“Physical Therapy Practice in
the Public School System”
Ben F. Massey, Jr., PT, MA
Executive Director
North Carolina Board of Physical Therapy Examiners
Koury Convention Center
Greensboro, NC
Nov 02, 2011 (Wednesday) - 10:45 am – 11:50 am
Purpose of PT Board of Examiners
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Protect the health, safety, and well-being of the
public.
Purpose of professional association (APTA /
NCPTA) is to promote the profession of physical
therapy.
Licensure is mandatory.
Membership is professional associations is
voluntary. (Policies, positions, & guidelines.)
Reimbursement policies (Medicaid, Medicare,
Private Insurance)
NC Physical Therapy Practice Act
90-270.24 - 90-270.39 (4 pages)
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Provides statutory authority for Board’s rules.
Licensees must follow the Practice Act &
Board’s rules
Policies by other agencies are not regulated by
the Board. Policies may be necessary for
reimbursement, but enforcement does not fall
under the purview of Board unless a licensee
commits fraud.
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Law that regulates the practice of physical therapy
Adopted by the North Carolina General Assembly
.24 - Definitions
.26 - Powers of Board (set qualifications for licensure, conduct
investigations & determine disciplinary actions, continuing
competence, establish fees)
. 29 - Qualifications
.30 - Foreign Trained applicants
.34 - Exemptions (students, employees of US government, PT
Aides, )
.35 - Unlawful practice (Direct Access - # 4. Failure to refer)
.36 - Grounds for disciplinary action (1 – 9)
“Modernization of the PT Practice” – spearheaded by the
NCPTA
Board’s rules
(Chapter 48 – Board of Examiners – Subchapters A - H ) – (37 pages)
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Proposed Rules must be adopted by NC Rules
Review Commission and approved by the General
Assembly
Public process, totally transparent, encourages
participation by the public
48 A - Organization
48 A .0105 – Definitions
48 B – Types of Licenses (Exam and Endorsement)
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48 C – Scope of Physical Therapist Practice
48 C .0101 Permitted Practice
Position Statements (EMG, Intramuscular
Manual Therapy / Dry Needling / Mobilization
48 C .0102 – Responsibilities
48 C .0200 – Physical Therapy Assistants
48 C .0201 – Supervision by PT
48 C .0102 – Responsibilities
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(a) The physical therapist must determine the patient care plan and the
elements of that plan appropriate for delegation.
(b) The physical therapist must determine that those persons acting under
his or her supervision possess the competence to perform the delegated
activities.
(c) The physical therapist may delegate responsibilities to physical
therapist assistants. The supervising physical therapist must determine that
the PT or PTA student is working under supervision at all times.
(d) The physical therapist must enter and review chart documentation,
reexamine and reassess the patient and revise the patient care plan if
necessary, based on the needs of the patient.
(e) The physical therapist must establish the discharge plan.
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(f) For each date of service, a physical therapist must provide
all therapeutic interventions that require the expertise of a
physical therapist and must determine the use of assistive
personnel who provide delivery of service that is safe and
effective for each patient.
(g) A physical therapist's responsibility for patient care
management must include first-hand knowledge of the status
of each patient and oversight of all documentation for services
rendered to each patient, including awareness of fees and
reimbursement structures.
(h) A physical therapist must be immediately available
directly or by telecommunication to a physical therapist
assistant supervising a physical therapy aide or student
engaging in patient care.
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(i) A physical therapist must be limited to clinically
supervising only that number of assistive personnel,
including physical therapists assistants, physical therapy
aides, and students completing clinical requirements, as is
appropriate for providing safe and effective patient
interventions at all times.
(j) If a physical therapist assistant or physical therapy aide
is involved in the patient care plan, the patient must be
reassessed by the supervising physical therapist no less
frequently than every 30 days.
(k) A physical therapist who is supervising a physical
therapy aide or student must be present in the same facility
when patient care is provided.
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(l) The physical therapist must document every evaluation and
intervention/treatment, which must include the following elements:
• (1)
Authentication (signature and designation) by the physical therapist
who performed the service;
• (2)
Date of the evaluation or treatment;
• (3)
Length of time of total treatment session or evaluation;
• (4)
Patient status report;
• (5)
Changes in clinical status;
• (6)
Identification of specific elements of each intervention/modality
provided. Frequency, intensity, or other details may be included in the plan of
care and if so, do not need to be repeated in the daily note;
• (7)
Equipment provided to the patient or client; and
• (8)
Interpretation and analysis of clinical signs and symptoms and
response to treatment based on subjective and objective findings, including any
adverse reactions to an intervention.
(m) At least every 30 days, the therapist must document:
• (1)
The patient’s response to therapy intervention;
• (2)
Progress toward achieving goals; and
• (3)
Justifications for continued treatment.
Physical Therapist Assistant
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Scope of work – see definition in Practice Act
Supervision (Position Statement)
Documentation
SECTION .0200 –
PHYSICAL THERAPIST ASSISTANTS
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21 NCAC 48C .0201 SUPERVISION BY PHYSICAL THERAPIST
(a) A physical therapist assistant may assist in the practice of physical
therapy only to the extent allowed by the supervising physical therapist.
(b) A physical therapist assistant may make modifications of treatment
programs that are consistent with the established patient care plan.
(c) A physical therapist assistant may engage in off-site patient related
activities that are appropriate for the physical therapist assistant's
qualifications and the status of the patient.
(d) A physical therapist assistant may document care provided without the
co-signature of the supervising physical therapist.
(e) A physical therapist assistant who is supervising a physical therapy
aide or student must be present in the same facility when patient care is
provided.
(f) The physical therapist assistant must document every
intervention/treatment, which must include the following elements:
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(1) Authentication (signature and designation) by the physical therapist
assistant who performed the service;
(2) Date of the intervention/treatment;
(3) Length of time of total treatment session;
(4) Patient status report;
(5) Changes in clinical status;
(6) Identification of specific elements of each intervention/modality
provided. Frequency, intensity, or other details may be included in the plan
of care and if so, do not need to be repeated in the daily note;
(7) Equipment provided to the patient or client; and
(8) Response to treatment based on subjective and objective findings,
including any adverse reactions to an intervention.
Specific Questions for School
System PT’s & PTA’s
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Are POC’s (Plan of Care) portable?
Can PTA’s write quarterly progress notes?
Can PTA’s attend IEP Meetings?
OVERVIEW
SECTION .0100 – LICENSURE RENEWAL;
CONTINUING COMPETENCE
(7 pages)
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SECTION .0100 – LICENSURE RENEWAL; CONTINUING COMPETENCE
21 NCAC 48G .0105
DEFINITIONS
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21 NCAC 48G .0106
CONTINUING COMPETENCE REQUIREMENT
21 NCAC 48G .0107
STANDARDS FOR CONTINUING COMPETENCE ACTIVITIES
21 NCAC 48G .0108
APPROVAL OF PROVIDERS AND ACTIVITIES
21 NCAC 48G .0109
CONTINUING COMPETENCE ACTIVITIES
21 NCAC 48G .0110
EVIDENCE OF COMPLIANCE
21 NCAC 48G .0111
EXEMPTIONS AND DEFERMENTS
21 NCAC 48G .0112
COSTS
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Typical Complaints and
Disciplinary Actions
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Disciplinary Actions (Voluntary Surrender of
License, Revocation, Suspension, Probation,
Warning) - [Advisory Letter – nondisciplinary action]
21 NCAC 48G .0601
PROHIBITED ACTIONS
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Page 37 in the Board’s rules
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(a) Behaviors and activities which may result in disciplinary action by the
Board pursuant to G.S. 90-270.36(1), (6), (7), (8) and (9) and G.S. 90270.35(4) include the following:
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(1) recording false or misleading data, measurements or notes regarding
a patient;
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. (28) furnishing false or misleading information on an application for
licensure renewal.
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False documentation
Failure to complete documentation in a timely manner
Billing for treatments not performed (phantom visits)
Supervision issues – primarily failing to provide
appropriate supervision
Practicing beyond the scope of practice – primarily PTA’s
Diverting drugs – chemical dependence – (Contract with
NC Board of Nursing)
Failing to observe professional boundaries (sexual
misconduct)
Failing to complete continuing competence by deadline or
failing to respond to the Audit in a timely manner.
Q&A
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Questions
Comments
Opinions
Thank you!!