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The Missouri Practice Act

1. The Missouri Practice Act. A RESOURCE TO Good practice. Presented by: Members of the Advisory Commission for Physical Therapists. 2. William Hopfinger PT, Chair St. Louis Judi Pastorino, PTA, Secretary Columbia

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The Missouri Practice Act

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  1. 1 The Missouri Practice Act • A RESOURCE TO Good practice

  2. Presented by: Members of the Advisory Commission for Physical Therapists 2 • William Hopfinger PT, Chair St. Louis • Judi Pastorino, PTA, Secretary Columbia • Tamara Burlis, PT, Member St. Louis • Jim Dronberger, PT, Member Kansas City • Vacancy

  3. Mission StatementBoard of Healing Arts 3 • “To protect the citizens of the State through the licensing of physicians and other health designated professionals, assessing their competence to practice and their moral character, and to investigate all complaints against its licensees in a fair and equitable manner.”

  4. Physical Therapy Advisory Commissionserves the Board of Healing Arts and its mission 4 • Primary role is to protect the public from incompetence, misconduct, gross negligence, fraud, misrepresentation or dishonesty • Licenses only “qualified” professionals by examination and evaluation of minimum competency • Enforces standards by implementing legislation and administrative rules

  5. Licensing Boards vs. Professional Associations 5 Missouri State Board of Healing Arts Federation of State Boards of Physical Therapy

  6. 6 “The Practice Act”

  7. www.mopt.orgMYMPTA > ASSOCIATION DOCUMENTS > PRACTICE ACTM 7

  8. http://pr.mo.gov/physicaltherapists.asp 8

  9. Statutes and Rules 9 • Statute = Law (if it starts with 334, it’s a statute) • Shall” – means you have to do this • “Must” – means you have to do this • “May” – means you should probably do this • Rules= Statements promulgated through a formal process that further define statutes. These can be found in the Code of State Regulations. (if it starts with 20 CSR 2150… it’s a rule)

  10. Statutes 10

  11. Statutes – let’s look at this one 11

  12. Statute 334.506.1 12 • As used in this section, "approved health care provider" means a person holding a current and active license as a physician and surgeon under this chapter, a chiropractor under chapter 331, a dentist under chapter 332, a podiatrist under chapter 330, a physician assistant under this chapter, an advanced practice registered nurse under chapter 335, or any licensed and registered physician, chiropractor, dentist, or podiatrist practicing in another jurisdiction whose license is in good standing.

  13. Statute 334.506.1 13 • As used in this section, "approved health care provider" means a person holding a current and active license as a physician and surgeon under this chapter, a chiropractor under chapter 331, a dentist under chapter 332, a podiatrist under chapter 330, a physician assistant under this chapter, an advanced practice registered nurse under chapter 335, or any licensed and registered physician, chiropractor, dentist, or podiatrist practicing in another jurisdiction whose license is in good standing.

  14. Statute 334.506.1 14 • As used in this section, "approved health care provider" means a person holding a current and active license as a physician and surgeon under this chapter, a chiropractor under chapter 331, a dentist under chapter 332, a podiatrist under chapter 330, a physician assistant under this chapter, an advanced practice registered nurse under chapter 335, or any licensed and registered physician, chiropractor, dentist, or podiatrist practicing in another jurisdiction whose license is in good standing.

  15. Statute 334.506.1 15 • As used in this section, "approved health care provider" means a person holding a current and active license as a physician and surgeon under this chapter, a chiropractor under chapter 331, a dentist under chapter 332, a podiatrist under chapter 330, a physician assistant under this chapter, an advanced practice registered nurse under chapter 335, or any licensed and registered physician, chiropractor, dentist, or podiatrist practicing in another jurisdiction whose license is in good standing.

  16. Statute 334.506.1 16 • As used in this section, "approved health care provider" means a person holding a current and active license as a physician and surgeon under this chapter, a chiropractor under chapter 331, a dentist under chapter 332, a podiatrist under chapter 330, a physician assistant under this chapter, an advanced practice registered nurse under chapter 335, or any licensed and registered physician, chiropractor, dentist, or podiatrist practicing in another jurisdiction whose license is in good standing.

  17. Statute 334.506.1 17 • As used in this section, "approved health care provider" means a person holding a current and active license as a physician and surgeon under this chapter, a chiropractor under chapter 331, a dentist under chapter 332, a podiatrist under chapter 330, a physician assistant under this chapter, an advanced practice registered nurse under chapter 335, or any licensed and registered physician, chiropractor, dentist, or podiatrist practicing in another jurisdiction whose license is in good standing.

  18. Statute 334.506.1 18 • As used in this section, "approved health care provider" means a person holding a current and active license as a physician and surgeon under this chapter, a chiropractor under chapter 331, a dentist under chapter 332, a podiatrist under chapter 330, a physician assistant under this chapter, an advanced practice registered nurse under chapter 335, or any licensed and registered physician, chiropractor, dentist, or podiatrist practicing in another jurisdiction whose license is in good standing.

  19. Statute 334.506.2 19 • Shall not initiate treatment for a new injury or illness without a prescription

  20. Statute 334.506.3 20 • May provide educational resources and training, develop fitness or wellness programs for asymptomatic persons, or provide screening and consultative services

  21. Statute 334.506.4 21 • May examine and treat without the prescription and direction any person with a recurring self-limited* injury within one year of diagnosis or chronic illness* that has been previously diagnosed. The physical therapist shall: • 1. Contact patient’s current health care provider within seven days of initiating physical therapy services. • * To be defined…

  22. Let’s look at the rules for a minute 22 • 20 CSR 2150-3.200 • Recurring self-limiting injury= injury that occurs multiple times with a repeat of signs and symptoms for the initially diagnosed injury and does not precipitate additional injury or illness.

  23. Let’s look at the rules for a minute 23 • 20 CSR 2150-3.200 • Chronic Illness= the diagnosis of a disease process, illness or disability with a specified set of signs and symptoms and the continuation or progression of continued signs and symptoms consistent with the original diagnosis for >6 months

  24. Statute 334.506.4 24 • May examine and treat without the prescription and direction any person with a recurring self-limited* injury within one year of diagnosis or chronic illness* that has been previously diagnosed. The physical therapist shall: • 1. Contact patient’s current health care provider within seven days of initiating physical therapy services.

  25. Statute 334.506.4 (continued) 25 • May examine and treat without the prescription and direction any person with a recurring self-limited injury within one year of diagnosis or chronic illness that has been previously diagnosed. The physical therapist shall: • 2. PT may not change an existing physical therapy • referral available to the physical therapist without • the approval of the patient’s current health care • provider

  26. Statute 334.506.4 (continued) 26 • May examine and treat without the prescription and direction any person with a recurring self-limited injury within one year of diagnosis or chronic illness that has been previously diagnosed. The physical therapist shall: • 3.PT will refer to an approved health care provider any • patient whose medical condition at time of the • examination or treatment is beyond the scope of the • practice of physical therapy

  27. Statute 334.506.4 (continued) 27 • May examine and treat without the prescription and direction any person with a recurring self-limited injury within one year of diagnosis or chronic illness that has been previously diagnosed. The physical therapist shall: • 4. Refer to an approved health care provider any patient • whose condition for which physical therapy services are • rendered under this subsection has not been • documented to be progressing toward documented • treatment goals after six visits or fourteen days, • whichever comes first

  28. Statute 334.506.4 (continued) 28 • May examine and treat without the prescription and direction any person with a recurring self-limited injury within one year of diagnosis or chronic illness that has been previously diagnosed. The physical therapist shall: • 5. PT will notify the patient’s current approved health care • provider prior to the continuation of treatment if treatment • rendered under this subsection is to continue beyond thirty • days. The physical therapist shall provide such notification for each • successive period of thirty days.

  29. Statute 334.506.5 29 • The provision of physical therapy services of evaluation and screening pursuant to this section shall be limited to a physical therapist and any authority for evaluation and screening granted with this section may not be delegated. • Upon each re-initiation of services a PT shall provide a full PT evaluation prior to treatment. . . . Treatment may be delegated to a PTA only if patient’s current health care provider has been so informed as part of PT’s seven day notification

  30. Statute 334.506.6 30 • No person licensed to practice, or applicant for licensure, as a physical therapist or physical therapist assistant shall make a medical diagnosis.

  31. Statute 334.506.7 31 • A physical therapist shall only delegate physical therapy treatment • (1) to a physical therapist assistant or • (2) to a person in an entry level of a professional education program approved by the Commission for Accreditation of Physical Therapists and Physical Therapist Assistant Education (CAPTE) who satisfies supervised clinical education requirements related to the person's physical therapist or physical therapist assistant education. The entry-level person shall be under onsite supervision of a physical therapist.

  32. Continuing Education 32 • 20 CSR 2150-3.20 (Rule) • 30 hours required by all PTs and PTAs • 24-month reporting period begins January 1 of an even-number year and ends December 31 of odd-number year • Extra hours cannot be carried over to next reporting period • Failure to obtain and report continuing education = license will not be renewed

  33. Continuing Education (CE) 33 • 20 CSR 2150-3.203 (Rule) • Acceptable continuing education is defined as education obtained for the purpose of maintaining, expanding and/or developing new and/or improved skills and knowledge directly related to the practice of physical therapy, which contributes to professional competence of the licensee.

  34. Continuing Education (CE) 34 • 20 CSR 2150-3.203 (Rule) • Missouri BOHA and/or PT Advisory Commission will not pre-approve courses or activities. The burden is on the licensee. • However, courses are automatically acceptable if obtained as follows: • APTA (or any of its components including state chapters) • AMA (must at least in part relate to practice of PT) • AOA (must at least in part relate to practice of PT) • FSBPT

  35. Continuing Education (CE) 35 • 20 CSR 2150-3.201 (Rule) • Licensee who fails to obtain and report in a timely fashion shall not engage in the practice of physical therapy unless an extension is granted. (see reference section re: extensions) • For a lapsed license, PT/PTA must submit documentation confirming completion of all continuing education hours during the period the license was not current.

  36. Continuing Education (CE) 36 • 20 CSR 2150-3.201 (Rule) • All licensees shall retain records documenting attendance and completion of the required thirty hours for a minimum of four years after reporting period. • Records shall document title, date, location, course sponsor and number of hours earned. • The board may conduct an audit to verify compliance. Licensees shall assist this audit by providing timely and complete responses.

  37. Supervision of Physical Therapist Assistants 37 • 334.650. 2A licensed physical therapist shall direct and supervise a physical therapist assistant. The physical therapist shall retain ultimate authority and responsibility for the physical therapy treatment. The licensed physical therapist shall have the responsibility of supervising the physical therapy treatment program.

  38. Supervision of Physical Therapist Assistants 38 • 334.650. 2 (continued) • No physical therapist may establish a treating office in which the physical therapist assistant is the primary care provider. • No licensed physical therapist shall have under their direct • supervision more than four full-time equivalent physical therapist assistants and shall be predicated by the following factors: • ► the complexity and acuity of the patient, • ► proximity and accessibility to the PT

  39. Supervision of Physical Therapist Assistants 39 • 20 CSR 2150-3.090 • A licensed PT must direct and supervise a PTA at all times. The PT holds responsibility of supervision of the PT treatment program. The following responsibilities are maintained by the PT: • Interpretation of referrals • Initial examination and problem identification • Development or modification of a plan of care which includes the PT treatment goals • Determination of which tasks require PT and which can be delegated to PTA…(continued)

  40. Supervision of Physical Therapist Assistants 40 • 20 CSR 2150-3.090 (continued) • A licensed PT must direct and supervise a PTA at all times. The PT holds • responsibility of supervision of the PT treatment program. The following • responsibilities are maintained by the PT: • (E) Delegation and instruction of the services to be rendered by a PTA • (F) Timely renew of treatment documentation, re-evaluation of the patient and the patient’s treatment goals, at least every 30 days with revision of the plan of care as needed. • (G) Patient care and management shall include accurate documentation and billing of the services provided.

  41. Supervision of Physical Therapist Assistants 41 • 20 CSR 2150-3.090 • When supervising a PTA, the following requirements must be • maintained: • (A) The initial visit, evaluation and treatment plan must be made by a PT • (B) There must be regularly scheduled reassessments by the PT every 30 days

  42. Supervision of Physical Therapist Assistants 42 • 20 CSR 2150-3.090 (continued) • When supervising a PTA, the following requirements must be • maintained: • (C) There must be conferences with the PT and PTA regarding patients at least weekly or more often. Evidence of PT conferences with the PTA need to be documented at least every 30 days • (D) A licensed PT must be accessible by telecommunication to the PTA at all times while the PTA is treating patients

  43. Supervision of Physical Therapist Assistants 43 • 20 CSR 2150-3.090 (continued) • When supervising a PTA, the following requirements must be • maintained: • (E) A supervisory visit should include an on-site reassessment of the patient, plan of care, assessment for utilization of outside resources. On-site defined as wherever it is required to have an on-site licensed PT to provide services.

  44. Licensure 44 • Qualifications for license—examinations, scope • 334.530.1 • PT candidate shall be at least 21 years old (PTA candidate must be at • least 19 years old per 334.655) • Candidate shall furnish evidence of good moral character • Candidate shall furnish evidence of successful completion of program • in PT approved by the Commission on Accreditation in Physical • Therapy Education (CAPTE)

  45. Licensure 45 • Jurisprudence Examination • 334.530. • The applicant shall pass a test administered by the board on the statutes and rules related to the practice of physical therapy in Missouri. • The Jurisprudence examination will consist of 20 Questions • 10 True/False • 10 Multiple Choice • The examination is Open Book: must achieve a score of at least 75% to pass

  46. Medical Records 46 • This issue is part of the Practice Act • 334.602. 1Physical therapists and physical therapist assistants shall provide documentation in order that an adequate and complete patient record can be maintained. All patient records shall be legible and available for review and shall include at a minimum documentation of the following information: • (1) Identification of the patient, including • name, birth date, address, and telephone number; • (2) The date or dates the patient was seen; • (3) The current status of the patient, including the reason for the visit; • (continued)

  47. Medical Records 47 • This issue is part of the Practice Act • 334.602. 1 (continued) • (4) Observation of pertinent physical findings; • (5) Assessment and clinical impression of physical • therapy diagnosis; • (6) Plan of care and treatment; • (7) Documentation of progress toward goals; • (8) Informed consent; • (9) Discharge summary

  48. Medical Records 48 • 334.602. 1 • Patient records remaining under the care, custody, and control of the licensee shall be maintained by the licensee of the board, or the licensee's designee, for a minimum of seven years from the date of when the last professional service was provided.

  49. Medical Records 49 • 334.602. 1 • Any correction, addition, or change in any patient record shall be clearly marked and identified as such, and the date, time, and name of the person making the correction, addition, or change shall be included, as well as the reason for the correction, addition, or change. 

  50. Disciplinary Process 50 • Complaints addressed to the Board of Healing Arts must be typed or handwritten and signed by the complainant. • Complainant must be identified by name and address. • Anonymous Complaints – May be investigated, based on type of complaint

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