Title of Regulation: 18VAC112-20. Regulations Governing the Practice of Physical Therapy (amending 18VAC112-20-10, 18VAC112-20-27, 18VAC112-20-60, 18VAC112-20-65, 18VAC112-20-90, 18VAC112-20-130, 18VAC112-20-140, 18VAC112-20-200; adding 18VAC112-20-82).

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

Public Hearing Information:

October 20, 2020 - 9:15 a.m. - Department of Health Professions, Perimeter Center, 9960 Mayland Drive, 2nd Floor Conference Center, Henrico, VA 23233

Public Comment Deadline: October 30, 2020.

 

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 § 54.1-2400 of the Code of Virginia, which provides the Board of Physical Therapy the authority to promulgate regulations to administer the regulatory system. The specific statutory authority for regulation of physical therapists and physical therapist assistants as part of an interstate compact is found in § 54.1-3484 of the Code of Virginia.

Purpose: The purpose of this regulation is to establish the requirement, including a fee, for obtaining and maintaining a compact privilege to practice in Virginia without a Virginia license. In order to protect public health and safety in the delivery of physical therapy services, a practitioner holding a compact privilege is held to the same standards of practice and is accountable for compliance with all applicable laws and regulations pertaining to physical therapy.

Substance: To comply with compact rules, all applicants for licensure are required to have criminal background checks, and holders of a compact privilege are required to adhere to the laws and regulations governing practice in the compact state in which they practice. A member state may set a fee that is charged to obtain and renew a compact privilege in that state. The amendments include setting the fee in Virginia at $50, which is similar to the fee charged by other states. Regulations are amended to implement compact requirements in Virginia.

Issues: The advantage to the public is increased access to physical therapy service from practitioners holding a compact privilege to practice in Virginia. Regulations for compact privilege holders require compliance with laws and regulations and adherence to the same standard of care. There are no disadvantages.

There are no particular advantages or disadvantages to the agency. While it is expected that the board will experience some reduction in revenue from applicants for licensure from other states, it will have revenue from physical therapists and physical therapist assistants who want to have a compact privilege in Virginia. Any resulting decrease in revenue can be absorbed in the existing budget without any anticipated impact on current licensees or the operation of the board.

Department of Planning and Budget's Economic Impact Analysis:

Summary of the Proposed Amendments to Regulation. Pursuant to Chapter 300 of the 2019 Acts of the Assembly (Chapter 300),¹ the Board of Physical Therapy (Board) proposes to amend 18VAC112-20 Regulations Governing the Practice of Physical Therapy in order for Virginia to participate in the Physical Therapy Licensure Compact (Compact).² The Compact is an agreement between member states to improve access to physical therapy services for the public by increasing the mobility of eligible physical therapy providers to work in multiple states. Also pursuant to Chapter 300, the Board proposes to require that all applicants for licensure as a physical therapist or physical therapist assistant undergo a criminal history background check.

Background. Chapter 300 states that "The General Assembly hereby enacts, and the Commonwealth of Virginia hereby enters into, the Physical Therapy Licensure Compact with any and all jurisdictions legally joining therein according to its terms, …"

Chapter 300 also stipulates that "The Board shall require each applicant for licensure as a physical therapist or physical therapist assistant to submit fingerprints and provide personal descriptive information to be forwarded along with his fingerprints through the Central Criminal Records Exchange to the Federal Bureau of Investigation for the purpose of obtaining criminal history record information regarding the applicant. The cost of fingerprinting and the criminal history record search shall be paid by the applicant."

The second enactment clause of Chapter 300 states "That the provisions of this act shall become effective on January 1, 2020. The third enactment clause stipulates "That the Board of Physical Therapy shall promulgate regulations to implement the provisions of this act to be effective within 280 days of its enactment." An emergency regulation is currently in place and expires on June 30, 2021. The Board is now proposing non-expiring amendments.

Estimated Benefits and Costs.

Compact: Under the Compact, physical therapists and physical therapist assistants licensed in a participating state are able to legally practice in other participating states without obtaining additional licenses from those other states. The physical therapists and physical therapist assistants would need only to obtain a compact privilege. In order to obtain a compact privilege, the applicant must:³

1. Hold a current, valid physical therapist or physical therapist assistant license in their home state.

2. Have their home state be a member of the Compact and actively issuing compact privileges.

3. Not have any encumbrances against any physical therapist or physical therapist assistant license.

4. Not have any disciplinary action against any physical therapist or physical therapist assistant license within the last two years.

5. Have the state where they are seeking a compact privilege be a member of the Compact and actively issuing compact privileges.

6. Successfully complete the jurisprudence requirement for the state(s) the applicant wants a compact privilege in. Note: Virginia does not have a jurisprudence requirement.

7. Pay a $45 fee to the Physical Therapy Compact Commission.

8. Pay a fee to the state that the applicant wants a compact privilege in. This fee is set by each member state. Note: The Board proposes that the Commonwealth's fee for obtaining a compact privilege to practice in Virginia be $50.

The current Compact member states are: Arizona, Arkansas, Colorado, Iowa, Kentucky, Louisiana, Mississippi, Missouri, Nebraska, New Hampshire, North Carolina, North Dakota, Oklahoma, Oregon, Tennessee, Texas, Utah, Virginia, Washington, and West Virginia. Delaware, Georgia, Maryland, Montana, New Jersey, South Carolina, South Dakota, and Wisconsin have enacted legislation to join the Compact but are not yet issuing or accepting compact privileges.⁴

According to a report from the Virginia Healthcare Workforce Data Center,⁵ 97 percent of Virginia physical therapists were employed in the profession and involuntary unemployment⁶ was nearly nonexistent. Thus, it appears that the Commonwealth would benefit from having more qualified physical therapists available to offer their services. The Compact makes it easier for physical therapists and physical therapist assistants who are licensed in other states and wish to practice in the Commonwealth to do so. Practitioners who move to Virginia for family reasons, such as having a spouse in the military, and out-of-state practitioners who reside near the border and are willing able to serve patients within the Commonwealth are particularly likely candidates. The Compact also makes it easier for Virginia practitioners to gain more clients across the border into neighboring states. All states bordering Virginia either are current Compact members (Kentucky, North Carolina, Tennessee, and West Virginia) or have enacted legislation to join the Compact, but are not yet issuing or accepting compact privileges (Maryland). The District of Columbia does not appear to participate in the Compact.

The Commonwealth officially joined the Compact on January 1, 2020, and compact privileges were first issued on January 2, 2020. According to the Department of Health Professions (DHP), as of February, 14, 2020, 27 compact privileges had been issued to practice in Virginia: 19 as physical therapists and 8 physical therapist assistants. The privileges were obtained from the following numbers of persons licensed in the following states: 11 in North Carolina, 9 in Tennessee, 2 in Washington, 1 in Louisiana, 1 in Kentucky, 1 in Colorado, 1 in New Hampshire, and 1 in Missouri. As of January 29, 2020, 11 Virginia licensees obtained compact privileges for other Compact states: seven as physical therapists and four as physical therapist assistants.

In its analysis of the impact of joining the Compact, the Board provided data in 2016 showing that there were 2,587 physical therapists and physical therapist assistants licensed in Virginia with out-of-state addresses. If all of those licensees were in Compact states and all chose to let their Virginia licenses lapse and opted for a compact privilege, the Board would lose $315,575 with each biennial renewal. If the compact privilege fee for Virginia is set at $50, the revenue from that number of licensees would be $129,350 (less 3.5% banking fee to Compact), resulting in a biennial loss of revenue of $190,752. If all of the Virginia licensees with out-of-state addresses do not choose to let their Virginia licenses lapse, then the reduction in revenue would be less. As of June 30, 2019, the Board had a balance of $1,897,707; consequently, any potential loss of revenue could be absorbed in the current budget for the foreseeable future.

Criminal History Background Check: In order to join the Compact, each member state must require that all applicants for licensure as a physical therapist or physical therapist assistant undergo a criminal history background check. As stated above, this requirement was part of Chapter 300 and is now proposed to be added to the regulation. Adding this requirement enables the Commonwealth to gain the benefits of joining the Compact, and would help the Board gain additional information about license applicants when they are being considered for licensure. The proposed requirement that all applicants for licensure as a physical therapist or physical therapist assistant undergo a criminal history background check would cost in-state applicants $35.95 and out-of-state applicants $38.95.⁷

It is estimated that the requiring of criminal history background checks for all licensure applicants would require the Virginia State Police Central Criminal Records Exchange to process an additional 1,200 to 1,500 sets of fingerprints per year.⁸ It is estimated that one additional employee would be needed for the additional fingerprint searches, billing and record review at an annual rate of $66,439 (salary and fringe).⁹

Businesses and Other Entities Affected. There are 8,706 physical therapists and 3,691 physical therapist assistants licensed in Virginia.¹⁰ According to survey data from a Virginia Healthcare Workforce Data Center report published in March 2019, the primary type of employers of physical therapists in the Commonwealth are distributed as follows: ¹¹

Establishment Type	Percentage
Private Practice, Group	17%
Rehabilitation Facility, Outpatient Clinic	15%
Home Health Care	14%
General Hospital, Outpatient Department	11%
General Hospital, Inpatient Department	10%
Skilled Nursing Facility	8%
Private Practice, Solo	7%
Rehabilitation Facility, Residential/Inpatient	4%
Academic Institution	3%
Physician Office	3%
K-12 School System	3%
Assisted Living or Continuing Care Facility	2%
Other	5%

Adverse impact is indicated if there is any increase in net cost or reduction in net revenue for any entity, even if the benefits exceed the costs for all entities combined. Mandated by Chapter 300, the proposal to require that all applicants for licensure as a physical therapist or physical therapist assistant undergo a criminal history background check increases costs for applicants. Thus, adverse impact is indicated to reflect the effects of the non-discretionary changes mandated by legislation.

Small Businesses¹² Affected.

Types and Estimated Number of Small Businesses Affected: The Board regulates individual practitioners, but not their employers. Thus, data on the number of small businesses affected is not available. The types of businesses that are potentially affected and may qualify as small are described in the table above.

Costs and Other Effects: Joining the Compact increases the supply of physical therapists and physical therapist assistants that could be hired by small firms in the Commonwealth. This may reduce their hiring costs.

Alternative Method that Minimizes Adverse Impact; There are no clear alternative methods that both reduce adverse impact and meet the intended policy goals.

Localities¹³ Affected.¹⁴ Virginia joining the Compact may particularly affect localities bordering or otherwise near North Carolina, Tennessee, Kentucky, West Virginia, and eventually Maryland. The first four states listed are current members. Legislation has passed in Maryland for that state to join as well.¹⁵

The proposal does not disproportionately affect any particularly locality nor appear to introduce additional costs for local governments.

Projected Impact on Employment. Joining the Compact increases the supply of physical therapists and physical therapist assistants that could practice in the Commonwealth. This may lead to more physical therapists and physical therapist assistants working in Virginia.

Effects on the Use and Value of Private Property. To the extent that increasing the supply of physical therapists and physical therapist assistants who can practice in the Commonwealth decreases hiring costs for employers, the value of the employing firms may increase. The proposed amendments do not affect real estate development costs.

____________________________

¹See https://lis.virginia.gov/cgi-bin/legp604.exe?191+ful+CHAP0300

²See http://ptcompact.org/about-compact

³Sources: http://ptcompact.org/portals/0/images/Eligibility_Requirements_to_Obtain_a_Compact
Privilege.pdf and http://ptcompact.org/Compact-Privilege-Fee-Jurisprudence-and-Waiver-Table

⁴Source: http://ptcompact.org/ptc-states.

⁵See https://www.dhp.virginia.gov/media/dhpweb/docs/hwdc/
pt/2305PT2018.pdf This is for 2018, the most recent data available.

⁶"Involuntary unemployment" is used here in the colloquial sense. Technically someone who is voluntarily not seeking employment would not be part of the labor force, and hence not technically unemployed.

⁷Source: DHP

⁸See https://lis.virginia.gov/cgi-bin/legp604.exe?191+oth+SB1106FER122
+PDF

⁹Ibid

¹⁰Source: https://www.dhp.virginia.gov/about/stats/2020Q2/04CurrentLicenseCountQ2FY2020.pdf

¹¹Source: https://www.dhp.virginia.gov/media/dhpweb/docs/hwdc/pt/
2305PT2018.pdf

¹²Pursuant 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."

¹³"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.

¹⁴§ 2.2-4007.04 defines "particularly affected" as bearing disproportionate material impact.

¹⁵See http://ptcompact.org/ptc-states

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 amendments are necessary for Virginia to participate in the Physical Therapy Compact, as required by Chapter 300 of the 2019 Acts of Assembly, which allows a physical therapist or physical therapist assistant who has obtained a compact privilege to practice in the Commonwealth without a Virginia license. To comply with compact rules, the amendments require all applicants for licensure to have criminal background checks and require all holders of a compact privilege to adhere to the laws and regulations governing practice in Virginia. As permitted by the compact rules, the amendments set the fee in Virginia at $50, which is similar to the fee charged by other states.

Part I
General Provisions

18VAC112-20-10. Definitions.

In addition to the words and terms defined in § §§ 54.1-3473 and 54.1-3486 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.

"Compact" means the Physical Therapy Licensure Compact (§ 54.1-3485 of the Code of Virginia).

"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.

"Physical Therapy Compact Commission" or "commission" means the national administrative body whose membership consists of all states that have enacted the compact.

"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.

18VAC112-20-27. Fees.

A. Unless otherwise provided, fees listed in this section shall not be refundable.

B. Licensure by examination.

1. The application fee shall be $140 for a physical therapist and $100 for a physical therapist assistant.

2. The fees for taking all required examinations shall be paid directly to the examination services.

C. Licensure by endorsement. The fee for licensure by endorsement shall be $140 for a physical therapist and $100 for a physical therapist assistant.

D. Licensure renewal and reinstatement.

1. The fee for active license renewal for a physical therapist shall be $135 and for a physical therapist assistant shall be $70 and shall be due by December 31 in each even-numbered year.

2. The fee for an inactive license renewal for a physical therapist shall be $70 and for a physical therapist assistant shall be $35 and shall be due by December 31 in each even-numbered year.

3. A fee of $50 for a physical therapist and $25 for a physical therapist assistant for processing a late renewal within one renewal cycle shall be paid in addition to the renewal fee.

4. The fee for reinstatement of a license that has expired for two or more years shall be $180 for a physical therapist and $120 for a physical therapist assistant and shall be submitted with an application for licensure reinstatement.

E. Other fees.

1. The fee for an application for reinstatement of a license that has been revoked shall be $1,000; the fee for an application for reinstatement of a license that has been suspended shall be $500.

2. The fee for a duplicate license shall be $5, and the fee for a duplicate wall certificate shall be $15.

3. The handling fee for a returned check or a dishonored credit card or debit card shall be $50.

4. The fee for a letter of good standing/verification standing or verification to another jurisdiction shall be $10.

5. The application fee for direct access certification shall be $75 for a physical therapist to obtain certification to provide services without a referral.

6. The state fee for obtaining or renewing a compact privilege to practice in Virginia shall be $50.

18VAC112-20-60. Requirements for licensure by examination.

Every applicant for initial licensure by examination shall submit:

1. Documentation of having met the educational requirements specified in 18VAC112-20-40 or 18VAC112-20-50;

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; and

3. Documentation of passage of the national examination as prescribed by the board.

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. United States jurisdiction;

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 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. United States 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. United States 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 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.

18VAC112-20-82. Requirements for a compact privilege.

To obtain a compact privilege to practice physical therapy in Virginia, a physical therapist or physical therapist assistant licensed in a remote state shall comply with the rules adopted by the Physical Therapy Compact Commission in effect at the time of application to the commission.

18VAC112-20-90. General responsibilities.

A. The physical therapist shall be responsible for managing all aspects of the physical therapy care of each patient and shall provide:

1. The initial evaluation for each patient and its documentation in the patient record;

2. Periodic reevaluation, including documentation of the patient's response to therapeutic intervention; and

3. The documented status of the patient at the time of discharge, including the response to therapeutic intervention. If a patient is discharged from a health care facility without the opportunity for the physical therapist to reevaluate the patient, the final note in the patient record may document patient status.

B. The physical therapist shall communicate the overall plan of care to the patient or his the patient's legally authorized representative and shall also communicate with a referring doctor of medicine, osteopathy, chiropractic, podiatry, or dental surgery,; nurse practitioner; or physician assistant to the extent required by § 54.1-3482 of the Code of Virginia.

C. A physical therapist assistant may assist the physical therapist in performing selected components of physical therapy intervention to include treatment, measurement, and data collection, but not to include the performance of an evaluation as defined in 18VAC112-20-10.

D. A physical therapist assistant's visits to a patient may be made under general supervision.

E. A physical therapist providing services with a direct access certification as specified in § 54.1-3482 of the Code of Virginia shall utilize the Direct Access Patient Attestation and Medical Release Form prescribed by the board or otherwise include in the patient record the information, attestation and written consent required by subsection B of § 54.1-3482 of the Code of Virginia.

F. A physical therapist or physical therapist assistant practicing in Virginia on a compact privilege shall comply with all applicable laws and regulations pertaining to physical therapy practice in Virginia.

18VAC112-20-130. Biennial renewal of license.

A. A physical therapist and physical therapist assistant who intends to continue practice shall renew his license biennially by December 31 in each even-numbered year and pay to the board the renewal fee prescribed in 18VAC112-20-27.

B. A licensee whose licensure has not been renewed by the first day of the month following the month in which renewal is required shall pay a late fee as prescribed in 18VAC112-20-27.

C. In order to renew an active license, a licensee shall be required to:

1. Complete a minimum of 160 hours of active practice in the preceding two years; and

2. Comply with continuing competency requirements set forth in 18VAC112-20-131.

D. In order to renew a compact privilege to practice in Virginia, the holder shall comply with the rules adopted by the Physical Therapy Compact Commission in effect at the time of the renewal.

18VAC112-20-140. Traineeship requirements.

A. The traineeship shall be approved by the board and under the direction and supervision of a licensed physical therapist.

B. Supervision and identification of trainees:

1. There shall be a limit of two physical therapists assigned to provide supervision for each trainee.

2. The supervising physical therapist shall countersign patient documentation (i.e., notes, records, charts) for services provided by a trainee.

3. The trainee shall wear identification designating them as a "physical therapist trainee" or a "physical therapist assistant trainee."

C. Completion of traineeship.

1. The physical therapist supervising the trainee shall submit a report to the board at the end of the required number of hours on forms supplied by the board.

2. If the traineeship is not successfully completed at the end of the required hours, as determined by the supervising physical therapist, the president of the board or his designee shall determine if a new traineeship shall commence. If the president of the board determines that a new traineeship shall not commence, then the application for licensure shall be denied.

3. The second traineeship may be served under a different supervising physical therapist and may be served in a different organization than the initial traineeship. If the second traineeship is not successfully completed, as determined by the supervising physical therapist, then the application for licensure shall be denied.

D. A traineeship shall not be approved for an applicant who has not completed a criminal background check for initial licensure pursuant to § 54.1-3484 of the Code of Virginia.

18VAC112-20-200. Advertising ethics.

A. Any statement specifying a fee, whether standard, discounted, or free, for professional services that does not include the cost of all related procedures, services, and products which that, to a substantial likelihood, will be necessary for the completion of the advertised service as it would be understood by an ordinarily prudent person shall be deemed to be deceptive or misleading, or both. Where reasonable disclosure of all relevant variables and considerations is made, a statement of a range of prices for specifically described services shall not be deemed to be deceptive or misleading.

B. Advertising a discounted or free service, examination, or treatment and charging for any additional service, examination, or treatment that is performed as a result of and within 72 hours of the initial office visit in response to such advertisement is unprofessional conduct unless such professional services rendered are as a result of a bona fide emergency. This provision may not be waived by agreement of the patient and the practitioner.

C. Advertisements of discounts shall disclose the full fee that has been discounted. The practitioner shall maintain documented evidence to substantiate the discounted fees and shall make such information available to a consumer upon request.

D. A licensee or holder of a compact privilege shall not use the term "board certified" or any similar words or phrase calculated to convey the same meaning in any advertising for his practice unless he holds certification in a clinical specialty issued by the American Board of Physical Therapy Specialties.

E. A licensee or holder of a compact privilege of the board shall not advertise information that is false, misleading, or deceptive. For an advertisement for a single practitioner, it shall be presumed that the practitioner is responsible and accountable for the validity and truthfulness of its content. For an advertisement for a practice in which there is more than one practitioner, the name of the practitioner or practitioners responsible and accountable for the content of the advertisement shall be documented and maintained by the practice for at least two years.

F. Documentation, scientific and otherwise, supporting claims made in an advertisement shall be maintained and available for the board's review for at least two years.