TITLE 18. PROFESSIONAL AND OCCUPATIONAL LICENSING

BOARD OF PHYSICAL THERAPY

Fast-Track Regulation

Title of Regulation: 18VAC112-20. Regulations Governing the Practice of Physical Therapy (amending 18VAC112-20-65).

Statutory Authority: § 54.1-2400 of the Code of Virginia.

Public Hearing Information: No public hearing is currently scheduled.

Public Comment Deadline: March 25, 2026.

Effective Date: April 9, 2026.

Agency Contact: Corie Tillman Wolf, Executive Director, Board of Physical Therapy, 9960 Mayland Drive, Suite 300, Henrico, VA 23233, telephone (804) 367-4674, fax (804) 527-4413, or email ptboard@dhp.virginia.gov.

Basis: Section 54.1-2400 of the Code of Virginia authorizes the Board of Physical Therapy to promulgate regulations to effectively administer the regulatory system.

Purpose: This action protects public health by bringing Virginia into compliance with the Physical Therapy Licensure Compact, avoiding a loss of access to health care that the compact was intended to provide. Both physical therapists practicing in Virginia under a compact privilege and those practitioner's patients would be harmed by the inability of compact privilege practitioners to continue practicing.

Rationale for Using Fast-Track Rulemaking Process: This action is noncontroversial and appropriate for the fast-track rulemaking process because the amendments align Virginia with national standards as required by the compact Virginia has entered. The amendments will not affect the licensure process for a vast majority of applicants.

Substance: The amendments remove the acceptance of any examination accepted by another state or Canadian province for licensure by endorsement applicants. Compact Commission rules require that states only accept the National Physical Therapy Examination for licensure; therefore, neither a state examination nor the Physiotherapy Competency Exam accepted by Canadian provinces may be accepted to license physical therapists in Virginia.

Issues: The primary advantage to the public is that Virginia will remain in compliance with the Physical Therapy Licensure Compact and can continue to provide practitioners from other states a compact privilege to work in Virginia. There are no disadvantages to the public. There are no primary advantages or disadvantages to the agency or the Commonwealth.

Department of Planning and Budget Economic Impact Analysis:

The Department of Planning and Budget (DPB) has analyzed the economic impact of this proposed regulation in accordance with § 2.2-4007.04 of the Code of Virginia and Executive Order 19. The analysis presented represents DPB's best estimate of the potential economic impacts as of the date of this analysis.¹

Summary of the Proposed Amendments to Regulation. The Board of Physical Therapy (board) is proposing to amend Regulations Governing the Practice of Physical Therapy (18VAC112-20) to indicate that the only accepted examination for licensure as a physical therapist or physical therapist assistant is the National Physical Therapy Examination (NPTE).²

Background. The board initiated a periodic review for 18VAC112-20 in 2018. One of the changes resulting from that periodic review was an amendment to allow licensed physical therapists and physical therapist assistants to become licensed in Virginia via licensure by endorsement by documenting passage of an examination required by another state or Canadian province. At that time, Canadian jurisdictions and Michigan allowed passage of the Physiotherapy Competency Exam instead of the NPTE. The regulatory changes stemming from the periodic review became final on April 30, 2021. These changes, which allowed licensure via endorsement following passage of the Physiotherapy Competency Exam, inadvertently conflicted with state law. More specifically, the conflict results from the Physical Therapy Licensure Compact (compact), which the Commonwealth entered into pursuant to Chapter 300 of the 2019 Acts of Assembly. Under the compact, physical therapists and physical therapist assistants licensed in a participating state can legally practice in other participating states without obtaining additional licenses from those other states. The legislation also added § 54.1-3495 of the Code of Virginia, which in part states that "Any rule that has been previously adopted by the Commission shall have the full force and effect of law on the day the compact becomes law in that state." However, commission rules require compact members to only license physical therapists and physical therapist assistants who have passed the NPTE, which the board was not initially aware of. Now that the board is aware of the conflict, it is proposing to amend the regulation to be consistent with Compact Commission (commission) rules by only allowing passage of the NPTE to be used when applying for licensure by endorsement.

Estimated Benefits and Costs. According to the Department of Health Professions (DHP), in practice no one has applied for Virginia licensure by endorsement based upon possessing a Canadian license as a physical therapist or a physical therapist assistant. Once the board and DHP became aware of the conflict, they would not have accepted such an application since in their view, pursuant to § 54.1-3495 of the Code of Virginia, the commission rules have the effect of statutes and control over Virginia regulations.³ Thus the proposed amendment conforms the regulation to what is required in practice. Amending the text to accurately reflect the requirements in practice is beneficial in that readers of the regulation would no longer be misled concerning what examination or examinations are accepted.

Businesses and Other Entities Affected. The Code of Virginia requires DPB to assess whether an adverse impact may result from the proposed regulation.⁴ An adverse impact is indicated if there is any increase in net cost or reduction in net benefit for any entity, even if the benefits exceed the costs for all entities combined. The proposal does not increase costs or reduce revenue. Thus, no adverse impact is indicated.

Small Businesses⁵ Affected.⁶ The proposed amendments do not adversely affect small businesses.

Localities⁷ Affected.⁸ The proposed amendments do not disproportionately affect particular localities or affect costs for local governments.

Projected Impact on Employment. The proposed amendments do not affect total employment.

Effects on the Use and Value of Private Property. The proposed amendments affect neither the use and value of private property nor real estate development costs.

_____________________________

¹ Section 2.2-4007.04 of the Code of Virginia requires that such economic impact analyses determine the public benefits and costs of the proposed amendments. Further the analysis should include but not be limited to: (1) the projected number of businesses or other entities to whom the proposed regulatory action would apply, (2) the identity of any localities and types of businesses or other entities particularly affected, (3) the projected number of persons and employment positions to be affected, (4) the projected costs to affected businesses or entities to implement or comply with the regulation, and (5) the impact on the use and value of private property.

² The proposed text is "Documentation of passage of an examination equivalent to the national examination as prescribed by the board." The Agency Background Document makes clear that the national examination prescribed by the board is the NPTE. See https://townhall.virginia.gov/l/GetFile.cfm?File=133\5951\9610\AgencyStatement_DHP_9610_v1.pdf.

³ Source: DHP.

⁴ Pursuant to § 2.2-4007.04 D: In the event this economic impact analysis reveals that the proposed regulation would have an adverse economic impact on businesses or would impose a significant adverse economic impact on a locality, business, or entity particularly affected, the Department of Planning and Budget shall advise the Joint Commission on Administrative Rules, the House Committee on Appropriations, and the Senate Committee on Finance. Statute does not define "adverse impact," state whether only Virginia entities should be considered, nor indicate whether an adverse impact results from regulatory requirements mandated by legislation.

⁵ Pursuant to § 2.2-4007.04, small business is defined as "a business entity, including its affiliates, that (i) is independently owned and operated and (ii) employs fewer than 500 full-time employees or has gross annual sales of less than $6 million."

⁶ If the proposed regulatory action may have an adverse effect on small businesses, § 2.2-4007.04 requires that such economic impact analyses include: (1) an identification and estimate of the number of small businesses subject to the proposed regulation, (2) the projected reporting, recordkeeping, and other administrative costs required for small businesses to comply with the proposed regulation, including the type of professional skills necessary for preparing required reports and other documents, (3) a statement of the probable effect of the proposed regulation on affected small businesses, and (4) a description of any less intrusive or less costly alternative methods of achieving the purpose of the proposed regulation. Additionally, pursuant to § 2.2-4007.1 of the Code of Virginia, if there is a finding that a proposed regulation may have an adverse impact on small business, the Joint Commission on Administrative Rules shall be notified.

⁷ "Locality" can refer to either local governments or the locations in the Commonwealth where the activities relevant to the regulatory change are most likely to occur.

⁸ Section 2.2-4007.04 defines "particularly affected" as bearing disproportionate material impact.

Agency Response to Economic Impact Analysis: The Board of Physical Therapy concurs with the economic impact analysis prepared by the Department of Planning and Budget.

Summary:

The amendments bring Virginia into compliance with the Physical Therapy Licensure Compact by removing acceptance of any examination accepted by another state or Canadian province and instead specifying that applicants for physical therapy licensure by endorsement must pass a national exam as prescribed by the Board of Physical Therapy.

18VAC112-20-65. Requirements for licensure by endorsement.

A. A physical therapist or physical therapist assistant who holds a current, unrestricted license in the United States, its territories, the District of Columbia, or Canada may be licensed in Virginia by endorsement.

B. An applicant for licensure by endorsement shall submit:

1. Documentation of having met the educational requirements prescribed in 18VAC112-20-40 or 18VAC112-20-50. In lieu of meeting such requirements, an applicant may provide evidence of clinical practice consisting of at least 2,500 hours of patient care during the five years immediately preceding application for licensure in Virginia with a current, unrestricted license issued by another United States jurisdiction or Canadian province;

2. The required application, fees, and credentials to the board, including a criminal history background check as required by § 54.1-3484 of the Code of Virginia;

3. A current report from the National Practitioner Data Bank (NPDB);

4. Documentation of passage of an examination equivalent to the Virginia national examination at the time of initial licensure or documentation of passage of an examination required by another state or Canadian province at the time of initial licensure in that state or province as prescribed by the board; and

5. Documentation of active practice in physical therapy in another United States jurisdiction or Canada for at least 320 hours within the four years immediately preceding application for licensure. A physical therapist who does not meet the active practice requirement shall successfully complete 320 hours in a traineeship in accordance with requirements in 18VAC112-20-140.

C. A physical therapist assistant seeking licensure by endorsement who has not actively practiced physical therapy for at least 320 hours within the four years immediately preceding application for licensure shall successfully complete 320 hours in a traineeship in accordance with the requirements in 18VAC112-20-140.