Title of Regulation: 18VAC85-120. Regulations Governing the Licensure of Athletic Trainers (amending 18VAC85-120-10, 18VAC85-120-110).

Statutory Authority: §§ 54.1-2400 and 54.1-2957.4 of the Code of Virginia.

Public Hearing Information: No public hearings are scheduled.

Public Comment Deadline: July 24, 2019.

Effective Date: August 8, 2019.

Agency Contact: William L. Harp, M.D., Executive Director, Board of Medicine, 9960 Mayland Drive, Suite 300, Richmond, VA 23233, telephone (804) 367-4558, FAX (804) 527-4429, or email william.harp@dhp.virginia.gov.

Basis: Regulations are promulgated under the general authority of § 54.1-2400 of the Code of Virginia, which provides the Board of Medicine the authority to promulgate regulations to administer the regulatory system.

Purpose: The amendments clarify the meaning of "direction" of an athletic trainer and will further protect the health and safety of persons who receive treatment and care from a licensed athletic trainer by clarifying the role of the doctor or dentist providing direction for such care. The regulatory change is consistent with the principle that regulations should be clearly written and easily understandable.

Rationale for Using Fast-Track Rulemaking Process: As required by Executive Order 14 (2018), the Board of Medicine conducted a periodic review of 18VAC85-120, Regulations Governing the Licensure of Athletic Trainers. The amendments are clarifying or intended for consistency with current practice and model regulatory language for the profession. There are no substantive changes, so the amendments are not expected to be controversial.

Substance: Pursuant to its periodic review of 18VAC85-120, the board has adopted amendments to define in regulation the meaning of the word "direction" to facilitate an understanding by all parties of how an athletic trainer is allowed to practice when the licensee who is providing direction is or is not present.

Issues: The advantage to the public is facilitation of practice by an athletic trainer and a clearer understanding of the role of the doctor providing direction for such practice. There are no disadvantages to the public. The amendments are clarifying and consistent with current practice and interpretation. There are no advantages or disadvantages to the agency or the Commonwealth.

Small Business Impact Review Report of Findings: This fast-track regulatory action serves as the report of the findings of the regulatory review pursuant to § 2.2-4007.1 of the Code of Virginia.

Department of Planning and Budget's Economic Impact Analysis:

Summary of the Proposed Amendments to Regulation. Pursuant to a periodic review,¹ the Board of Medicine (Board) proposes to add a definition for "direction" by a physician.

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

Estimated Economic Impact. The statutory definition of "practice of athletic training" (§ 54.1-2900) includes the phrase "under the direction of" but the meaning of direction is not spelled out either in statute or in the regulation.

"Practice of athletic training" means the prevention, recognition, evaluation, and treatment of injuries or conditions related to athletic or recreational activity that requires physical skill and utilizes strength, power, endurance, speed, flexibility, range of motion or agility or a substantially similar injury or condition resulting from occupational activity immediately upon the onset of such injury or condition; and subsequent treatment and rehabilitation of such injuries or conditions under the direction of the patient's physician or under the direction of any doctor of medicine, osteopathy, chiropractic, podiatry, or dentistry, while using heat, light, sound, cold, electricity, exercise or mechanical or other devices.(emphasis added)

During the periodic review, several athletic trainers sought clarification as to the meaning of "direction." In response to those inquiries, the Board proposes to adopt the model language developed by the National Board of Certification for the Athletic Trainer:

"Direction" means authorization by a doctor of medicine, osteopathy, chiropractic, podiatry, or dentistry for care and treatment by a verbal order if the doctor or dentist is present or by written order, telecommunication, plans of care, protocols, or standing orders if the doctor or dentist is not present.

The proposed definition is consistent with the statute and the current interpretation of the word "direction" by the Board. Therefore, no significant economic effect is expected from this change beyond adding the clarity sought by several trainers on what "direction" means in the context of athletic training.

Businesses and Entities Affected. The proposed change pertains to the 1,589 licensed athletic trainers in the Commonwealth.

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

Projected Impact on Employment. The proposed amendment would not affect employment.

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

Real Estate Development Costs. The proposed amendment would 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 would not have costs or other effects on small businesses.

Alternative Method that Minimizes Adverse Impact. The proposed amendment would not impose adverse impacts on small businesses.

Adverse Impacts:

Businesses. The proposed amendment would not impose adverse impacts on businesses.

Localities. The proposed amendment would not adversely affect localities.

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

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¹http://townhall.virginia.gov/l/ViewPReview.cfm?PRid=1653

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

Summary:

The amendments add a definition of "direction" consistent with model rules of the National Board of Certification for the Athletic Trainer and with current practice that makes clear that direction by a doctor or dentist may be by verbal or written order.

18VAC85-120-10. Definitions.

In addition to words and terms defined in § 54.1-2900 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:

"Advisory board" means the Advisory Board on Athletic Training to the board as specified in § 54.1-2957.5 of the Code of Virginia.

"Athletic trainer" means a person licensed by the Virginia Board of Medicine to engage in the practice of athletic training as defined in § 54.1-2900 of the Code of Virginia.

"Board" means the Virginia Board of Medicine.

"Direction" means authorization by a doctor of medicine, osteopathy, chiropractic, podiatry, or dentistry for care and treatment by a verbal order if the doctor or dentist is present or by written order, telecommunication, plans of care, protocols, or standing orders if the doctor or dentist is not present.

"NATABOC" means the National Athletic Trainers' Association Board of Certification.

"Student athletic trainer" means a person enrolled in an accredited bachelor's or master's level educational program in athletic training.

18VAC85-120-110. Individual responsibilities.

A. The athletic trainer's responsibilities are to evaluate the individual being treated, plan the treatment program, and administer and document treatment within the limit of his professional knowledge, judgment and skills and in accordance with the practice of athletic training as set forth in § 54.1-2900 of the Code of Virginia.

B. An athletic trainer practices under the direction of the individual's physician or under the direction of any doctor of medicine, osteopathy, chiropractic, podiatry, or dentistry.