21feb02...2513h

4/10/02 3129s

4/16/02 3498s

2may02...3785eba

2002 SESSION

01-2326

10/09

HOUSE BILL 1377-FN

COMMITTEE: Executive Departments and Administration

ANALYSIS

This bill revises the law for the regulation of physical therapists by the physical therapy governing board and the allied health professional board of directors.

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Explanation: Matter added to current law appears in bold italics.

Matter removed from current law appears [in brackets and struckthrough.]

Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

21feb02...2513h

4/10/02 3129s

4/16/02 3498s

2may02...3785eba

01-2326

10/09

STATE OF NEW HAMPSHIRE

In the Year of Our Lord Two Thousand Two

Be it Enacted by the Senate and House of Representatives in General Court convened:

237:1 Physical Therapy Practice Act. RSA 328-A is repealed and reenacted to read as follows:

CHAPTER 328-A

PHYSICAL THERAPY PRACTICE ACT

328-A:1 Legislative Intent. This chapter is enacted for the purpose of protecting the public health, safety, and welfare, and of providing for state administrative control, supervision, licensure and regulation of the practice of physical therapy. It is the legislature's intent that only individuals who meet and maintain prescribed standards of competence and conduct may engage in the practice of physical therapy as authorized by this chapter. This chapter shall be liberally construed to promote the public interest and to accomplish the purpose stated herein.

328-A:2 Definitions. In this chapter and RSA 328-F:

I. "Board" means the physical therapy governing board established in RSA 328-F:3, I.

II. "Consultation by means of telecommunication" means that a physical therapist renders professional or expert opinion or advice to another physical therapist or health care provider via telecommunications or computer technology from a distant location. It includes the transfer of data or exchange of educational or related information by means of audio, video, or data communications.

III. "Direct personal supervision" means that the physical therapist or the physical therapist assistant is physically present and immediately available to direct and supervise tasks that are related to patient/client management. The direction and supervision is continuous throughout the time these tasks are performed. Telecommunications does not meet the requirement of direct personal supervision.

IV. "Direct supervision" means that the physical therapist is physically present and immediately available for direction and supervision. The physical therapist will have direct contact with the patient/client during each visit that is defined as all encounters with a patient/client in a 24-hour period. Telecommunications does not meet the requirement of direct supervision.

V. "General supervision" means that the physical therapist is not required to be on-site for direction and supervision, but must be available at least by telecommunications.

VI. "Jurisdiction of the United States" means any state, territory or the District of Columbia that licenses physical therapists.

VII. "Physical therapist" or "physiotherapist" means a person who is licensed pursuant to this chapter to practice physical therapy in this state.

VIII. "Physical therapist assistant" means a person who meets the requirements of this chapter for licensure and who assists the physical therapist in selected components of physical therapy intervention.

IX. "Physical therapy" or "physiotherapy" means the care and services provided by or under the direction and supervision of a physical therapist who is licensed pursuant to this chapter.

X. "Physical therapy aide" means a support person trained under the direction of a physical therapist who performs designated and supervised routine tasks related to physical therapy.

XI. "Practice of physical therapy" or "practice of physiotherapy" means:

(a) Testing, examining and evaluating impairments, movement dysfunctions, and disabilities or other health and movement-related conditions in order to determine a diagnosis, prognosis, and plan of intervention, and to assess the outcomes of intervention.

(b) Alleviating impairments, movement dysfunctions, and disabilities by designing and implementing, and modifying interventions that include, but are not limited to therapeutic exercise; training related to movement dysfunctions in self care and in home, community or work integration or reintegration; manual therapy including soft tissue and joint mobilization; therapeutic massage; assistive and adaptive orthotic, prosthetic, protective and supportive devices and equipment related to movement dysfunctions; airway clearance techniques; integumentary protection and repair techniques; debridement and wound care; physical agents or modalities; mechanical and electrotherapeutic modalities; and patient-related instruction.

(c) Reducing the risk of injury, impairment, movement dysfunctions and disability, including the promotion and maintenance of health, wellness, and fitness in populations of all ages.

(d) Engaging in administration, consultation, education and research.

XII. "Restricted license" means a license on which the board places restrictions or conditions, or both, as to scope of practice, place of practice, supervision of practice, duration of licensed status, or type or condition of patient or client to whom the licensee may provide services.

XIII. "Testing" means standardized methods and techniques used to gather data about the patient, including electrodiagnostic and electrophysiologic tests and measures.

328-A:3 Powers and Duties of the Board. The board shall:

I. Provide for the examinations for physical therapists and physical therapist assistants and adopt passing scores for these examinations.

II. Issue licenses to persons who meet the requirements of this chapter.

III. Regulate the practice of physical therapy by interpreting and enforcing this chapter.

IV. Adopt rules pursuant to RSA 328-A:4 consistent with this chapter and RSA 328-F.

V. Establish mechanisms for assessing continuing competence of licensees.

VI. Elect officers from its members necessary for the operations and obligations of the board. Terms of office shall be one year.

VII. Provide for the timely orientation and training of new professional and public appointees to the board regarding board licensing and disciplinary procedures, this chapter and board rules, policies and procedures.

VIII. Maintain a current list of all persons regulated under this chapter, including the person's name, current business and residential address, telephone numbers and license number.

IX. Provide information to the public regarding the complaint process.

X. Employ necessary personnel to carry out the administrative work of the board. Board personnel are eligible to receive compensation pursuant to RSA 328-F:6.

XI. Enter into contracts for services necessary for adequate enforcement of this chapter.

XII. Publish, at least annually, final disciplinary action taken against a licensee.

XIII. Publish, at least annually, board rulings, opinions, and interpretations of statutes or rules in order to guide persons regulated pursuant to this chapter.

XIV. Participate in or conduct performance audits of the board.

328-A:4 Rulemaking Authority. The board shall adopt rules, pursuant to RSA 541-A, relative to:

I. Examinations for physical therapists and physical therapy assistants.

II. Licensing, license renewals, and continuing education requirements.

III. Ethical standards and disciplinary actions for the enforcement of this chapter

IV. The proper administration of this chapter and the board's duties and responsibilities under RSA 328-F.

328-A:5 Qualifications for Licensure and Certification.

I. An applicant for a license as a physical therapist shall:

(a) Be of good moral character.

(b) Have completed the application process.

(c) Be a graduate of a professional physical therapy education program accredited by a national accreditation agency approved by the board.

(d) Have successfully passed the national examination approved by the board.

(e) Have maintained a current level of professional knowledge in physical therapy for a period of one year prior to filing.

II. An applicant for a license as a physical therapist who has been educated outside of the United States shall:

(a) Be of good moral character.

(b) Have completed the application process.

(c) Provide satisfactory evidence that the applicant's education is substantially equivalent to the requirements of physical therapists educated in accredited educational programs as determined by the board. If it is determined that a foreign-educated applicant's education is not substantially equivalent the board may require the person to complete additional course work before it proceeds with the application process.

(d) Provide written proof that the applicant's school of physical therapy education is recognized by its own ministry of education.

(e) Provide written proof of authorization to practice as a physical therapist without limitations in the country where the professional education occurred.

(f) Have the applicant's credentials evaluated by a board-approved credential evaluation agency.

(g) Have passed the board-approved English proficiency examinations if the applicant's native language if not English.

(h) Have successfully passed the national examination approved by the board.

III. Notwithstanding the provisions of paragraph II, if the foreign-educated physical therapist applicant is a graduate of an accredited educational program as approved by the board, the board may waive the requirements in subparagraph II(c), (d), and (f).

IV. An applicant for a license as a physical therapist assistant shall:

(a) Be of good moral character.

(b) Have completed the application process.

(c) Be a graduate of a physical therapist assistant education program accredited by a national agency approved by the board.

(d) Have successfully passed the national examination approved by the board.

(e) Have maintained a current level of professional knowledge in physical therapy for a period of one year prior to filing.

328-A:6 Application; Statement of Deficiencies; Hearing.

I. An applicant for licensure shall file a complete application as required by the board. The applicant shall include application and licensure fees as prescribed in rules adopted pursuant to RSA 328-F:13 and RSA 328-F:15.

II. The board shall notify an applicant of any deficiencies in the application. An applicant who disagrees with the identified deficiencies may request in writing and, upon request, shall be granted a hearing pursuant to RSA 328-F:25 and RSA 541-A.

328-A:7 Examination.

I. The board shall conduct examinations within the state at least quarterly at a time and place prescribed by the board. The passing score shall be determined by the board.

II. A physical therapist applicant may take the examination for licensure after the application process has been completed. The National Physical Therapy Exam shall test competency related to physical therapy theory, examination and evaluation, diagnosis, prognosis, treatment intervention, prevention, and consultation.

III. A physical therapist assistant applicant may take the examination for licensure after the application process has been completed. The national examination shall test for requisite knowledge and skills in the technical application of physical therapy services.

IV. An applicant for licensure who does not pass the examination after the first attempt may retake the examination 3 additional times. Before the board may approve an applicant for subsequent testing, the applicant shall reapply for licensure and shall demonstrate evidence satisfactory to the board, pursuant to rules adopted by the board under RSA 541-A, of successful completion of additional clinical training or course work, or both, as determined by the board.

328-A:8 Exemptions from Licensure.

I. Nothing in this chapter shall be construed to restrict a person licensed under any law of this state from engaging in the profession or practice for which that person is licensed. II. For physical therapists, the following persons are exempt from the licensure requirements of this chapter when engaged in the following activities:

(a) A person in a professional education program approved by the board who is pursuing a course of study leading to a degree as a physical therapist and that person is satisfying supervised clinical education requirements related to the person's physical therapy education while under on-site supervision of a licensed physical therapist.

(b) A physical therapist who is practicing in the Untied States Armed Services, United States Public Health Service or Veterans Administration pursuant to federal regulations for state licensure of health care providers.

(c) A physical therapist who is licensed in another jurisdiction of the United States or a foreign-educated physical therapist credentialed in another country if that person is performing physical therapy in connection with teaching or participating in an educational seminar of no more than 60 days in a calendar year.

(d) A physical therapist who is licensed in another jurisdiction of the United States if that person is providing consultation by means of telecommunication to a physical therapist licensed under this chapter.

III. For physical therapist assistants, the following persons are exempt from the licensure requirements of this chapter when engaged in the following activities:

(a) A person in a professional education program approved by the board who is pursuing a course of study leading to a degree as a physical therapist assistant and that person is satisfying supervised clinical education requirements related to the person's physical therapist assistant education while under direct supervision of a physical therapist.

(b) A physical therapist assistant who is practicing in the United States Armed Services, United States Public Health Service or Veterans Administration pursuant to federal regulations for state licensure of health care providers.

(c) A person licensed as a physical therapist assistant in another jurisdiction of the United States if that person is assisting in selected components of physical therapy intervention in connection with teaching or participating in an educational seminar of no more than 60 days in a calendar year.

328-A:9 Lawful Practice.

I. A physical therapist licensed under this chapter is fully authorized to practice physical therapy as defined herein.

II. A physical therapist shall refer a patient or client to appropriate health care practitioners when:

(a) The physical therapist has reasonable cause to believe symptoms or conditions are present that require services beyond the scope of practice; or

(b) Physical therapy is contraindicated; or

(c) There is no documented improvement within 25 calendar days of the initiation of treatment.

III. A physical therapist shall adhere to the recognized standards of ethics of the physical therapy profession and as further established in rules.

IV. A physical therapist assistant licensed under this chapter is fully authorized to assist in selected components of physical therapy intervention.

V. A physical therapist assistant shall adhere to recognized standards of ethics of the physical therapy profession and as further established in rules.

VI. A physical therapist may purchase and store topical and aerosol medications, to be administered upon the prescription of an appropriately licensed health care practitioner, as part of the practice of physical therapy as defined herein. A physical therapist shall comply with any regulation duly adopted by the New Hampshire pharmacy board specifying protocols for storage of medications.

VII. Nothing in this chapter shall be construed as authorizing a licensed physical therapist to practice medicine, osteopathy, chiropractic, naturopathy, or any other form or method of healing, except physical therapy. The use of roentgen rays and radium for diagnostic and therapeutic purposes, and the use of electricity for surgical purposes including cauterization, shall not be authorized under the term "physical therapy" as used in this chapter.

328-A:10 Use of Titles; Restrictions; Classification of Violation.

I. A physical therapist shall use the letters "PT" in connection with the physical therapist's name or place of business to denote licensure under this chapter.

II. A person or business entity, its employees, agents or representatives shall not use in connection with that person's name or the name or activity of the business, the words "physical therapy," "physical therapist," "physiotherapy," "physiotherapist" or "registered physical therapist," the letters "PT," "LPT," "RPT," "CPT," "MPT," "DPT," or any other words, abbreviations or insignia indicating or implying directly or indirectly that physical therapy is provided or supplied, including the billing of services labeled as physical therapy, unless such services are provided by or under the direction of a physical therapist licensed pursuant to this chapter. A person or entity that violates this paragraph is guilty of a violation for a first offense, and guilty of a misdemeanor for any subsequent violations of this paragraph.

III. A physical therapist assistant shall use the letters "PTA" in connection with that person's name to denote licensure hereunder.

IV. A person shall not use the title "physical therapist assistant," the letters "PTA," "RPTA," "LPTA," "CPTA," or any other words, abbreviations or insignia in connection with that person's name to indicate or imply, directly or indirectly, that the person is a physical therapist assistant unless that person is licensed as a physical therapist assistant pursuant to this chapter. A person who violates this paragraph is guilty of a misdemeanor.

328-A:11 Patient Care Management.

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

(a) The initial written evaluation for each patient;

(b) Periodic written re-evaluation of each patient; and

(c) A written discharge plan for the patient and the patient's response to treatment at discharge.

II. A physical therapist shall assure the qualifications of all assistive personnel to perform specific designated tasks through written documentation of the assistive personnel's education and training.

III. For each date of service, a physical therapist shall provide all therapeutic interventions that require the expertise of a physical therapist and shall determine the use of assistive personnel that provides delivery of service that is safe, effective, and efficient for each patient.

IV. A physical therapist assistant shall work under a physical therapist's general supervision. A physical therapist assistant shall document care provided and shall report to a supervising physical therapist any status in a patient requiring a change in the plan of care. The supervising physical therapist shall review and co-sign all notes during each reevaluation. V. A physical therapist may use physical therapy aides for designated routine tasks. A physical therapy aide shall work under the direct personal supervision of a physical therapist or a physical therapist assistant.

VI. A physical therapist may concurrently utilize no more than any combination of 3 assistive personnel. In addition to 3 assistive personnel, a physical therapist may supervise one additional person who is a physical therapist student, physical therapist assistant student or physical therapist under restricted license or interim license.

VII. A physical therapist's responsibility for patient care management shall include oversight of all documentation for services rendered to each patient, including awareness of fees charged or reimbursement methodology used. A physical therapist shall also be aware of what constitutes unreasonable or fraudulent fees.

328-A:12 Unlawful Practice; Classification; Civil Penalties; Injunctive Relief.

I. It is unlawful for any person to practice or in any manner to represent, imply or claim to practice physical therapy or use any word or designation that implies that the person is a physical therapist unless that person is licensed pursuant to this chapter. A person who engages in an activity requiring a license pursuant to this chapter or uses any work, title, letters, or any description of services that incorporates one or more of the terms, designations, or abbreviations in violation of RSA 328-A:10 that implies that the person is licensed to engage in the practice of physical therapy is guilty of a misdemeanor.

II. It is unlawful for any person who is not licensed as a physical therapist assistant under this chapter to assist in selected components of physical therapy intervention requiring the knowledge and skill or a physical therapist assistant. A person who engages in an activity requiring a license pursuant to this chapter or uses any work, title, letters, or any description of services that incorporates one or more of the terms, designations, or abbreviations in violation of RSA 328-A:10 is guilty of a misdemeanor.

III. The board may investigate any person to the extent necessary to determine if the person is engaged in the unlawful practice of physical therapy. If an investigation indicates that a person may be practicing physical therapy unlawfully, the board shall inform the person of the alleged violation. The board may refer the matter for prosecution regardless of whether the person ceases the unlawful practice of physical therapy.

IV. The board, through the attorney general, may apply for injunctive relief in any court of competent jurisdiction to enjoin any person from committing any act in violation of this chapter. Injunctive proceedings are in addition to, and not in lieu of, all penalties and other remedies prescribed in this chapter.

328-A:13 Reporting Violations; Immunity.

I. A person, including but not limited to a licensee, corporation, insurance company, health care organization or health care facility and state or local governmental agencies shall report to the board any conviction or determination by an agency or court that a licensee has committed an act that constitutes a violation of this chapter.

II. A person shall be immune from civil liability, whether direct or derivative, for providing information in good faith to the board pursuant to paragraph I.

III. The board shall not disclose the identity of a person who provides information unless such information is essential to proceedings conducted pursuant to RSA 328-F:23-26 or unless required by a court of law.

382-A:14 Substance Abuse Recovery Program. In lieu of a disciplinary proceeding prescribed by this chapter or RSA 328-F, the board may permit a licensee to actively participate in a board-approved substance abuse recovery program if:

I. The board has evidence that the licensee is impaired.

II. The licensee has not been convicted of a felony relating to a controlled substance in a court of law of the United States or any other territory or country.

III. The licensee enters in to a written agreement with the board for a restricted license and complies with all the terms of the agreement, including making satisfactory progress in the program and adhering to any limitations on the licensee's practice work imposed by the board to protect the public. Failure to enter into such an agreement shall activate an immediate investigation and disciplinary proceedings by the board.

IV. As part of the agreement established between the licensee and the board, the licensee signs a waiver allowing the substance abuse program to release information to the board if the licensee does not comply with the requirements of this section or is unable to practice or work with reasonable skill or safety.

328-A:15 Rights of Consumers.

I. The public shall have access to the following information:

(a) A list of licensees and interim license holders that includes place of practice, license or interim license number, date of license or interim license expiration and status of license.

(b) A list of physical therapist assistants licensed in the state, including place of employment, license number and date of license expiration.

(c) A list of official actions taken by the board.

II. The home address and telephone numbers of physical therapists and physical therapist assistants shall not be public record and shall be kept confidential by the board unless they are only addresses and telephone numbers of record.

III. If a referring practitioner is deriving direct or indirect compensation from the referral to physical therapy the physical therapist shall disclose this information in writing to the patient prior to the initial evaluation.

IV. A physical therapist shall disclose in writing to a patient any financial interest in products that the physical therapist endorses and recommends to the patient at the time of such endorsement or recommendation.

V. A physical therapist shall inform each patient that the patient has freedom of choice in services and products.

VI. Information relating to the physical therapist-patient relationship is confidential and shall not be communicated to a third party who is not involved in that patient's care without the prior written consent of the patient. A physical therapist shall divulge to the board information it requires in connection with any investigation, public hearing, or other proceedings. The physical therapist-patient privilege does not extend to cases in which the physical therapist has a duty to report information as required by law.

VII. Any person may submit a complaint regarding any licensee or any other person potentially in violation of this chapter. Confidentiality shall be maintained subject to law.

VIII. The board shall keep all information relating to receiving and investigating complaints filed against licensees confidential until the information becomes public record or as required by law. Patient records, including clinical records, files, any other report or oral statement relating to diagnostic findings or treatment of patients, any information from which a patient or the patient's family might be identified, or information received and records or reports kept by the board as a result of an investigation made pursuant to this chapter shall not be available to the public and shall be kept confidential by the board.

IX. Each licensee shall display a copy of the licensee's license or current renewal verification or a notice of the availability of this information in a location accessible to public view at the licensee's place of practice.

237:2 Definition; Physical Therapy. Amend RSA 328-F:2, V to read as follows:

V. "Physical therapy" or "physiotherapy" means "physical therapy" or "physiotherapy" as defined in RSA [328-A:1, VI] 328-A:1, IX.

237:3 Rulemaking; Allied Health Professionals; Physical Therapy Governing Board. Amend RSA 328-F:11, III to read as follows:

III. The governing board of physical therapy shall adopt rules as provided in RSA [328-A:14] 328-A:4.

237:4 Application; Reissuance of Licenses.

I. Any person licensed by the physical therapy governing board prior to the effective date of this act and who either presently holds a physical therapist II license, or presently holds a physical therapist I license and has held the physical therapist I license for at least 2 years shall be reissued a license by the board, notwithstanding any further requirements provided in section 1 of this act.

II. A person who presently holds a physical therapist I license and has held the physical therapist I license for less than 2 years shall be reissued a license if the person either shows proof of 2 years experience and completion of continuing education deemed sufficient as defined in rules adopted by the board, or evidences graduation, after May 1, 1999, from a masters level physical therapy educational program accredited by a national agency approved by the board.

237:5 Application of Penalties. A person who is not licensed as a physical therapist by the board but who, prior to the effective date of this act, legally used the terms, designations, or abbreviations listed in RSA 328-A:10, II, shall be permitted to continue the use of such terms, designations, or abbreviations for one year following the effective date of this act, and shall not be subject to penalties under RSA 328-A:10, II or RSA 328-A:12, I as inserted by this act. Following the one-year period, such persons shall be subject to the penalties for unlawful practice.

237:6 Effective Date. This act shall take effect July 1, 2002.

(Approved: May 17, 2002)

(Effective Date: July 1, 2002)