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Update from the Ohio Physical Therapy Board Jeffrey M. Rosa, Executive Director http://otptat.ohio.gov board@otptat.ohio.gov. Topics. Purpose of Regulation Information About the Board Recent Rules Changes Proposed 2010 Rules Changes Investigation & Discipline Consumer Education

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  1. Update from the Ohio Physical Therapy BoardJeffrey M. Rosa, Executive Directorhttp://otptat.ohio.govboard@otptat.ohio.gov Ohio OTPTAT Board

  2. Topics • Purpose of Regulation • Information About the Board • Recent Rules Changes • Proposed 2010 Rules Changes • Investigation & Discipline • Consumer Education • 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. The Purpose of Regulation… • Regulation is intended to: • Ensure public protection; • Offer assurance to public that practitioner is competent to provide safe services; and • Provide a means to discipline individuals who fail to comply with the profession’s standards. *Schmitt, Kara & Shimberg, Benjamin. (1996). Demystifying Occupational and Professional Regulation. Lexington, KY: The Council on Licensure, Enforcement and Regulation. Ohio OTPTAT Board

  5. The Board’s Authority • The Revised Code empowers the Board to regulate the professions of OT, PT, & AT. • Board members appointed by the Governor to three-year terms. • The law authorizes the Board to adopt administrative rules (Administrative Code). • Authorizes hiring an Executive Director. Ohio OTPTAT Board

  6. Major Responsibilities of the Board • Establish Entrance Requirements • Education Training and Experience • Assessing initial competence • Rule Making • Discipline • Assuring Continued Competence Ohio OTPTAT Board

  7. OTPTAT Board Info • Joint Board consisting of an Occupational Therapy, Physical Therapy, and Athletic Trainers Section • Total of 8 full-time staff • 2 Admin Staff, 3 Investigative Staff, 3 Licensure Staff • PT Section has 9 Section members Ohio OTPTAT Board

  8. Board Composition – PT Section Ohio OTPTAT Board

  9. Board Composition – PT Section Ohio OTPTAT Board

  10. 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

  11. Recent Rules Changes Key changes effective on May 1, 2009. • 4755-23-03 – License by Examination • Removed required remedial activities for individuals who: • Failed NPTE 3+ times • Graduated 3+ years from PT school • 4755-23-04 – License by Endorsement • Removed required remedial activities for individuals out of practice more than 3 years • Add requirement that individuals out of practice more than 5 years retake and pass NPTE Ohio OTPTAT Board

  12. Recent Rules Changes • 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

  13. Recent Rules Changes • 4755-23-10 – Reinstatement of License • Removed required remedial activities for individuals out of practice more than 3 years • Add requirement that individuals out of practice more than 5 years retake and pass NPTE • Updated CE required for reinstatement • If you apply to reinstate w/in 1 month of expiration, CE for reinstatement = CE needed for that renewal (e.g.: 0 hours if it was your 1st renewal) Ohio OTPTAT Board

  14. Recent Rules Changes • 4755-23-12 – Requirements for Teaching PT • Rule needed per amendment in HB 403 (ORC 4755.482) • Allows non-Ohio licensed PTs to teach PT theory & procedures (as faculty of record) course up to 1 year w/o Ohio license • Need Ohio license to teach more than 1 year • No license needed for guest faculty/CE presenters • Individual or school must notify Board before individual starts teaching Ohio OTPTAT Board

  15. 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

  16. 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

  17. 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

  18. Proposed 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

  19. Proposed 2010 Rules Changes • 4755-23-06 – Biennial Renewal of Licensure • Change word “application” to “notice” to reflect current practices • 4755-23-10 – Reinstatement of License • 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 • 4755-23-12 – Requirements for Foreign Educated Applicants • Changes to reflect current practices Ohio OTPTAT Board

  20. Proposed 2010 Rules Changes • 4755-23-15 – Reinstatement of Revoked License • Specifies the criteria used by Board when reviewing application from individual whose license was denied or revoked • Criteria include: • Nature/severity of act(s) that resulted in denial/revocation • Time elapsed • Possible additional violations • Compliance with previous Board orders • Any evidence of rehabilitation submitted • 4755-24-05 – License re-issuance fee • Eliminate fee for duplicate ID card Ohio OTPTAT Board

  21. 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 4755-23-05 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

  22. Ohio OTPTAT Board

  23. Supervision & Delegation Rules • Changes to rules 4755-27-01 to 4755-27-04 went into effect on May 1, 2008. • These changes clarified and modified the role of unlicensed personnel. Ohio OTPTAT Board

  24. 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

  25. PTA Responsibilities • Under PT supervision, the PTA may: • Carry out duties appropriate to established PT services • Adjust treatment procedure within the established plan of care • Review medical information with medical persons, family, or the patient • Progress patient treatment program within parameters of the plan of care • Document in patient records Ohio OTPTAT Board

  26. Other Licensed Personnel Any person holding an Ohio license to practice as a health care practitioner other than a PT/PTA Unlicensed Personnel Any person who is on the job trained Other Licensed Personnel vs. Unlicensed Personnel Ohio OTPTAT Board

  27. Other Licensed Personnel • Category includes individuals such as: ATs, RNs, OTs, LMTs, etc., providing services pursuant to the PT plan of care • Responsibility for care rendered lies at all times with the PT • Must work under direct supervision of a PT or PTA, as delegated by the PT Ohio OTPTAT Board

  28. Other Licensed Personnel • Direct supervision = PT/PTA in same building & able to immediately respond to needs of patient • PT/PTA must have involvement with patient during each visit • Delegation done in accordance with knowledge and legal scope of practice of the other licensed personnel Ohio OTPTAT Board

  29. Unlicensed Personnel • Responsibility for care rendered lies at all times with the PT • Support the delivery of PT services by personally assisting the PT / PTA / PT Student / PTA Student while one of these individuals is concurrently providing services to the same patient • “A second pair of hands” Ohio OTPTAT Board

  30. Unlicensed Personnel • May be assigned ROUTINE duties that assist in the delivery of PT operations, including: • Maintenance & care of equipment and supplies • Preparation, maintenance, and cleanup of treatment areas • Transportation of patients • Office & clerical procedures • Assisting patients preparing for, during, and at the conclusion of treatment (eg: changing clothes) Ohio OTPTAT Board

  31. Supervision • PT has ultimate responsibility for all care and services delivered as physical therapy • PT shall select appropriate portions of the program to be delegated and shall direct PTA in delegated functions • PT must assure that care is provided in accordance with state law Ohio OTPTAT Board

  32. Supervision of the PTA • Supervising PT not required to be physically on site or on location • Supervising PT must be available by telecommunications at all times and able to appropriately respond to patient’s needs • Supervising PT should have regularly scheduled & documented conferences with the PTA • Board recommends at least 1x per month Ohio OTPTAT Board

  33. Supervision of Students • Students must be enrolled in CAPTE program • Must function under on-site supervision at all times • Student PT needs PT supervision • Student PTA needs PT or PTA supervision • Supervisor must countersign all student documentation Ohio OTPTAT Board

  34. Physical abuse/injuries to a patient Patient neglect Falsification of documentation* Billing fraud* Failure to complete documentation prior to ending employment Mental impairment issues Drug/alcohol abuse Competency issues Criminal convictions Unprofessional behavior Unlicensed practice Failure to complete CE Falsifying an application What Does the Board Investigate? Ohio OTPTAT Board

  35. CE/Audit violations Unlicensed practice Practice prior to licensure Practice on expired license Negligence/gross misconduct Supervision issues Illegal advertising/soliciting of patients Fraud Documenting services not actually provided Most Common Violations Ohio OTPTAT Board

  36. Expired Practice • Licenses expire on Jan. 31 – there is no grace period • If you practice without an Ohio license, you will be disciplined for practicing physical therapy without a license!! • “Licensure Applicant” status eliminated in 2007 Ohio OTPTAT Board

  37. Consumer Education • Each Section of the Board developed informational guides about the professions and role of the Board for consumers • Documents available under “Consumer” section of the website • Licensees are permitted AND ENCOURAGED to print copies to make available to clients Ohio OTPTAT Board

  38. Ohio OTPTAT Board

  39. Ohio OTPTAT Board

  40. Ohio OTPTAT Board

  41. Question 1 • What’s the maximum ratio of PTAs to one supervising PT? • PT law is silent on PT:PTA ratios and does not regulate caseloads • Supervising PT must ensure appropriate patient management based on unique needs of the clients, taking into account complexity of patient population • PT must not provide or supervise care for higher # of patients than that for which skilled care by licensed practitioners can be delivered Ohio OTPTAT Board

  42. Question 2 • Is there maximal productivity standard allowed in Ohio? • Ohio law doesn’t regulate caseloads. • PT practitioner must ensure that the highest priority patient needs are met • PT must challenge productivity expectations if these standards cannot be met Ohio OTPTAT Board

  43. Question 3 • Can a PTA teach aerobic exercise classes at a fitness center? • Under Ohio law, PT practitioner providing fitness/wellness services must follow PT law if services are represented as physical therapy • PTA must follow rules governing delegation and supervision • If fitness/wellness services not represented as physical therapy, they don’t fall under jurisdiction of PT Practice Act • Licensee shouldn’t use credential “PT” or “PTA” in this scenario • Board recommends appropriate medical screenings are in place prior to exercise to ensure participant safety • Fitness/wellness records should be stored separately from physical therapy or medical records Ohio OTPTAT Board

  44. Question 4 • Is it legal for PT or PTA to document the medications that a patient is taking? • Nothing in PT law prohibits the PT/PTA from performing medication reconciliation. • Medication reconciliation not part of PT plan of care; performed as an administrative task of any health care professional • Reconciliation includes interviewing patient about current meds & comparing to list of prescribed meds; referring the meds list to other practitioners and/or computerized programs to identify potential drug interactions Ohio OTPTAT Board

  45. Question 5 • If I’m laid off, am I required to document a transfer of care for my patients? • Abandonment is inappropriate termination of PT/patient relationship by the PT • PTs have legal & ethical obligation to make every effort to follow through with established plan of care • PT has responsibility to refer patients elsewhere if he/she can no longer continue to treat a patient Ohio OTPTAT Board

  46. Question 6 • If I work in a hospital with other PTs to provide 7-day per week coverage, do I have to document transfer of care every time I take a day off? • No, a formal transfer is not needed. • It’s opinion of the Board that if 2 or more PTs are participating in job-sharing caseload, and if they are assuming collective responsibility for patient’s care each day, they aren’t terminating PT/patient relationship (therefore no transfer of care needed) Ohio OTPTAT Board

  47. Question 7 • If the evaluating PT resigns from that patient’s facility, does that PT have any further responsibility for the patient? • Each practice should determine a system that allows for transfer of care when a PT terminates the PT/patient relationship • Transfer of care must be documented in patient record by identifying new PT by name (or to PT supervisor for reassignment) Ohio OTPTAT Board

  48. Question 8 • If a PT provides merely an interview/consultation to evaluate a client and provides recommendations for follow up, is a physician referral required? • Refer to R.C. 4755.481 for practice w/o referral • Physician notification required w/in 5 days of direct access evaluation • Consult/referral required w/in 30 days if no substantial progress made • No notification/consult/referral required for: • Fitness/wellness/prevention purposes • Treatment of previously diagnosed chronic, neuromuscular, or developmental conditions Ohio OTPTAT Board

  49. Question 9 • If the PT documents a discharge eval 2 days prior to patient’s discharge, may a PTA provide and document treatment the next day? Can that info from the PTA constitute the discharge summary? • Discharge planning and completion of discharge eval are responsibility of PT • PTA may provide care per that discharge assessment & may document objective info, but PT must then complete final discharge summary Ohio OTPTAT Board

  50. Question 10 • Can a PT or PTA develop the plan for a restorative aide to provide maintenance therapy in a nursing home? • Yes • A PT or PTA may provide administrative oversight of an unlicensed aide who is providing restorative or maintenance care in a nursing home after the termination of a PT plan of care Ohio OTPTAT Board

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