“ Physical Therapy Practice in the Public School System”

1. Ben F. Massey, Jr., PT, MA Executive Director North Carolina Board of Physical Therapy Examiners “Physical Therapy Practice in the Public School System” Koury Convention Center Greensboro, NC Nov 02, 2011 (Wednesday) - 10:45 am – 11:50 am

2. Purpose of PT Board of Examiners 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)

3. NC Physical Therapy Practice Act90-270.24 - 90-270.39 (4 pages) 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.

4. 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

5. Board’s rules(Chapter 48 – Board of Examiners – Subchapters A - H ) – (37 pages) 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)

6. 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

7. 48 C .0102 – Responsibilities (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.

8. (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.

9. (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.

10. (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.

11. Physical Therapist Assistant Scope of work – see definition in Practice Act Supervision (Position Statement) Documentation

12. section .0200 – physical therapist assistants 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.

13. (f) The physical therapist assistant must document every intervention/treatment, which must include the following elements: (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.

14. Specific Questions for School System PT’s & PTA’s Are POC’s (Plan of Care) portable? Can PTA’s write quarterly progress notes? Can PTA’s attend IEP Meetings?

15. OverviewSection .0100 – Licensure Renewal; Continuing Competence (7 pages) Section .0100 – Licensure Renewal; Continuing Competence 21 NCAC 48G .0105 DEFINITIONS 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

16. Typical Complaints and Disciplinary Actions Disciplinary Actions (Voluntary Surrender of License, Revocation, Suspension, Probation, Warning) - [Advisory Letter – non-disciplinary action]

17. 21 NCAC 48G .0601 PROHIBITED ACTIONS Page 37 in the Board’s rules (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. 90-270.35(4) include the following: (1) recording false or misleading data, measurements or notes regarding a patient; . . . (28) furnishing false or misleading information on an application for licensure renewal.

18. 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.

19. Q & A Questions Comments Opinions Thank you!!