To streamline, clarify, reorganize and restructure existing rule requirements in a manner more easily understood.

Notice of Proposed Rule

DEPARTMENT OF HEALTH

Board of Physical Therapy Practice

RULE NOS.:RULE TITLES:

64B17-6.001Minimum Standards of Physical Therapy Practice.

64B17-6.002General Supervision of Physical Therapist Assistants; Eligibility; Requirements.

64B17-6.0042Medical Records of Deceased Physical Therapists or Physical Therapist Assistants.

PURPOSE AND EFFECT: To streamline, clarify, reorganize and restructure existing rule requirements in a manner more easily understood.

SUMMARY: Streamline, clarify, reorganize and restructure existing rule requirements in a manner more easily understood.

SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COST AND LEGISLATIVE RATIFICATION: When considering the proposed language, the Board determined that there would be no adverse impact on small businesses, nor are the proposed amendments likely to increase regulatory costs in excess of $200,000 within one year, or $1 million within five years. Also, the Board determined that no SERC nor legislative ratification was necessary because the rule amendments streamline, clarify, reorganize and restructure existing rule requirements in a manner more easily understood, and do not add any new requirements. Accordingly, the Board expects the rule amendments to result in lower overall regulatory compliance costs.

Any person who wishes to provide information regarding a statement of estimated regulatory costs, or provide a proposal for a lower cost regulatory alternative must do so in writing within 21 days of this notice.

RULEMAKING AUTHORITY:  456.058, 486.025 FS.

LAW IMPLEMENTED:  456.057(12), 456.058, 486.021(5), (6), (9), (10), (11), 486.025, 486.123, 486.125(1)(b), (d), (e), (f), (i), (j), 486.161(3), 486.171 FS.

IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE SCHEDULED AND ANNOUNCED IN THE FAR.

THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS:  Allen Hall, Executive Director, Board of Physical Therapy Practice, 4052 Bald Cypress Way, Bin #C05, Tallahassee, Florida 32399-3255, [phone]

 

THE TEXT OF THE PROPOSED RULE IS:

 

64B17-6.001 Minimum Standards of Physical Therapy Practice.

(1) through (1)(b) No change.

(c) Direction Delegation – The physical therapist's authorization and empowerment by a physical therapist of a the physical therapist assistant or unlicensed personnel, as authorized by outlined in Rule 64B17-6.007, F.A.C., to carry out actions requiring subject to licensure under Chapter 486, Florida Statutes.

(d) No change.

(e) Direct Supervision – Supervision of subordinate personnel performing directed actions subject to licensure pursuant to Chapter 486, Florida Statutes, while the licensed supervisor is immediately physically available. On-site Supervision means direct supervision.

(f) General supervision – Supervision of a physical therapist assistant, other than by direct supervision, whereby the shall not require on-site supervision by the physical therapist. The physical therapist is shall be accessible at all times by two-way communication, available, which enables the physical therapist to respond to an inquiry when made and to be readily available for consultation during the delivery of care, and is shall be within the same geographic location as the physical therapist assistant.

(g) through (i) No change.

(2) Physical Therapy Personnel Responsibilities In General to Patients’ Rights and Dignity. Physical therapy is a profession involving skilled practice of patient care. The primary concern of the physical therapist and physical therapist assistant is always the safety, well being, and best interest of the patient who must therefore recognize and carry out services consistent with legal rights and personal dignity of the patient. Accordingly, it is the responsibility of all physical therapists and physical therapist assistants to:

(a) Physical therapy is a profession involving skilled practice of patient care. The delegation of tasks and direction of actions to subordinates is a serious responsibility for the physical therapist. The primary concern of the physical therapist is always the safety, well being, and best interest of the patient.

(a)(b) Physical therapists and physical therapist assistants shall recognize and carry out services consistent with legal rights and personal dignity of the patient. It is the responsibility of the licensee to Ccommunicate effectively to the patient the treatment evaluation process and techniques to be used in any procedures before beginning treatment and anytime during the course of the treatment process.

(b)(c) Physical therapists and physical therapist assistants shall Ssafeguard the confidentiality of information and require written consent from the patient or legally authorized representative prior to releasing information to a third party not involved in the actual care.

(c)(d) Physical therapists and physical therapist assistants shall Aavoid acts which blatantly disregard a patient’s modesty and shall neither suggest nor engage in sexual activities with patients under their care.

(d)(e) Physical therapists and physical therapist assistants shall not Neither use nor or participate in the use of any form of communication containing false, fraudulent, misleading, deceptive, unfair or sensational statement or claim, nor use bribery in any form, nor use false advertising, nor misrepresentation of services or self, nor engage in other unprofessional conduct, including, but not limited to,

1. through 5. No change.

(e)(f) Physical therapists and physical therapist assistants shall Nnot exploit the patient or client for the financial gain of the licensee or a third party.

(f)(g) Physical therapists and physical therapist assistants must Ppractice physical therapy with that level of care, skill, and treatment which is recognized by a reasonably prudent similar physical therapy practitioner as being acceptable under similar conditions and circumstances.

(3) Physical Therapist Responsibilities. All physical therapists shall:

(a) The physical therapist shall Bbe professionally responsible for providing a referring practitioner, or a practitioner of record, with any information which will assist in the determination of an accurate medical diagnosis.

(b) The physical therapist shall Nnot implement any plan of care, that, in the physical therapist’s judgment judgement, is contraindicated. If the plan of care was requested by a referring practitioner, the physical therapist shall immediately notify the referring practitioner that he is not going to follow the request and the reasons for such refusal.

(c) The physical therapist shall Nnot direct delegate any function or task which requires the skill, knowledge, and judgment of the physical therapist.

(d) The physical therapist shall Aassume the responsibility for assessing the patient, identifying the level of acuity of illness, planning the patient’s treatment program, and implementing and directing the program.

(e) The physical therapist shall Hhold primary responsibility for physical therapy care rendered under the therapist’s his direction and shall be available for consultation at all times.

(f) The Pphysical therapist’s professional responsibilities include, but are not limited to:

1. through 2. No change.

3. Initial iIdentification of and documentation of precautions, special problems, contraindications.

4. through 5. No change.

6. Direction Delegation of appropriate tasks.

7. Direction and supervision of supportive staff in a manner appropriate for the patient’s individual needs.

7.8. No change.

9. Collaboration with members of the health care team when appropriate.

(g) Physical therapists, Wwhen participating in student and/or trainee programs, shall assure that the programs are approved or pending approval by the appropriate accrediting agency recognized by the Council on Postsecondary Accreditation (formerly the National Commission on Accreditation and the Federation of Regional Accrediting Commissions of Higher Education) or the United States Department of Education and provide on-site supervision when students are performing patient care activities.

(h) Physical therapists shall Kkeep written medical records justifying the course of treatment of the patient, including, but not limited to, initial physical therapy assessment, plan of treatment, treatment notes, progress notes, examination results, test results, and discharge summary.

(4) The Physical Therapist Assistant Responsibilities.  All physical therapist assistants shall:

(a) The physical therapist assistant shall Nnot initiate or change treatment without the prior assessment and approval of the physical therapist.

(b) During the delivery of physical therapy care to a patient who is an inpatient in a hospital, or who is in the acute phase of injury or illness, the physical therapist assistant shall not provide services to patient, unless the physical therapist is readily and physically available to provide consultation.

(c) The physical therapist assistant shall Nnot carry out treatment procedures detrimental to the patient or for which the assistant is not qualified.

(d) The physical therapist assistant shall Rreport all untoward patient responses or change in medical status to the physical therapist.

(e) The physical therapist assistant shall Rrefer inquiries regarding patient prognosis to the physical therapist.

(f) The physical therapist assistant shall Ddiscontinue immediately any treatment procedures which in the assistant’s judgment appear to be harmful to the patient and shall report them to the physical therapist.

(g) When participating in student and/or trainee programs assure that the programs are approved or pending approval by the appropriate accrediting agency recognized by the Council on Postsecondary Adccreditation or the United States Department of education and provide on-site supervision when students are performing patient care activities.

(5) through (5)(c)1. No change.

2. The physical therapist shall should be readily available to the physical therapist assistant with emphasis placed on directing the assistant through frequent reporting, both verbal and written, and frequent observations of the care rendered to the patient.

(d) The physical therapist shall not delegate portions of the skilled physical therapy functions or tasks to any lesser trained health personnel than the physical therapist assistant.

(6) No change.

(7) Pre-1973 Physical Therapy “Aide.” No person licensed pursuant to Chapter 486, Florida Statutes, shall delegate any acts that are the subject of licensure pursuant to Chapter 486, Florida Statutes, except to a unless the person who is licensed pursuant to that chapter, or unless the person was performing, prior to the 1973 amendments to that chapter, “duties” which are now acts subject to licensure. Furthermore, any unlicensed person currently being delegated and performing acts which are subject to licensure, by reason of having performed them prior to 1973, shall comply with Rule 64B17-6.001, F.A.C., except that, in all practice settings, such person shall perform such acts only under the direct supervision of the physical therapist.

(7)(8) No change.

Rulemaking Authority 486.025 FS. Law Implemented 483.021 486.021(5), (6), (9), (10), (11), 486.123, 486.125(1)(b), (d), (e), (f), (i), (j), 486.135, 486.151(1)(d), 486.161(3), 486.171 FS. History–New 8-6-84, Formerly 21M-9.30, Amended 9-22-87, Formerly 21M-9.030, Amended 9-5-90, 3-5-92, 3-24-93, Formerly 21MM-6.001, 61F11-6.001, Amended 8-16-95, Formerly 59Y-6.001, Amended 1-8-98, 1-11-99, 4-18-04, 6-1-09.

 

64B17-6.002 General Supervision of Physical Therapist Assistants by Physicians; Eligibility; Requirements.

(1) A physical therapist assistant employed by a board-certified orthopedic physician or physiatrist, or a chiropractic physician certified in physiotherapy, shall be under the general supervision of a physical therapist. A physical therapist assistant employed by any physician other than as identified above a board certified orthopedic physician or physiatrist or a chiropractic physician certified in physiotherapy shall be under the onsite supervision of a physical therapist.

(2) In order to insure adequate supervision of the physical therapist assistant by the supervising physical therapist wWhere general supervision is permitted, there shall be a an written agreement between the board-certified orthopedic physician, or physiatrist or chiropractic physician and the supervising physical therapist, specifying the duties and responsibilities of both parties. The Agreement must contain, at a minimum, which includes at least the minimum standards of physical therapy practice specified by contained in Rule 64B17-6.001, F.A.C.

(3) The physical therapist assistant shall report all untoward patient responses, inquiries regarding patient prognosis, or the discontinuation of any treatment procedure, to the physical therapist and to the employing board certified orthopedic physician or physiatrist or chiropractic physician certified in physiotherapy.

Rulemaking Specific Authority 486.025 FS. Law Implemented 486.021(6), (9), 486.025 FS. History–New 9-22-87, Formerly 21M-9.035, 21MM-6.002, 61F11-6.002, 59Y-6.002,                    .

 

64B17-6.0042 Medical Records of Deceased, Relocating, or Terminating Practice Physical Therapists or Physical Therapist Assistants.

(1) Licensees shall retain medical records as long as needed not only to serve and protect clients/patients, but also to protect themselves against adverse actions. This rule sets forth standards which, if not met, will constitute a violation of Sections 456.058 and 486.125, Florida Statutes, and will subject licensees to disciplinary proceedings.

(2) Licensees relocating or terminating practice.  Each licensee engaged in practice, who maintains the responsibility for client/patient medical records, shall, when terminating or relocating the practice, notify each client/patient of such termination or relocation.  Such notification shall consist of at a minimum, causing to be published, in the newspaper of greatest general circulation in each county in which the licensee practices or practiced, a notice which shall contain the date of termination or relocation and an address at which medical records may be obtained. Such notice shall be published no less than 4 times over a period of at least 4 weeks. In addition, the licensee shall place in a conspicuous location in or on the facade of the licensee’s office, a sign, announcing the termination or relocation of the practice. The sign shall be placed at least thirty (30) days prior to the termination or relocation and shall remain until the date of termination or relocation. Both the notice and the sign shall advise the clients/patients of their opportunity to transfer or receive their medical records. Each such licensee shall ensure that client/patient records are maintained and may be obtained by the client/patient for a minimum of two (2) years after the termination or relocation of practice.

(3) Deceased Physical Therapists or Physical Therapist Assistants.

(a)(1) Each licensee physical therapist or physical therapist assistant engaged in practice, who maintains the responsibility for client/ patient medical records, shall ensure that the executor, administrator, personal representative or survivor of such licensee physical therapist or physical therapist assistant shall arrange to maintain those medical records in existence upon the death of the licensee physical therapist or physical therapist assistant for a period of at least two (2) years from the date of the death of the licensee physical therapist or physical therapist assistant.

(b)(2) Within one (1) month from the date of death of the licensee physical therapist or physical therapist assistant, the executor, administrator, personal representative or survivor shall cause to be published in the newspaper of greatest general circulation in the county where the licensee physical therapist or physical therapist assistant practiced, a notice indicating to the clients/patients of the deceased licensee physical therapist or physical therapist assistant that the licensee’s medical records are available to the clients/patients or their duly constituted representative from a specific person at a certain location.

(c)(3) At the conclusion of a 22-month period of time from the date of death of the licensee physical therapist or physical therapist assistant or thereafter, the executor, administrator, personal representative or survivor shall cause to be published once during each week for four (4) consecutive weeks, in the newspaper of greatest general circulation in the county where the licensee physical therapist or physical therapist assistant practiced, a notice indicating to the clients/patients of the deceased licensee that client/patient records will be disposed of or destroyed one (1) month or later from the last day of the fourth week of publication of notice.

(4) All client/patient Any records shall be disposed of in a manner that will would secure the permanent confidentiality of records.

Rulemaking Specific Authority 456.058, 486.025 FS.  Law Implemented 456.057(12), 456.058, 486.021(6), (11) FS. History–New 5-13-99, Amended            .

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Board of Physical Therapy Practice

NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Board of Physical Therapy Practice

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: August 6, 2015

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: September 24, 2015