[atlas:bill]

AN ACT Relating to physical therapy; adding a new chapter to Title 18 RCW; and repealing RCW 18.74.005, 18.74.010, 18.74.012, 18.74.015, 18.74.020, 18.74.023, 18.74.025, 18.74.027, 18.74.029, 18.74.030, 18.74.035, 18.74.040, 18.74.050, 18.74.060, 18.74.065, 18.74.070, 18.74.073, 18.74.075, 18.74.085, 18.74.090, 18.74.095, 18.74.120, 18.74.125, 18.74.130, 18.74.135, 18.74.140, 18.74.900, 18.74.910, and 18.74.911.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

NEW SECTION. Sec. 1. This chapter is enacted for the purpose of protecting the public health, safety, and welfare, and to provide for state administrative control, supervision, licensure, and regulation of the practice of physical therapy. It is the intent of the legislature that only individuals who meet and maintain prescribed standards of competence and conduct may engage in the practice of physical therapy as authorized by this chapter. This chapter shall be liberally construed to promote the public interest and to accomplish the purpose stated in this chapter.

NEW SECTION. Sec. 2. The definitions in this section apply throughout this chapter unless the context clearly requires otherwise.

(1) "Board" means the state board of physical therapy.

(2) "Physical therapy" means the care and services provided by or under the direction and supervision of a physical therapist licensed by the state.

(3) "Physical therapist" means a person who meets all the requirements of this chapter and is licensed in this state to practice physical therapy.

(4) "Practice of physical therapy" means:

(a) Examining, evaluating, and testing individuals with mechanical, physiological, and developmental impairments, functional limitations, and disability or other health and movement-related conditions in order to determine a diagnosis, prognosis, plan of therapeutic intervention, and to assess and document the ongoing effects of intervention;

(b) Alleviating impairments and functional limitations by designing, implementing, and modifying therapeutic interventions that include, but are not limited to therapeutic exercise; functional training in self-care and in-home, community, or work reintegration; manual therapy including soft tissue and joint mobilization and manipulation; therapeutic massage, assistive and adaptive orthotic, prosthetic, protective, and supportive devices and equipment; airway clearance techniques; debridement and wound care; physical agents or modalities; mechanical and electrotherapeutic modalities; and patient-related instruction;

(c) Reducing the risk of injury, impairment, functional limitation, and disability, including the promotion and maintenance of fitness, health, and quality of life in all age populations;

(d) Engaging in administration, consultation, education, and research.

(5)(a) "Physical therapist assistant" means a person who meets the requirements of this chapter for licensure as a physical therapist assistant and who performs physical therapy procedures and related tasks that have been selected and delegated only by the supervising physical therapist.

(b) "Physical therapy aide" means a person trained under the direction of a physical therapist who performs designated and supervised routine physical therapy tasks.

(c) "Other assistive personnel" means other trained or educated health care personnel, not defined in (a) or (b) of this subsection, who perform specific designated tasks related to physical therapy under the supervision of a physical therapist. At the direction of the supervising physical therapist, and if properly credentialed and not prohibited by any other law, other assistive personnel may be identified by the title specific to their training or education.

(6) "Restricted physical therapy license" means a license to which restrictions or conditions, or both, as to scope of practice, place of practice, supervision of practice, duration of licensed status, or type or condition of patient or client served are imposed by the board.

(7) "On-site supervision" means the supervising physical therapist must (a) be continuously on-site and present in the department or facility where assistive personnel or holders of interim permits are performing services; (b) be immediately available to assist the person being supervised in the services being performed; and (c) maintain continued involvement in appropriate aspects of each treatment session in which a component of treatment is delegated to assistive personnel.

NEW SECTION. Sec. 3. (1) The board shall consist of five members who shall be appointed by the governor. Four members shall be physical therapists who reside in Washington and who possess an unrestricted license to practice physical therapy in the state and who shall have been practicing in Washington for no less than five years preceding appointment. One member shall be a resident of Washington appointed from the public at large and who is not affiliated with or has a financial interest in, any health care profession and who has an interest in the rights of consumers.

(2) All appointments are for terms of four years and shall be staggered. No member shall serve for more than two successive four- year terms or for more than ten consecutive years. By board approval, members may extend service beyond four years until a new member is appointed or the member is reappointed.

(3) The governor may, at the request of the board, remove any member of the board for misconduct, incompetence, or neglect of duty.

(4) Each board member shall be entitled to reimbursement of travel expenses as provided in RCW 43.03.050 and 43.03.060 for attending each meeting of the board or for representing the board in an official board-approved activity.

(5) There shall be no liability on the part of, and no action for damages against, any member of the board when the person is functioning within the scope of board duties and acting without malice and in the reasonable belief that the action taken by him or her is warranted by law.

NEW SECTION. Sec. 4. The board has the following powers and duties:

(1) Evaluate the qualifications of applicants for licensure and provide for the national examinations for physical therapists and physical therapist assistants;

(2) Adopt passing scores for examinations;

(3) Issue licenses or permits to those who qualify under this chapter;

(4) Regulate the practice of physical therapy by interpreting and enforcing the provisions of this chapter, including disciplinary action;

(5) Adopt and revise rules as it deems necessary and appropriate, consistent with this chapter and chapter 34.05 RCW, for the discharge of its obligation under this chapter. The rules, when lawfully adopted, shall have the effect of law;

(6) Meet at least once each quarter in compliance with the open public meetings act, chapter 42.30 RCW. A majority of board members shall constitute a quorum for the transaction of business. The board shall keep an official record of all of its proceedings;

(7) Establish requirements for assessing continuing competence;

(8) Establish and collect fees for sustaining the necessary operation and expenses of the board;

(9) Elect officers from its members necessary for the operations and obligations of the board. Terms of office shall be one year;

(10) Provide for the timely orientation and training of new professional and public appointees to the board, including training in licensing and disciplinary procedures and orientation to all statutes, rules, policies, and procedures of the board;

(11) Maintain a current listing of all persons licensed or otherwise regulated under this chapter, including the name, current business and residential address, telephone numbers, and license;

(12) Provide information to the public regarding the complaint process;

(13) Employ necessary personnel to carry out the administrative work of the board;

(14) Enter into contracts for services necessary for adequate enforcement of this chapter;

(15) Report final disciplinary action taken against a licensed physical therapist or licensed physical therapist assistant to the national disciplinary data base recognized by the board;

(16) Publish, at least annually, final disciplinary action taken against any licensed physical therapist or licensed physical therapist assistant;

(17) Publish board rulings, opinions, or interpretations of statutes or rules to guide persons regulated under this chapter;

(18) Participate in or conduct performance audits.

NEW SECTION. Sec. 5. The physical therapy licensing account is created in the custody of the state treasurer. All receipts from this chapter must be deposited into the account. Expenditures from the account may be used only for the purposes of this chapter. Only the board or the board's designee may authorize expenditures from the account. The account is subject to allotment procedures under chapter 43.88 RCW, but an appropriation is not required for expenditures.

NEW SECTION. Sec. 6. (1) It is unlawful for any person to practice or in any manner hold himself or herself out to practice physical therapy or designate himself or herself as a physical therapist, unless he or she is duly licensed in accordance with this chapter.

(2) Nothing in this chapter shall be construed as restricting persons licensed under any other law of this state from engaging in the profession or practice for which they are licensed, provided, however, that they are not representing themselves to be physical therapists or providers of physical therapy.

(3) The following persons are exempt from licensure as physical therapists under this chapter when engaged in the following activities:

(a) A person who is pursuing a course of study leading to a degree as a physical therapist in an approved professional education program and is satisfying supervised clinical education requirements related to his or her physical therapy education while under on-site supervision of a licensed physical therapist;

(b) A physical therapist while practicing in the United States armed services, United States public health service, or veterans administration as based on requirements under federal regulations for state licensure of health care providers;

(c) A physical therapist licensed in another United States jurisdiction, or a foreign-educated physical therapist credentialed in another country, performing physical therapy as part of teaching or participating in an educational seminar of no more than sixty days in a calendar year.

NEW SECTION. Sec. 7. (1) An applicant for licensure as a physical therapist or for licensure as a physical therapist assistant shall file an application as required by the board. A nonrefundable application fee and the cost of the examination shall accompany the completed written application. Fees shall be established by rules adopted in accordance with section 4 of this act.

(2) Any applicant may request in writing and, upon request, shall be granted a hearing based upon action taken by the board regarding his or her application.

NEW SECTION. Sec. 8. (1) An applicant may take the examination for physical therapist licensure after the application process has been completed. The national examination shall test entry-level competency related to physical therapy theory, examination and evaluation, diagnosis, prognosis, treatment intervention, prevention, and consultation.

(2) An applicant may take the examination for physical therapist assistant licensure after the application process has been completed. The national examination shall test for requisite knowledge and skills in the technical application of physical therapy services.

(3) Examinations shall be available within the state at least quarterly, at such time and place as the board shall determine. The passing score shall be determined by the board.

(4) Applicants who do not pass the examination after the first attempt may retake the examination one additional time without reapplication for licensure. This must occur within six months from the first failure. Prior to being approved by the board for subsequent testing beyond two attempts, individuals shall reapply and demonstrate evidence satisfactory to the board of having successfully completed either additional clinical training or coursework, or both, as determined by the board.

NEW SECTION. Sec. 9. (1) An applicant for a license as a physical therapist shall have the following qualifications:

(a) Be of good moral character;

(b) Have completed the application process;

(c) Be a graduate of a professional physical therapy education program accredited by a national accreditation agency approved by the board;

(d) Have successfully passed the national examination approved by the board.

(2) The board shall issue a license to a physical therapist who has a valid unrestricted license from another United States jurisdiction in which he or she, when granted the license, previously met all requirements as specified in subsection (1) of this section or section 10 of this act, and as further established by rule.

NEW SECTION. Sec. 10. (1) An applicant for licensure as a physical therapist who has been educated outside of the United States shall meet the following qualifications:

(a) Be of good moral character;

(b) Have completed the application process;

(c) Provide satisfactory evidence that his or her education is substantially equivalent to the requirements of physical therapists educated in accredited educational programs as determined by the board. If the board determines that a foreign-educated applicant's education is not substantially equivalent, it may require completion of additional coursework before proceeding with the application process;

(d) Provide written proof that the school of physical therapy education is recognized by its own ministry of education;

(e) Provide written proof of authorization to practice as a physical therapist without limitations in the country where the professional education occurred;

(f) Provide proof of legal authorization to reside and seek employment in the United States or its territories;

(g) Have his or her educational credentials evaluated by a board-approved credential evaluation agency;

(h) Have passed the board-approved English proficiency examinations if his or her native language is not English;

(i) Have participated in an interim supervised clinical practice period prior to licensure;

(j) Have successfully passed the national examination approved by the board.

(2) Notwithstanding the provisions of this section, if the foreign-educated physical therapist applicant is a graduate of a professional physical therapy education program accredited by an agency approved by the board, the requirements in subsection (1)(c), (d), (g), and (i) of this section may be waived.

NEW SECTION. Sec. 11. (1) When a foreign-educated applicant satisfies the board's requirements as listed in section 10 of this act, prior to licensure the board shall issue an interim permit to the applicant for the purpose of participating in a supervised clinical practice period. An applicant who has failed the national examination is not eligible for an interim permit until after he or she has passed the examination.

(2) The time period of an interim permit shall be no less than ninety days nor more than six months.

(3) An interim permit holder shall, to the satisfaction of the board, complete a period of clinical practice under the continuous and on-site supervision of a physical therapist who holds an unrestricted license issued pursuant to this chapter in a facility approved by the board and as further required by rules.

(4) An interim permit is immediately revoked upon notification of an interim permit holder that he or she has failed the licensing examination.

NEW SECTION. Sec. 12. An applicant for licensure as a physical therapist assistant shall meet the following requirements:

(1) Be of good moral character;

(2) Have completed the application process;

(3) Be a graduate of a physical therapist assistant education program accredited by an agency approved by the board;

(4) Have successfully passed the national examination approved by the board.

NEW SECTION. Sec. 13. The board shall waive the examination and grant a license to a person who has practiced as a physical therapist assistant in this state on the effective date of this section if the board determines that the person meets commonly accepted standards for practicing as a physical therapist assistant, as established by rule of the board. Persons eligible for licensure as a physical therapist assistant under this section shall apply for a license before October 1, 1999.

NEW SECTION. Sec. 14. (1) A physical therapist licensed under the provisions of this chapter shall renew his or her license as specified in rules. An individual who fails to renew his or her license by the date of expiration shall not practice physical therapy in the state of Washington. A physical therapist assistant licensed under the provisions of this chapter shall renew his or her license as specified in rules. An individual who fails to renew his or her license by the date of expiration shall not continue to function as a physical therapist assistant.

(2) Each licensee shall report to the board a name change and changes in business and home address within thirty days of the change.

NEW SECTION. Sec. 15. (1) Reinstatement of a lapsed license following a renewal deadline requires payment of a renewal fee and late penalty in accordance with rules.

(2) Reinstatement of a license that has lapsed for more than three consecutive years requires reapplying for a license and payment of fees in accordance with rules. The individual shall successfully demonstrate to the board competency in the practice of physical therapy, or shall serve an internship under a restricted license or take remedial courses as determined by the board, or both, at the board's discretion. The board may also require the applicant to take an examination.

NEW SECTION. Sec. 16. (1) No person shall practice or in any manner hold himself or herself out to be engaging in the practice of physical therapy or designate himself or herself as a physical therapist unless duly licensed as a physical therapist in accordance with this chapter.

(2) A physical therapist licensed under this chapter is fully authorized to practice physical therapy as defined in this chapter.

(3) A physical therapist shall refer persons under his or her care to appropriate health care practitioners if the physical therapist has reasonable cause to believe symptoms or conditions are present that require services beyond the scope of practice or when physical therapy is contraindicated.

(4) Physical therapists shall adhere to the recognized standards of ethics of the physical therapy profession and as further established by rule.

(5) A physical therapist who meets further qualifications as established by rule may penetrate tissue for the purpose of testing neuromuscular performance.

(6) A physical therapist may perform wound debridement and wound management that includes, but is not limited to, sharp debridement, debridement with other agents, dry dressings, wet dressings, topical agents including enzymes, and hydrotherapy.

(7) A physical therapist may purchase, store, and administer topical and aerosol medications as part of the practice of physical therapy as defined in this chapter. A physical therapist shall comply with rules duly adopted by the board of pharmacy or the department of health specifying protocols for storage of medications.

NEW SECTION. Sec. 17. (1) A physical therapist shall use the letters "PT" in connection with his or her name or place of business to denote licensure under this chapter.

(2) It is unlawful for any person, or for any business entity, its employees, agents, or representatives to use in connection with his or her name, or the name or activity of the business, the words "physical therapy," "physical therapist," "physiotherapy," "physiotherapist," "registered physical therapist," the letters "PT," "LPT," "RPT," or any other words, abbreviations, or insignia indicating or implying directly or indirectly that physical therapy is provided or supplied, including the billing of services labeled as physical therapy, unless the services are provided by or under the direction of a physical therapist licensed in accordance with this chapter.

(3) A physical therapist assistant shall use the letters "PTA" in connection with his or her name to denote licensure under this chapter.

(4) No person shall use the title "physical therapist assistant," the letters "PTA," or any other words, abbreviations, or insignia in connection with his or her name to indicate or imply, directly or indirectly, that he or she is a physical therapist assistant without being licensed in accordance with this chapter as a physical therapist assistant.

NEW SECTION. Sec. 18. Any physical therapist licensed under this chapter not practicing physical therapy or providing services may place his or her license in an inactive status. The board shall prescribe requirements for maintaining an inactive status and converting from an inactive or active status. The secretary of the department of health may establish fees for alterations in license status.

NEW SECTION. Sec. 19. (1) Physical therapists are responsible for patient care given by assistive personnel under their supervision. A physical therapist may delegate to assistive personnel and supervise selected acts, tasks, or procedures that fall within the scope of physical therapy practice but do not exceed the education or training of the assistive personnel.

(2) Physical therapist assistants shall at all times be under the supervision of a licensed physical therapist as further set forth in rule.

(3) Physical therapy aides and other assistive personnel shall perform patient care activities under on-site supervision of a licensed physical therapist.

NEW SECTION. Sec. 20. The uniform disciplinary act, chapter 18.130 RCW, governs unlicensed practice, the issuance and denial of licenses and interim permits, and the discipline of licensees and holders of interim permits under this chapter.

NEW SECTION. Sec. 21. (1) The public shall have access to the following information:

(a) A listing of physical therapists licensed in the state, including place of practice, license number, date of expiration, and status of license. This listing shall also include interim permit holders;

(b) A listing of physical therapist assistants licensed in the state, including place of employment, license number, and date of expiration;

(2) Home addresses and telephone numbers of physical therapists and physical therapist assistants are not public records and shall be kept confidential by the board.

(3) Physical therapists shall disclose in writing to patients if a referring practitioner is deriving direct or indirect compensation from the referral to physical therapy.

(4) Physical therapists shall disclose in writing any financial interest in products they endorse and recommend to their patients.

(5) Physical therapists have the responsibility to ensure that the patient has knowledge of freedom of choice in services and products.

(6) Information relating to the physical therapist/patient relationship is confidential and may not be communicated to a third party not involved in that patient's care without the prior written consent of the patient. The physical therapist/patient privilege does not extend to cases in which the physical therapist has a duty to report information as required by law.

(7) Any person may submit a complaint regarding any licensee or any other person potentially in violation of this chapter. Confidentiality shall be maintained subject to law.

(8) The board shall keep all information relating to the receiving and investigation of complaints filed against licensees confidential until the information becomes public record or as required by law.

(9) Each licensee shall display a copy of his or her license or current renewal verification in a location accessible to public view at his or her place of practice.

NEW SECTION. Sec. 22. The following acts or parts of acts are each repealed:

(1) RCW 18.74.005 (Purpose) and 1983 c 116 s 1;

(2) RCW 18.74.010 (Definitions) and 1997 c 275 s 8, 1991 c 12 s 1, 1988 c 185 s 1, 1983 c 116 s 2, 1961 c 64 s 1, & 1949 c 239 s 1;

(3) RCW 18.74.012 (Consultation with health care practitioner not required for certain treatments) and 1991 c 12 s 2, 1990 c 297 s 19, & 1988 c 185 s 2;

(4) RCW 18.74.015 (Referral to health care practitioners--When required) and 1988 c 185 s 3;

(5) RCW 18.74.020 (Board created--Members--Staff assistance--Compensation and travel expenses) and 1991 c 3 s 174, 1984 c 287 s 46, 1983 c 116 s 3, 1979 c 158 s 62, 1975-'76 2nd ex.s. c 34 s 44, & 1949 c 239 s 2;

(6) RCW 18.74.023 (Board--Powers and duties) and 1995 c 299 s 1 & 1995 c 198 s 9;

(7) RCW 18.74.025 (Standards for appropriateness of physical therapy care--Violation) and 1991 c 12 s 5;

(8) RCW 18.74.027 (Board--Officers--Meetings--Quorum) and 1983 c 116 s 5;

(9) RCW 18.74.029 (Application of Uniform Disciplinary Act) and 1993 c 133 s 2, 1987 c 150 s 47, & 1986 c 259 s 123;

(10) RCW 18.74.030 (Qualifications of applicants) and 1983 c 116 s 6, 1961 c 64 s 2, & 1949 c 239 s 3;

(11) RCW 18.74.035 (Examinations--Scope--Time and place) and 1995 c 198 s 10, 1991 c 3 s 176, 1983 c 116 s 7, & 1961 c 64 s 3;

(12) RCW 18.74.040 (Licenses) and 1991 c 3 s 177, 1983 c 116 s 8, & 1949 c 239 s 4;

(13) RCW 18.74.050 (Licenses--Fees) and 1996 c 191 s 59, 1991 c 3 s 178, 1985 c 7 s 63, 1983 c 116 s 9, 1975 1st ex.s. c 30 s 65, 1961 c 64 s 4, & 1949 c 239 s 5;

(14) RCW 18.74.060 (Licensure by endorsement) and 1996 c 191 s 60, 1991 c 3 s 179, 1985 c 7 s 64, 1983 c 116 s 10, 1975 1st ex.s. c 30 s 66, 1961 c 64 s 5, & 1949 c 239 s 6;

(15) RCW 18.74.065 (Licenses--Issuance to persons licensed or registered before July 24, 1983) and 1983 c 116 s 11;

(16) RCW 18.74.070 (Renewal of license) and 1996 c 191 s 61, 1991 c 3 s 180, 1983 c 116 s 12, 1975 1st ex.s. c 30 s 67, 1971 ex.s. c 266 s 13, 1961 c 64 s 6, & 1949 c 239 s 7;

(17) RCW 18.74.073 (Licenses--Inactive status--Fees) and 1998 c 143 s 1;

(18) RCW 18.74.075 (Interim permits) and 1993 c 133 s 1;

(19) RCW 18.74.085 (Advertising of spinal manipulation or mobilization prohibited) and 1988 c 185 s 4;

(20) RCW 18.74.090 (False advertising--Use of name and words--License required--Prosecutions of violations) and 1991 c 3 s 181, 1987 c 150 s 48, 1986 c 259 s 125, 1983 c 116 s 18, 1961 c 64 s 8, & 1949 c 239 s 9;

(21) RCW 18.74.095 (False advertising--Injunctions) and 1991 c 3 s 182, 1983 c 116 s 19, & 1961 c 64 s 9;

(22) RCW 18.74.120 (Record of proceedings--Register) and 1991 c 3 s 183, 1983 c 116 s 21, 1979 c 158 s 63, 1977 c 75 s 11, & 1949 c 239 s 12;

(23) RCW 18.74.125 (Construction of chapter--Activities not prohibited--Use of letters or words in connection with name) and 1961 c 64 s 10;

(24) RCW 18.74.130 (Exemptions) and 1983 c 116 s 22;

(25) RCW 18.74.135 (Insurance coverage and benefits not required or regulated) and 1988 c 185 s 5;

(26) RCW 18.74.140 (Practice setting not restricted) and 1991 c 12 s 4;

(27) RCW 18.74.900 (Severability--1949 c 239) and 1949 c 239 s 13;

(28) RCW 18.74.910 (Severability--1961 c 64) and 1961 c 64 s 11; and

(29) RCW 18.74.911 (Severability--1983 c 116) and 1983 c 116 s 24.

NEW SECTION. Sec. 23. Sections 1 through 21 of this act constitute a new chapter in Title 18 RCW.