	Live or recorded instructional electronic media relating to the practice of physical therapy that does not include specific goals and objectives.	Four hours	Instead of course goals, objectives and certificate of completion, the PT shall write and submit to the department a minimum of two takeaways for each hour of running time.
c.	Books or articles reviewed.	Eight hours (reading time only)	The PT shall write and submit to the department a one-page synopsis in ((twelve))12-point font for each hour of reading time. The time spent writing a synopsis is not reportable.
d.	Preparation and presentation of professional physical therapy courses or lectures.	((Sixteen))16 hours	The PT shall submit to the department a description and objectives of the presentation, date, and location of presentation.
e.	Written preparation and publication of original scholarly research or work published in a peer-review journal.	((Ten))10 hours	The PT shall submit to the department proof of publication which may include poster presentations.
f.	Clinical instruction of physical therapy students enrolled in a physical therapy educational program accredited by the American Physical Therapy Association's Commission on Accreditation in Physical Therapy Education (CAPTE) or clinical instruction in a postgraduate residency or fellowship through the American Board of Physical Therapy Residency and Fellowship Education (ABPTRFE).	((Ten))10 hours	The PT shall obtain and submit to the department a letter or certificate from the student's academic institution verifying that the student has completed the course of clinical instruction. Each ((thirty-two))32 hours of student mentorship equals one hour for purposes of CE credit.
g.	Courses required for professional certification such as to work in public schools.	((Fifteen))15 hours	The PT shall submit a copy of the completion certificate to the department.
h.	Courses provided by an accredited institution of higher education which may include, but are not limited to, courses leading to an advanced degree in physical therapy or other courses that advance the PT's competence.	No limit	The PT shall submit a transcript to the department verifying courses taken. One quarter credit is equal to ((ten))10 hours; one trimester is equal to ((twelve))12 hours; and one semester credit is equal to ((fifteen))15 hours.
i.	Attendance at science-based conferences.	No limit	Certificate of attendance.
j.	Preparing for and successfully taking and passing board certification exams through the American Board of Physical Therapy Specialties.	No limit	Certificate of certification.
k.	Passing the Washington state jurisprudence examination.	One hour	Certificate of completion.

(2) Every two years a physical therapist who holds a spinal manipulation endorsement shall complete at least 10 hours of continuing education directly related to spinal manipulation with at least five hours related to procedural techniques and application of spinal manipulation. For documentation, refer to the documentation required for the particular type of continuing education chosen. The hours spent completing spinal manipulation continuing education count toward meeting any applicable continuing competency requirements.

(3) Every two years, a physical therapist assistant (PTA) shall complete 24 hours of continuing education through any of the following means:

	CE Type	Hours Allowed	Documentation Requirements
a.	Participation in a course, live or online, including recorded.	No limit	Keep certificates of completion for each course, and, if not contained in the certificate of completion, information describing the course sponsors, the goals and objectives of the course, the credentials of the presenter as a recognized authority on the subject presented, dates of attendance, and total hours for all continuing education courses being reported.
b.	Live or recorded instructional electronic media relating to the practice of physical therapy that does not include specific goals and objectives.	Four hours	Instead of course goals, objectives and certificate of completion, the PTA shall submit to the department a minimum of two takeaways for each hour of running time.
c.	Books or articles reviewed.	Eight hours (reading time only)	The PTA shall write and submit a one-page synopsis in ((twelve))12-point font for each hour of reading time. The time spent writing a synopsis is not reportable.
d.	Preparation and presentation of professional physical therapy courses or lectures.	((Sixteen))16 hours	The PTA shall submit to the department a description and objectives of the presentation, date, and location of presentation.
e.	Written preparation and publication of original scholarly research or work published in a peer-review journal.	((Ten))10 hours	The PTA shall submit proof of publication which may include poster presentations.
f.	Clinical instruction of physical therapist assistant students enrolled in a physical therapy assistant program accredited by the American Physical Therapy Association's Commission on Accreditation in Physical Therapy Education (CAPTE) or clinical instruction in a postgraduate residency or fellowship through the American Board of Physical Therapy Residency and Fellowship Education (ABPTRFE).	((Ten))10 hours	The PTA shall obtain and submit to the department a letter or certificate from the student's academic institution verifying that the student has completed the course of clinical instruction. Each ((thirty-two))32 hours of student mentorship equals one hour for purposes of CE credit.
g.	Courses required for professional certification such as to work in public schools.	((Fifteen))15 hours	The PTA shall submit a copy of the completion certificate.
h.	Courses provided by an accredited institution of higher education which may include, but are not limited to, courses leading to an advanced degree in physical therapy or other courses that advance the PTA's competence.	No limit	The PTA shall submit a transcript verifying courses taken. One quarter credit is equal to ((ten))10 hours; one trimester credit is equal to ((twelve))12 hours; and one semester credit is equal to ((fifteen))15 hours.
i.	Attendance at science-based conferences.	No limit	Certificate of attendance.
j.	Preparing for and successfully taking and passing board certification exams through the American Board of Physical Therapy Specialties.	No limit	Certificate of certification.
k.	Passing the Washington state jurisprudence examination.	One hour	Certificate of completion.

(4) Every two years, each physical therapist and physical therapist assistant shall complete two hours of health equity continuing competency training as described in WAC 246-12-800 through 246-12-830. For documentation, refer to the documentation required for the particular type of continuing education chosen. The hours spent completing health equity training continuing education count toward meeting any applicable continuing competency requirements.

(5) Each physical therapist and physical therapist assistant shall complete a one-time, three hour suicide assessment training described in WAC 246-915-086.

(6) Each physical therapist and physical therapist assistant shall take and pass the Washington state jurisprudence examination within their first full continuing education cycle after initial licensure. Fulfilling this requirement will count as one hour towards the physical therapist or physical therapist assistant's CE requirements.

(7) Every two years, each physical therapist and physical therapist assistant shall complete 200 hours involving the application of physical therapy knowledge and skills which may be obtained in the clinical practice of physical therapy or in the nonclinical activities which include, but are not limited to, the following:

	Clinical Activities	Hours Allowed	Documentation
a.	Physical therapy clinical practice.	No limit	Documentation of physical therapy employment, the PT or PTA shall provide copies of employment records or other proof acceptable to the board of employment for the hours being reported.

	Nonclinical Activities	Hours Allowed (within the ((two hundred))200 hours required)	Documentation
b.	Physical therapy teaching of: • Patient/client management, prevention and wellness. • Physical therapy ethics and standards of practice. • Professional advocacy/involvement.	No limit	The PT or PTA shall provide documentation of such activities as acceptable to the board.
c.	Active service on boards or participation in professional or government organizations, or attendance at professional or government organizations meetings specifically related to the practice of physical therapy.	No limit	The PT or PTA shall provide documentation of such activities as acceptable to the board.
d.	Developing course work in physical therapy schools or education programs or physical therapy continuing education courses.	No limit	The PT or PTA shall provide documentation of such activities as acceptable to the board.
e.	Physical therapy research as a principal or associate researcher.	No limit	The PT or PTA shall provide documentation of such activities as acceptable to the board.
f.	Physical therapy consulting.	No limit	The PT or PTA shall provide documentation of such activities as acceptable to the board.
g.	Management of physical therapy services.	No limit	The PT or PTA shall provide documentation of such activities as acceptable to the board.
h.	Physical therapy volunteer hours or observation in physical therapy practice.	No limit	The PT or PTA shall provide documentation verifying volunteer or observation hours.

AMENDATORY SECTION(Amending WSR 23-16-125, filed 8/1/23, effective 9/1/23)

WAC 246-915-120Foreign educated applicants.

(1) An applicant whose professional degree in physical therapy was awarded from a foreign physical therapy program that is not or was not accredited by the CAPTE shall submit:

(a) ((An application for review by the board))A completed application on forms provided by the department;

(b) A credentials evaluation report of professional education and training prepared by a board-approved credentials evaluation agency. The report must be sent directly from the credentialing agency to the board. It is the responsibility of the applicant to pay the expenses associated with the credentials evaluation:

(i) The report must provide evidence and documentation that the applicant completed education outside a state or territory of the United States that is substantially equivalent to the education of a physical therapist who graduated from a physical therapy education program accredited by CAPTE.

(ii) To be approved as a credentialing agency, the agency must use the appropriate course work tool (CWT) adopted by the Federation of State Boards of Physical Therapy to determine substantial equivalency. The appropriate CWT means the CWT in place at the time the foreign educated physical therapist earned their ((first)) professional degree in physical therapy.

(i) Verification that English is the native language of the country of origin((, and))of the applicant; or

(ii) Verification the physical therapy program the applicant completed employs English as the language of training; or

(((ii)))(iii) Verification that the applicant has achieved a score of not less than 560 on the paper Test of English as a Foreign Language (TOEFL) or a score of not less than 220 on the computer Test of English as a Foreign Language (TOEFL), a score of not less than 50 on the Test of Spoken English (TSE) and a score of not less than four and one-half on the Test of Written English (TWE); or

(((iii)))(iv) Verification that the applicant has achieved an overall score of not less than 89, and the following minimum scores for each category of the internet-based TOEFL (ibTOEFL) examination: Writing, 22; speaking, 24; reading, 22; listening, 21.

(d) Verification of a valid, unencumbered license or authorization to practice physical therapy in the country in which the physical therapy education was obtained;

(e) Official transcripts from the physical therapy program showing degree date;

(f) ((Passing scores for the Washington jurisprudence examination;

(g))) Passing scores for the National Physical Therapy Examination (NPTE) as described in WAC 246-915-030; ((and))

(g) The application fee required under WAC 246-915-990; and

(h) Any additional supporting documentation as requested by the board.

(2) The applicant shall have received a grade of "C" or higher (or equivalent) in all professional education course work;

(3) The applicant may apply for the college-level education program (CLEP) and their scores may be applied toward college credit. The board will consider the conversion of CLEP scores to college credits provided by a board-approved credentialing agency;

(4) The board may allow applicants to correct general education and professional education course work deficiencies by:

(a) Completing course work ((pre-approved))preapproved by the board. To obtain course work preapproval, the applicant shall submit a written request along with the course description/syllabus for the proposed course; or

(b) Obtaining a new passing education evaluation from a board-approved credentials evaluation agency after correcting deficiencies as recommended by the credentialing agency. The report must be sent directly from the credentialing agency to the board; and

(5) An applicant whose professional degree in physical therapy was awarded from a foreign physical therapy program that is or was accredited by the CAPTE shall follow the requirements under WAC 246-915-030 and 246-915-100.