Title of Regulation: 18VAC112-20. Regulations Governing the Practice of Physical Therapy (amending 18VAC112-20-10, 18VAC112-20-65, 18VAC112-20-131, 18VAC112-20-135, 18VAC112-20-136).

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

Public Hearing Information:

August 22, 2017 - 9:35 a.m. - Department of Health Professions, Perimeter Center, 9960 Mayland Drive, 2nd Floor Conference Center, Board Room 4, Henrico, VA 23233

Public Comment Deadline: October 22, 2017.

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 provides the Board of Physical Therapy the authority to promulgate regulations to administer the regulatory system. Section 54.1-3479 of the Code of Virginia provides the board with specific authority to require professional activity or to serve in a traineeship as evidence of competency to practice. Additionally, the board has a statutory mandate to require continuing education for renewal pursuant to § 54.1-3480.1 of the Code of Virginia.

Purpose: The board currently recognizes the Practice Review Tool (PRT) for competency assessment developed and administered by the Federation of State Boards of Physical Therapy (FSBPT). Physical therapists who take the assessment and those who meet the standard, as set by FSBPT, can receive continuing education credits. Meeting the standard on the PRT also allows an applicant for licensure by endorsement or for reinstatement who has not been actively practicing to reduce the required number of hours in a traineeship.

FSBPT has informed member boards that, as of November 30, 2016, it no longer offers the PRT and has replaced it with a different assessment tool called oPTion. oPTion uses scenarios and multiple-choice questions that emphasize clinical application of knowledge necessary for safe, effective practice. Each scenario is followed by three to five multiple-choice questions for a total of 100 questions. With the shift to oPTion, the FSBPT has also eliminated the PRT "standard" and replaced it with an assessment report that categorizes the therapist's performance into Levels 1 through 4.

The purpose of the proposed action is to utilize a self-assessment tool that allows physical therapists to compare their knowledge, skills, and abilities to entry-level general physical therapy practice. A physical therapist cannot fail oPTion, and the results are not an assurance of minimal competence. Therefore, the board must balance its responsibility to adopt regulations that protect the public health and safety with an opportunity for applicants to reduce the number of traineeship hours or receive continuing education credits by taking the assessment tool oPTion.

Substance: Since meeting the "standard" on the PRT has been replaced with four levels of competency, the board proposes to replace the Practice Review Tool, an assessment tool previously offered by the Federation of State Boards of Physical Therapy, with oPTion, the tool currently available. Attainment of at least Level 2 on oPTion may be used for continuing education credits or to replace hours in a supervised traineeship for applicants for licensure by endorsement, reinstatement of license, or reactivation of license if the physical therapist has not been engaged in active practice for the two years immediately preceding application for an active license.

According to FSBPT, the levels are described as follows: (i) Level 1 indicates the ability to apply entry-level knowledge, concepts, and principles across a limited range of patient conditions; (ii) Level 2 indicates the ability to apply entry-level knowledge, concepts, and principles across a moderate range of patient conditions; (iii) Level 3 demonstrates ability in a broad range of patient conditions; and (iv) Level 4 demonstrates ability across an extensive range of patient conditions.

Issues: The primary advantage of the amendments is more flexibility in meeting requirements for evidence of continued competency--both for current licensees to meet the hours of Type 1 CE required for renewal and for applicants who have not been engaged in active practice in the past two years. There are no disadvantages to the public because attaining a minimum of Level 2 on oPTion would not be the only requirement necessary for continuing competency. Such assessment tools are advantageous in that they indicate to the licensee their areas of strength and weakness to encourage them to seek additional education and training if needed.

There are no advantages or disadvantages to the Commonwealth.

The proposed amendments are a foreseeable result of the statute requiring the board to protect the health and safety of patients in the Commonwealth. They are optional and offer licensees more flexibility; and therefore, they do not constitute any restraint on competition.

Department of Planning and Budget's Economic Impact Analysis:

Summary of the Proposed Amendments to Regulation. The Board of Physical Therapy (Board) proposes to replace the Practice Review Tool (PRT), which was recently retired by the Federation of State Boards of Physical Therapy (FSBPT), with the FSBPT's new assessment tool called "oPTion." The Board also proposes to decrease the number of continuing education hours that may be earned by completing the assessment tool.

Result of Analysis. For one proposed regulatory change, benefits likely outweigh costs. There is insufficient information to ascertain whether the benefits for other proposed changes will outweigh their costs.

Estimated Economic Impact. Current regulation allows physical therapists to use the PRT to meet continuing education (CE) requirements as well as to decrease the number of traineeship hours needed for licensure by endorsement for applicants who do not meet the Board required active practice requirement. Physical therapists can currently use completion of the PRT for 10 of the 30 biennially required CE hours if they do not successfully meet the standards of this tool and can get credit for 20 hours if they meet the standard of the PRT.¹ However, the FSBPT discontinued use of the PRT in November 2016 and replaced it with a new self-assessment tool called oPTion. While the PRT was essentially an assessment with a knowledge level that could be satisfied (or not), the oPTion assessment tool has leveled grading with Levels 1 through 4. As reported by Board staff, Level 1 indicates the ability to apply entry-level knowledge, concepts and principles across a limited range of patient conditions, Level 2 indicates the ability to apply entry-level knowledge, concepts and principles across a moderate range of patient conditions, Level 3 demonstrates ability in a broad range of patient conditions and Level 4 demonstrates ability across an extensive range of patient conditions.

The Board now proposes to allow physical therapists who take the oPTion assessment and attain a Level 2 score to satisfy five of their 30 biennially required CE hours (as compared to the 10 CE hours currently allowed for completion of the PRT). Under the Board’s proposal, physical therapists who take the oPTion assessment and attain a Level 3 or 4 score will be able to satisfy 10 CE hours (as compared to the 20 CE hours currently satisfied by successful completion of the PRT). The Board also proposes to limit physical therapists to getting CE credit for completion of the FSBPT assessment tool only once every four years. Board staff reports that the Board proposes to reduce the hours of credit allowed for completion of the FSBPT and limit that credit to being allowed only once every two licensure cycles so that physical therapists complete a wide range of allowable CE activities. To the extent that requiring more diverse CE increases the safety or efficacy of physical therapy practice, these changes may benefit the public. These changes will, however, require physical therapists who currently take the FSBPT assessment to meet CE requirements to participate in a greater number of activities eligible for CE credit which will increase time costs for physical therapists. To the extent that these additional activities have fees, physical therapists will also incur those costs on account of these proposed changes. There is insufficient information to measure whether any benefit gained would outweigh these costs.

Current regulation also allows applicants for licensure by endorsement who do not meet the active practice requirement for licensure to satisfy 160 of the 320 traineeship hours that would otherwise be required by the Board. Since the PRT is no longer available, the Board now proposes to specify that attaining at least a Level 2 score on the oPTion assessment will satisfy the same 160 hours of traineeship that successful completion of the PRT would. Since this change only substitutes reference to the old assessment tool (PRT) with reference to the new assessment tool (oPTion), no affected entities are likely to incur any costs. Interested parties are likely to gain the benefit of additional regulatory clarity because obsolete language is being replaced with reference to the current assessment tool.

Businesses and Entities Affected. These proposed regulatory changes will affect all physical therapists licensed in the Commonwealth as well as future applicants for licensure by endorsement. Board staff reports that there are 8,277 licensed physical therapists in Virginia and also reports that the Board has no estimates of how many of those physical therapists might qualify as small businesses.

Localities Particularly Affected. No locality is likely to be particularly affected by these proposed regulatory changes.

Projected Impact on Employment. These proposed regulatory changes are unlikely to affect employment in the Commonwealth.

Effects on the Use and Value of Private Property. These proposed regulatory changes are unlikely to affect the use or value of private property in the Commonwealth.

Real Estate Development Costs. These proposed regulatory changes are unlikely to affect real estate development costs in the Commonwealth.

Small Businesses:

Definition. Pursuant to § 2.2-4007.04 of the Code of Virginia, 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."

Costs and Other Effects. To the extent that affected physical therapists qualify as small businesses, and currently take the FSBPT assessment for CE credit, their businesses will likely incur costs for additional CE activities that they will have to complete. These costs will likely include time spent on additional activities and may also include fees incurred.

Alternative Method that Minimizes Adverse Impact. Absent evidence that the public might benefit from limiting credit hours for the FSBPT assessment, the Board could allow physical therapists to avoid time and other costs by allowing credit for the oPTion assessment at the same rate as current regulation allows credit for the PRT assessment.

Adverse Impacts:

Businesses. To the extent that affected physical therapists work independently in their own businesses, and currently take the FSBPT assessment for CE credit, their businesses will likely incur costs for additional CE activities that they will have to complete. These costs will likely include time spent on additional activities and may also include fees incurred.

Localities. No locality is likely to be adversely affected by these proposed regulatory changes.

Other Entities. No other entities are likely to be adversely affected by these proposed regulatory changes.

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¹ Meeting the standard means passing the assessment.

Agency's Response to Economic Impact Analysis: The Board of Physical Therapy concurs with the analysis of the Department of Planning and Budget.

Summary:

The proposed amendments replace references to an obsolete assessment tool provided by the Federation of State Boards of Physical Therapy (FSBPT) with references to the current assessment tool offered by FSBPT titled "oPTion." The proposed amendments require achievement of Level 2 or higher on the oPTion assessment tool to (i) use participation in the assessment tool for continuing education credit or (ii) replace hours in a supervised traineeship for applicants for licensure by endorsement, reinstatement of license, or reactivation of license if the physical therapist has not been engaged in active practice for the two years immediately preceding application for an active license.

Part I
General Provisions

18VAC112-20-10. Definitions.

In addition to the words and terms defined in § 54.1-3473 of the Code of Virginia, the following words and terms when used in this chapter shall have the following meanings unless the context clearly indicates otherwise:

"Active practice" means a minimum of 160 hours of professional practice as a physical therapist or physical therapist assistant within the 24-month period immediately preceding renewal. Active practice may include supervisory, administrative, educational or consultative activities or responsibilities for the delivery of such services.

"Approved program" means an educational program accredited by the Commission on Accreditation in Physical Therapy Education of the American Physical Therapy Association.

"Assessment tool" means oPTion or any other self-directed assessment tool approved by FSBPT.

"CLEP" means the College Level Examination Program.

"Contact hour" means 60 minutes of time spent in continuing learning activity exclusive of breaks, meals or vendor exhibits.

"Direct supervision" means a physical therapist or a physical therapist assistant is physically present and immediately available and is fully responsible for the physical therapy tasks or activities being performed.

"Discharge" means the discontinuation of interventions in an episode of care that have been provided in an unbroken sequence in a single practice setting and related to the physical therapy interventions for a given condition or problem.

"Evaluation" means a process in which the physical therapist makes clinical judgments based on data gathered during an examination or screening in order to plan and implement a treatment intervention, provide preventive care, reduce risks of injury and impairment, or provide for consultation.

"FCCPT" means the Foreign Credentialing Commission on Physical Therapy.

"FSBPT" means the Federation of State Boards of Physical Therapy.

"General supervision" means a physical therapist shall be available for consultation.

"National examination" means the examinations developed and administered by the Federation of State Boards of Physical Therapy and approved by the board for licensure as a physical therapist or physical therapist assistant.

"PRT" means the Practice Review Tool for competency assessment developed and administered by FSBPT.

"Reevaluation" means a process in which the physical therapist makes clinical judgments based on data gathered during an examination or screening in order to determine a patient's response to the treatment plan and care provided.

"Support personnel" means a person who is performing designated routine tasks related to physical therapy under the direction and supervision of a physical therapist or physical therapist assistant within the scope of this chapter.

"TOEFL" means the Test of English as a Foreign Language.

"Trainee" means a person seeking licensure as a physical therapist or physical therapist assistant who is undergoing a traineeship.

"Traineeship" means a period of active clinical practice during which an applicant for licensure as a physical therapist or physical therapist assistant works under the direct supervision of a physical therapist approved by the board.

"TSE" means the Test of Spoken English.

"Type 1" means continuing learning activities offered by an approved organization as specified in 18VAC112-20-131.

"Type 2" means continuing learning activities which may or may not be offered by an approved organization but shall be activities considered by the learner to be beneficial to practice or to continuing learning.

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 U.S. jurisdiction;

2. The required application, fees, and credentials to the board;

3. A current report from the Healthcare Integrity and Protection Data Bank (HIPDB);

4. Evidence of completion of 15 hours of continuing education for each year in which the applicant held a license in another U.S. jurisdiction, or 60 hours obtained within the past four years;

5. Documentation of passage of an examination equivalent to the Virginia examination at the time of initial licensure or documentation of passage of an examination required by another state at the time of initial licensure in that state; and

6. Documentation of active practice in physical therapy in another U.S. jurisdiction for at least 320 hours within the four years immediately preceding his application for licensure. A physical therapist who does not meet the active practice requirement shall:

a. Successfully complete 320 hours in a traineeship in accordance with requirements in 18VAC112-20-140; or

b. Document that he meets the standard of the PRT attained at least Level 2 on the FSBPT assessment tool within the two years preceding application for licensure in Virginia and successfully complete 160 hours in a traineeship in accordance with the 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 his application for licensure shall successfully complete 320 hours in a traineeship in accordance with the requirements in 18VAC112-20-140.

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 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. Up to two of the Type 2 continuing education hours may be satisfied through delivery of physical therapy services, without compensation, to low-income individuals receiving services through a local health department or a free clinic organized in whole or primarily for the delivery of health services.

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 attained at least Level 2 on the FSBPT assessment tool may receive 10 five 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 attained at least Level 3 or 4 on the FSBPT assessment tool may receive 20 10 hours of Type 1 credit for the biennium in which the assessment tool was taken. Continuing competency credit shall only be granted for the FSBPT assessment tool once every four years.

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.

18VAC112-20-135. Inactive license.

A. A physical therapist or physical therapist assistant who holds a current, unrestricted license in Virginia shall, upon a request on the renewal application and submission of the required renewal fee, be issued an inactive license.

1. The holder of an inactive license shall not be required to meet active practice requirements.

2. An inactive licensee shall not be entitled to perform any act requiring a license to practice physical therapy in Virginia.

B. A physical therapist or physical therapist assistant who holds an inactive license may reactivate his license by:

1. Paying the difference between the renewal fee for an inactive license and that of an active license for the biennium in which the license is being reactivated;

2. Providing proof of 320 active practice hours in another jurisdiction within the four years immediately preceding application for reactivation.

a. If the inactive physical therapist licensee does not meet the requirement for active practice, the license may be reactivated by completing 320 hours in a traineeship that meets the requirements prescribed in 18VAC112-20-140 or documenting that he has met the standard of the PRT attained at least Level 2 on the FSBPT assessment tool within the two years preceding application for reactivation of licensure in Virginia and successfully completing 160 hours in a traineeship in accordance with requirements in 18VAC112-20-140.

b. If the inactive physical therapist assistant licensee does not meet the requirement for active practice, the license may be reactivated by completing 320 hours in a traineeship that meets the requirements prescribed in 18VAC112-20-140; and

3. Completing the number of continuing competency hours required for the period in which the license has been inactive, not to exceed four years.

18VAC112-20-136. Reinstatement requirements.

A. A physical therapist or physical therapist assistant whose Virginia license is lapsed for two years or less may reinstate his license by payment of the renewal and late fees as set forth in 18VAC112-20-27 and completion of continued competency requirements as set forth in 18VAC112-20-131.

B. A physical therapist or physical therapist assistant whose Virginia license is lapsed for more than two years and who is seeking reinstatement shall:

1. Apply for reinstatement and pay the fee specified in 18VAC112-20-27;

2. Complete the number of continuing competency hours required for the period in which the license has been lapsed, not to exceed four years; and

3. Have actively practiced physical therapy in another jurisdiction for at least 320 hours within the four years immediately preceding applying for reinstatement.

a. If a physical therapist licensee does not meet the requirement for active practice, the license may be reinstated by completing 320 hours in a traineeship that meets the requirements prescribed in 18VAC112-20-140 or documenting that he has met the standard of the PRT attained at least Level 2 on the FSBPT assessment tool within the two years preceding application for licensure in Virginia and successfully completing 160 hours in a traineeship in accordance with requirements in 18VAC112-20-140.

b. If a physical therapist assistant licensee does not meet the requirement for active practice, the license may be reinstated by completing 320 hours in a traineeship that meets the requirements prescribed in 18VAC112-20-140.