Update from the Ohio Physical Therapy Board School-Based OT/PT Institute August 10, 2010

1. Update from the Ohio Physical Therapy BoardSchool-Based OT/PT InstituteAugust 10, 2010

2. Topics • About the Board • Recent Rules Changes • Interactions with ODE • Comparison of Responsibilities of PTs and PTAs • IEP vs POC • Frequently Asked Questions Ohio OTPTAT Board

3. Mission of the Board The mission of the Ohio Occupational Therapy, Physical Therapy, and Athletic Trainers Board is to actively promote and protect the health of the citizens of Ohio through effective regulation of the professions of occupational therapy, physical therapy, and athletic training. Ohio OTPTAT Board

4. Board Composition – PT Section Ohio OTPTAT Board

5. How Rules Are Changed • Rule review is a public process. • Board seeks input on initial draft before rule language is filed. • Information on proposed changes sent to listserv and posted on the Board’s website. • Once filed, full text of the rules is available at: http://www.registerofohio.state.oh.us • Public hearing on proposed changes required. • Board’s goal is new rules go into effect on May 1. Ohio OTPTAT Board

6. Recent Rules Changes Key changes effective on May 1, 2009 • 4755-23-08 – Continuing Education • Added language specifying category of CE activities that don’t require Ohio Approval Number • Passage of ABPTS specialty exam or Hand Therapy certification exam (24 hours) • Completion of APTA credentialed residency or fellowship (24 hours) • Completion of Federation of State Boards of Physical Therapy Practice Review Tool (3 hours) Ohio OTPTAT Board

7. Recent Rules Changes • 4755-23-14 – Criminal Records Checks • Must be submitted to Board directly from BCI • Board only accepts results for 6 months from date of receipt (not 1 year) • Ohio law requires both BCI and FBI • Only applies for new licensees – not for renewal • 4755-27-03 – Delegation • Clarified that delegation to “other licensed personnel” must be within that person’s legal scope of practice • Clarified that documentation by “other licensed personnel” includes patient’s response to intervention Ohio OTPTAT Board

8. Recent Rules Changes • 4755-27-04 – Supervision • Clarified supervision levels for SPT and SPTA • Supervisor must be: • On-site and • Available to immediately respond to needs of the patient • 4755-27-05 – Code of Ethical Conduct • Added provisions about documenting/billing for services not actually performed • Licensee can’t sexually harass patients, students and/or colleagues • Licensee can’t misrepresent credential, title, and/or specialty certifications held Ohio OTPTAT Board

9. Recent Rules Changes • 4755-27-06 – Reporting Requirements • Clarify that licensee must notify board of impairment by physical or mental illness • 4755-27-07 – Documentation (new rule) • PTs must use “PT” and PTAs must use “PTA” following signature to indicate licensure • LPT, LPTA, RPT not acceptable credentials • MPT and DPT are academic degrees, not the license • Sign as Jane Doe, PT, DPT; not John Doe, MPT • SPT and SPTA are OK to use for students Ohio OTPTAT Board

10. 2010 Rules Changes • 4755-21-02 – Public Notice • Technical changes only • 4755-23-04 – License by Endorsement • Specifies what it means to be “out of practice for five or more years • Actively engaged in PT practice for fewer than 500 hours over the 5 year period • 4755-23-05 – Certificate of License • Elimination of pocket ID cards Ohio OTPTAT Board

11. 2010 Rules Changes Pocket ID Cards • As of May 1, 2010, the Board will no longer issue pocket ID cards • Recent increase in # of doctored ID cards • Enhancement of currency of information on, and acceptance of, online license verification • Rule 4755-3-02 will require licensees to have available current license information from Ohio e-License Center (https://license.ohio.gov/lookup) • Availability can be printed page, smartphone access, client’s home computer, etc. Ohio OTPTAT Board

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13. PT Section working with ODE Ohio OTPTAT Board

14. Interactions with ODE • PT Section working with ODE to ensure safe and adequate PT services for students • Numerous meetings with staff from Office for Exceptional Children • Continuing correspondence to clarify PT Practice Act for school based practitioners and administrators • Section presentation to the Ohio Association of Pupil Services Administrators (OAPSA) Ohio OTPTAT Board

15. Rule 3301-51-09 (H) • Requires appropriate professional licensure • PT must be licensed pursuant to the appropriate section of the Ohio Revised Code • PTA must be licensed pursuant to the appropriate section of the Ohio Revised Code • PTA provide services under the supervision of the PT in accordance with their respective practice acts Ohio OTPTAT Board

16. Rule 3301-51-09 (I)Service Provider Ratios for Delivery of Services Ohio OTPTAT Board 16 August 10, 2010 • Determination of ratios for individual service provider must consider scheduling and time demands, including but not limited to: • All areas of service provision to children w/ and w/o disabilities including screening, assessment, consultation, training, intervention design, educational interventions • Time for planning • Severity of each child’s needs • Additional time for diagnostic testing and classroom observation, coordination of program, parent, staff and agency conference re individual children, staff development activities, follow-up and demands of an itinerant schedule including number of buildings served and distance between buildings

17. How Does Supervision of Assistants Impact Determination of Ratios? A review of therapists’ and assistants’ responsibilities provides insight Ohio OTPTAT Board

18. PT Interpret referrals to physical therapy Complete evals & interpret/analyze eval data. Write report for ETR PTA Refer all requests for physical therapy to PT Contribute to eval process by gathering data, administering standardized tests &/or obj. meas. tools, & reporting observations Only PT can interpret/analyze results of standardized tests and obj. measurement tools Who can receive PT referrals? Ohio OTPTAT Board

19. PT Responsibilities • Rule 4755-27-03 (C) outlines the tasks that a physical therapist cannot delegate. • These include, but are not limited to: • Interpreting physician referrals • Initial patient evaluation • Developing plan of care • Assessing competence of other personnel • Adjustment of plan of care • Performing final evaluation Ohio OTPTAT Board

20. PT Collaborate w/ IEP team (may include PTA), to develop IEP goals/objectives & determine if PT services required for student to meet IEP goals & access general curriculum PTA Collaborate with PT and IEP teams to assist in development of IEP goals/objectives Who writes the goals? Ohio OTPTAT Board

21. PT Develop, interpret, & modify the PT plan of care in collaboration with PTA PT to determine which portions of plan PTA will implement PTA Implement portions of PoC as assigned by PT PTA can select treatment activities to address the assigned goals and objectives or specific services as described in PoC Who is responsible for the PoC? Ohio OTPTAT Board

22. Is the IEP a Plan of Care? NO* * Medicaid does accept the IEP as a Plan of Care Ohio OTPTAT Board

23. PT Initial collaboration to ensure PoC is understood and implemented as intended, periodic consultation, with documentation of supervision provided PT to review & co-sign the treatment/daily notes of the PTA PTA Document intervention/therapy sessions & ensure PT reviews and co-signs notes Who supervises an Assistant? Ohio OTPTAT Board

24. PT 5. Review student progress with PTA Co-sign progress reports to indicate review & collaboration with PTA PTA 5. Complete periodic progress reports to be reviewed & co-signed by PT Who assesses progress? Ohio OTPTAT Board

25. PT 6. Complete assessment/analysis for periodic review & collaborate w/ IEP team to develop new goals & determine if PT services still needed Write discharge summary/plan when PT services are discontinued PTA 6. Provide data for assessment & participate in IEP team collaboration for periodic review Provide info to the PT for use in discharge plan when PT services are discontinued Can the PTA complete the periodic assessments? Ohio OTPTAT Board

26. What does therapist supervision of assistant require? • Must be able to be reached by telecommunication at all times • Development of PoC and assignment of appropriate elements to assistant • Ensure that assistant understands PoC and implements it as therapist intended • Review and co-sign assistant’s therapy notes • Review, re-assess, and change PoC as child makes progress Ohio OTPTAT Board

27. Ultimate Responsibility for Child Lies with the Therapist • What does this mean for determination of therapist’s caseload? Ohio OTPTAT Board

28. It means: Every child assigned to a PTA is part of the PT’s caseload The Board’s caseload ≠ ODE’s caseload ODE caseload = max. # of students to whom an individual may provide direct services Board caseload = all students for whom PT have ultimate responsibility PT must not provide/supervise care for higher # of students than that for which skilled care by licensed practitioners can be delivered Ohio OTPTAT Board

29. Ohio OTPTAT Board

30. Question 1 • Question 1. For school-based therapists, does the IEP count as the physical therapy plan of care? • Answer: No. The IEP does not meet the requirements of the physical therapy plan of care. • The IEP is an Ohio Department of Education approved document that delineates the student's educational needs, goals, and benchmarks. The duration and frequency of the services that will be provided in order to meet the educational goals and benchmarks are stated in the IEP. • The school-based physical therapist must write a plan of care for his/her records for each student indicating specific physical therapy goals and intervention to achieve those goals, as well as precautions/contraindications. • How the physical therapy services will be implemented and precautions/contraindications are not a part of the IEP. This is the information that must be documented in a separate physical therapy plan of care. Ohio OTPTAT Board

31. Question 2 • Question 2. What's the maximum ratio of physical therapist assistants to one supervising physical therapist? • Answer: The Ohio Physical Therapy Practice Act is silent on the supervision ratio for physical therapist assistants and does not regulate caseloads. However, the Section requires the physical therapist to ensure appropriate patient management based on the unique needs of the clients, taking into account the complexity of the patient population. The ultimate responsibility for care of the patient lies with the evaluating physical therapist regardless of whether the therapist or physical therapist assistant provide follow-up treatment. In any given period of time, a physical therapist must not provide or supervise care for a higher number of patients than that for which skilled care by licensed practitioners can be delivered. Ohio OTPTAT Board

32. Listserv • Each Section has its own listserv • Important news announced on listserv • Rules changes • New information posted to website • To join, send an email to: board@otptat.ohio.gov • Or go to http://otptat.ohio.gov and select “Join a Board Listserv” link on the homepage Ohio OTPAT Board

33. Contacting the Board Email: board@otptat.ohio.gov Internet: http://otptat.ohio.gov Phone: 614-466-3774 Fax: 614-995-0816 Mail: Ohio OTPTAT Board 77 S. High Street, 16th Floor Columbus, OH 43215-6108 Ohio OTPAT Board 33 August 10, 2010