New PT Licensing Board Rules Took Effect August 17th

MEMORANDUM

From: Diana Godwin
To: PPSIG Members

Date: August 31, 2018
Re: New PT Licensing Board Rules Took Effect August 17th

The Physical Therapy Licensing Board has been going through a comprehensive review and revision of its administrative rules for the past year or so and the final revised and new rules became effective August 17th. Here’s a quick summary of some of the key provisions, listed by rule number. (WAC stands for Washington Administrative Code)

WAC 246-915-010 Definitions.

The definition of “Direct Supervision” of assistive personnel was expanded to be more strict. The new definition reads:

(5) "Direct supervision" means the supervisor shall:

(a) Be continuously on-site and present where the person being supervised is performing services;

(b) Be immediately available to assist the person being supervised in the services being performed; and

(c) Maintain continued involvement in appropriate aspects of each treatment session in which a component of treatment is delegated to assistive personnel or is required to be directly supervised under RCW 18.74.180.

Note: Aides and other assistive personnel – other than PTAs – must function under direct supervision. PTAs may function under either direct or indirect supervision.

The definition of indirect supervision was not changed. It reads:

(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.

WAC 246-915-085 Continuing Competency

The rules on continuing education were changed to lower the number of hours for PTs from 40 hours to 32 hours during every two year period. For PTAs the number of hours was lowered from 40 hours to 24 hours during every two year period. The rule was also completely re-written and re-formatted to a chart listing “CE Type”, “Maximum Hours Allowed” for that CE type, and “Documentation Requirements” for that CE type. I recommend that you go on the Board’s website and on the left hand side of the home page, click on “Laws” and then click on “Washington Administrative Code: WAC 246-915”, then scroll down and click on 246-915-085 to review the new chart.

WAC 246-915-086 Suicide Assessment Training Standards

As you know, every PT and PTA must complete a one-time 3 hour suicide assessment training. The rule reads:

(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.

WAC 246-915-130 Initial Evaluation – Referral – Recommendations – Follow-up

This rule was amended to add two new ways – email and fax – to the existing ways by which a PT can receive a direct referral of a patient from another medical provider. (The prior rule said the referral could be by “telephone, letter or in person.”)

WAC 246-915-140 Personnel Identification

This rule was amended to now allow a PT or PTA to post at their work site either the license, a copy of the license, or – now – “a printout from the department’s provider credential web site.” A new sentence was added as follows: “If the physical therapist or physical therapist assistant does not have a principal place of business or conducts business in any other location, he or she shall have a copy of his or her license available for inspection while performing services within his or her authorized scope of practice.”

WAC 246-915-182 Unprofessional Conduct – Sexual Misconduct

This rule was substantially re-written and expanded to go into lengthy detail as to all the types of sexual activity that are prohibited. It still prohibits any form of sexual conduct with a current patient or within two years after the provider/patient relationship ends, but in addition to prohibiting sexual conduct with a patient, it also prohibits it with a “key party”, who is defined as follows:

"Key party" means immediate family members and others who would be reasonably expected to play a significant role in the health care decisions of the patient or client and includes, but is not limited to, the spouse, domestic partner, sibling, parent, child, guardian and person authorized to make health care decisions of the patient or client.” (WAC 246-16-020)

WAC 246-915-190 Division of Fees – Rebating – Financial Interest – Endorsement

This is a new rule and reads in its entirety: “A physical therapist or physical therapist assistant shall comply with chapter 19.68.”

Chapter 19.68 of the RCW states it is unprofessional conduct and a basis for disciplinary action for a medical practitioner to offer or receive kickbacks for the referral of patients.

WAC 246-915-210 Mandatory Reporting

This rule reads in its entirety: “The Board adopts the model rules for mandatory reporting as contained in chapter 246-16 WAC.”

WAC 246-16 says that mandatory reports must be submitted to the Department of Health and the Department will forward them to the appropriate licensing board for review or possible investigation and further action. A medical provider has a duty to report:

When a patient has been harmed
When they have actual knowledge that there has been a conviction, determination or finding that another practitioner has committed an act that constitutes unprofessional misconduct by another practitioner
When another practitioner may not be able to practice his or her profession with reasonable skill and safety due to a mental or physical condition.

Reports must be submitted no later than 30 calendar days after the reporting provider has actual knowledge of the information that must be reported. Reports must contain enough information to enable the disciplinary authority to assess the report. If known, the report should include:

(a) The name, address, and telephone number of the person making the report.

(b) The name, address, and telephone number(s) of the license holder being reported.

(d) A brief description or summary of the facts that caused the report, including dates.

(e) If court action is involved, the name of the court, the date of filing, and the docket number.

(f) Any other information that helps explain the situation.

A medical provider must also self-report the following within 20 calendar days:

1) Any conviction, determination, or finding that he or she has committed unprofessional conduct; or

(2) Information that he or she is unable to practice with reasonable skill and safety due to a mental or physical condition; or

(3) Any disqualification from participation in the federal medicare or medicaid program.

Any medical provider or organization that employs a medical provider must report to the Department of Health when they fire or restrict the practice of the employee provider based on a final determination or finding that the employee provider:

(a) Has committed an act or acts that may constitute unprofessional conduct; or

(b) May not be able to practice his or her profession with reasonable skill and safety due to a mental or physical condition.

The employer must submit the report to the Department of Health no later than 20 days after a final determination or finding is made. Failure to file a required report can result in a civil penalty of up to $500 and the licensing board can separately take action against the employer for unprofessional conduct.

Since the Board began the formal administrative process for making these changes and additions to the rules before the 2018 changes in the assistive personnel statute took effect in June, the current administrative rule on supervision, WAC 246-915-181, still says a PT may supervise only two assistive personnel. However, the revised statute, RCW 18.74.180, takes precedence over the administrative rule and PTs are now allowed to supervise up to three assistive personnel. We anticipate that the Board will update the rule in the near future to conform it to the statute.

Let me know if you have any questions.

I hope you enjoyed your summer and are now looking forward to the start of the new school/work year after Labor Day. We’ll look forward to seeing many of you at the Fall Conference, October 5th and 6th.

Diana E. Godwin, PPSIG Executive Director

Attorney at Law

1500 SW 1st Avenue, Suite 1170

Portland, OR 97201

Phone: (503) 224-0019

Fax: (971) 275-1218

E-mail: dianagodwin@engravlawoffice.com