House Bill 4140, Physical Therapy Practice Acts, was updated by the WVBOPT and WVPTA last year. This was passed through legislature and signed by Governor Manchin. We are now working towards getting the rules section passed. This has been an interesting process to say the least. These are the new rules to govern and clarify the new law (practice acts) passed last year.
The month of February has been productive as the rules portion has passed both the House Government Organization Committee (Feb. 3, 2011) and most recently passed the House Judiciary Committee (Feb.17, 2011). The rules were bundled (mixed with other legislature) and will now be under house bill 2639. This process will continue on to the senate side as it will be in at least 2 committees prior to being voted on and then signed. It is hopeful that this could be complete during the current legislative session; however I don’t look for it to be effective as law until late summer. This is assuming that it doesn’t meet any more opposition.
So, what does this all mean? In general the new practice acts passed last year and already in effect help clarify our laws and make things such as regulation and discipline more effective. It also changed the supervision ratio of PT: PTA from 2:1 to 4:1 to help us meet the demands and provide care to more in WV.
The current bill which passed the House and is now heading to the Senate has a number of changes that PTs and PTAs will be interesting in reading. The following are just a few of the many changes:
- The definition of physical therapy aide has been clarified such that aide works under the direct supervision of the PT, and added that a PTA can directly supervise the aide in emergency situations to provide for patient safety. Previously there was no provision that allowed the PTA to directly supervise the aide.
- New sections have been added as an “ethics” section. It is a list of things we should do (adhere to standards of ethical practice that are moral and honorable) and things we should not do (cheat, alter records, practice while impaired) as licensees.
- Licensees must now self report any disciplinary action against a license they may hold in another jurisdiction with the BOPT reserving the right to discipline the licensee. Failure to self report leaves the licensee subject to disciplinary procedures in WV.
- Changes in the supervision of the physical therapist assistant have been included in the rules. The physical therapist must continue to evaluate the patient and establish the plan of care. The physical therapist must make the final visit to terminate the plan of care.
- The rule now allows each physical therapist to supervise no more than 4 PTA’s, PTA’s with temporary permits, physical therapy aides or any combination of these persons. This is an increase from the previous 2. Students are NOT included in this definition, meaning the PT can also supervise a student.
- Physical therapist assistants would be able to work under general supervision 40% of the time in a hospital, or other acute care center, free-standing, outpatient, or independent practice setting. However, the PTA would be required to have 1000 hours of work experience. Previously on-site supervision was required in these settings. General supervision (no PT on site) has been allowed in skilled/unskilled nursing facilities, distinct part skilled/unskilled nursing unit or swing bed unit in an acute care hospital, home health and school systems since the early 1990’s as well as in our surrounding states.
- The rule extends from 21 days to 30 days the maximum interval between physical therapist visits in the general supervision settings of nursing facilities, home health and schools. However it leaves the visit interval at 10, so it is at least every 10 PTA visits, or 30 calendar days, whichever occurs first a physical therapist must visit the patient. This places the visit interval in line with Medicare/Medicaid guidelines.
- The initial and follow-up joint on site visit with the PT and PTA requirement has been eliminated in the rule. However, it does not eliminate the requirement that the PT be accessible by telecommunications at all times and be available to make a joint on site visit with the PTA within 24 hours if a situation would arise.
- Language has been added that allow for emergency situations up to 3 days in length that a PTA could continue to work under the supervision of another PT. This would include illness of the PT, or family member, or death of a family member.
- Language has been added to allow for temporary situations up to one day in which a PTA could continue to render services under the supervision of another physical therapist.
- Both temporary and emergency situations limit the PTA to working with established patients that the PTA has previously participated in the treatment.
- The final change is a new section on continuing education that more clearly defines what may be counted as hours. It increases the number of hours required from 10 annually to 24 over a two-year renewal period.
You can read the Bill in its entirety and track its steps through legislature by going to www.legis.state.wv.us and using bill number 2639. These are the rules that will change the way you practice. I encourage you to read and get involved in the process. The WVBOPT and WVPTA are also great resources for all your PT/PTA questions.