Title of Regulation: 18VAC112-20. Regulations Governing the Practice of Physical Therapy (amending 18VAC112-20-131).

Statutory Authority: §§ 54.1-2400 and 54.1-3474 of the Code of Virginia.

Public Hearing Information: No public hearings are scheduled.

Public Comment Deadline: September 11, 2013.

Effective Date: September 26, 2013.

Agency Contact: Lisa R. Hahn, Executive Director, Board of Physical Therapy, 9960 Mayland Drive, Suite 300, Richmond, 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 establishes the general powers and duties of the Board of Physical Therapy, including the responsibility to promulgate regulations, which are reasonable and necessary to administer effectively the regulatory system.

The mandate for regulations setting criteria for continuing education is found in § 54.1-3480.1 of the Code of Virginia, which states that as a prerequisite to renewal of a license or reinstatement of a license, each physical therapist shall be required to take biennial courses relating to physical therapy as approved by the board. The board shall prescribe criteria for approval of courses of study and credit hour requirements. Further, § 54.1-3474 of the Code of Virginia requires the board to promulgate regulations establishing requirements to ensure continuing competency of physical therapists and physical therapist assistants and permits the board to approve persons who provide or accredit programs to ensure continuing competency.

Purpose: The proposed regulatory action is intended to ease the burden of obtaining required hours of continuing education by accepting health care organizations that are deemed in compliance with the Centers for Medicare and Medicaid Services (CMS) but do not necessarily maintain accreditation by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). The goal is to eliminate any requirement that is not essential to ensure that licensees are remaining current in their knowledge and practice skills for protection of the health and safety of their patients.

Rationale for Using Fast-Track Process: The amendment is less restrictive and not controversial. The board is responding to a petition for rulemaking; all comments on the petition were supportive.

Substance: The amendment to 18VAC112-20-131 will approve continuing education courses offered by health care organizations that are accredited by a national accrediting organization granted authority by CMS to assure compliance with Medicare conditions of participation, rather than only those accredited by the JCAHO.

Issues: More inclusive and less burdensome rules for continuing education facilitate completion of renewal requirements, which is advantageous to the public and the licensees. There are no disadvantages to the public. There are no advantages or disadvantages to the agency or the Commonwealth.

Department of Planning and Budget's Economic Impact Analysis:

Summary of the Proposed Amendments to Regulation. Under the current regulations, the Board of Physical Therapy (Board) accepts continuing education courses from a variety of organizations. If the provider (or approving organization) is a health care organization, the current regulations require that the organization be accredited by the Joint Commission on Accreditation of Healthcare Organizations. The Board proposes to instead accept courses from (or approved by) health care organizations accredited by a national accrediting organization granted authority by the Centers for Medicare and Medicaid Services to assure compliance with Medicare conditions of participation.

Result of Analysis. The benefits likely exceed the costs for all proposed changes.

Estimated Economic Impact. These regulations require that physical therapists and physical therapist assistants complete at least 30 contact hours of continuing learning activities every two years in order to maintain active licensure. At least 15 of those hours for physical therapists and 10 of those hours for physical therapist assistants must be in face-to-face courses. The current regulations require that the courses be approved or provided by one of the following organizations or any of its components:

a. The Virginia Physical Therapy Association;

b. The American Physical Therapy Association;

c. Local, state or federal government agencies;

d. Regionally accredited colleges and universities;

e. Health care organizations accredited by the Joint Commission on Accreditation of Healthcare Organizations;

f. The American Medical Association - Category I Continuing Medical Education course; and

g. The National Athletic Trainers Association.

The Board proposes to delete the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and replace it with a national accrediting organization granted authority by the Centers for Medicare and Medicaid Services to assure compliance with Medicare conditions of participation.

A petition for rulemaking was filed by a physical therapist on behalf of Sentara health care system which is moving to accreditation by Det Norske Veritas (DNV) rather than JCAHO. Therefore, recognizing only JCAHO prohibits the Board from accepting continuing education courses offered by Sentara entities for their employees. DNV is a national accrediting organization granted authority by the Centers for Medicare and Medicaid Services (CMS) to assure compliance with Medicare conditions of participation.¹ Other accrediting bodies that have been deemed as meeting CMS standards for accreditation are also excluded under the current language. By enabling the Board to approve courses from additional entities which are deemed to meet the same standard of quality will reduce costs for some physical therapists and physical therapist assistants without presumably compromising the quality of training. For example, the Department of Health Professions believes the proposed change will enable some physical therapists and physical therapist assistants to obtain qualifying continuing education at no cost as part of in-service training that would not have qualified as hours toward license renewal under the current regulations. Therefore the proposed amendment will likely provide a net benefit.

Businesses and Entities Affected. There are 6,090 licensed physical therapists and 2,460 licensed physical therapist assistants in the Commonwealth.² Most work in health care organizations or school systems. Most of the businesses would qualify as small businesses.

Localities Particularly Affected. The proposed amendments do not disproportionately affect particular localities.

Projected Impact on Employment. The proposed amendments are unlikely to significantly affect total employment. There may be a small shift in demand among providers of continuing education; but this would not likely affect total employment.

Effects on the Use and Value of Private Property. The proposed amendment may cause a small shift in demand among providers of continuing education; this may cause a moderate increase in value for those that receive greater demand and a moderate decrease in value for those that receive less demand. Some physical therapists, physical therapist assistants, and their employers will benefit from potentially reduced continuing education costs.

Small Businesses: Costs and Other Effects. The proposed amendments will not increase costs for small businesses.

Small Businesses: Alternative Method that Minimizes Adverse Impact. The proposed amendments will not adversely impact small businesses as a whole. Some providers of continuing education may lose demand for their services to others, while potential costs for those that employ physical therapists and physical therapist assistants may be reduced.

Real Estate Development Costs. The proposed amendments will not affect real estate development costs.

Legal Mandate. 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 Administrative Process Act and Executive Order Number 14 (10). Section 2.2-4007.04 requires that such economic impact analyses include, but need not be limited to, a determination of the public benefit, the projected number of businesses or other entities to whom the regulation would apply, the identity of any localities and types of businesses or other entities particularly affected, the projected number of persons and employment positions to be affected, the projected costs to affected businesses or entities to implement or comply with the regulation, and the impact on the use and value of private property. Further, if the proposed regulation has an adverse effect on small businesses, § 2.2-4007.04 requires that such economic impact analyses include (i) an identification and estimate of the number of small businesses subject to the regulation; (ii) the projected reporting, recordkeeping, and other administrative costs required for small businesses to comply with the regulation, including the type of professional skills necessary for preparing required reports and other documents; (iii) a statement of the probable effect of the regulation on affected small businesses; and (iv) a description of any less intrusive or less costly alternative methods of achieving the purpose of the regulation. The analysis presented above represents DPB's best estimate of these economic impacts.

¹ Source: Centers for Medicare and Medicaid Services

² Source: Department of Health Professions

Agency's Response to Economic Impact Analysis: The Board of Physical Therapy concurs with the analysis of the Department of Planning and Budget for amendments to 18VAC112-20, Regulations Governing the Practice of Physical Therapy, relating to the listing of approved continuing education providers.

Summary:

The regulatory action amends the list of approved sponsors of continuing education to include health care organizations accredited by a national accrediting organization granted authority by the Centers for Medicare and Medicaid Services to assure compliance with Medicare conditions of participation, rather than only those organizations accredited by the Joint Commission on Accreditation of Healthcare Organizations.

18VAC112-20-131. Continued competency requirements for renewal of an active license.

A. In order to renew an active license biennially, a physical therapist or a physical therapist assistant shall complete at least 30 contact hours of continuing learning activities within the two years immediately preceding renewal. In choosing continuing learning activities or courses, the licensee shall consider the following: (i) the need to promote ethical practice, (ii) an appropriate standard of care, (iii) patient safety, (iv) application of new medical technology, (v) appropriate communication with patients, and (vi) knowledge of the changing health care system.

B. To document the required hours, the licensee shall maintain the Continued Competency Activity and Assessment Form that is provided by the board and that shall indicate completion of the following:

1. A minimum of 20 of the contact hours required for physical therapists and 15 of the contact hours required for physical therapist assistants shall be in Type 1 courses. For the purpose of this section, "course" means an organized program of study, classroom experience or similar educational experience that is directly related to the clinical practice of physical therapy and approved or provided by one of the following organizations or any of its components:

a. The Virginia Physical Therapy Association;

b. The American Physical Therapy Association;

c. Local, state or federal government agencies;

d. Regionally accredited colleges and universities;

e. Health care organizations accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) a national accrediting organization granted authority by the Centers for Medicare and Medicaid Services to assure compliance with Medicare conditions of participation;

f. The American Medical Association - Category I Continuing Medical Education course; and

g. The National Athletic Trainers Association.

2. No more than 10 of the contact hours required for physical therapists and 15 of the contact hours required for physical therapist assistants may be Type 2 activities or courses, which may or may not be offered by an approved organization but which shall be related to the clinical practice of physical therapy. Type 2 activities may include but not be limited to consultation with colleagues, independent study, and research or writing on subjects related to practice.

3. Documentation of specialty certification by the American Physical Therapy Association may be provided as evidence of completion of continuing competency requirements for the biennium in which initial certification or recertification occurs.

4. Documentation of graduation from a transitional doctor of physical therapy program may be provided as evidence of completion of continuing competency requirements for the biennium in which the physical therapist was awarded the degree.

5. A physical therapist who can document that he has taken the PRT may receive 10 hours of Type 1 credit for the biennium in which the assessment tool was taken. A physical therapist who can document that he has met the standard of the PRT may receive 20 hours of Type 1 credit for the biennium in which the assessment tool was taken.

C. A licensee shall be exempt from the continuing competency requirements for the first biennial renewal following the date of initial licensure by examination in Virginia.

D. The licensee shall retain his records on the completed form with all supporting documentation for a period of four years following the renewal of an active license.

E. The licensees selected in a random audit conducted by the board shall provide the completed Continued Competency Activity and Assessment Form and all supporting documentation within 30 days of receiving notification of the audit.

F. Failure to comply with these requirements may subject the licensee to disciplinary action by the board.

G. The board may grant an extension of the deadline for continuing competency requirements for up to one year for good cause shown upon a written request from the licensee prior to the renewal date.

H. The board may grant an exemption for all or part of the requirements for circumstances beyond the control of the licensee, such as temporary disability, mandatory military service, or officially declared disasters.

I. Physical therapists holding certification to provide direct access without a referral shall include four contact hours as part of the required 30 contact hours of continuing education in courses related to clinical practice in a direct access setting.