1. 3/19/2010 Ohio OTPTAT Board1 Update from the Ohio Physical Therapy Board Jeffrey M. Rosa, Executive Director http://otptat.ohio.gov board@otptat.ohio.gov http://otptat.ohio.gov board@otptat.ohio.gov

2. 3/19/2010 Ohio OTPTAT Board2 Topics Purpose of Regulation Information About the Board Recent Rules Changes Proposed 2010 Rules Changes Investigation & Discipline Consumer Education Frequently Asked Questions

3. 3/19/2010 Ohio OTPTAT Board3 Mission of the Board The mission of the Ohio Occupational Therapy, Physical Therapy, and Athletic Trainers Board is to actively promote and protect the health of the citizens of Ohio through effective regulation of the professions of occupational therapy, physical therapy, and athletic training.

4. 3/19/2010 Ohio OTPTAT Board4 The Purpose of Regulation… Regulation is intended to: Ensure public protection; Offer assurance to public that practitioner is competent to provide safe services; and Provide a means to discipline individuals who fail to comply with the profession’s standards. *Schmitt, Kara & Shimberg, Benjamin. (1996). Demystifying Occupational and Professional Regulation. Lexington, KY: The Council on Licensure, Enforcement and Regulation.

5. 3/19/2010 Ohio OTPTAT Board5 The Board’s Authority The Revised Code empowers the Board to regulate the professions of OT, PT, & AT. Board members appointed by the Governor to three-year terms. The law authorizes the Board to adopt administrative rules (Administrative Code). Authorizes hiring an Executive Director.

6. 3/19/2010 Ohio OTPTAT Board6 Major Responsibilities of the Board Establish Entrance Requirements Education Training and Experience Assessing initial competence Rule Making Discipline Assuring Continued Competence

7. 3/19/2010 Ohio OTPTAT Board7 OTPTAT Board Info Joint Board consisting of an Occupational Therapy, Physical Therapy, and Athletic Trainers Section Total of 8 full-time staff 2 Admin Staff, 3 Investigative Staff, 3 Licensure Staff PT Section has 9 Section members

8. 3/19/2010 Ohio OTPTAT Board8 Board Composition – PT Section MemberCity Term Expires Term Ray Bilecky, PT, ChairColumbia Station20112nd Marilyn Mount, PT, Sec’yCleveland Heights20101st Tom Caldwell, PTGalena20112nd Sam Coppoletti, PTCincinnati20122nd Dale Deubler, PTColumbus20111st All terms expire on Aug. 27 of designated year. Pursuant to ORC 4755.01, members shall not serve for more than 3 consecutive terms.

9. 3/19/2010 Ohio OTPTAT Board9 Board Composition – PT Section MemberCity Term Expires Term Mary Kay Eastman, PTAthens20101st Karen Holtgrefe, PTCincinnati20121st James Lee, PTWadsworth20121st Kimberly Payne, PTColumbus20111st All terms expire on Aug. 27 of designated year. Pursuant to ORC 4755.01, members shall not serve for more than 3 consecutive terms.

10. 3/19/2010 Ohio OTPTAT Board10 How Rules Are Changed Rule review is a public process. Board seeks input on initial draft before rule language is filed. Information on proposed changes sent to listserv and posted on the Board’s website. Once filed, full text of the rules is available at: http://www.registerofohio.state.oh.us Public hearing on proposed changes required. Board’s goal is new rules go into effect on May 1.

11. 3/19/2010 Ohio OTPTAT Board11 Recent Rules Changes Key changes effective on May 1, 2009. 4755-23-03 – License by Examination Removed required remedial activities for individuals who: Failed NPTE 3+ times Graduated 3+ years from PT school 4755-23-04 – License by Endorsement Removed required remedial activities for individuals out of practice more than 3 years Add requirement that individuals out of practice more than 5 years retake and pass NPTE

12. 3/19/2010 Ohio OTPTAT Board12 Recent Rules Changes 4755-23-08 – Continuing Education Added language specifying category of CE activities that don’t require Ohio Approval Number Passage of ABPTS specialty exam or Hand Therapy certification exam (24 hours) Completion of APTA credentialed residency or fellowship (24 hours) Completion of Federation of State Boards of Physical Therapy Practice Review Tool (3 hours)

13. 3/19/2010 Ohio OTPTAT Board13 Recent Rules Changes 4755-23-10 – Reinstatement of License Removed required remedial activities for individuals out of practice more than 3 years Add requirement that individuals out of practice more than 5 years retake and pass NPTE Updated CE required for reinstatement If you apply to reinstate w/in 1 month of expiration, CE for reinstatement = CE needed for that renewal (e.g.: 0 hours if it was your 1 st renewal)

14. 3/19/2010 Ohio OTPTAT Board14 Recent Rules Changes 4755-23-12 – Requirements for Teaching PT Rule needed per amendment in HB 403 (ORC 4755.482) Allows non-Ohio licensed PTs to teach PT theory & procedures (as faculty of record) course up to 1 year w/o Ohio license Need Ohio license to teach more than 1 year No license needed for guest faculty/CE presenters Individual or school must notify Board before individual starts teaching

15. 3/19/2010 Ohio OTPTAT Board15 Recent Rules Changes 4755-23-14 – Criminal Records Checks Must be submitted to Board directly from BCI Board only accepts results for 6 months from date of receipt (not 1 year) Ohio law requires both BCI and FBI Only applies for new licensees – not for renewal 4755-27-03 – Delegation Clarified that delegation to “other licensed personnel” must be within that person’s legal scope of practice Clarified that documentation by “other licensed personnel” includes patient’s response to intervention

16. 3/19/2010 Ohio OTPTAT Board16 Recent Rules Changes 4755-27-04 – Supervision Clarified supervision levels for SPT and SPTA Supervisor must be: On-site and Available to immediately respond to needs of the patient 4755-27-05 – Code of Ethical Conduct Added provisions about documenting/billing for services not actually performed Licensee can’t sexually harass patients, students and/or colleagues Licensee can’t misrepresent credential, title, and/or specialty certifications held

17. 3/19/2010 Ohio OTPTAT Board17 Recent Rules Changes 4755-27-06 – Reporting Requirements Clarify that licensee must notify board of impairment by physical or mental illness 4755-27-07 – Documentation (new rule) PTs must use “PT” and PTAs must use “PTA” following signature to indicate licensure LPT, LPTA, RPT not acceptable credentials MPT and DPT are academic degrees, not the license Sign as Jane Doe, PT, DPT; not John Doe, MPT SPT and SPTA are OK to use for students

18. 3/19/2010 Ohio OTPTAT Board18 Proposed 2010 Rules Changes 4755-21-02 – Public Notice Technical changes only 4755-23-04 – License by Endorsement Specifies what it means to be “out of practice for five or more years Actively engaged in PT practice for fewer than 500 hours over the 5 year period 4755-23-05 – Certificate of License Elimination of pocket ID cards

19. 3/19/2010 Ohio OTPTAT Board19 Proposed 2010 Rules Changes 4755-23-06 – Biennial Renewal of Licensure Change word “application” to “notice” to reflect current practices 4755-23-10 – Reinstatement of License Specifies what it means to be “out of practice for five or more years Actively engaged in PT practice for fewer than 500 hours over the 5 year period 4755-23-12 – Requirements for Foreign Educated Applicants Changes to reflect current practices

20. 3/19/2010 Ohio OTPTAT Board20 Proposed 2010 Rules Changes 4755-23-15 – Reinstatement of Revoked License Specifies the criteria used by Board when reviewing application from individual whose license was denied or revoked Criteria include: Nature/severity of act(s) that resulted in denial/revocation Time elapsed Possible additional violations Compliance with previous Board orders Any evidence of rehabilitation submitted 4755-24-05 – License re-issuance fee Eliminate fee for duplicate ID card

21. 3/19/2010 Ohio OTPTAT Board21 Pocket ID Cards As of May 1, 2010, the Board will no longer issue pocket ID cards Recent increase in # of doctored ID cards Enhancement of currency of information on, and acceptance of, online license verification Rule 4755-23-05 will require licensees to have available current license information from Ohio e- License Center (https://license.ohio.gov/lookup)https://license.ohio.gov/lookup Availability can be printed page, smartphone access, client’s home computer, etc.

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23. 3/19/2010 Ohio OTPTAT Board23 Supervision & Delegation Rules Changes to rules 4755-27-01 to 4755-27-04 went into effect on May 1, 2008. These changes clarified and modified the role of unlicensed personnel.

24. 3/19/2010 Ohio OTPTAT Board24 PT Responsibilities Rule 4755-27-03 (C) outlines the tasks that a physical therapist cannot delegate. These include, but are not limited to: Interpreting physician referrals Initial patient evaluation Developing plan of care Assessing competence of other personnel Adjustment of plan of care Performing final evaluation

25. 3/19/2010 Ohio OTPTAT Board25 PTA Responsibilities Under PT supervision, the PTA may: Carry out duties appropriate to established PT services Adjust treatment procedure within the established plan of care Review medical information with medical persons, family, or the patient Progress patient treatment program within parameters of the plan of care Document in patient records

26. 3/19/2010 Ohio OTPTAT Board26 Other Licensed Personnel vs. Unlicensed Personnel Other Licensed Personnel Any person holding an Ohio license to practice as a health care practitioner other than a PT/PTA Unlicensed Personnel Any person who is on the job trained

27. 3/19/2010 Ohio OTPTAT Board27 Other Licensed Personnel Category includes individuals such as: ATs, RNs, OTs, LMTs, etc., providing services pursuant to the PT plan of care Responsibility for care rendered lies at all times with the PT Must work under direct supervision of a PT or PTA, as delegated by the PT

28. 3/19/2010 Ohio OTPTAT Board28 Other Licensed Personnel Direct supervision = PT/PTA in same building & able to immediately respond to needs of patient PT/PTA must have involvement with patient during each visit Delegation done in accordance with knowledge and legal scope of practice of the other licensed personnel

29. 3/19/2010 Ohio OTPTAT Board29 Unlicensed Personnel Responsibility for care rendered lies at all times with the PT Support the delivery of PT services by personally assisting the PT / PTA / PT Student / PTA Student while one of these individuals is concurrently providing services to the same patient “A second pair of hands”

30. 3/19/2010 Ohio OTPTAT Board30 Unlicensed Personnel May be assigned ROUTINE duties that assist in the delivery of PT operations, including: Maintenance & care of equipment and supplies Preparation, maintenance, and cleanup of treatment areas Transportation of patients Office & clerical procedures Assisting patients preparing for, during, and at the conclusion of treatment (eg: changing clothes)

31. 3/19/2010 Ohio OTPTAT Board31 Supervision PT has ultimate responsibility for all care and services delivered as physical therapy PT shall select appropriate portions of the program to be delegated and shall direct PTA in delegated functions PT must assure that care is provided in accordance with state law

32. 3/19/2010 Ohio OTPTAT Board32 Supervision of the PTA Supervising PT not required to be physically on site or on location Supervising PT must be available by telecommunications at all times and able to appropriately respond to patient’s needs Supervising PT should have regularly scheduled & documented conferences with the PTA Board recommends at least 1x per month

33. 3/19/2010 Ohio OTPTAT Board33 Supervision of Students Students must be enrolled in CAPTE program Must function under on-site supervision at all times Student PT needs PT supervision Student PTA needs PT or PTA supervision Supervisor must countersign all student documentation

34. 3/19/2010 Ohio OTPTAT Board34 What Does the Board Investigate? Physical abuse/injuries to a patient Patient neglect Falsification of documentation* Billing fraud* Failure to complete documentation prior to ending employment Mental impairment issues Drug/alcohol abuse Competency issues Criminal convictions Unprofessional behavior Unlicensed practice Failure to complete CE Falsifying an application

35. 3/19/2010 Ohio OTPTAT Board35 Most Common Violations CE/Audit violations Unlicensed practice Practice prior to licensure Practice on expired license Negligence/gross misconduct Supervision issues Illegal advertising/soliciting of patients Fraud Documenting services not actually provided

36. 3/19/2010 Ohio OTPTAT Board36 Expired Practice Licenses expire on Jan. 31 – there is no grace period If you practice without an Ohio license, you will be disciplined for practicing physical therapy without a license!! “Licensure Applicant” status eliminated in 2007

37. 3/19/2010 Ohio OTPTAT Board37 Consumer Education Each Section of the Board developed informational guides about the professions and role of the Board for consumers Documents available under “Consumer” section of the website Licensees are permitted AND ENCOURAGED to print copies to make available to clients

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41. 3/19/2010 Ohio OTPTAT Board41 Question 1 What’s the maximum ratio of PTAs to one supervising PT? PT law is silent on PT:PTA ratios and does not regulate caseloads Supervising PT must ensure appropriate patient management based on unique needs of the clients, taking into account complexity of patient population PT must not provide or supervise care for higher # of patients than that for which skilled care by licensed practitioners can be delivered

42. 3/19/2010 Ohio OTPTAT Board42 Question 2 Is there maximal productivity standard allowed in Ohio? Ohio law doesn’t regulate caseloads. PT practitioner must ensure that the highest priority patient needs are met PT must challenge productivity expectations if these standards cannot be met

43. 3/19/2010 Ohio OTPTAT Board43 Question 3 Can a PTA teach aerobic exercise classes at a fitness center? Under Ohio law, PT practitioner providing fitness/wellness services must follow PT law if services are represented as physical therapy PTA must follow rules governing delegation and supervision If fitness/wellness services not represented as physical therapy, they don’t fall under jurisdiction of PT Practice Act Licensee shouldn’t use credential “PT” or “PTA” in this scenario Board recommends appropriate medical screenings are in place prior to exercise to ensure participant safety Fitness/wellness records should be stored separately from physical therapy or medical records

44. 3/19/2010 Ohio OTPTAT Board44 Question 4 Is it legal for PT or PTA to document the medications that a patient is taking? Nothing in PT law prohibits the PT/PTA from performing medication reconciliation. Medication reconciliation not part of PT plan of care; performed as an administrative task of any health care professional Reconciliation includes interviewing patient about current meds & comparing to list of prescribed meds; referring the meds list to other practitioners and/or computerized programs to identify potential drug interactions

45. 3/19/2010 Ohio OTPTAT Board45 Question 5 If I’m laid off, am I required to document a transfer of care for my patients? Abandonment is inappropriate termination of PT/patient relationship by the PT PTs have legal & ethical obligation to make every effort to follow through with established plan of care PT has responsibility to refer patients elsewhere if he/she can no longer continue to treat a patient

46. 3/19/2010 Ohio OTPTAT Board46 Question 6 If I work in a hospital with other PTs to provide 7-day per week coverage, do I have to document transfer of care every time I take a day off? No, a formal transfer is not needed. It’s opinion of the Board that if 2 or more PTs are participating in job-sharing caseload, and if they are assuming collective responsibility for patient’s care each day, they aren’t terminating PT/patient relationship (therefore no transfer of care needed)

47. 3/19/2010 Ohio OTPTAT Board47 Question 7 If the evaluating PT resigns from that patient’s facility, does that PT have any further responsibility for the patient? Each practice should determine a system that allows for transfer of care when a PT terminates the PT/patient relationship Transfer of care must be documented in patient record by identifying new PT by name (or to PT supervisor for reassignment)

48. 3/19/2010 Ohio OTPTAT Board48 Question 8 If a PT provides merely an interview/consultation to evaluate a client and provides recommendations for follow up, is a physician referral required? Refer to R.C. 4755.481 for practice w/o referral Physician notification required w/in 5 days of direct access evaluation Consult/referral required w/in 30 days if no substantial progress made No notification/consult/referral required for: Fitness/wellness/prevention purposes Treatment of previously diagnosed chronic, neuromuscular, or developmental conditions

49. 3/19/2010 Ohio OTPTAT Board49 Question 9 If the PT documents a discharge eval 2 days prior to patient’s discharge, may a PTA provide and document treatment the next day? Can that info from the PTA constitute the discharge summary? Discharge planning and completion of discharge eval are responsibility of PT PTA may provide care per that discharge assessment & may document objective info, but PT must then complete final discharge summary

50. 3/19/2010 Ohio OTPTAT Board50 Question 10 Can a PT or PTA develop the plan for a restorative aide to provide maintenance therapy in a nursing home? Yes A PT or PTA may provide administrative oversight of an unlicensed aide who is providing restorative or maintenance care in a nursing home after the termination of a PT plan of care

51. 3/19/2010 Ohio OTPTAT Board51 Question 11 Under the supervision and delegation rules, can an on- the-job trained aide apply a hot pack or ultrasound to a patient while the therapist is concurrently documenting on that patient in the same area? Rule on delegation to unlicensed personnel is intended to limit involvement of unlicensed personnel in direct patient care to assisting the PT or PTA as “a 2 nd pair of hands on the same patient” Not intended that unlicensed personnel provide component of PT treatment to patient A while the PT treats patient B or performs other activities (e.g.: documentation)

52. 3/19/2010 Ohio OTPTAT Board52 Listserv Each Section has its own listserv Important news announced on listserv Rules changes New information posted to website To join, send an email to: board@otptat.ohio.gov Or go to http://otptat.ohio.gov and select “Join a Board Listserv” link on the homepagehttp://otptat.ohio.gov

53. 3/19/2010 Ohio OTPTAT Board53 Contacting the Board Email: board@otptat.ohio.gov Internet: http://otptat.ohio.govhttp://otptat.ohio.gov Phone: 614-466-3774 Fax: 614-995-0816 Mail: Ohio OTPTAT Board 77 S. High Street, 16 th Floor Columbus, OH 43215-6108