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: January 23, 2019.

Effective Date: February 10, 2019.

Agency Contact: Corie Tillman Wolf, 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: Regulations are promulgated under the general authority of Chapter 24 (§ 54.1-2400 et seq.) of Title 54.1 of the Code of Virginia. Section 54.1-2400 provides the Board of Physical Therapy the authority to promulgate regulations that are reasonable and necessary to administer effectively the regulatory system.

Purpose: The purpose of the amended regulation is to encourage participation in the policy-making and disciplinary work of the board to give licensees a better understanding of the laws and regulations governing their practice. While a licensee can satisfy up to two hours of Type 2 continuing education with attendance at a board meeting or a hearing, the licensee is still required to have 20 Type 1 hours of approved continuing education for physical therapists and 15 Type 1 hours for physical therapist assistants necessary to acquire new knowledge and skills. Therefore, the public health is served by a better understanding of ethical practice, but public safety is not sacrificed by permitting this use of two hours of Type 2 continuing education hours required for renewal.

Rationale for Using Fast-Track Rulemaking Process: The allowance of hours of attendance at board meetings or disciplinary hearings is voluntary and less restrictive. A licensee is not required to attend but may be credited with continuing education hours for doing so. The provision is permissive and not controversial.

Substance: The board has adopted an amendment to the regulation to allow physical therapists and physical therapist assistants to count two hours of the Type 2 hours allowed for renewal to be satisfied by attending a board meeting or an informal conference or a formal hearing conducted by the board.

Issues: The advantage to the public is the incentive given for licensees to participate in the policy and disciplinary activities of the board in exchange for credit toward meeting continuing education requirements. 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. The Board of Physical Therapy (Board) proposes to allow physical therapists and physical therapist assistants to count up to two hours of required Type 2 continuing education hours to be satisfied by attending a board meeting, an informal conference, or a formal hearing.

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

Estimated Economic Impact. In order to renew an active license biennially, a physical therapist or a physical therapist assistant must complete at least 30 contact hours of continuing learning activities within the two years immediately preceding renewal. Up to 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. The current regulation states that 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. The Board proposes to allow attendance at a meeting of the Board or disciplinary proceeding conducted by the Board to count for up to two hours of required Type 2 continuing education hours. According to the Department of Health Professions, continuing education hours would be granted on a one-for-one basis for the time of attendance (up to the two-hour limit).

Similar to consultation with colleagues, attendance of board meetings or disciplinary proceeding would help practitioners be aware of current issues affecting the profession. Attendance of Board meetings would enable licensees to hear discussion of the statutes and regulations that directly affect physical therapy licensure and practice, including for recent examples, discussions about dry needling, consideration of participation in a physical therapy licensure compact, and tools available for physical therapists to gauge continuing competency, as well as possible legislation and regulatory proposals. Attendance of disciplinary proceedings would give licensees an opportunity to see/hear first-hand the practice issues/violations that are seen by the Board in disciplinary cases and how the Board sanctions violations. This would not only be an educational experience, it may also have a deterrent impact by virtue of educating practitioners about actions or conduct they should avoid in their practice.

Businesses and Entities Affected. The proposed amendment potentially affects the 8,032 physical therapists and 3,348 physical therapist assistants licensed in the Commonwealth.¹ Many physical therapists and physical therapist assistants work for large health systems. It is unknown how many work for small businesses.

Localities Particularly Affected. The proposed amendment does not disproportionately affect particular localities.

Projected Impact on Employment. The proposed amendment does not significantly affect employment.

Effects on the Use and Value of Private Property. The proposed amendment does not significantly affect the use and value of private property.

Real Estate Development Costs. The proposed amendment does not affect real estate development costs.

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. The proposed amendment does not significantly affect costs for small businesses.

Alternative Method that Minimizes Adverse Impact. The proposed amendment does not adversely affect small businesses.

Adverse Impacts:

Businesses. The proposed amendment does not adversely affect businesses.

Localities. The proposed amendment does not adversely affect localities.

Other Entities. The proposed amendment does not adversely affect other entities.

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¹Data source: Department of Health Professions

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

Summary:

The amendment allows physical therapists and physical therapist assistants to satisfy up to two hours of the total Type 2 continuing education hours allowed for license renewal to be satisfied by attending a board meeting or an informal conference or a formal hearing conducted by the board.

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;

g. The National Athletic Trainers' Association; or

h. The Federation of State Boards of Physical Therapy.

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 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. Up to two of the Type 2 continuing education hours may be satisfied by attendance at a meeting of the board or disciplinary proceeding conducted by the board.

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 attained at least Level 2 on the FSBPT assessment tool may receive five hours of Type 1 credit for the biennium in which the assessment tool was taken. A physical therapist who can document that he attained at least Level 3 or 4 on the FSBPT assessment tool may receive 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.