WSR 15-14-093

PERMANENT RULES

DEPARTMENT OF HEALTH

(Board of Physical Therapy)

[Filed June 29, 2015, 4:19 p.m., effective July 1, 2015]

Effective Date of Rule: July 1, 2015.

Other Findings Required by Other Provisions of Law as Precondition to Adoption or Effectiveness of Rule: The board of physical therapy (board) and the department of health must begin implementing rules under ESHB 2160 (chapter 116, Laws of 2014) no later than July 1, 2015.

Purpose: Chapter 246-915 WAC, Physical therapists (PT) and physical therapist assistants (PTA). The PT board is adopting rules to identify the qualifications required for a licensed PT to receive a spinal manipulation endorsement, and the duties of a clinical supervisor. The PT board is also amending rules to identify a one-time, three hour training for suicide screening and referral, and the standards a program must meet to qualify as a suicide prevention training program.

Citation of Existing Rules Affected by this Order: Amending WAC 246-915-085.

Statutory Authority for Adoption: RCW 18.74.023 and 43.70.442.

Adopted under notice filed as WSR 15-09-110 on April 21, 2015.

Changes Other than Editing from Proposed to Adopted Version:

WAC 246-915-085(2) Continuing competency and 246-915-086 (1)(a) Suicide assessment training standards (new section):

Proposed language: WAC 246-915-085(2) delete "risk assessment," a term used to describe all elements of suicide prevention training per ESHB 2315 (2014) as well as ESHB 1424 (2015).

WAC 246-915-086 (1)(a) delete "risk assessment" a term used referring to all elements of suicide prevention training per ESHB 2315 (2014) as well as ESHB 1424 (2015).

Adopted language: WAC 246-915-085(2), the term, "risk assessment" was deleted. It reads as, "Physical therapists are required to complete a one-time training in suicide assessment that includes screening and referral elements appropriate for this profession."

WAC 246-915-086 (1)(a), the term, "risk assessment" was deleted. It reads as, "Be an empirically supported training in suicide assessment that includes screening and referral;".

The board received feedback to remove the term "risk assessment" when describing the training elements required of PTs and PTAs by ESHB 2315 (2014) and ESHB 1424 (2015). The board agreed to remove the term "risk assessment" since PTs and PTAs are only required to do a three-hour, one-time training that is to include screening and referral elements only. Making this change was deemed to provide clarity and meet the intent of the statute.

WAC 246-915-085(2) Continuing competency:

Proposed language: WAC 246-915-085(2), replace 2014 legislation terminology as stated in the CR-102 proposed amendment language with 2015 legislation terminology that pertains to when providers are required to complete their one-time training. Delete "A physical therapist or physical therapy assistant must complete a one-time training required by this section during the first full continued competency reporting period after initial licensure, whichever occurs later," and replace with, "A physical therapist or physical therapy assistant must complete a one-time training by the end of the first full continued competency reporting period after January 1, 2016, or during the first full continued competency reporting period after initial licensure, whichever is later."

Adopted language: WAC 246-915-085(2), "A physical therapist or physical therapy assistant must complete a one-time training by the end of the first full continued competency reporting period after January 1, 2016, or during the first full continued competency reporting period after initial licensure, whichever is later." This language is taken from ESHB 1424 from the 2015 legislative session, which replaces language from ESHB 2315 from the 2014 legislative session.

The department received feedback to replace the terminology in the CR-102 proposed rules that referenced ESHB 2315 timeframes with more current timeframes referenced in ESHB 1424 from the 2015 legislative session. The board agreed to add this language since it is in the most recent legislation and statute defining when PTs and PTAs may take the one-time training.

WAC 246-915-381 (1)(d)(ii) Spinal manipulation—Endorsement:

Proposed language: WAC 246-915-381 (1)(d)(ii), delete the term, " … as defined in RCW 18.74.010" in the sentence that read, "Be under the close supervision of the clinical supervisor for a minimum of the first one hundred fifty hours of the supervised clinical practical experience, after which the supervised clinical practical experience must be under the direct supervision of the clinical supervisor as defined in RCW 18.74.010."

Adopted language: WAC 246-915-381 (1)(d)(ii), the phrase was deleted. The revised sentence reads as, "Be under the close supervision of the clinical supervisor for a minimum of the first one hundred fifty hours of the supervised clinical practical experience, after which the supervised clinical practical experience must be under the direct supervision of the clinical supervisor."

The board received a comment to remove the reference to RCW 18.74.010 in the sentence that read, "Be under the close supervision of the clinical supervisor for a minimum of the first one hundred fifty hours of the supervised clinical practical experience, after which the supervised clinical practical experience must be under the direct supervision of the clinical supervisor as defined in RCW 18.74.010." The board agreed to remove the term since the board will be undergoing an entire chapter review later in the year and will be adding definitions in which the requirements of RCW 18.74.010 can be addressed in rule at that time.

WAC 246-916-382 Spinal manipulation—Clinical supervisor:

Proposed language: WAC 246-915-382, delete the entire first paragraph under WAC 246-915-382 that was in the CR-102 proposed rule language. The paragraph in the CR-102 language reads as, "To qualify as a clinical supervisor under WAC 246-915-380 (1)(d)(i)(C), a person must be a licensed physical therapist who holds an endorsement or advanced certification for which the training requirements are commensurate with the training requirements in WAC 246-915-380 (1)(a) through (d). A clinical supervisor must provide direct and close supervision per the definitions in RCW 18.74.010, and the clinical supervisor under WAC 246-915-380 (1)(d)(i)(C) must have at least one of these credentials." Also add to the section title, "Effective July 1, 2015, until June 30, 2020."

Adopted language: WAC 246-915-382, some sentences within the first paragraph were removed. The adopted language reads as, "To qualify as a clinical supervisor under WAC 246-915-380 (1)(d)(i)(C), a person must be a licensed physical therapist who holds an endorsement or advanced certification for which the training requirements are commensurate with the training requirements in WAC 246-915-380 (1)(a) through (d) and have at least one of the following credentials.["] The following information was also added to the section title, "Effective July 1, 2015, until June 30, 2020."

The board received a comment to remove the entire first paragraph under WAC 246-915-382 Spinal manipulation, because language in the proposed CR-102 rules is confusing the difference between qualification for the applicant to qualify as a clinical supervisor versus the requirement for being a clinical supervisor. The board agreed to remove some of the sentences in the first paragraph - not the entire paragraph. Finally, the board agreed to add reference to the effective date of this section for clinical supervisor in the title of the section. The board cited these revisions comply with the intent of the law and provide clarity regarding clinical supervisor requirements.

A final cost-benefit analysis is available by contacting Kris Waidely, P.O. Box 47852, Olympia, WA 98504-7852, phone (360) 236-4847, fax (360) 236-2901, e-mail Kris.waidely@doh.wa.gov.

Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 4, Amended 1, Repealed 0.

Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.

Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.

Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 4, Amended 1, Repealed 0.

Date Adopted: June 1, 2015.

Robert Schmidt, PT, DPT, Chair

Board of Physical Therapy

AMENDATORY SECTION (Amending WSR 08-17-026, filed 8/13/08, effective 8/13/08)

WAC 246-915-085 Continuing competency.

Licensed physical therapists and physical therapist assistants must provide evidence of continuing competency in the form of continuing education and employment related to physical therapy every two years.

(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))).

(2) Physical therapists and physical therapist assistants are required to complete a one-time training in suicide assessment that includes screening and referral elements appropriate for this profession. The training must be at least three hours in length and must meet the requirements for training per WAC 246-915-086.

A physical therapist or physical therapist assistant must complete a one-time training by the end of the first full continued competency reporting period after January 1, 2016, or during the first full continued competency reporting period after initial licensure, whichever is later. Training completed between June 12, 2014, and January 1, 2016, that meets the requirements of this section will be accepted as meeting the one-time training requirements.

(3) Acceptable continuing education specifically relating to the practice of physical therapy((;

(b))) includes, but is not limited to, the following:

(a) Participation in a course with specific goals and objectives relating to the practice of physical therapy;

(((c))) (b) 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))) (c) Correspondence course work completed.

(((2))) (4) A physical therapist with a spinal manipulation endorsement must complete at least ten hours of continuing education per continuing competency reporting period directly related to spinal manipulation. At least five hours of the training must be related to procedural technique and application of spinal manipulation.

(5) In addition to the ((requirements in subsection (1) of this section,)) required continuing education hours, physical therapists and physical therapist assistants must complete 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;

(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)) (6) Licensed physical therapists and physical therapist assistants 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.

NEW SECTION

WAC 246-915-086 Suicide assessment training standards.

(1) A qualifying training in suicide assessment must:

(a) Be an empirically supported training in suicide assessment that includes screening and referral;

(b) Be provided by a single provider and must be at least three hours in length which may be provided in one or more sessions.

(2) The hours spent completing a training program in suicide assessment under this section count toward meeting any applicable continued competency requirements.

NEW SECTION

WAC 246-915-380 Spinal manipulation—Endorsement. (Effective July 1, 2015, until June 30, 2020.)

(1) A physical therapist may perform spinal manipulation only after being issued a spinal manipulation endorsement by the secretary. The secretary, upon approval by the board, shall issue an endorsement to a physical therapist who has at least one year of full-time, orthopedic, postgraduate practice experience that consists of direct patient care, averaging at least thirty-six hours a week, and who provides evidence in a manner acceptable to the board of all of the following additional requirements:

(a) Training in differential diagnosis of no less than one hundred hours outlined within a course curriculum;

(b) Didactic and practical training related to the delivery of spinal manipulative procedures of no less than two hundred fifty hours clearly delineated and outlined in a course curriculum;

(c) Specific training in spinal diagnostic imaging of no less than one hundred fifty hours outlined in a course curriculum; and

(d) At least three hundred hours of supervised clinical practical experience in spinal manipulative procedures. The supervised clinical practical experience must:

(i) Be supervised by a clinical supervisor who:

(A) Holds a spinal manipulation endorsement under this section;

(B) Is a licensed chiropractor or osteopathic physician and surgeon; or

(C) Holds an endorsement or advanced certification the training requirements for which are commensurate with the training requirements as specified in WAC 246-915-382;

(ii) Be under the close supervision of the clinical supervisor for a minimum of the first one hundred fifty hours of the supervised clinical practical experience, after which the supervised clinical practical experience must be under the direct supervision of the clinical supervisor;

(iii) Be completed within eighteen months of completing the educational requirements in (a) through (c) of this subsection, unless the physical therapist has completed the educational requirements in (a) through (c) of this subsection prior to July 1, 2015, in which case the supervised clinical practical experience must be completed by January 1, 2017.

(2) A physical therapist holding a spinal manipulation endorsement under subsection (1) of this section shall consult with a health care practitioner, other than a physical therapist, authorized to perform spinal manipulation if spinal manipulative procedures are required beyond six treatments.

(3) A physical therapist holding a spinal manipulation endorsement under subsection (1) of this section may not:

(a) Have a practice in which spinal manipulation constitutes the majority of the services provided;

(b) Practice or utilize chiropractic manipulative therapy in any form;

(d) Bill a health carrier for spinal manipulation separately from, or in addition to, other physical therapy procedures.

(4) A physical therapist holding a spinal manipulation endorsement under this section shall complete continuing education directly related to spinal manipulation as specified in WAC 246-915-085.

(5) If a physical therapist is intending to perform spinal manipulation on a patient who the physical therapist knows is being treated by a chiropractor for the same diagnosis, the physical therapist shall make reasonable efforts to coordinate patient care with the chiropractor to prevent conflict or duplication of services.

NEW SECTION

WAC 246-915-381 Spinal manipulation—Endorsement. (Effective July 1, 2020.)

(1) A physical therapist may perform spinal manipulation only after being issued a spinal manipulation endorsement by the secretary. The secretary, upon approval by the board, shall issue an endorsement to a physical therapist who has at least one year of full-time, orthopedic, postgraduate practice experience that consists of direct patient care and averages at least thirty-six hours a week and who provides evidence in a manner acceptable to the board of all of the following additional requirements:

(a) Training in differential diagnosis of no less than one hundred hours outlined within a course curriculum;

(b) Didactic and practical training related to the delivery of spinal manipulative procedures of no less than two hundred fifty hours clearly delineated and outlined in a course curriculum;

(c) Specific training in spinal diagnostic imaging of no less than one hundred fifty hours outlined in a course curriculum; and

(d) At least three hundred hours of supervised clinical practical experience in spinal manipulative procedures. The supervised clinical practical experience must:

(i) Be supervised by a clinical supervisor who:

(A) Holds a spinal manipulation endorsement under this section; or

(B) Is a licensed chiropractor or osteopathic physician and surgeon;

(3) A physical therapist holding a spinal manipulation endorsement under subsection (1) of this section may not:

(a) Have a practice in which spinal manipulation constitutes the majority of the services provided;

(b) Practice or utilize chiropractic manipulative therapy in any form;

(d) Bill a health carrier for spinal manipulation separately from, or in addition to, other physical therapy procedures.

(4) A physical therapist holding a spinal manipulation endorsement under this section shall complete continuing education directly related to spinal manipulation as specified in WAC 246-915-085.

NEW SECTION

WAC 246-915-382 Spinal manipulation—Clinical supervisor. (Effective July 1, 2015, until June 30, 2020.)

To qualify as a clinical supervisor under WAC 246-915-380 (1)(d)(i)(C), a person must be a licensed physical therapist who holds an endorsement or advanced certification for which the training requirements are commensurate with the training requirements in WAC 246-915-380 (1)(a) through (d) and have at least one of the following credentials:

(1) Orthopedic Manual Therapy Fellowship/Fellow American Academy of Orthopedic Manual Physical Therapy designation trained under an American Board of Physical Therapy residencies and Fellowship Education.

(2) Orthopedic Physical Therapy Residency trained under an American Board of Physical Therapy residencies and Fellowship Education credentialed program.

(3) Orthopedic Certified Specialist/Orthopedic Clinical Specialist designation (American Board of Physical Therapy Specialties).

(4) Orthopedic manual physical therapy certification as a:

(a) Certified Functional Manual Therapist at the Institute of Physical Art; or

(b) Certified Manual Physical Therapist at the North American Institute of Orthopaedic Manual Therapy; or

(i) Maitland Australian Physiotherapy Seminars; or

(ii) North American Institute of Orthopaedic Manual Therapy; or

(iii) Ola Grimsby Institute; or

(d) Therapist with a Manual Therapy Certification from:

(i) Evidence in Motion; or

(ii) The University of St. Augustine for Health Sciences; or

(e) Other certifications approved by the board.