Jurisprudence: The Legal Basis of Physical Therapy Practice

Transcription

1 Jurisprudence: The Legal Basis of Physical Therapy Practice 2016

2 Tennessee Physical Therapy Association Jurisprudence: The Legal Basis of Physical Therapy Practice Table of Contents Jurisprudence Slides... 1 Physical Therapy Practice Act APTA Code of Ethics APTA Standards of Ethical Conduct for the Physical Therapist Assistant Ten Tips for Protecting Your Practice Resources and References Post-test Course Objectives Describe the purpose of the Practice Act, Rules, and Board of Physical Therapy Policy Statements Explain the rules related to continuing competence, license renewal, and the licensure process Describe the Practice Act and Rules related to the scope of practice and disclosures to patients Describe offenses that may lead to disciplinary action Explain the rules of supervision for Physical Therapist Assistants, Physical Therapy assistive personnel, and others (students, volunteers) The Code of Ethics for the Physical Therapist and the Standards of Ethical Conduct for the Physical Therapist Assistant are reprinted with permission of the American Physical Therapy Association. This material is copyrighted, and any further reproduction or distribution is prohibited.

3 7/6/2016 JURISPRUDENCE: THE LEGAL BASIS OF PHYSICAL THERAPY PRACTICE Did You Know that in Tennessee PTs & PTAs have received the following disciplinary actions on their licenses: Letters of reprimand CEU requirements from hours in ethics, jurisprudence, documentation, supervision, & Medicare regulations Quarterly performance reports from their supervisor to the licensing board Did You Know that in Tennessee PTs & PTAs have received the following disciplinary actions on their licenses: Civil penalties (fines) from $500 to $2,000 Probation from 1-5 years License suspended up to 2 years License revoked If You Want to Know More Anyone can go online and view a listing of the monthly disciplinary actions taken by health related boards at: Licensure Verification NAME SOMEWHERE, TN Profession: Physical Therapist Rank: Physical Therapist NAME SOMEWHERE ELSE, TN Profession: Physical Therapist Rank: Physical Therapist License Number: XXXX Status: Active Original Date: mo/da/year Expiration Date: mo/da/year License Number: 0000 Status: Active Original Date: mo/da/year Expiration Date: mo/da/year View: Practitioner Profile View: Practitioner Profile Adverse Licensure Actions Good Reasons to Study the Law To legally support the decisions you make associated with physical therapy practice To avoid finding yourself in violation of the law because I just didn t know! Educate others about the practice of physical therapy 1

4 7/6/2016 The Practice Act The Practice Act is the law that governs physical therapy practice Passed by the state legislature Defines who can practice physical therapy Defines the legal scope of practice The Rules The Rules Governing the Practice of Physical Therapy is a companion document to the Practice Act The licensing board writes the rules to interpret and clarify the Practice Act Defines the standards of practice Accountability PTs and PTAs licensed in Tennessee are accountable to both: Practice Act Rules The purpose of the Practice Act and Rules is to protect the public Board of Physical Therapy Typically, it is referred to as the Licensing Board It is an entity of the state of Tennessee TPTA and the Board of Physical Therapy are NOT the same organization. Members are appointed by the Governor 3 PTs, 1 PTA, 1 member of the public 2

5 7/6/2016 Board of Physical Therapy Regulates the practice of physical therapy according to the terms of the Practice Act and the Rules Reviews qualifications & issues licenses Interprets issues related to practice Takes disciplinary action Board Administrator Works for the state of Tennessee Administers the day to day operations of the board Must follow procedures established by board Cannot make policy or interpret issues More Accountability In addition to the Practice Act and Rules, PTs and PTAs are accountable to Board of Physical Therapy Policies Board of Physical Therapy Policies From time to time, the Board of Physical Therapy develops policies that attempt to clarify issues regarding the practice of physical therapy. These policies assist in interpreting the Practice Act and Rules. Board of Physical Therapy Policies Renewal for Licensees Called to Active Military Duty ( ): Special consideration for license renewal for military personnel called to active duty Multidisciplinary Health Screening ( ): Health screenings outside the scope of practice are unsafe to the public & may subject the licensee to disciplinary action. Board of Physical Therapy Policies Lapsed License ( ): If the license is not renewed, a PT or PTA may not practice legally after the expiration date If the license has been expired for less than 30 days, you may apply for reinstatement of your license (Regular Renewal Fee, Late Renewal Fee, & Reinstatement Fee) 3

6 7/6/2016 Board of Physical Therapy Policies Lapsed License ( ): If you keep practicing from 30 days to 6 months: You will receive a citation which is reported as a disciplinary action on your practitioner profile You may apply for reinstatement of license (Regular Renewal Fee, Late Renewal Fee, Reinstatement Fee, and a fine of $250 per month) Board of Physical Therapy Policies Lapsed License ( ): If you practice more than 6 months after the expiration date, your case will go to the office of investigations as a complaint of unlicensed practice and will be handled by the Office of General Counsel Board of Physical Therapy Policies Other Consequences of a Lapsed License Medicare rules require that physical therapy be rendered by a licensed PT or PTA Healthcare facility may have to pay money back to Medicare for services the PT/PTA rendered because they were practicing without a license Unhappy employer -??? Your job security??? Board of Physical Therapy Policies Home Health Aides ( ): The monitoring of home health aides by physical therapy practitioners is not in itself a violation of the physical therapy practice act and rules if no other ethical or practice violations are present. Board of Physical Therapy Policies Patient Referrals for Physical Therapy (2-2-01): PTs may receive referrals from physician assistants and nurse practitioners. These practitioners can only refer per the physician s protocol and their referrals are considered orders of the supervising physician. Board of Physical Therapy Policies Fingerstick Techniques ( ): Performing fingerstick techniques (such as glucometer readings, coumadin readings, etc.) is within the scope of practice of a PT or PTA, so long as such activities are performed and called for during the course of the practice of physical therapy as provided under the Practice Act. 4

7 7/6/2016 Board of Physical Therapy Policies Continuing Competence ( ) Failure to comply with the requirement: If a PT has at least 8 hours or a PTA has at least 5 hours: 1. Civil penalty of $100 per hour he/she is lacking and must be paid within 30 days 2. Make up the deficient hours within 60 days Board of Physical Therapy Policies Continuing Competence ( ) Failure to comply with the requirement: If a PT has less than 8 hours or a PTA has less than 5 hours: 1. Civil penalty of $100 per hour he/she is lacking and must be paid within 30 days 2. Make up the deficient hours within 60 days 3. License will be suspended at least 45 days & will continue to be suspended until hours are made up Continuing Competence Planned learning experiences which occur beyond the entry level educational requirement for PTs & PTAs Content must relate to physical therapy intervention, examination, research, documentation, education, management Continuing Competence Hours are required for the twenty-four (24) months that precede the licensure renewal month. Purpose is to assure safe & effective practice Continuing Competence PTs 30 hours At least 20 hours from Class I activities Only 10 hours may be acquired online PTAs 30 hours At least 20 hours from Class I activities Only 10 hours may be acquired online Continuing Competence Ethics & Jurisprudence Requirement PTs & PTAs 4 hours of Ethics and Jurisprudence (counts as Class I) For current licensees, required every license renewal cycle For new licensees, within the initial period of licensure before the first renewal & then go to every license renewal cycle 5

8 7/6/2016 Continuing Competence Transition Period for New Requirements If your next license renewal date occurs from now until June 30, 2017, the old rules will apply If your next license renewal date occurs on or after July 1, 2017, the new rules will apply Continuing Competence Class I Activities External & internal peer review Approved continuing education courses (APTA or its sections, TPTA, accredited TN PT or PTA schools) University credit courses Present continuing education courses Author peer reviewed research Adjunct teaching in PT or PTA program Continuing Competence Class I Activities Clinical specialist certification or recertification by the American Board of Physical Therapy Specialties Other clinical specialist certification (McKenzie, NDT, Ola Grimsby, etc.) Advanced degree Clinical residency program GCS Continuing Competence Class II activities Self-instruction reading literature Attend educational sessions that do not meet Class I criteria Clinical instructor Study group participation Attend or present in-services APTA service delegate, committee, board, task force Continuing Competence Unacceptable activities CPR, OSHA, TOSHA, & safety courses Meetings for policy decisions Non-educational sessions or entertainment activities at professional meetings Visiting exhibits at conferences Continuing Competence Documentation must be retained for 5 years after completion of requirements Examples of documentation may be found in Rule (8) (d) You do not have to submit documentation every time you renew your license The Board of Physical Therapy randomly audits 5% of the renewals each month to verify compliance 6

9 7/6/2016 Retirement of License May apply to convert an active license to inactive (retired) status Cannot practice PT or imply that you are actively licensed in Tennessee Do not have to pay renewal fee Reactivation of License Submit a written request Fees for renewal & reinstatement Complete the continuing competence requirements Board of Physical Therapy has the discretion to require additional education, supervised clinical practice, or successful passage of licensure examination Use of Direct Thrust Scope of Practice Use of Direct Thrust Direct Access Provisions The scope of practice of physical therapy shall not include the performance of treatment where the PT or PTA uses direct thrust to move a joint of the patient s spine beyond its normal range of motion without exceeding the limits of anatomical integrity. Dry Needling Direct Access Provisions PTs must practice with a referral from a doctor of: Medicine Chiropractic Dentistry Podiatry Osteopathy Referred to as doctor on the following slides Except for the exemptions described on the following slides Direct Access Provisions Initial evaluations Provide assessments & instructions to asymptomatic persons Emergency Situations provide treatment if absence of attention could result in: Health in serious jeopardy Serious impairment to bodily functions Serious dysfunction of bodily part 7

10 7/6/2016 Direct Access Provisions Patient wants PT to inform his/her doctor A patient comes to your clinic with low back pain & wants you to let his doctor know that he has come to PT. You must then inform his doctor of the initiation of PT services no later than business days after the evaluation. You must then consult with his doctor within the first visits or business days, whichever comes first, or no further treatment can occur. Direct Access Provisions Patient wants PT to inform his/her doctor Consultation is defined in the Rules as: A meeting that is conducted either face-toface or by some other medium such as, but not limited to, telephone, facsimile, mail, or electronic means, wherein two or more health professionals discuss the diagnosis, prognosis, and treatment of a particular case. Direct Access Provisions Patient does not have a doctor A patient comes to your clinic with a sprained ankle from slipping on ice. She tells you she just moved to town and does not have a doctor. You have her sign a consent form and place it in her patient record & tell her that you will not be able to treat her longer than days since she does not have a doctor. You provide her with a list of doctors. Direct Access Provisions Patient does not want his/her doctor informed of PT A patient comes to your clinic with a sore neck from a motorcycle accident. He tells you that he does not want you to tell his doctor about PT. You have him sign a consent form and place it in his patient record. You tell him that you will not be able to treat him longer than days unless you consult with his doctor. Direct Access Provisions Patient has seen a doctor for the problem within past 12 months A patient was seen by his doctor in January for lateral epicondylitis. He comes to PT in August with the same problem, but he has not been to his doctor for it. True or false: The PT must obtain the patient s consent to inform the doctor of the patient coming to PT. Direct Access Provisions Patient progress If no substantial progress is made in 15 calendar days or 6 visits, the PT must stop treatment & refer the patient to a doctor For patients previously diagnosed with chronic, neuromuscular, or developmental conditions by a doctor, this provision does not apply 8

11 7/6/2016 Direct Access Provisions Summary of maximum length of treatment No limit once a consultation has occurred (unless patient is not making progress) due to: Patient request Patient having seen doctor within past 12 months for the problem 30 day limit on treating patient if doctor has not been notified of PT services if: Patient does not have a doctor Patient does not want doctor notified Direct Access Provisions Patient referral for recurring condition If a patient returns to PT within 90 days of treatment with the same complaint, the PT must refer to the appropriate health care provider For patients previously diagnosed with chronic, neuromuscular, or developmental conditions by a doctor, this provision does not apply Direct Access Provisions To treat patients without a referral, a PT must meet one of the following three conditions: 1. A master s or doctorate degree in physical therapy & one year of experience 2. Successful completion of a residency or clinical fellowship approved by the board (APTA or AAOMPT) Direct Access Provisions 3. Three years of experience & completion of a 15 hour physical therapy screening course approved by the board & offered by an accredited university PT_DirAccPolicy.pdf Dry Needling Educational Requirements: All instruction must be in person A combined 50 hours of instruction in: Musculoskeletal and Neuromuscular systems Anatomical basis of pain mechanisms, chronic pain, and referred pain Trigger Points Universal Precautions (These are generally satisfied in PT school) Dry Needling Educational Requirements: 24 hours of dry needling specific instruction in: Dry needling technique Dry needling indications and contraindications Documentation of dry needling Management of adverse effects Practical psychomotor competency OSHA s Bloodborne Pathogen Protocol 9

12 7/6/2016 Dry Needling Dry Needling Courses: Must specify what anatomical regions are included and describe whether it offers introductory or advanced instruction Must be pre-approved or approved by the licensing board or its designee If you have taken a course that is not approved by the licensing board, you may submit information for approval 30 days before the next board meeting Dry Needling Dry Needling Courses: The provider must provide to the Licensing Board administrator: Name of the course provider Synopsis and description of the course Copy or description of any course materials used PTs who obtained dry needling training in another state or country must provide this same information to the Licensing Board administrator for approval. Dry Needling A newly-licensed PT may not practice dry needling for at least 1 year from the date of initial licensure, unless he/she can demonstrate compliance with the educational requirements through prelicensure educational coursework. Dry Needling Dry needling may only be performed by a PT and may not be delegated to a PTA or support personnel All PT patients receiving dry needling shall be provided with information that includes a definition and description of the practice of dry needling, and a description of any risks, benefits, and potential side effects of dry needling. Scope of Practice Practicing physical therapy in violation of the practice act or any rule or written order adopted by the Board Practicing or offering to practice beyond the scope of practice 10

13 7/6/2016 Patient Records Failure to maintain adequate records: Physical therapy evaluation Physical therapy treatment diagnosis Plan of care including desired outcomes Treatment record Results of interventions Discharge plan Patient identification information Patient Records Position Statement on PT Discharge Evaluations/Summaries The Board of PT recognizes that in some situations a patient s discharge is out of control of the PT A discharge plan, evaluation, or summary is required for every patient record Substandard Care Substandard care by a PT due to ignorance, incompetence, or a deliberate or negligent act or failure to act Substandard care by a PTA, which includes exceeding the authority to perform the task selected & delegated by the supervising PT Substandard Care Over-utilization or underutilization Intervention unwarranted by the patient s condition Treatment beyond the point of reasonable benefit Abandonment without informing of other options Failure to practice in accordance with standards in the Guide to Physical Therapist Practice Inadequate Supervision Inadequately supervising or delegating duties which exceed the scope of practice for support personnel PTAs Assistive Personnel Students, volunteers Aiding or abetting a person not licensed who directly or indirectly performs activities requiring a license Inadequate Supervision Assistive personnel, students, and volunteers must have on-site supervision. The supervising PT or PTA must be: Continuously on-site and present Immediately available to assist Maintain continued involvement in appropriate aspects of each treatment session 11

14 7/6/2016 Inadequate Supervision Supervision of students On-site supervision Clinical instructor must have 1 year of experience Volunteers On-site supervision May not provide physical therapy to patients PTA Supervision A PT must perform the evaluation & develop a (written or verbal) treatment plan including goals, frequency, & time period of service. A PT must perform & document re-evaluations, assessments, and modifications in the treatment plan every days. PTA Supervision For patients seen longer than 60 days, a PT must inspect the actual act of therapy services rendered by a PTA at least every days. A PTA may see the patient for the discharge evaluation as long as the PT signs off on the note. (True or False) PTA Supervision A PT may concurrently supervise no more than the equivalent of full-time PTAs. The PT & the PTA are equally responsible & accountable for carrying out the supervision provisions in the Rules. (True or False) A PT may not supervise a PTA that is delivering services at a site further than miles or hour(s) from the PT. PTA Supervision Case 1 After patient evaluation in January, PT delegated treatment to a PTA PTA treated per original treatment plan 2-3 times weekly until October PTA performed assessments & status reports monthly for MD, except in April when this was done by PT PTA documentation was incomplete & unsigned at times Did the Board of Physical Therapy take disciplinary action against the PT? 12

15 7/6/2016 Against the PT 1 year probation; $2,000 fine; 50 hours of education in ethics, jurisprudence, documentation, & supervision The PT was disciplined for violation of: Inadequate supervision of assistive personnel Failure to re-evaluate patient every 30 days & observe PTA services every 60 days Failure to maintain adequate patient records Did the Board of Physical Therapy take disciplinary action against the PTA? Against the PTA 1 year probation; quarterly reports from a different supervisor; 50 hours of education in ethics, jurisprudence, documentation, & supervision The PTA was disciplined for violation of: Practicing beyond the scope of practice Engaging in substandard care by a PTA by exceeding the authority to perform the task Failure to maintain adequate patient records PTA Supervision Case 2 A PTA performed Functional Capacity Evaluations Did the Board of Physical Therapy take disciplinary action against the PTA? Against the PTA 1 year probation; ordered to Cease & Desist from performing FCEs; continuing education related to the scope of practice of PTAs The PTA was disciplined for violation of: Practicing beyond the scope of practice Engaging in substandard care by a PTA by exceeding the authority to perform the task Ethics Failure to adhere to the standards of ethics of the physical therapy profession The Rules adopt the: APTA Code of Ethics for the Physical Therapist APTA Standards of Ethical Conduct for the Physical Therapist Assistant 13

16 7/6/2016 Competence Issues Practicing while impaired by drugs or alcohol DUI Conviction Have to report on license renewal license may be put on probation Will be put on monitoring by Tennessee Professional Assistance Program (TNPAP) May jeopardize credentialing by insurance companies and their willingness to reimburse for services Competence Issues Having been judged mentally incompetent by a court of competent jurisdiction Disciplinary action taken against license held in another state Failure to meet the continuing competence requirement Patient Confidentiality Failure to maintain patient confidentiality without prior written consent or unless otherwise required by law Suspected child abuse must be reported to Child Protective Services ( ) Suspected abuse of dependent older adults & people with disabilities must be reported to Adult Protective Services ( ) Sexual Misconduct Engaging in or soliciting sexual relationships, whether consensual or non-consensual, while a PT/PTA relationship with a patient exists Making sexual advances, requesting sexual favors, & engaging in other verbal or physical conduct or physical contact of a sexual nature with patients Intentionally viewing a disrobed patient if not related to care Conviction of a felony Criminal Issues Interfering with an investigation or disciplinary proceeding by willful misrepresentation of facts or by the use of threats Violation or assisting or conspiring to violate any provisions of the practice act, rules, or criminal statute Fraud Medicare & insurance regulations make fraud a federal crime A Tennessee PT was convicted of 26 felony counts involving fraud, extortion, & bribery Sentenced to 52 months in federal prison Ordered to pay $864,000 in restitution & fines PT license was revoked 14

17 7/6/2016 Fraud Fraud & deceit in obtaining license or in practice Requesting, receiving or participating in the dividing, transferring, assigning, rebating or refunding of an unearned fee Charging unreasonable or fraudulent fees for services performed or not performed Fraud Making misleading, deceptive, untrue or fraudulent representations Promoting unnecessary devices, intervention or service for financial gain Fee splitting for patient referral Payment or acceptance of commissions on fees for services or articles supplied to patients Fraud Law enforcement, government regulators, and legislative bodies are strengthening resources to combat fraud Ten Tips for Protecting Your Practice (From National Heritage Insurance) False Advertising The Rules contain comprehensive requirements to promote truth in advertising Rule Reporting Requirement Failure to report any act or omission of a licensee, applicant, or any other person, which violates the provisions of the Practice Act Complaints are filed with the Office of Investigations or Reporting Requirement Issues Not Within Board Authority Fees and/or billing disputes (amounts charged for services, overcharges, etc.) Insurance matters (unless it deals with fraud by a practitioner) These types of complaints should go to Consumer Affairs at

18 7/6/2016 Other Issues Employing illegal aliens Delinquency in child support payments Defaulting on student loans Disclosures to Patients PTs must inform the patient of any financial arrangements connected to the referral process PTs must disclose in writing any financial interest in products they recommend or endorse to their patients PTs have the responsibility to ensure that the patient has knowledge of freedom of choice in services & products PT Practice Act Puzzlers IT S QUESTION TIME!! Summary It is in your best interest to understand the Practice Act, Rules, & Licensing Board Policies This knowledge will keep you from inadvertently violating the law If you are asked to do something illegal by an employer, knowledge of these documents arms you so that you can work with the employer to change their practice Summary Understanding the Practice Act, Rules, & Licensing Board Policies helps support the decisions you make associated with physical therapy practice POST-TEST 16

19 Title 63 Professions Of The Healing Arts Chapter 13 Occupational and Physical Therapy Part Part 1 Part 2 Part 3 General Provisions Certification of Occupational Therapists and Assistants Licensure of Physical Therapists and Assistants Part 1 General Provisions Short title. This chapter shall be known and may be cited as the Occupational and Physical Therapy Practice Act. [Acts 1984, ch. 921, 2; T.C.A., ; Acts 1999, ch. 528, 2.] Legislative intent. This chapter is enacted for the purposes of protecting the public health, safety, and welfare, and providing for state administrative control, supervision, licensure and regulation of the practice of physical therapy and occupational therapy. It is the general assembly's intent that only individuals who meet and maintain prescribed standards of competence and conduct may engage in the practice of physical therapy and occupational therapy as authorized by this chapter. This chapter is intended to promote the public interest and to accomplish the purposes stated in this section. [Acts 1984, ch. 921, 2; T.C.A., , ; Acts 1999, ch. 528, 3.] Chapter definitions. Please note - definitions related to Occupational Therapy have been deleted from this section. As used in this chapter, unless the context otherwise requires: (3) Board means: (A) As used in part 2 of this chapter, the board of occupational therapy; and (B) As used in part 3 of this chapter, the board of physical therapy; (4) Division means the division of health related boards of the department of health; (10) On-site supervision means the supervising physical therapist or physical therapist assistant must: (A) Be continuously on-site and present in the department or facility where assistive personnel are performing services; 1

20 (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; (11) Physical therapist means a person who is licensed pursuant to this chapter to practice physical therapy; (12) Physical therapist assistant means a person who meets the requirements of this act 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; (13) Physical therapy means the care and services provided by or under the direction and supervision of a physical therapist who is licensed pursuant to this chapter; (14) Physical therapy assistive personnel : (A) Other assistive personnel means other trained or educated health care personnel not defined in subdivision (13) and (15)(B), who perform specific designated tasks related to physical therapy under the supervision of a physical therapist. At the discretion of the supervising physical therapist, and if properly credentialed and not prohibited by any other law, other assistive personnel or other support personnel may be identified by the title specific to their training or education; and (B) Physical therapy aide, inclusive of the terms aide, technician and transporter, means a person trained by and under the direction of a physical therapist who performs designated and supervised routine physical therapy tasks; (15) 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 movementrelated conditions in order to determine a physical therapy treatment diagnosis, prognosis, a plan of therapeutic intervention, and to assess the ongoing effect 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; manual therapy; therapeutic massage; assistive and adaptive orthotic, prosthetic, protective and supportive 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, impairments, functional limitation and disability, including the promotions and maintenance of fitness, health and quality of life in all age populations; and (D) Engaging in administration, consultation, education and research; (16) Restricted physical therapist assistant license means a license on which the committee has placed any restrictions due to action imposed by the committee; (17) Restricted physical therapy license means a license on which the committee places restrictions or conditions, or both, as to scope of practice, place of practice, supervision of practice, duration of licensed status, or type of condition of patient to whom the licensee may provide services; 2

21 (18) Supervision of the physical therapist assistant means the supervising physical therapist will be readily available to the physical therapist assistant being supervised. When the physical therapist assistant is practicing in an offsite setting, the supervising physical therapist will be immediately accessible by telecommunications; patient conferences will be regularly scheduled and documented and supervisory visits will be made as further outlined in the rules and regulations; and [Acts 1984, ch. 921, 2; T.C.A., ; Acts 1988, ch. 824, 1-4; 1988, ch. 1023, 1, 2; 1991, ch. 245, 1, 2; 1993, ch. 225, 1; T.C.A., ; Acts 1999, ch. 415, 1; 1999, ch. 528, 4; 2006, ch. 765, 1; 2007, ch. 115, 1.] Unauthorized practice of medicine Scope of practice. (a) Nothing in this chapter shall be construed as allowing physical therapists to practice medicine, osteopathy, podiatry, chiropractic, or nursing. (b) (1) The scope of practice of physical therapy shall be under the written or oral referral of a licensed doctor of medicine, chiropractic, dentistry, podiatry or osteopathy, with exceptions as stated in (2) The scope of practice of physical therapy shall not include the performance of treatment where the physical therapist or physical therapist assistant uses direct thrust to move a joint of the patient's spine beyond its normal range of motion without exceeding the limits of anatomical integrity. [Acts 1999, ch. 528, 10; 2007, ch. 423, 1.] Part 3 Licensure of Physical Therapists and Assistants Sec License requirement Referrals Ethical standards Exceptions to referral requirements Board powers Claims and practices of other licensed professionals Exemptions from licensure Application Examinations Qualifications of applicants Reciprocity License renewal Changes in name or address Retirement Inactive status Exemption from continuing education requirements Reinstatement of license Failure to renew license Unlawful use of titles or designations indicating licensure Supervision of students and assistive personnel Denial, suspension or revocation of licenses Disciplinary actions of the board Administrative procedure of disciplinary actions Jurisdiction of board Penalties Peer assistance program Fees Disclosures to patient Confidentiality of information Complaints Display of license Board of physical therapy. 3

22 License requirement. (a) A physical therapist licensed under this chapter is fully authorized to practice physical therapy as defined in this chapter. (b) No person shall practice, or in any manner claim to be engaging in the practice of physical therapy or designate as being a physical therapist unless duly licensed as a physical therapist in accordance with this chapter. [Acts 1999, ch. 528, 12.] Referrals Ethical standards. (a) A physical therapist shall refer persons under the physical therapist's care to appropriate health care practitioners, after consultation with the referring practitioner, 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 treatment is contraindicated. (b) Physical therapists shall adhere to the recognized standards of ethics of the physical therapy profession and as further established by rule. [Acts 1999, ch. 528, 13.] Exceptions to referral requirements. (a) The practice of physical therapy shall be under the written or oral referral of a licensed doctor of medicine, chiropractic, dentistry, podiatry or osteopathy, except a licensed physical therapist may: (1) Conduct an initial evaluation of a patient without referral; (2) Provide physical assessments or instructions, including a recommendation of exercise to an asymptomatic person, without the referral of a referring practitioner; (3) (A) In emergency circumstances, including minor emergencies, provide assistance to a person to the best of a therapist's ability without the referral of a referring practitioner. Except as provided in subdivision (a)(4), the physical therapist shall refer the person to the appropriate health care practitioner, as indicated, immediately after providing assistance; (B) For the purposes of subdivision (a)(3)(a): (i) Emergency circumstances means instances where emergency medical care is required; and (ii) Emergency medical care means bona fide emergency services provided after the sudden onset of a medical condition manifesting itself by acute symptoms of sufficient severity, including severe pain, such that the absence of immediate medical attention could reasonably be expected to result in: (a) Placing the patient's health in serious jeopardy; (b) Serious impairment to bodily functions; or (c) Serious dysfunction of any bodily organ or part; and (4) Treat a patient without a referral when all of the following apply: 4

23 (A) When a patient provides the name of a licensed doctor of medicine, chiropractic, dentistry, podiatry or osteopathy and expressly wants the physical therapist to inform that physician, the physical therapist shall inform the patient's licensed doctor of medicine, chiropractic, dentistry, podiatry or osteopathy no later than five (5) business days after the evaluation. A consultation shall occur between the physical therapist and the patient's licensed doctor of medicine, chiropractic, dentistry, podiatry or osteopathy within the first six (6) visits or fifteen (15) business days, whichever comes first, of the findings of the patient's initial visit for physical therapy and any subsequent visits. Should that consultation not take place, no further therapy beyond the six (6) visits or fifteen (15) days, whichever comes first, shall be delivered; (B) When a patient does not provide the name of a licensed doctor of medicine, chiropractic, dentistry, podiatry or osteopathy or expressly states to the therapist that the patient does not want a licensed doctor of medicine, chiropractic, dentistry, podiatry or osteopathy informed of the initiation of therapy services, the therapist shall have the patient sign a consent form that confirms the patient either does not have a licensed doctor of medicine, chiropractic, dentistry, podiatry or osteopathy or does not want a licensed doctor of medicine, chiropractic, dentistry, podiatry or osteopathy informed of the initiation of therapy treatment. The consent form shall be maintained in the patient's record; (C) If the patient presents to the physical therapist for a problem for which the patient has been seen by a licensed doctor of medicine, chiropractic, dentistry, podiatry or osteopathy within the past twelve (12) months, the consent of the patient is not necessary to inform that licensed doctor of medicine, chiropractic, dentistry, podiatry or osteopathy of the presentation for the physical therapy treatment. If the patient has no licensed doctor of medicine, chiropractic, dentistry, podiatry or osteopathy, then the physical therapist shall make a suggestion from the list of available providers and shall inform the patient of the thirty-day limitation in subdivision (a)(4)(e); (D) If the physical therapist determines, based on reasonable evidence, that no substantial progress has been made with respect to that patient within fifteen (15) calendar days or six (6) visits, whichever occurs first, immediately following the date of the patient's initial visit with the physical therapist, the physical therapist shall not provide any additional physical therapy services and shall refer the patient to a licensed physician, doctor of chiropractic, dentist, podiatrist or osteopath. If the patient previously was diagnosed with chronic, neuromuscular, or developmental conditions by a physician, doctor of chiropractic, dentist, podiatrist or osteopath and the evaluation, treatment or services are being provided for problems or symptoms associated with one (1) or more of those previously diagnosed conditions, then this subdivision (a)(4)(d) shall not apply. If a patient returns to the physical therapist within ninety (90) days of treatment with the same complaint, then the physical therapist shall make an immediate referral to the appropriate health care provider; (E) When a patient's licensed doctor of medicine, chiropractic, dentistry, podiatry or osteopathy has not been notified of the physical therapy services, under no circumstances should therapy services continue beyond thirty (30) days immediately following the date of the patient's first visit; (F) (i) It shall be considered unprofessional conduct for the purposes of for a physical therapist to knowingly initiate services for the same complaint for which a patient: (a) Has started therapy services but another therapist did not inform a licensed doctor of medicine, chiropractic, dentistry, podiatry or osteopathy within five (5) business days of the initial evaluation in accordance with subdivision (a)(4)(a); 5

24 (b) Has reached the fifteen (15) day and six (6) visit limit imposed by subdivision (a)(4)(d) where no substantial progress has been made from another physical therapist; or (c) Has reached the thirty-day limit imposed by subdivision (a)(4)(e); (ii) This subdivision (a)(4)(f) does not apply if a referral from a licensed doctor of medicine, chiropractic, dentistry, podiatry or osteopathy is made; and (G) If, at any time, the physical therapist has reason to believe that the patient has symptoms or conditions that require treatment or services beyond the scope of practice of a physical therapist, the physical therapist shall refer the patient to a licensed health care practitioner acting within the practitioner's scope of practice. (b) No person shall practice physical therapy other than upon the referral of a patient by a person who is licensed in this or another state to practice medicine, chiropractic, dentistry, osteopathic medicine, or podiatric medicine, within the scope of those practices, and whose license is in good standing and who holds a CPR certificate, or its equivalent, unless one of the following conditions is met: (1) The person holds a master's or doctorate degree from a professional physical therapy program that is accredited by a national accreditation agency recognized by the United States department of education and by the board of physical therapy and the person has completed at least one (1) year of experience as a licensed physical therapist; (2) The person has successfully completed a residency or clinical fellowship in physical therapy at a program approved by the board; or (3) (A) The person has completed at least three (3) years of experience as a licensed physical therapist; and (B) The person has completed a course approved by the board of physical therapy and offered by an accredited university of at least fifteen (15) hours, designed to enable the physical therapist to identify signs and symptoms of systemic disease, particularly those that can mimic cardiological, neurological, oncological, or musculoskeletal disorders, and to recognize conditions that require timely referral to a physician, dentist, osteopath, podiatrist or chiropractor. [Acts 1999, ch. 528, 14; 2007, ch. 115, 10; 2007, ch. 423, 2.] Board powers. The board of physical therapy has the power and authority to: (1) Evaluate the qualifications of applicants for licensure and provide for the examination of physical therapists and physical therapist assistants; (2) Adopt passing scores for examination; (3) Issue licenses to those who qualify under this chapter; (4) Regulate the practice of physical therapy by interpreting and enforcing the provisions of this statute, including disciplinary action; (5) Adopt and revise rules, as it deems necessary and appropriate, consistent with this law, for the discharge of its obligation under this section. Such rules, when lawfully adopted, shall have the effect of law; 6

25 (6) Establish requirements for assessing continuing competence of licensees; and (7) Assess all license and registration fees. [Acts 1999, ch. 528, 15; 2007, ch. 115, 10.] Claims and practices of other licensed professionals Exemptions from licensure. (a) Nothing in this chapter shall be construed as restricting a person licensed or certified under any other law of this state from engaging in the profession or practice for which the person is licensed or certified; provided, that the person does not claim to be a physical therapist, a physical therapist assistant or a provider of physical therapy. (b) The following persons shall be exempt from licensure as a physical therapist or physical therapist assistant under this chapter: (1) A person who is pursuing a course of study leading to a degree as a physical therapist or physical therapist assistant in a professional education program approved by the board and is satisfying supervised clinical education requirements related to physical therapy education; (2) A physical therapist or physical therapist assistant 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; (3) A physical therapist or physical therapist assistant 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 (60) days in a calendar year; and (4) A physical therapist or physical therapist assistant licensed in another United States jurisdiction who is temporarily performing physical therapy for members of established athletic teams, athletic corporations, or performing arts companies that are training, competing, or performing in Tennessee; provided, however, that a person performing physical therapy in this state pursuant to this subdivision (b)(4) shall agree to use the secretary of state for service of process pursuant to title 20, chapter 2, part 2. (c) Nothing in this chapter shall be construed as restricting persons licensed under any other law of this state from performing physical agent modalities for which they have received education and training. [Acts 1999, ch. 528, 16; 2003, ch. 8, 1; 2007, ch. 115, 10.] Application Examinations. (a) An applicant for licensure as a physical therapist or physical therapist assistant shall file an application as required by the board. A non-refundable application fee and the cost of the examination shall accompany the completed written application. Fees shall be established by the rules promulgated by the board. (b) After the application process has been completed, an applicant shall take the examination for physical therapist licensure that covers current physical therapy practice. (c) After the application process has been completed, an applicant shall take the examination for physical therapist assistant licensure that covers current technical application of physical therapy services. 7

26 (d) Examinations shall be available within the state at such time and place as the board shall determine. The board shall determine the passing score. (e) Applicants who do not pass the examination after the first attempt may retake the examination one (1) additional time without re-application for licensure. This must occur with six (6) months of initial board approval to take the examination. Prior to being approved by the board for subsequent testing beyond two (2) attempts, individuals shall submit a new application with all applicable fees and demonstrate evidence satisfactory to the board of having successfully completed additional clinical training and/or course work as determined by the board and defined in the rules. [Acts 1999, ch. 528, 17; 2007, ch. 115, 10.] Qualifications of applicants Reciprocity. (a) An applicant for licensure as a physical therapist shall have the following qualifications: (1) Must be at least eighteen (18) years of age; (2) Be of good moral character; (3) Have completed the application process; (4) Be a graduate of a professional physical therapy education program accredited by an accreditation agency approved by the board; and (5) Have successfully passed an examination approved by the board. (b) An applicant for license as a physical therapist assistant shall meet the following requirements: (1) Must be at least eighteen (18) years of age; (2) Be of good moral character; (3) Have completed the application process; (4) Be a graduate of a physical therapist assistant education program accredited by an accreditation agency approved by the board; and (5) Have successfully passed an examination approved by the board. (c) The board shall issue a license to a physical therapist or physical therapist assistant who has a valid unrestricted license from another United States jurisdiction in which such person, when granted such license, previously met all requirements as specified in subsections (a) and (b), and as further established by rules promulgated by the board. (d) An applicant for licensure as a physical therapist who has been educated outside the United States shall meet the following qualifications: (1) Must be at least eighteen (18) years of age; (2) Be of good moral character; (3) Have completed the application process; 8

27 (4) Provide satisfactory evidence that the applicant's 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 course work before proceeding with the application process; (5) Provide written proof that the school of physical therapy education is recognized by its own ministry of education; (6) Provide written proof of authorization to practice as a physical therapist without limitations in the country where the professional education occurred; (7) Provide proof of legal authorization to reside and seek employment in the United States or its territories; (8) Have the applicant's educational credentials evaluated by a board-approved credential evaluation agency; (9) Have passed the board approved English proficiency examinations, if the applicant's native language is not English; (10) Have participated in and completed an interim supervised clinical practice period prior to licensure; and (11) Have successfully passed the examination approved by the board. (e) 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 subdivisions (d)(4), (5), (8), and (10) may be waived. (f) In determining the qualifications of an applicant for licensure as a physical therapist or as a physical therapist assistant, only a majority vote of the board of physical therapy shall be required. [Acts 1999, ch. 528, 18; 2007, ch. 115, 10.] License renewal Changes in name or address Retirement Inactive status Exemption from continuing education requirements. (a) A physical therapist or physical therapist assistant licensed under the provisions of this part shall renew such person's license as specified in the rules. An individual, who fails to renew the license by the date of expiration, shall not practice physical therapy or function as a physical therapist assistant in the state of Tennessee. (b) Each licensee shall report to the division a name change and changes in business and home address within thirty (30) days of the change. (c) Any person licensed by the board to practice in this state, who has retired or may retire from such practice in this state, is not required to register as required by this part, if such person files with the board an affidavit on a form to be furnished by the board, which affidavit states the date on which the person retired from such practice and any other facts, as the board considers necessary, that tends to verify such retirement. If such person thereafter reengages in practice in this state, such person shall apply for licensure with the board as provided by this part, and shall meet such continuing education requirements that are established by the board, except for good and sufficient reasons as determined by the board. 9