PROPOSED RULES
(Board of Physical Therapy)
Original Notice.
Preproposal statement of inquiry was filed as WSR 07-16-063.
Title of Rule and Other Identifying Information: Amending chapter 246-915 WAC regarding the licensing and supervision of physical therapist assistants.
Hearing Location(s): Hawthorn Suites, 6329 South 212th Street, Kent, WA 98032, on April 22, 2008, at 9:30 a.m.
Date of Intended Adoption: April 22, 2008.
Submit Written Comments to: Kris Waidely, P.O. Box 47867, Olympia, WA 98504-7867, web site http://www3.doh.wa.gov/policyreview/, fax (360) 664-9077, by April 16, 2008.
Assistance for Persons with Disabilities: Contact Kris Waidely by April 4, 2008, TTY (800) 833-6388 or 711.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: ESSB 5292 (chapter 98, Laws of 2007) passed during the 2007 legislative session. The new legislation expands the regulation of physical therapy to include licensure for physical therapist assistants (PTAs). The legislation requires the board to revise the existing physical therapy rules to include licensure requirements for PTAs. The proposed rules also waive the examination requirement and issue a license to [a] person, currently practicing, who meets commonly accepted standards for practicing as a PTA.
Reasons Supporting Proposal: Rules are required by statute, therefore, there are no alternatives to rule making. These standards need to be established in rule in order to be enforced. In addition, these rules establish adequate education and training required for licensed PTAs to safely perform physical therapy procedures and tasks delegated by a supervising physical therapist. Without these rules there could be unqualified practitioners providing patient care. This could lead to substandard care.
Statutory Authority for Adoption: RCW 18.74.023.
Statute Being Implemented: Chapter 18.74 RCW.
Rule is not necessitated by federal law, federal or state court decision.
Name of Proponent: Washington state department of health, governmental.
Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Kris Waidely, 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.
The proposed rules do the following:
1. Identify the education/training and examination requirements for applicants applying for a license to practice as a PTA.
2. Identify the requirements for waiving the examination requirement for a person who meets the commonly accepted standards for practicing as a PTA.
3. Allows PTAs to utilize their time more efficiently and effectively when completing their continuing education requirements.
4. Maintains existing quality of care provided by well-informed and educated PTAs.
5. Restructures the language of the rule to make it more clear and understandable.
2. Is a Small Business Economic Impact Statement (SBEIS) Required for this Rule? Yes.
3. Which Industries Are Affected by this Rule? In
preparing this SBEIS, the department of health used the
following NAICS codes:
| NAICS | Description |
| 623110 | Skilled nursing facilities |
| 623210 | Intermediate care facilities |
| 623110 | Nursing and personal care, nec |
| 622110 | General medical & surgical hospital |
| 622310 | Specialty hospitals exc. psychiatric |
| 621610 | Home health care services |
Continuing Competency: Licensed PTAs will be required to complete forty hours of continuing competency in the form of continuing education, in addition to two hundred hours of physical therapy related employment, every two years. The average cost to the practitioner will be approximately $1,000.
The continuing education can be earned through classroom or correspondence coursework, cassette tape, videotape, or book review. The board recognizes the almost universal conclusion that the current results of mandatory continuing education programs are debatably effective. Therefore, the board has not sought to limit the professional development and interests of licensed PTAs to continuing education activities only. The board believes professional skills and knowledge can be maintained and enhanced through active practice. For this reason, the board of physical therapy has attempted to create a balance by establishing a relatively moderate requirement of forty contact hours of continuing education as well as two hundred hours of employment every two years.
The board received public comments requesting considering lowering the number of hours required for PTAs because they don't receive the same pay as licensed physical therapists. The board also received input from PTAs requesting the board to require the same number of hours for PTAs as physical therapists. The board believes this rule satisfies the legislative mandate to assure professional competence.
Examination: The Federation of State Board of Physical Therapy develops and administers the National Physical Therapy Examination (NPTE) for physical therapists and PTAs. All fifty states and three additional jurisdictions use the NPTE as one factor in the licensure or certification of physical therapist[s] and PTAs. The board feels this exam provides a common element in the evaluation of candidates so standards will be comparable from jurisdiction to jurisdiction. It also protects the public interest in having only those persons who have the requisite knowledge of physical therapy be licensed to practice physical therapy. The board feels the examination ensures minimum knowledge and competency of physical therapy. The cost to take the NPTE is $350 and it is offered on demand. The legislation allows waiver of examination for PTAs currently practicing. Only newly graduating students will incur the exam cost.
The national exam ensures minimum knowledge and competency of physical therapy. PTAs currently practicing physical therapy may be eligible for licensure without taking the exam.
AIDS Education and Training: PTAs may come into contact with wounds and need to have appropriate infection control education and training. The average cost to take a seven hour course is $0 to $50. There are a variety of courses, on-line courses and locations to obtain the education and training. In addition, most physical therapy curriculum includes this training so PTAs already have the required training prior to applying for licensure.
5. Does the Rule Impose a Disproportionate Impact on Small Businesses? No. Passing the national exam is a part of the business requirement for currently practicing PTAs as well as newly graduating students.
AIDS education and training may impose costs for the PTA if this training was not completed as part of their physical therapy curriculum. The average cost of a seven-hour course for AIDS and education is $0 to $50. This cost range is less that [than] the threshold compliance costs associated with these industries.
If the licensed PTA is working for a small business, the PTA would need to go off site to get the required continuing competency training to comply with this rule. If the licensed PTA works for large businesses, the licensed PTA would be able to get this training on the job posing no costs to the licensed PTA to comply with this rule. The average cost to the practitioner will be approximately $1,000. The board has determined that the benefits of the proposed rules assure that licensed PTAs are adequately trained which, in turn, provides a benefit to the public.
6. If the Rule Imposes a Disproportionate Impact on Small Businesses, What Efforts Were Taken to Reduce That Impact (Or Why Is it Not "Legal and Feasible" to Do So) by Reducing, Modifying, or Eliminating Substantive Regulatory Requirements? ESSB 5292 requires an examination to obtain licensure. The national examination is the only examination currently available. All fifty states and three additional jurisdictions use the NPTE as one factor in the licensure or certification of physical therapist[s] and PTAs. The board feels this exam provides a common element in the evaluation of candidates so standards will be comparable from jurisdiction to jurisdiction. It also protects the public interest in having only those persons who have the requisite knowledge of physical therapy be licensed to practice physical therapy. The board feels the examination ensures minimum knowledge and competency of physical therapy.
RCW 70.24.270 requires all health professions to obtain AIDS education.
The new legislation authorizes the board of physical therapy to establish and administer requirements for continuing competency as a prerequisite for PTA license renewal. The legislation requires the establishment of continuing competency requirements and assurance of compliance before a physical therapy license can be renewed. The board recognizes the almost universal conclusion that the current results of mandatory continuing education programs are debatably effective. Therefore, the board has not sought to limit the professional development and interests of licensed PTAs to continuing education activities only. The board believes professional skills and knowledge can be maintained and enhanced through active practice. For this reason, the board of physical therapy has attempted to create a balance by establishing a relatively moderate requirement of forty contact hours of continuing education as well as two hundred hours of employment every two years. The board believes this rule satisfies the legislative mandate to assure professional competence.
One way the board mitigated was by considering not requiring PTAs to complete 2,500 hours of work experience in a three-year period to be granted a license without taking the examination. The board received opposition regarding the number of hours of experience. Some PTAs only work part-time which would make them ineligible to apply for licensure without taking the exam even though they may have been practicing in Washington for the past twenty years.
PTAs currently practicing in Washington are required to work under supervision of a licensed physical therapist. The board feels that rather than requiring a specific number of work experience hours, they will allow the supervising licensed physical therapist to attest to the completion of work experience hours. This creates no change in the rule as the rules currently indicate that the licensed physical therapist is professionally and legally responsible for patient care provided by their supportive personnel. The board will develop a form for supervising physical therapists to complete.
ESSB 5292 become[s] effective July 1, 2008, and requires an examination to obtain licensure. The national examination is the only examination currently available.
RCW 70.24.270 requires all health professions to obtain AIDS education prior to obtaining licensure.
Although the rule may cause a disproportionate impact to small businesses, the benefit to the public outweighs the cost.
7. 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 interested parties.
A copy of the statement may be obtained by contacting Kris Waidley, P.O. Box 47867, Olympia, WA 98504-7867, Olympia, WA 98504-7867, 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 47867, Olympia, WA 98504-7867, phone (360) 236-4847, fax (360) 664-9077, e-mail kris.waidely@doh.wa.gov.
March 18, 2008
Kris Waidely
Program Manager
OTS-1126.3
PHYSICAL THERAPISTS AND PHYSICAL THERAPIST ASSISTANTS
(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" means the licensed physical therapist.
(4) "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)) meets all the requirements of
this chapter and is licensed 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. However, a physical therapist may not
delegate sharp debridement to a physical therapist assistant;
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" 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.
(6) "Indirect supervision" 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.
(7) "Acquired immunodeficiency syndrome" or "AIDS" means the clinical syndrome of HIV-related illness as defined by the board of health by rule.
(8) "Office on AIDS" means 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.
(9) "Spinal manipulation" or "manipulative mobilization" means movement beyond the normal physiological range of motion.
(10) "Patient reevaluation" means the licensed physical therapist must physically observe and interview the patient.
[Statutory Authority: RCW 18.74.023 (3), (6) and (7). 04-13-052, § 246-915-010, filed 6/11/04, effective 7/12/04. 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.]
(2))) Physical therapy students in their last year may apply for licensure by examination prior to graduation under the following circumstances:
(a) Receipt of a letter from an official, of their physical therapy school, verifying the probability of graduation prior to the date of the examination for which they are applying.
(b) Results of the examination will be withheld until a diploma, official transcript or certification letter from the registrar's office certifying completion of all requirements for degree or certificate in physical therapy is received by the department.
(((3))) (2) Applicants who do not pass the examination
after two attempts shall demonstrate evidence satisfactory to
the board of having successfully completed clinical training
and/or ((coursework)) course work as determined by the board
before being permitted two additional attempts.
[Statutory Authority: RCW 18.74.023. 93-04-081 (Order 328B), § 246-915-020, filed 2/1/93, effective 3/4/93; 91-02-011 (Order 103B), recodified as § 246-915-020, filed 12/21/90, effective 1/31/91; 87-08-065 (Order PM 644), § 308-42-040, filed 4/1/87; 84-03-055 (Order PL 455), § 308-42-040, filed 1/18/84. Statutory Authority: RCW 18.74.020. 83-05-032 (Order PL 426), § 308-42-040, filed 2/10/83; 79-05-035 (Order PL 302), § 308-42-040, filed 4/24/79; Order PL 191, § 308-42-040, filed 5/29/75; Order 704207, § 308-42-040, filed 8/7/70, effective 9/15/70.]
(a) Beginning November 8, 1995, the criterion referenced passing point recommended by the Federation of State Boards of Physical Therapy for the examination approved by the board. The passing point shall be set to equal a scaled score of 600 based on a scale ranging from 200 to 800.
(b) Beginning February 28, 1991, through July 12, 1995, not less than sixty-eight percent of the raw score for the examination approved by the board; or
(c) Prior to February 28, 1991, not less than sixty percent raw score on each of the three examination parts for the examination approved by the board.
(2) If a candidate fails to receive a passing score on the examination, he or she will be required to retake the examination.
(3) Where necessary, applicant's score will be rounded off to the nearest whole number.
[Statutory Authority: RCW 18.74.023. 96-13-008, § 246-915-030, filed 6/6/96, effective 6/7/96; 92-16-082 (Order 294B), § 246-915-030, filed 8/4/92, effective 9/4/92; 91-14-006 (Order 178B), § 246-915-030, filed 6/21/91, effective 7/22/91; 91-05-094 (Order 144B), § 246-915-030, filed 2/20/91, effective 3/23/91; 91-02-011 (Order 103B), recodified as § 246-915-030, filed 12/21/90, effective 1/31/91. Statutory Authority: Chapter 18.74 RCW. 90-16-070 (Order 074), § 308-42-045, filed 7/30/90, effective 8/30/90. Statutory Authority: RCW 18.74.023. 86-19-063 (Order PM 619), § 308-42-045, filed 9/16/86; 84-17-032 (Order PL 477), § 308-42-045, filed 8/8/84. Statutory Authority: RCW 18.74.020. 83-05-032 (Order PL 426), § 308-42-045, filed 2/10/83; 81-19-071 (Order PL 384), § 308-42-045, filed 9/15/81; Order PL 191, § 308-42-045, filed 5/29/75.]
(a) Submission of a completed physical ((therapy))
therapist or physical therapist assistant license application
on which the applicant indicates that he or she wishes to
receive a temporary practice permit;
(b) Payment of the application fee ((and temporary
practice permit fee));
(c) Submission of all required supporting documentation as described in the application forms and instructions provided by the department of health, excepting the seven hour AIDS education requirement as described in WAC 246-915-110.
(2) Applicants wishing to receive a temporary practice
permit shall be granted an additional ninety days to complete
the AIDS education requirement; however, issuance of a
physical ((therapy)) therapist or physical therapist assistant
license is contingent upon evidence of having met this
requirement.
(3) The temporary permit shall expire upon the issuance of a license by the board; initiation of an investigation by the board of the applicant; or ninety days, whichever occurs first.
(4) An applicant who receives a temporary practice permit and who does not complete the application process may not receive additional temporary practice permits even upon submission of a new application in the future.
[Statutory Authority: RCW 18.74.023. 92-16-082 (Order 294B), § 246-915-075, filed 8/4/92, effective 9/4/92.]
(1) Payment of the application fee;
(2) Evidence of having obtained a physical therapy degree from a board approved school;
(3) Completed a physical ((therapy)) therapist or
physical therapist assistant license application on which the
applicant:
(a) Requests to receive an interim permit;
(b) Provides the name, location and telephone number of his or her place of employment;
(c) Provides the name and license number of his or her licensed supervising physical therapist; and
(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 provided;
(iii) Ensure that the holder of the interim permit wears 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)) therapist or physical
therapist assistant license immediately upon notification of
having passed the examination.
[Statutory Authority: RCW 18.74.023 (3), (6) and (7). 04-13-052, § 246-915-078, filed 6/11/04, effective 7/12/04. Statutory Authority: RCW 18.74.023. 94-05-014 (Order 403B), § 246-915-078, filed 2/4/94, effective 3/7/94.]
(1) Education - Licensed physical therapists and physical therapist assistants must complete 40 hours of continuing education every two years as required in chapter 246-12 WAC, Part 7.
(a) Continuing education specifically relating to the practice of physical therapy;
(b) Participation in a course with specific goals and objectives relating to the practice of physical therapy;
(c) Audio or video recordings or other multimedia devices, and/or book/article review. A maximum of ten hours may be used for books/articles reviewed;
(d) Correspondence course work completed.
(2) In addition to the requirements in subsection (1) of this section, 200 hours involving the application of physical therapy knowledge and skills, which may be obtained as follows:
(a) In the clinical practice of physical therapy; or
(b) In nonclinical activities that involve the direct application of physical therapy skills and knowledge, examples of which include, but are not limited to:
(i) Active service on boards or in physical therapy school or education program accrediting bodies;
(ii) Physical therapy teaching or presentations on:
(A) Patient/client management, prevention and wellness;
(B) Physical therapy ethics and standards of practice;
(C) Professional advocacy/involvement;
(iii) Developing course work in physical therapy schools or education programs or physical therapy continuing education courses;
(iv) Physical therapy research as a principal or associate researcher; and
(v) Physical therapy consulting.
(3) Licensees shall maintain records of all activities relating to continuing education and professional experience for a period of four years. Acceptable documentation shall mean:
(a) Continuing education. Certificates of completion, course sponsors, goals and objectives of the course, credentials of the presenter as a recognized authority on the subject presented, dates of attendance and total hours, for all continuing education being reported.
(b) Audio or video recordings or other multimedia devices, and/or book/article review. A two-page synopsis of each item reviewed must be written by the licensee.
(i) For audio or video recordings or other multimedia devices, a two-page double-spaced synopsis for every one to four hours of running time must be written by the licensee. Time spent writing a synopsis is not reportable.
(ii) For book/article review, a two-page double-spaced synopsis on each subject reviewed must be written by the licensee. Time spent writing a synopsis is not reportable.
(c) Correspondence course work completed. Course description and/or syllabus and copies of the completed and scored examination must be kept on file by the licensee.
(d) Physical therapy employment. Certified copies of employment records or proof acceptable to the board of physical therapy employment for the hours being reported.
[Statutory Authority: RCW 18.74.023(4). 04-08-101, § 246-915-085, filed 4/6/04, effective 5/7/04. Statutory Authority: RCW 43.70.280. 98-05-060, § 246-915-085, filed 2/13/98, effective 3/16/98. Statutory Authority: RCW 18.74.023. 94-05-014 (Order 403B), § 246-915-085, filed 2/4/94, effective 3/7/94.]
(a) Have a bachelor's degree in physical therapy with all credits earned at an institution of higher learning that confers at least a bachelor's degree in physical therapy which is approved by the country's Ministry of Education/Health, or governmental entity;
(b) Have a valid, unencumbered license or authorization to practice physical therapy in the country in which the physical therapy education was obtained;
(c) Have graduated from a program of physical therapy education with requirements substantially equal to those required of graduates of board-approved programs;
(d) Submit an application for review by the board;
(e) Submit official transcripts from the physical therapy program showing degree date; and
(f) Submit transcripts, fees, and other documentation to a credentialing service approved by the board and request the evaluation report be sent directly to the board.
(2) In addition to the other requirements of this rule, the applicant must demonstrate a working knowledge of English by obtaining:
(a) Scores of at least:
(i) 4.5 on the test of written English (TWE);
(ii) 50 on the test of spoken English (TSE); and
(iii) 220 on the computer-based test of English as a foreign language (TOEFL) or 560 on the paper-based TOEFL; or
(b) Scores on the test of English as a foreign language (TOEFL) internet-based test (IBT) of at least:
(i) 24 on the writing section;
(ii) 26 on the speaking section;
(iii) 21 on the reading section;
(iv) 18 on the listening comprehension section; and
(v) 89 on the overall examination.
(3) The board may request additional supporting documentation as necessary.
(4) The degree's total credits must be at least one hundred twenty-three. A semester credit is equal to fifteen hours of classroom instruction per semester. For courses with a laboratory component, a semester credit is also equal to thirty hours of laboratory instruction per semester. (A semester credit equals 0.67 quarter credits.)
The applicant may meet the objective of one hundred twenty-three semester credits requirement by using additional elective credits in either general or professional education beyond the minimal requirements.
(5) Substantially equal physical therapy education as used in subsection (1)(c) of this section, shall include a total of one hundred twenty-three semester credits or equivalent credits of college education including:
General education - at least fifty-four semester credits:
(a) Humanities - nine semester credits which may include English, speech, foreign language, literature, music/art, philosophy and other humanities courses;
(b) Social sciences - ten semester credits which may include history, social sciences, philosophy, civilization, psychology, sociology, economics and other social science courses;
(c) Biological, natural, and physical science - eight semester credits which may include chemistry, mathematics, physics, biology, zoology, anatomy, kinesiology, physiology and other biological and natural science courses. In addition, the applicant must have one semester (five semester credits) of chemistry with laboratory and one semester (four semester credits) of physics with laboratory.
(6) Professional education. An applicant who has graduated from an unapproved school must complete at least sixty-nine semester credits in the following topics:
(a) Basic health sciences. At least one semester (at least four semester credits) in each of the following topics:
(i) Human anatomy (specific to physical therapy);
(ii) Human physiology (specific to physical therapy);
(iii) Neurological science;
(iv) Kinesiology or functional anatomy;
(v) Abnormal or developmental psychology; and
(vi) Pathology.
(b) Clinical sciences. The essential element of physical therapy education is teaching the student to assess and treat appropriately across the spectrum of age. Therefore, any educational course work should contain all of the following:
(i) Clinical medicine pertinent to physical therapy. Including, but not be limited to:
(A) Neurology;
(B) Orthopedics;
(C) Pediatrics;
(D) Geriatrics.
(ii) Physical therapy course work including, but not limited to:
(A) Physical agents;
(B) Musculoskeletal assessment and treatment;
(C) Neuromuscular assessment and treatment;
(D) Cardiopulmonary assessment and treatment;
(E) Wound debridement/wound care;
(F) Pharmacology.
(c) Clinical education. Clinical education must include demonstrated application of physical therapy theories, techniques, and procedures, as supervised by a physical therapist. The applicant must have at least two clinical affiliations of no less than eight hundred hours total.
(d) Related professional course work. The applicant must complete three semester courses in the following topics:
(i) Professional ethics;
(ii) Administration;
(iii) Community health;
(iv) Research;
(v) Educational techniques; and
(vi) Medical terminology.
(7) Applicants must have received a grade of "C" or higher in all professional education course work.
(8) 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.
(9) The board may allow applicants who have not graduated from a physical therapy program approved by the board to correct deficiencies by completing board-approved course work. To obtain course work preapproval, the applicant must submit a written request along with the course description/syllabus for the proposed course.
[Statutory Authority: RCW 18.74.023. 07-07-066, § 246-915-120, filed 3/15/07, effective 4/15/07; 94-05-014 (Order 403B), § 246-915-120, filed 2/4/94, effective 3/7/94; 93-04-081 (Order 328B), § 246-915-120, filed 2/1/93, effective 3/4/93; 92-08-039 (Order 259B), § 246-915-120, filed 3/24/92, effective 4/24/92; 91-02-011 (Order 103B), recodified as § 246-915-120, filed 12/21/90, effective 1/31/91; 84-13-057 (Order PL 471), § 308-42-125, filed 6/19/84.]
(a) Physical therapists are responsible for answering legitimate inquiries regarding a patient's physical dysfunction and treatment progress, and
(b) Information is to be provided by physical therapists and physical therapist assistants to insurance companies for billing purposes only.
(2) Physical therapists and physical therapist assistants are not to compensate or to give anything of value to a representative of the press, radio, television, or other communication medium in anticipation of, or in return for, professional publicity in a news item. A paid advertisement is to be identified as such unless it is apparent from the context it is a paid advertisement.
(3) It is the ((licensee's)) physical therapist's and
physical therapist assistant's responsibility to report any
unprofessional, incompetent or illegal acts that are in
violation of chapter 18.74 RCW or any rules established by the
board.
(4) It is the ((licensee's)) physical therapist's and
physical therapist assistant's responsibility to recognize the
boundaries of his or her own professional competencies and
that he or she uses only those in which he or she can prove
training and experience.
(5) Physical therapists and physical therapist assistants shall recognize the need for continuing education and shall be open to new procedures and changes.
(6) It is the ((licensee's)) physical therapist's and
physical therapist assistant's responsibility to represent his
or her academic credentials in a way that is not misleading to
the public.
(7) It is the responsibility of the physical therapist and physical therapist assistant to refrain from undertaking any activity in which his or her personal problems are likely to lead to inadequate performance or harm to a client and/or colleague.
(8) A physical therapist and physical therapist assistant shall not use or allow to be used any form of public communication or advertising connected with his or her profession or in his or her professional capacity as a physical therapist which:
(a) Is false, fraudulent, deceptive, or misleading;
(b) ((Uses testimonials;
(c))) Guarantees any treatment or result;
(((d))) (c) Makes claims of professional superiority.
(9) Physical therapists and physical therapist assistants are to recognize that each individual is different from all other individuals and to be tolerant of and responsive to those differences.
(10) Physical therapists shall not receive reimbursement for evaluating or treating him or herself.
(11) Physical therapists shall only delegate physical therapy tasks to trained supportive personnel as defined in WAC 246-915-010 (4)(a) and (b).
[Statutory Authority: RCW 18.74.023. 05-06-023, § 246-915-180, filed 2/22/05, effective 3/25/05; 92-08-039 (Order 259B), § 246-915-180, filed 3/24/92, effective 4/24/92; 91-05-094 (Order 144B), § 246-915-180, filed 2/20/91, effective 3/23/91; 91-02-011 (Order 103B), recodified as § 246-915-180, filed 12/21/90, effective 1/31/91; 84-13-057 (Order PL 471), § 308-42-150, filed 6/19/84.]
(2) Sexual contact or sexual activity is prohibited with a former client for two years after cessation or termination of professional services.
(3) The physical therapist and physical therapist assistant shall never engage in sexual contact or sexual activity with former clients if such contact or activity involves the abuse of the physical therapist-client relationship. Factors which the board may consider in evaluating if the physical therapist or physical therapist assistant-client relationship has been abusive includes, but is not limited to:
(a) The amount of time that has passed since therapy terminated;
(b) The nature and duration of the therapy;
(c) The circumstances of cessation or termination;
(d) The former client's personal history;
(e) The former client's current mental status;
(f) The likelihood of adverse impact on the former client and others; and
(g) Any statements or actions made by the physical therapist or physical therapist assistant during the course of therapy suggesting or inviting the possibility of a post termination sexual or romantic relationship with the former client.
(4) The physical therapist and physical therapist assistant shall never engage in sexually harassing or demeaning behavior with current or former clients.
(5) These rules do not prohibit:
(a) The provision of physical therapy services on an urgent, unforeseen basis where circumstances will not allow a physical therapist or physical therapist assistant to obtain reassignment or make an appropriate referral;
(b) The provision of physical therapy services to a spouse, or family member, or any other person who is in a preexisting, established relationship with the physical therapist or physical therapist assistant where no evidence of abuse of the physical therapist or physical therapist assistant-client relationship exists.
[Statutory Authority: RCW 18.74.023(3), 18.74.025, 18.130.050(1), and 18.130.180(24). 04-08-102, § 246-915-182, filed 4/6/04, effective 5/7/04.]
(2) Appropriate physical therapy services must be of such
a level of complexity and sophistication, or the condition of
the patient must be such, that the services required can be
safely and effectively performed only by a ((qualified))
physical therapist((,)) or physical therapist assistant under
supervision of a ((qualified)) physical therapist.
[Statutory Authority: RCW 18.74.023. 92-08-039 (Order 259B), § 246-915-185, filed 3/24/92, effective 4/24/92.]
(2) Physical therapists and physical therapist assistants who practice physical therapy as partners or in other business entities may pool fees and moneys received, either by the partnership or other entity, for the professional services furnished by any physical therapist or physical therapist assistant member or employee of the partnership or entity. Physical therapists and physical therapist assistants may divide or apportion the fees and moneys received by them, in the partnership or other business entity, in accordance with the partnership or other agreement.
(3) There shall be no rebate to any health care practitioner who refers or authorizes physical therapy treatment or evaluation as prohibited by chapter 19.68 RCW.
(4) Physical therapists and physical therapist assistants are not to influence patients to rent or purchase any items which are not necessary for the patient's care.
[Statutory Authority: RCW 18.74.023. 91-02-011 (Order 103B), recodified as § 246-915-190, filed 12/21/90, effective 1/31/91; 84-13-057 (Order PL 471), § 308-42-155, filed 6/19/84.]
(a) "Unprofessional conduct" as used in these regulations shall mean the conduct described in RCW 18.130.180.
(b) "Hospital" means any health care institution licensed pursuant to chapter 70.41 RCW.
(c) "Nursing home" means any health care institution which comes under chapter 18.51 RCW.
(d) "Home health agency" means a person administering or providing two or more home health services directly or through a contract arrangement to individuals in places of temporary or permanent residence. A person administering or providing nursing services only may elect to be designated a home health agency for purposes of licensure.
(e) "Board" means the physical therapy board((, whose
address is:)).
((Department of Health
P.O. Box 47868
Olympia, WA 98504-7868))
(f) "Physical therapist" means a person licensed
((pursuant to)) under chapter 18.74 RCW.
(g) "Physical therapist assistant" means a person licensed under chapter 18.74 RCW.
(h) "Mentally or physically disabled physical therapist or physical therapist assistant" means a physical therapist or physical therapist assistant who has either been determined by a court to be mentally incompetent or mentally ill or who is unable to practice physical therapy with reasonable skill and safety to patients by reason of any mental or physical condition.
(2) All reports required by WAC 246-915-220 through 246-915-280 shall be submitted to the board as soon as possible. A report shall contain the following information if known:
(a) The name, address and telephone number of the person making the report.
(b) The name and address and telephone numbers of the physical therapist or physical therapist assistant being reported.
(c) The case number of any patient whose treatment is a subject of the report.
(d) A brief description or summary of the facts which gave rise to the issuance of the report, including dates of occurrences.
(e) If court action is involved, the name of the court in which the action is filed along with the date of filing and docket number.
(f) Any further information which would aid the evaluation of the report.
[Statutory Authority: RCW 18.74.023(3) and 18.130.070. 04-08-100, § 246-915-210, filed 4/6/04, effective 5/7/04. Statutory Authority: RCW 18.74.023. 91-05-094 (Order 144B), § 246-915-210, filed 2/20/91, effective 3/23/91; 91-02-011 (Order 103B), recodified as § 246-915-210, filed 12/21/90, effective 1/31/91. Statutory Authority: RCW 18.130.070. 87-18-040 (Order PM 675), § 308-42-210, filed 8/28/87.]
(a) Another physical therapist or physical therapist assistant has committed unprofessional conduct under RCW 18.130.180, including violations of chapter 18.74 RCW and chapter 246-915 WAC; or
(b) A physical therapist or physical therapist assistant is unable to practice with reasonable skill and safety as the result of a physical or mental condition.
(2) Failure to comply with these reporting requirements may constitute a violation of laws which regulate the practice of physical therapy.
[Statutory Authority: RCW 18.74.023(3) and 18.130.070. 04-08-100, § 246-915-220, filed 4/6/04, effective 5/7/04. Statutory Authority: RCW 18.74.023. 91-02-011 (Order 103B), recodified as § 246-915-220, filed 12/21/90, effective 1/31/91. Statutory Authority: RCW 18.130.070. 87-18-040 (Order PM 675), § 308-42-220, filed 8/28/87.]
[Statutory Authority: RCW 18.74.023(3) and 18.130.070. 04-08-100, § 246-915-230, filed 4/6/04, effective 5/7/04. Statutory Authority: RCW 18.74.023. 91-02-011 (Order 103B), recodified as § 246-915-230, filed 12/21/90, effective 1/31/91. Statutory Authority: RCW 18.130.070. 87-18-040 (Order PM 675), § 308-42-230, filed 8/28/87.]
(1) Demonstrated incompetence or acted with negligence in the practice of physical therapy;
(2) Has engaged in unprofessional conduct under RCW 18.130.180; or
(3) Is mentally or physically unable to perform as a physical therapist or physical therapist assistant. The report shall be made regardless to whether the physical therapist or physical therapist assistant appeals, accepts or acts upon the determination made by the association or society. Any notification of appeals shall be included with the report.
[Statutory Authority: RCW 18.74.023(3) and 18.130.070. 04-08-100, § 246-915-240, filed 4/6/04, effective 5/7/04. Statutory Authority: RCW 18.74.023. 91-02-011 (Order 103B), recodified as § 246-915-240, filed 12/21/90, effective 1/31/91. Statutory Authority: RCW 18.130.070. 87-18-040 (Order PM 675), § 308-42-240, filed 8/28/87.]
[Statutory Authority: RCW 18.74.023(3) and 18.130.070. 04-08-100, § 246-915-250, filed 4/6/04, effective 5/7/04. Statutory Authority: RCW 18.74.023. 91-02-011 (Order 103B), recodified as § 246-915-250, filed 12/21/90, effective 1/31/91. Statutory Authority: RCW 18.130.070. 87-18-040 (Order PM 675), § 308-42-250, filed 8/28/87.]
[Statutory Authority: RCW 18.74.023(3) and 18.130.070. 04-08-100, § 246-915-260, filed 4/6/04, effective 5/7/04. Statutory Authority: RCW 18.74.023. 91-02-011 (Order 103B), recodified as § 246-915-260, filed 12/21/90, effective 1/31/91. Statutory Authority: RCW 18.130.070. 87-18-040 (Order PM 675), § 308-42-260, filed 8/28/87.]
[Statutory Authority: RCW 18.74.023(3) and 18.130.070. 04-08-100, § 246-915-270, filed 4/6/04, effective 5/7/04. Statutory Authority: RCW 18.74.023. 91-02-011 (Order 103B), recodified as § 246-915-270, filed 12/21/90, effective 1/31/91. Statutory Authority: RCW 18.130.070. 87-18-040 (Order PM 675), § 308-42-270, filed 8/28/87.]
(1) Demonstrated incompetence or acted with negligence in the practice of physical therapy;
(2) Has engaged in unprofessional conduct under RCW 18.130.180; or
(3) Is mentally or physically unable to perform as a physical therapist or physical therapist assistant. Whenever such a physical therapist or physical therapist assistant has been judged to have demonstrated his/her incompetency or negligence in the practice of physical therapy, or has otherwise committed unprofessional conduct; or is a mentally or physically disabled physical therapist or physical therapist assistant.
[Statutory Authority: RCW 18.74.023(3) and 18.130.070. 04-08-100, § 246-915-280, filed 4/6/04, effective 5/7/04. Statutory Authority: RCW 18.74.023. 91-02-011 (Order 103B), recodified as § 246-915-280, filed 12/21/90, effective 1/31/91. Statutory Authority: RCW 18.130.070. 87-18-040 (Order PM 675), § 308-42-280, filed 8/28/87.]
[Statutory Authority: RCW 18.74.023. 91-14-006 (Order 178B), § 246-915-300, filed 6/21/91, effective 7/22/91.]
(2) "Contract" is a comprehensive, structured agreement between the recovering physical therapist or physical therapist assistant and the approved monitoring program stipulating the physical therapist's or physical therapist assistant's consent to comply with the monitoring program and its required components of the physical therapist's or physical therapist assistant's recovery activity.
(3) "Approved treatment facility" is a facility approved by the bureau of alcohol and substance abuse, department of social and health services according to RCW 70.96A.020(2) or 69.54.030 to provide intensive alcoholism or drug treatment if located within Washington state. Drug and alcohol treatment programs located out-of-state must be equivalent to the standards required for approval under RCW 70.96A.020(2) or 69.54.030.
(4) "Substance abuse" means the impairment, as determined by the board, of a physical therapist's or physical therapist assistant's professional services by an addiction to, a dependency on, or the use of alcohol, legend drugs, or controlled substances.
(5) "Aftercare" is that period of time after intensive treatment that provides the physical therapist or physical therapist assistant and the physical therapist's or physical therapist assistant's family with group or individual counseling sessions, discussions with other families, ongoing contact and participation in self-help groups and ongoing continued support of treatment program staff.
(6) "Support group" is a group of health care professionals meeting regularly to support the recovery of its members. The group provides a confidential setting with a trained and experienced health care professional facilitator in which physical therapists or physical therapist assistants may safely discuss drug diversion, licensure issues, return to work and other professional issues related to recovery.
(7) "Twelve steps groups" are groups such as alcoholics anonymous, narcotics anonymous, and related organizations based on a philosophy of anonymity, belief in a power outside of oneself, a peer group association, and self-help.
(8) "Random drug screens" are laboratory tests to detect the presence of drugs of abuse in body fluids which are performed at irregular intervals not known in advance by the person being tested.
(9) "Health care professional" is an individual who is licensed, certified or registered in Washington to engage in the delivery of health care to patients.
[Statutory Authority: RCW 18.74.023. 91-14-006 (Order 178B), § 246-915-310, filed 6/21/91, effective 7/22/91.]
(1) The approved monitoring program will not provide evaluation or treatment to the participating physical therapists or physical therapist assistants.
(2) The approved monitoring program staff must have the qualifications and knowledge of both substance abuse and the practice of physical therapy as defined in this chapter to be able to evaluate:
(a) Clinical laboratories;
(b) Laboratory results;
(c) Providers of substance abuse treatment, both individuals and facilities;
(d) Support groups;
(e) The physical therapy work environment; and
(f) The ability of the physical therapist or physical therapist assistant to practice with reasonable skill and safety.
(3) The approved monitoring program will enter into a contract with the physical therapist or physical therapist assistant and the board to oversee the physical therapist's or physical therapist assistant's compliance with the requirements of the program.
(4) The approved monitoring program may make exceptions to individual components of the contract on an individual basis.
(5) The approved monitoring program staff will determine, on an individual basis, whether a physical therapist or physical therapist assistant will be prohibited from engaging in the practice of physical therapy for a period of time and restrictions, if any, on the physical therapist's or physical therapist assistant's access to controlled substances in the work place.
(6) The approved monitoring program shall maintain records on participants.
(7) The approved monitoring program will be responsible for providing feedback to the physical therapist or physical therapist assistant as to whether treatment progress is acceptable.
(8) The approved monitoring program shall report to the board any physical therapist or physical therapist assistant who fails to comply with the requirement of the monitoring program.
(9) The approved monitoring program shall receive from the board guidelines on treatment, monitoring, and limitations on the practice of physical therapy for those participating in the program.
[Statutory Authority: RCW 18.74.023. 91-14-006 (Order 178B), § 246-915-320, filed 6/21/91, effective 7/22/91.]
(a) The physical therapist or physical therapist assistant shall undergo a complete physical and psychosocial evaluation before entering the approved monitoring program. This evaluation will be performed by health care professional(s) with expertise in chemical dependency. The person(s) performing the evaluation shall not also be the provider of the recommended treatment.
(b) The physical therapist or physical therapist assistant shall enter into a contract with the board and the approved substance abuse monitoring program to comply with the requirements of the program which shall include, but not be limited to:
(i) The physical therapist or physical therapist assistant will undergo intensive substance abuse treatment in an approved treatment facility.
(ii) The physical therapist or physical therapist assistant will agree to remain free of all mind-altering substances including alcohol except for medications prescribed by an authorized prescriber, as defined in RCW 69.41.030 and 69.50.101.
(iii) The physical therapist or physical therapist assistant must complete the prescribed aftercare program of the intensive treatment facility, which may include individual and/or group psychotherapy.
(iv) The physical therapist or physical therapist assistant must cause the treatment counselor(s) to provide reports to the approved monitoring program at specified intervals. Reports shall include treatment, prognosis and goals.
(v) The physical therapist or physical therapist assistant will submit to random drug screening as specified by the approved monitoring program.
(vi) The physical therapist or physical therapist assistant will attend support groups facilitated by a health care professional and/or twelve step group meetings as specified by the contract.
(vii) The physical therapist or physical therapist assistant will comply with specified employment conditions and restrictions as defined by the contract.
(viii) The physical therapist or physical therapist assistant shall sign a waiver allowing the approved monitoring program to release information to the board if the physical therapist or physical therapist assistant does not comply with the requirements of this contract.
(c) The physical therapist or physical therapist assistant is responsible for paying the costs of the physical and psychosocial evaluation, substance abuse treatment, and random drug screens.
(d) The physical therapist or physical therapist assistant may be subject to disciplinary action under RCW 18.130.160 if the physical therapist or physical therapist assistant does not consent to be referred to the approved monitoring program, does not comply with specified employment restrictions, or does not successfully complete the program.
(2) A physical therapist or physical therapist assistant who is not being investigated by the board or subject to current disciplinary action or currently being monitored by the board for substance abuse may voluntarily participate in the approved substance abuse monitoring program without being referred by the board. Such voluntary participants shall not be subject to disciplinary action under RCW 18.130.160 for their substance abuse, and shall not have their participation made known to the board if they meet the requirements of the approved monitoring program:
(a) The physical therapist or physical therapist assistant shall undergo a complete physical and psychosocial evaluation before entering the approved monitoring program. This evaluation will be performed by health care professional(s) with expertise in chemical dependency. The person(s) performing the evaluation shall not also be the provider of the recommended treatment.
(b) The physical therapist or physical therapist assistant shall enter into a contract with the approved substance abuse monitoring program to comply with the requirements of the program which shall include, but not be limited to:
(i) The physical therapist or physical therapist assistant will undergo intensive substance abuse treatment in an approved treatment facility.
(ii) The physical therapist or physical therapist assistant will agree to remain free of all mind-altering substances including alcohol except for medications prescribed by an authorized prescriber, as defined in RCW 69.41.030 and 69.50.101.
(iii) The physical therapist or physical therapist assistant must complete the prescribed aftercare program of the intensive treatment facility, which may include individual and/or group psychotherapy.
(iv) The physical therapist or physical therapist assistant must cause the treatment counselor(s) to provide reports to the approved monitoring program at specified intervals. Reports shall include treatment, prognosis and goals.
(v) The physical therapist or physical therapist assistant will submit to random drug screening as specified by the approved monitoring program.
(vi) The physical therapist or physical therapist assistant will attend support groups facilitated by a health care professional and/or twelve step group meetings as specified by the contract.
(vii) The physical therapist or physical therapist assistant will comply with employment conditions and restrictions as defined by the contract.
(viii) The physical therapist or physical therapist assistant shall sign a waiver allowing the approved monitoring program to release information to the board if the physical therapist or physical therapist assistant does not comply with the requirements of this contract.
(c) The physical therapist or physical therapist assistant is responsible for paying the costs of the physical and psychosocial evaluation, substance abuse treatment, and random drug screens.
(3) The treatment and pretreatment records of license holders referred to or voluntarily participating in approved monitoring programs shall be confidential, shall be exempt from RCW 42.17.250 through 42.17.450 and shall not be subject to discovery by subpoena or admissible as evidence except for monitoring records reported to the disciplinary authority for cause as defined in subsections (1) and (2) of this section. Records held by the board under this section shall be exempt from RCW 42.17.250 through 42.17.450 and shall not be subject to discovery by subpoena except by the license holder.
[Statutory Authority: RCW 18.74.023. 91-14-006 (Order 178B), § 246-915-330, filed 6/21/91, effective 7/22/91.]
(2) Practitioners with an inactive credential for three years or less who wish to return to active status must meet the requirements of chapter 246-12 WAC, Part 4.
(3) Practitioners with an inactive credential for more than three years, who have been in active practice in another United States jurisdiction, and wish to return to active status must:
(a) Submit verification of active practice from any other United States jurisdiction; and
(b) Meet the requirements of chapter 246-12 WAC, Part 4.
(4) Practitioners with an inactive credential for more than three years, who have not been in active practice in another United States jurisdiction, and wish to return to active status must:
(a) Successfully pass the examination as provided in RCW 18.74.035. The board may waive reexamination if the practitioner presents evidence of continuing competency satisfactory to the board; and
(b) Must meet the requirements of chapter 246-12 WAC, Part 2.
[Statutory Authority: RCW 18.74.073. 05-09-003, § 246-915-350, filed 4/7/05, effective 5/8/05.]
(1) Complete the application process including payment of fees; and
(2) Submit proof of graduation from a physical therapist assistant education program accredited by a national accreditation agency approved by the board at the time of graduation. 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 or a United States military physical therapy technician program that is substantially equivalent to an accredited United States physical therapist assistant program; and
(3) Provide verification of graduation on or before June 30, 2007 and verification of work experience within the last five years as a PTA in a physical therapy setting under the supervision of a licensed physical therapist legally able to practice in Washington.
[]
The following section of the Washington Administrative Code is repealed:
| WAC 246-915-160 | Responsibilities of supervision. |