NEW JERSEY REGISTER
VOLUME 33, NUMBER 9
MONDAY, MAY 7, 2001
RULE PROPOSAL

LAW AND PUBLIC SAFETY
DIVISION OF CONSUMER AFFAIRS
STATE BOARD OF PHYSICAL THERAPY
STATE BOARD OF PHYSICAL THERAPY RULES

Additions are indicated by <<+ Text +>>; deletions by <<- Text ->>.
Changes in tables are made but not highlighted.

Proposed Readoption with Amendments: N.J.A.C. 13:39A

Authorized By: State Board of Physical Therapy, Susan Gartland, Executive Director.

Authority: N.J.S.A. 45:1-32 and 45:9-37.18.
Proposal Number: PRN 2001-151.

Submit comments by June 6, 2001 to:

Susan Gartland

Executive Director

State Board of Physical Therapy

PO Box 45014

Newark, NJ 07101

The agency proposal follows:

Summary

Pursuant to the provisions of Executive Order No. 66(1978), the rules at N.J.A.C. 13:39A will expire on June 20, 2001. As required by the Executive Order, the Board of Physical Therapy ("the Board") has reviewed these rules and determined them to be necessary, reasonable and proper for the purpose for which they were originally promulgated.

A summary of each section and the proposed amendments follows:

Subchapter 1 concerns agency organization and administration.

N.J.A.C. 13:39A-1.1 details the process for the election of officers. The proposed amendments change the title of chairman to chairperson and vice chairman to vice chairperson.

N.J.A.C. 13:39A-1.2 delegates to the chairperson authority to act on emergent applications. The proposed amendments change the title of chairman to chairperson.

N.J.A.C. 13:39A-1.3 sets forth the fee schedule.

Subchapter 2 details the requirements for practice as a physical therapist and a physical therapist assistant.

N.J.A.C. 13:39A-2.1 contains definitions of words and terms used in the chapter. The Board has considered the evolution of the practice of physical therapy and has revised the definitions to conform with more accepted practice. Accordingly, the proposed amendments revise the definitions of physical therapy evaluation, physical therapy instruction, physical therapy practice, physical therapy treatment and physician direction and add new definitions of physical therapy diagnosis, physical therapy examination, intervention and referral.

N.J.A.C. 13:39A-2.2 outlines the authorized practice by a licensed physical therapist which includes the activities and practices that a physical therapist may engage in without physician direction. The proposed amendments require the physical therapist to continually monitor the patient's response to care and modify the therapeutic intervention accordingly and revise the rule to conform with the proposed new definitions in N.J.A.C. 13:39A-2.1. The proposed amendments also make technical revisions to the rule.

N.J.A.C. 13:39A-2.3 outlines the authorized practice by a licensed physical therapist assistant. This rule states that the physical therapist assistant may initiate physical therapy care and practice physical therapy at the direction of and under the direct supervision of a licensed physical therapist but may not initiate treatment upon the direction of a physician without the direct supervision of physical therapist. Additionally, the physical therapist assistant may not perform a physical therapy examination, evaluation or diagnosis, develop or modify a treatment plan or independently engage in physical therapy instruction. The proposed amendments require the physical therapist to document treatments in the patient record and permit the assistant's participation in the collection of patient data but the assistant may not interpret the data or any assessments.

N.J.A.C. 13:39A-2.4 permits the delegation of certain functions by a physical therapist to unlicensed persons. The rule also delineates tasks which may not be delegated to unlicensed persons. The proposed amendments reflect the Board's belief that a licensed physical therapist should not delegate any modalities to unlicensed persons because it would constitute the practice of physical therapy. Technical amendments intended to clarify the rule are also proposed.

N.J.A.C. 13:39A-2.5 addresses referrals of patients from chiropractors to physical therapists and the information which must be contained in the referral in order to initiate physical therapy.

Subchapter 3 concerns business practices and professional conduct of physical therapists.

N.J.A.C. 13:39A-3.1 contains the requirements that licensees must follow in keeping patient records. The Board proposes amendments which state that a physical therapist shall not falsify patient records, require the keeping of contemporaneous notes and state how the findings of examinations, evaluations and diagnosis must be noted in the patient records.

N.J.A.C. 13:39A-3.2 addresses the use of personal or other computers to prepare patient records. The rule specifies the types of programs that must be used and how the licensee must prepare the patient record. The Board proposes amendments requiring the licensee to generate a hard copy of the complete patient record upon request and to remove the old subsection (d) because the deadline to complete the modification specified in that subsection was July 15, 1997 and is no longer applicable. A technical amendment is also proposed.

N.J.A.C. 13:39A-3.3 details the process that a licensee must follow in the release of a patient record. The Board proposes an amendment permitting the person requesting the record to receive a transcription at no cost which conforms this subsection with N.J.A.C. 13:39A-3.3(a). Technical amendments are also proposed to clarify the rule.

N.J.A.C. 13:39A-3.4 sets forth licensee responsibilities with respect to the setting of fees and billing arrangements with clients and third party payors. The rule states that fees must be reasonable and commensurate with those of typical physical therapists in the geographic area. Additionally, the rule specifies the information the physical therapist must give to the patient prior to the initiation of physical therapy. Technical amendments are proposed to the rule.

N.J.A.C. 13:39A-3.5 required that notice of licensure and of availability of fee information be displayed. A technical amendment is proposed to the rule.

N.J.A.C. 13:39A-3.6 prohibits excessive fees and overutilization. The rule also describes the factors which may be considered in determining whether a price is excessive. The Board proposes an amendment deleting paragraph (b)vi because the Board believes that the experience, reputation and ability of the licensee is as an inappropriate factor in determining if the fee is excessive. Technical amendments to the rule are also proposed.

N.J.A.C. 13:39A-3.7 requires licensees to notify the Board of a change of address and that the address on file with the Board shall be used for the service of process.

N.J.A.C. 13:39A-3.8 specifies acts which may be deemed professional misconduct. The proposed amendments add the following actions to the list of prohibited practices: failure to produce a hard copy of a complete patient record upon request; falsifying or altering a patient record to obtain payment for services that were not rendered; authorizing the submission of a bill for services which were not rendered or were rendered merely for the purpose of obtaining additional reimbursement; failure by a licensed physical therapist to assure that any bills for services rendered under his or her professional license accurately represents the services rendered and that charges submitted for services rendered by a physical therapist or physical therapist assistant are based solely upon the services reflected in the patient record. Technical amendments are also proposed to the rule, and the subsection (a) definition of "referral" is relocated to N.J.A.C. 13:39A-2.1.

N.J.A.C. 13:39A-3.9 details the form of identification that physical therapists and physical therapist assistants must wear.

N.J.A.C. 13:39A-3.10 identifies conduct which is deemed to be sexual misconduct and details prohibitions on various forms of sexual contact between licensees and patients that is prohibited.

Subchapter 4 addresses the unlicensed practice of physical therapy.

N.J.A.C. 13:39A-4.1 sets forth acts which constitute the unlicensed practice of physical therapy. The Board proposes to add the designations D.D.S. and D.M.D. in order to be inclusive of all dental determinations which could potentially offer physical therapy. Technical amendments are also proposed to the rule.

N.J.A.C. 13:39A-4.2 states that it is unlawful for a physical therapist to aid or abet the unlicensed practice of physical therapy.

Subchapter 5 sets forth the requirements for the credentialing of applicants.

N.J.A.C. 13:39A-5.1 contains the educational credentials that applicants must submit to the Board for licensure as a physical therapist. The proposed amendments clarify and expand the qualifications for licensure for all applicants. The proposed amendments require all applicants to successfully complete a bachelors degree to conform to current educational standards. The foreign applicant would be required to complete a minimum of 50 semester hour credits in general education and a minimum of 60 semester hour credits in professional education. The general education requirements are amended to include one semester course in physics and one semester course in chemistry. The professional education component is expanded to include basic health sciences, clinical sciences, clinical education and related professional courses. The proposed amendments also add requirements for applicants who complete their education after January 1, 2002. These applicants must provide evidence of graduation from a physical therapy program that is substantially equivalent to a physical therapy program approved by an accrediting agency recognized by the Council on Post-Secondary Accreditation and the United States Department of Education. The amendments also specify educational requirements the foreign educated applicants must attain including a bachelor's degree and 120 semester hour credits and what the transcript must show. Technical amendments are also proposed.

N.J.A.C. 13:39A-5.2 sets forth examination requirements for physical therapy licensure. The proposed amendments make technical changes to the rule.

N.J.A.C. 13:39A-5.3 sets forth the educational credentials required for licensure as a physical therapist assistant. The proposed amendments delete the provision requiring the successful completion in an approved physical therapy program of at least 90 credits in order to conform with current standards.

N.J.A.C. 13:39A-5.4 sets forth the examination standards for licensure as a physical therapist assistant. Technical amendments are proposed.

N.J.A.C. 13:39A-5.5 permits applicants possessing a valid license in another state to seek licensure in New Jersey without examination. Minor technical amendments are proposed.

N.J.A.C. 13:39A-5.6 states that scores of standardized examinations administered in other states will be recognized by the Board provided the applicant obtains a certain score and passes all portions of the examination.

N.J.A.C. 13:39A-5.7 sets forth the language comprehension requirements that a foreign applicant for licensure as a physical therapist or physical therapist assistant must attain. The proposed amendment changes the required score on the Test of English as a Foreign Language (TOEFL) examination from 550 to 213 to conform to current scoring procedures. Technical amendments are also proposed.

N.J.A.C. 13:39A-5.8 permits an examinee who fails the physical therapy licensure examination to retake the examination without filing another application.

N.J.A.C. 13:39A-5.9 states that failure to appear at an examinationis considered a failure. The rule permits good cause reasons for the non- appearance and the proposed amendments add health, accident, disability or military service as examples of such good cause.

Subchapter 6 sets forth requirements for the temporary licensing of physical therapists.

N.J.A.C. 13:39A-6.1 states that any person deemed eligible to sit for initial examination for licensure as a physical therapist may apply to the Board for a temporary license from the Board. Technical amendments are proposed.

N.J.A.C. 13:39A-6.2 details the parameters for the expiration of a temporary license. The proposed amendment states that the temporary license expires 120 days from the date of issuance or upon the candidate being notified by the Board that the candidate has failed the examination. Additionally, upon the expiration of the temporary license, the candidate shall not practice physical therapy and must refrain from practicing physical therapy until licensure is attained.

N.J.A.C. 13:39A-6.3 permits the renewal of a temporary license and sets forth the consequences of a second failure and how the temporary license holder must notify the Board of their intent to take the examination in another jurisdiction. The proposed amendments permit the renewal of temporary licenses for a maximum of 120 days. Technical amendments to the rule are also proposed.

N.J.A.C. 13:39A-6.4 permits the temporary issuance of a license to practice physical therapy.

The reservation of N.J.A.C. 13:39A-6.5 is deleted.

Subchapter 7 sets forth the requirements for supervising physical therapy assistants.

N.J.A.C. 13:39A-7.1 states that a licensed physical therapist assistant must work only under the direct supervision of a licensed physical therapist. The proposed amendments state that in an emergency situation which causes the unanticipated absence of the supervising physical therapist, a licensed physical therapist assistant may continue rendering services only to those patients for which they have previously participated in the intervention for established plans of care which do not exceed the regularly scheduled operational hours of that particular day in the absence of direct supervision. The proposed amendments also require that every effort must be made by the physical therapist/physical therapist assistant to obtain direct supervision.

N.J.A.C. 13:39A-7.2 sets forth the responsibilities of the physical therapist supervisor and specifies the availability of the supervisor to the assistant. Technical amendments are proposed to the rule.

N.J.A.C. 13:39A-7.3 sets forth the responsibilities of a physical therapist assistant and states that an assistant may not render or continue to render care unless ongoing direction is obtained from the designated supervisor and notations are recorded in the patient's plan of care. Minor technical amendments are proposed.

Subchapter 7A sets forth the requirements for the supervision of temporary licensed physical therapists and physical therapist assistants.

N.J.A.C. 13:39A-7A.1 specifies the supervision requirements between the supervising physical therapist and temporary licensed physical therapists and temporary licensed physical therapist assistants. The proposed amendment prohibits a physical therapist or physical therapist assistant who holds a temporary license from providing services in the absence of a supervising physical therapist.

N.J.A.C. 13:39A-7A.2 outlines the responsibilities of the supervising physical therapist, which are the same responsibilities as those set forth in N.J.A.C. 13:39A-7.2. A technical amendment is proposed.

N.J.A.C. 13:39A-7A.3 sets forth the responsibilities of temporary licensed physical therapists and temporary licensed physical therapist assistants. The rule states that the temporary license holders may not provide care to a patient unless they have obtained permission from their designated supervisor and record notes in the patient's plan of care. A technical amendment is proposed.

Subchapter 8 regulates the advertising practices of physical therapists.

N.J.A.C. 13:39A-8.1 defines words and terms used in the advertising subchapter, how advertising may be conducted and the type of advertising which may be considered unprofessional. The proposed amendment removes a portion of subsection (e) because this is appropriately covered in the proposed amendments to N.J.A.C. 13:39A-3.8.

N.J.A.C. 13:39A-8.2 specifies the disclosures and statements that must be included in advertisements for services which are free or discounted.

N.J.A.C. 13:39A-8.3 regulates advertising by testimonials.

N.J.A.C. 13:39A-8.4 sets forth the information that must be included in all advertisements.

N.J.A.C. 13:39A-8.5 addresses the use of professional credentials and certifications by physical therapists in their practice and advertisements. A minor technical amendment is proposed.

N.J.A.C. 13:39A-8.6 regulates advertising by a business entity which offers physical therapy services and specifies the required content of any advertising.

N.J.A.C. 13:39A-8.7 requires that all advertisements must be retained and sets forth the record retention requirements for the advertisement.

Social Impact

The rules proposed for readoption and the amendments to N.J.A.C. 13:39A have a substantial and beneficial impact by its licensure procedures and standards of practice for physical therapists and physical therapist assistants. Regulatory authority over physical therapists and physical therapist assistants will protect the public by ensuring that physical therapy services are rendered by competent individuals who have the knowledge and skills appropriate to practice physical therapy. Additionally, the public will be shielded from being misled by incompetent or unauthorized persons and from unprofessional conduct on the part of licensed physical therapists and licensed physical therapist assistants. The public will derive substantial benefit from the readoption of these rules and the proposed amendments.

An analysis of the social impact of each subchapter follows.

Subchapter 2 benefits licensees and the public by setting forth definitions, standards of practice, and rules for delegation and referrals to chiropractors. The rules proposed for readoption and the proposed amendments clearly set forth what licensees are permitted and not permitted to do. The proposed amendments will benefit licensees by codifying the definitions with current standards of practice and make further clarifications for licensees and the public. The proposed amendments will benefit the public by requiring the physical therapist to continually monitor the patient's response to care and modify the therapeutic intervention accordingly and by clarifying the roles of the physical therapist and physical therapist assistant in the documenting of treatment in the patient record.

Subchapter 3 benefits the public and licensees by setting forth the requirements for patient records. The rules proposed for readoption and the proposed amendments place standards on licensees in the preparation of patient records and permit patients to obtain a copy of their record upon request. The public will benefit from the requirement that fees charged by a licensee be reasonable and commensurate with the status and experience of the licensee. The public will also benefit from the provision requiring licensees to discuss and make certain the patient understands the financial agreements before treatment begins. The public will additionally benefit from the proposed amendments which state that a physical therapist shall not falsify a patient's records, require the keeping of contemporaneous notes and provisions dealing with how the findings of examinations, evaluations and diagnosis must be noted in the patient records and from the additional acts that are considered professional misconduct by licensees. The provisions in the subchapter dealing with sexual misconduct will have a positive impact upon the public by increasing confidence in the physical therapy profession and enhancing the quality of physical therapy services by setting forth the parameters of appropriate conduct. The rules will also provide needed protection to patients, employees and co-workers of licensed physical therapists from sexual harassment and sexual contact. Patients will be able to receive physical therapy services without fear of unwanted sexual contact or harassment. Employees and co-workers will be granted workplace protection for unwanted advances and harassment, creating a safer and more productive workplace environment.

Subchapter 4 benefits the public and licensees by enumerating the acts that are considered to be unlicensed practice.

Subchapter 5 benefits licensees and the public by ensuring that physical therapists and physical therapist assistants have the knowledge and training necessary to engage in the practice of physical therapy. The proposed amendments to subchapter 5 will benefit the public and licensees by clarifying and expanding the qualifications for licensure for foreign educated applicants and by updating the language comprehension provisions.

Subchapter 6 benefits applicants by providing an opportunity to work, under supervision, while they are in the process of obtaining their licenses. The proposed amendments will also benefit applicants by clarifying the temporary licensure rules and procedures.

Subchapters 7 and 7A benefits the public by ensuring that licensed physical therapist assistants and temporary licensed physical therapists and physical therapist assistants are properly supervised. The proposed amendments will add additional benefits to the public by further specifying what a physical therapist assistant may do in an emergency situation and by stating that physical therapists and physical therapist assistants operating under a temporary license may not provide physical therapy services in the absence of the supervising physical therapist.

Subchapter 8 benefits the public by setting forth appropriate advertising standards. By regulating the practices used to advertise physical therapy services, the public is much less susceptible to misleading or deceptive advertising concerning physical therapy services. Identifying acceptable and unacceptable advertising practices within the profession helps set advertising parameters for licensees by explaining what they are permitted to do and not do when advertising their services.

Economic Impact

The rules proposed for readoption and the proposed amendments will have an economic impact on licensed physical therapists and licensed physical therapist assistants. The fee schedule in subchapter 1 is projected to yield revenues sufficient to cover expenses generated by the many tasks to be performed by the Board which include the evaluation of applications for licensure, issuance of licenses, investigation of complaints, initiation and prosecution of disciplinary actions and addressing issues relevant to the practice of physical therapy.

The rules proposed for readoption and the proposed amendments will directly impact potential licensees and licensees seeking renewal by requiring application and initial licensure fees, renewal fees, temporary visiting fees, late fees, reinstatement fees, and other miscellaneous fees. While the Board is aware of the financial hardships that may be incurred by these fees, the Board is required by statute to raise funds to cover operating expenses. The Board has endeavored to keep the proposed fees at the minimum levels necessary to cover estimated expenses.

The fee schedule does not impose direct costs upon the public or physical therapy patients, but may have an indirect impact on the public to the extent that fees may be passed along to the patient as a cost of practice.

Maintenance of patient records as mandated in subchapter 2 will have an economic impact on licensees. An expense will be incurred with the requirement that physical therapists establish and maintain detailed records about every client for seven years from the date of the last entry. The rules also mandate requirements if the licensee maintains records on a computer. The rules permit the licensee to charge a reasonable fee to the patient for the preparation and reproduction of the patient's record upon request. Licensees may also incur a minimal expense in having to post notices on their office premises.

The provisions in subchapter 5 will have an impact on all individuals seeking licensure as physical therapists in New Jersey. All applicants for licensure will incur costs associated with obtaining the education required prior to sitting for the licensure examination. Individuals seeking licensure will also have to pay an examination fee as well as the costs associated with submitting an education transcript to the Board for review prior to sitting for the examination. Another cost will be incurred by applicants trained in a foreign country where English is not the primary language. These individuals are required to take the Test of English as a Foreign Language (TOEFL), and, thus, will have to pay the test fee.

The regulation of advertising practices in subchapter 8 may limit the ability of physical therapists to promote themselves and their services, which may have a negative impact. However, subchapter 8 will have a positive impact on consumers and the public. The requirement that advertisements, which set forth a fee for a specifically described professional service, be limited to that which contains a fixed or stated range of fees and that all variables be disclosed will allow consumers to anticipate actual as well as potential additional costs of the services offered. In addition, when free or discounted services are advertised, the rule enables the consumer to make meaningful and accurate comparisons based upon standardized requirements for disclosing a fixed or stated range of fees against which the discount is to be made or the value of the free service to be measured.

Federal Standards Statement

A Federal standards analysis is not required because there are no Federal standards or requirements applicable to the rules proposed for readoption and the proposed amendments.

Jobs Impact

The Board does not believe that the rules proposed for readoption and the proposed amendments will either increase or decrease jobs in the State.

Agriculture Industry Impact

The rules proposed for readoption and the proposed amendments will have no impact on the agriculture industry.

Regulatory Flexibility Analysis

The Regulatory Flexibility Act, N.J.S.A. 52:14B-16 et seq. (the Act), requires the Board to give a description of the types and an estimate of the number of small businesses to which the proposed rules will apply. If, for the purposes of the Act, the approximately 5,040 physical therapists and 1,255 licensed physical therapist assistants are considered "small businesses" within the meaning of the Act, then the following analysis applies.

The Act requires the Board to set forth the reporting, recordkeeping, and other compliance requirements of the proposed rules including the kinds of professional services likely to be needed to comply with the requirements. The Act further requires the Board to estimate the initial and annual compliance costs, outline the manner in which it has designed the rules to minimize any adverse economic impact upon small businesses, and to set forth whether the rules establish differing compliance requirements for small businesses.

The rules contain no reporting requirements; however, the rules contain recordkeeping requirements which are further described in the Summary above. N.J.A.C. 13:39A-3.1 and 3.2 set forth the patient record requirements and the standards for the use of personal computers to prepare patient records and N.J.A.C. 13:39A-8.7 details the requirement for the retention of advertising records.

The rules also impose numerous compliance requirements which are further described in the Summary above. N.J.A.C. 13:39A-1.3 requires licensees to pay fees according to the fee schedule. N.J.A.C. 13:39A-2.5 sets forth the requirements for the referral of patients by chiropractors. Subchapter 3 contains requirements for licensees regarding the release of patient records, financial arrangements with clients and third party payers, displaying notification of licensure, prohibition of excessive fees, notification of change of address, acts which are prohibited, identification requirements and sexual misconduct. Subchapter 4 details several acts and practices that are considered to be the unlicensed practice of physical therapy. Applicants and licensees must comply with the requirements in subchapter 5 regarding the educational credentials, examination standards, endorsement, recognition of test scores from other states, language comprehension, re-examination and non- appearance in order to obtain licensure from the Board. Applicants must comply with the provisions in subchapter 6 detailing the granting, expiration and renewal of temporary licenses in order to obtain and/or renew their temporary license with the Board. Subchapter 7 contains provisions detailing the supervision requirements for physical therapist assistants and the responsibilities of physical therapists and physical therapist assistants. Subchapter 7A contains provisions detailing supervision requirements, responsibilities of the designated supervisor and the responsibilities of temporary licensees. Subchapter 8 sets forth requirements for licensees concerning advertising and soliciting practices, advertising free or discounted services, testimonial advertising, minimum credentials, use of professional credentials and certifications, and advertising by a business entity offering physical therapy services.

Costs of compliance are discussed in the Economic Impact above. The Board believes that no professional services are likely to be needed to comply with the rules proposed for readoption or the amendments. The Board considers the rules proposed for readoption with amendments necessary to preserve the health, safety and welfare of physical therapy patients and no differing compliance requirements based on size of the business have been provided in order to ensure that all physical therapy services are provided uniformly throughout the State.

Full text of the proposed readoption may be found in the New Jersey Administrative Code at N.J.A.C. 13:39A.

Full text of the proposed amendments follows:

SUBCHAPTER 1. AGENCY ORGANIZATIN AND ADMINISTRATION

<< NJ ADC 13:39A-1.1 >>

13:39A-1.1 Election of officers

The membership of the New Jersey Board of Physical Therapy shall once each year elect a <<-chairman, vice chairman->> <<+chairperson, vice chairperson+>> and a secretary. The <<-chairman->> <<+chairperson+>> shall have the responsibility to conduct all meetings unless, in his or her discretion, a delegation of that responsibility is made. In the absence of the <<-chairman->> <<+chairperson+>> and an express delegation of responsibility, the <<-vice chairman->> <<+vice chairperson+>> shall assume all of the duties of <<-chairman->> <<+chairperson+>>.

<< NJ ADC 13:39A-1.2 >>

13:39A-1.2 Delegation of authority to act on emergent applications

The <<-chairman->> <<+chairperson+>> shall be authorized to hear and decide emergent applications by the Attorney General made pursuant to N.J.S.A. 45:1-22 for the temporary suspension of any license. The <<- chairman->> <<+chairperson+>> may also undertake such other interim action as may be required by circumstances arising prior to the next meeting date of the Board, provided that said action is subsequently presented to the Board for its review and action <<-(for example, giving tentative approval to the settlement of a matter about to be heard or during the pendency of a hearing at the Office of Administrative Law.)->><<+.+>> Any decision made by the <<-chairman->> <<+chairperson+>> pursuant to this rule shall be placed on the agenda of the Board at its next regularly scheduled meeting for the purpose of its review. Insofar as it is practicable, the Board shall be provided with a transcript of the record made before the <<- chairman->> <<+chairperson+>> and the parties will be permitted to supplement the record with written submissions.

SUBCHAPTER 2. PRACTICE AS A PHYSICAL THERAPIST AND PHYSICAL THERAPIST ASSISTANT

<< NJ ADC 13:39A-2.1 >>

13:39A-2.1 Definitions

The following words and terms<<+,+>> when used in this chapter, shall have the following meanings, unless the context clearly indicates otherwise.

... "Direct supervision," when in reference to <<+a+>> physical therapist assistant, means the presence of the supervising physical therapist on site, readily available to respond <<-to an emergency during any treatment procedure->> <<+to any consequence regarding a patient's treatment or a patient's reaction to the treatment+>>.

"Disability" means the inability to engage in age specific, gender <<- specific->> <<+related+>>, or sex specific roles in a particular social context and physical environment.

... <<+"Intervention" means interaction of the licensed physical therapist or licensed physical therapist assistant with the patient using various physical therapy procedures and techniques to produce changes in condition consistent with the patient evaluation and diagnosis.+>>

... <<-"Physical therapy evaluation" includes taking a patient's relevant history, hands-on evaluation or assessment of objective symptoms and using tests and measures to assist the physical therapist in evaluating the patient's objective signs and symptoms. Such tests include, but are not limited to, tests to assess postural alignment; joint mobility and function; muscle and nerve function, including electrophysiologic status; movement skill; gait; necessity for assistive devices; the fit and fabrication of orthoses and prostheses; cardiopulmonary status; sensory and motor function, including related pain and tenderness; performance of activities required in daily living; and functional capacity. Physical therapy evaluation does not include examining any person for the purpose of diagnosing any disease or organic condition. Nothing herein is intended to preclude a physical therapist from conducting an evaluation within the scope of his practice, consistent with his education credentials or taking a history which is designed to ascertain if contraindications to therapy may be present and thus the referral to a plenary licensed physician is warranted.->>

<<-"Physical therapy instruction" includes providing consultative, educational or other advisory services for the purpose of preventing or reducing the incidence and severity of physical disability, bodily malfunction or pain from injury, disease or other physical condition or providing information to patients or groups of interested persons regarding the value of physical therapy agents and measures in general or regarding specific physical conditions. Physical therapy instruction shall not be construed to include physical therapy treatment. To the extent that instruction may involve any hands-on contact between the physical therapist and the person receiving physical therapy instruction, that contact shall be for demonstration purposes only.->>

<<-"Physical therapy practice" includes physical therapy evaluation and physical therapy treatment and instruction.->>

<<-"Physical therapy treatment" includes administering physical therapy measures, activities, agents or devices, including, but not limited to, postural correction; joint mobilization; range of motion exercise; muscle and soft tissue stretching; muscle strengthening exercise; balance and coordination exercises; massage techniques; pre and post-natal exercises; growthand development programs; biofeedback techniques; perceptual training; electrophysiologic tests and modalities; cardiopulmonary care; gait training; wound care; hydrotherapy and paraffin bath when used for preventative and therapeutic purposes to correct or limit physical disorders or dysfunctions.->>

<<+"Physical therapy diagnosis" means a description placed on a group of signs and symptoms that are identified as a result of the examination and evaluative process. The purpose of the diagnostic determination is to allow the licensed physical therapist to select the appropriate physical therapy intervention(s) to initiate the most efficacious care for the purpose of achieving the patient's goals.+>>

<<+"Physical therapy evaluation" means a review exclusively by a licensed physical therapist based on data and information collected during the examination and before any intervention. The evaluation reflects the chronicity and severity of the current patient problem and the possibility of multisystem and multisite involvement that may coexist with preexisting systematic conditions or diseases. The evaluation considers the level of the current impairment(s), functional limitation(s) and disability(s), the living environment, potential discharge destination(s) and social support(s). A "physical therapy evaluation" does not include examining any person for the purpose of diagnosing any disease or organic condition.+>>

<<+"Physical therapy examination" means an inquiry conducted by a licensed physical therapist into the patient history, relevant systems review, and tests and measurements, which is conducted prior to any intervention. The history is an account of past and current health status. The system review is an examination that provides information about the general health of the patient that helps the licensed physical therapist determine physical therapy diagnosis, a prognosis and a plan of care. Tests and measurements are performed by the licensed physical therapist after review of the patient's history and systems reviewed to elicit additional information.+>>

<<+"Physical therapy instruction" means the act of providing consultative, educational or advisory services to one or more individuals for the purpose of preventing or reducing physical dysfunction and disability that may lead to reduced functional abilities.+>>

<<+"Physical therapy practice" means the examining, evaluating, diagnosing, treating and, instructing of patients by a licensed physical therapist or licensed physical therapist assistant.+>>

<<+"Physical therapy treatment" means the interaction of the licensed physical therapist with the patient using various physical therapy procedures and techniques to produce changes in the condition consistent with the patient's dysfunction, disability, or level of function and consistent with the patient's projected outcome as a result of physical therapy intervention. When physical therapy instruction is provided to an individual as a part of his or her therapeutic interventions, the instruction must be considered part of physical therapy treatment.+>>

"Physician direction" includes any of the following:

1. Written <<-prescription->> <<+request or direction+>> of a plenary licensed physician, or a dentist <<-or a->><<+,+>> podiatrist<<-,->> <<+or chiropractor+>> to the extent that the treatment prescribed is within the scope of his or her practice, or such other health care practitioner authorized to <<-prescribe->> <<+request and direct+>> treatment;

2. Documentation of physician <<-clearance->> <<+agreement+>> for the <<-patient for->> <<+patient's+>> treatment which <<-may include a->> <<+includes+>> countersigning of the physical therapist's proposed plan of <<-treatment->> <<+care+>>;

3. Verbal <<-prescription->> <<+direction+>>, in person <<- or->><<+,+>> via telephone, <<+or electronically generated+>> which shall be memorialized <<-by the prescriber->> in writing within two weeks. <<-But, in no case, will physician direction be construed to have been provided on the basis of a patient's representation that he or she has obtained a physician's clearance.->>

<<+"Physician direction" does not include a patient's representation that he or she has obtained a physician request or direction.+>>

<<+"Referral" means the forwarding of a patient for professional services by one health care professional to another health care professional or health care entity which provides or supplies professional service, or the request for establishment of a plan of care by a health care professional, including the provision of professional services or other health care devices.+>>

<< NJ ADC 13:39A-2.2 >>

13:39A-2.2 Authorized practice by a licensed physical therapist

(a) A licensed physical therapist may engage in the following activities and practices without physician direction:

1. Physical therapy <<+examination,+>> evaluation<<-,->> <<+and diagnosis+>> excluding electromyographic testing;

2. (No change.)

3. Modification of physical therapy treatment <<-previously->> initiated upon physician direction provided that the modification is consistent with that physician direction <<-(for example, the physical therapist, in the exercise of his or her discretion, may determine to utilize a variety of modalities to effectuate the direction given by the physician)->>. If the physical therapist wishes to alter a therapeutic plan in a manner not consistent with the initial physician direction, contact <<-must->> <<+ shall+>> be made with the patient's physician for the purpose of obtaining additional direction.

<<+(b) The licensed physical therapist shall continually monitor the patient's response to care and modify the therapeutic intervention in a manner that is consistent with achieving the therapeutic goals.+>>

<<-(b)->><<+(c) +>>A physical therapist may bill a patient or third party payor for a diagnostic test in connection with a physical therapy evaluation provided:

1.-3. (No change.)

4. Any repeat or subsequent testing shall be for the purpose of substantiating the effectiveness of the physical therapy intervention. Testing intervals shall be determined by the <<-licensee->> <<+licensed physical therapist+>> and shall be consistent with the patient's diagnosis, disability and impairment.

Recodify existing (c) and (d) as <<+(d) and (e)+>> (No change in text.)

<< NJ ADC 13:39A-2.3 >>

13:39A-2.3 Authorized practice by a licensed physical therapist assistant

(a) A licensed physical therapist assistant may initiate patient physical therapy treatment and engage in the practice of physical therapy at the direction of and under the direct supervision of a licensed physical therapist pursuant to <<-a->> physician direction given to the physical therapist. A licensed physical therapist assistant <<-may->> <<+shall+>> not initiate physical therapy treatment upon the direction of a physician or other authorized health care provider without the direct supervision of a physical therapist.

(b) <<-A licensed physical therapist assistant must document treatments given, but such documentation does not relieve the supervising physical therapist from the responsibility of reviewing entries and documenting the initial evaluation, countersigning monthly progress notes and documenting discharge summaries.->> <<+A licensed physical therapist assistant shall document treatments in the patient record. The supervising physical therapist shall review and cosign contemporaneously the licensed physical therapist assistant's entries into the patient record.+>>

<<+(c) The licensed physical therapist assistant may participate in collecting data for the examination of the patient; however, any interpretation of the data or assessment shall be made by the supervising physical therapist.+>>

<<-(c)->><<+(d) +>>A licensed physical therapist assistant <<- may->> <<+shall+>> not perform a physical therapy examination, <<+ evaluation or diagnosis,+>> develop a treatment plan, modify a treatment plan, or <<+independently+>> engage in physical therapy instruction, including, but not limited to, the recommendation of assistive devices and modifications of the patient's physical environment.

<< NJ ADC 13:39A-2.4 >>

13:39A-2.4 Delegation by a physical therapist to unlicensed persons

(a) <<-Activities which may be delegated to unlicensed persons by physical therapists include->> <<+Licensed physical therapists may delegate to unlicensed persons+>> routine tasks relating to the cleanliness and maintenance of equipment and the physical plant and the management of the business aspects of the practice and such other assignments with respect to patient care as may be specifically made by the physical therapist, including <<+transporting the+>> patient <<-transport->>, positioning of the patient and <<+assisting with the+>> undressing and dressing <<+of the patient+>>.

(b) A physical therapist shall not authorize or permit an unlicensed person to engage in the following activities:

1.-2. (No change.)

3. Make notations <<-on a patient's permanent record->> <<+in the patient's record in relation to clinical treatment+>>;

4. <<-Attach->> <<+Place+>> electrodes of any kind <<-of->> <<+ on+>> the skin;

5. Administer any <<-of the following->> modalities<<+.+>><<-, or such other modalities as the Board may from time to time recognize, in light of developing technology;->>

<<-i. Ultraviolet rays;->>

<<-ii. Ultrasound;->>

<<-iii. Electromagnetic ray;->>

<<-iv. Laser;->>

<<-v. Diathermy;->>

6. <<-Vary exercise equipment parameters without direct licensed physical therapist supervision->> <<+Instruct and/or perform therapeutic exercise(s) and/or therapeutic activity(s)+>>; <<+and+>>

7. Provide therapeutic massage<<-;->><<+.+>>

<<-8. Assist in administering physical agents to a patient who has not had a direct initial evaluation by a licensed physical therapist.->>

<< NJ ADC 13:39A-2.5 >>

13:39A-2.5 Referral of patients by chiropractors

(a) Except as set forth in (b) below, a physical therapist shall not initiate physical therapy treatment unless the physical therapist has received the following information from the referring chiropractor in writing:

1.-3. (No change.)

4. The purpose of referral <<-(for example, "physical therapy examination and treatment")->>; and

5. (No change.)

(b) A physical therapist may initiate physical therapy treatment based on verbally supplied information provided that the physical therapist ensures that such information is confirmed in <<-written form->> <<+writing+>> within two weeks.

(c)-(d) (No change.)

SUBCHAPTER 3. BUSINESS PRACTICES; PROFESSIONAL CONDUCT

<< NJ ADC 13:39A-3.1 >>

13:39A-3.1 Patient records

(a) A <<-licensee->> <<+licensed physical therapist+>> shall prepare and maintain for each patient a contemporaneous, permanent patient record that accurately reflects the patient contact with the physical therapist whether in an office, hospital or other treatment, evaluation or consultation setting.

<<+(b) A licensed physical therapist shall not falsify a patient's record.+>>

<<-(b)->><<+(c) +>>The patient record shall include, in addition to usual and customary information, at least the following information:

1. (No change.)

2. Dates of all <<+examination,+>> evaluation<<+, diagnosis+>> and treatment sessions;

<<-3. Findings upon initial evaluation including the patient's relevant history and results of appropriate tests and measures;->>

<<+3. The findings of the examination including test results;+>>

<<+4. The conclusion of the evaluation;+>>

<<+5. The determination of the diagnosis;+>>

<<-4.->><<+6. +>>Documentation of physician direction and <<- efforts taken to memorialize->> <<+memorialization of+>> verbal and/or electronically submitted orders;

<<-5.->><<+7. +>>A plan of care establishing measurable goals of the <<-treatment program->> <<+intervention+>> with stated time frames, the type of <<-treatment->> <<+intervention+>>, and the frequency and expected duration of <<-treatment->> <<+intervention+>>;

<<+8. A contemporaneous note that accurately represents the services rendered during the treatment sessions including, but not limited to, the components of intervention and the patient's response to intervention;+>>

<<-6.->><<+9.+>> Progress notes in accordance with stated goals <<+ at a frequency consistent with diagnosis, evaluative findings and changes in the patient's conditions+>>;

<<-7.->><<+10. +>>The signature or initials <<+and license number+>> of the licensee who rendered care. If the licensee chooses to sign by means of initials, his or her complete signature <<-must->> <<+and license number shall+>> appear at least once on every page;

<<-8.->><<+11. +>>Changes in the treatment plan <<+which shall be documented contemporaneously and supported by physician concurrence+>>;

Recodify existing 9.-11. as <<+12.-14.+>> (No change in text.)

<<-(c)->><<+(d) +>>(No change in text.)

<< NJ ADC 13:39A-3.2 >>

13:39A-3.2 Use of personal or other computer to prepare patient records

(a)-(b) (No change.)

(c) The licensee shall finalize or "sign" the entry by means of a CPC. Where more than one individual is authorized to make entries into the computer file of any patient record, the licensee responsible for the <<- practice->> <<+entity+>> shall assure that each such person obtains a CPC and uses the program in the same manner.

<<-(d) A licensee wishing to continue a system of computerized patient records that does not meet the requirements of this section shall promptly initiate arrangements for modification of the system. The modification shall be completed by July 15, 1997. In the interim, the following shall apply:->>

<<-1. On the date of the first treatment, evaluation or consultation subsequent to July 15, 1996, and after each visit continuing to the date of the changeover, the licensee shall print out a hard copy of the entire computer recorded patient record and date and initial each page of the printout; and->>

<<-2. The licensee shall retain all hard copies as a permanent part of the patient record.->>

<<+(d) The licensee shall generate a hard copy of the complete patient record upon request.+>>

<< NJ ADC 13:39A-3.3 >>

13:39A-3.3 Release of patient record

(a) A <<-licensee->> <<+licensed physical therapist+>> shall provide one copy of the patient's record of physical therapy treatment within 15 days of a written request by the patient or any person whom the patient has designated to receive that record.

(b) <<-Licensees->> <<+Licensed physical therapists+>> may require a record request to be in writing and may charge a fee for the reproduction of records, which shall be no greater than $1.00 per page or $100.00 for the entire record, whichever is less. (If the record requested is less than 10 pages, the licensee may charge up to $10.00 to cover postage and the miscellaneous costs associated with retrieval of the record.) If the patient requests a summary in lieu of the actual record, the charge for the summary shall not exceed the cost that would be charged for the actual record.

(c) If the patient or a subsequent treating health care professional is unable to read the treatment record, either because it is illegible or prepared in a language other than English, the <<-licensee->> <<+licensed physical therapist+>> shall provide a transcription at no cost to the patient <<+or the person requesting the record+>>.

(d) Where the patient has requested the release of a professional treatment record or a portion thereof to a specified individual or entity, in order to protect the confidentiality of the records, the <<-licensee->> <<+ licensed physical therapist+>> shall:

1.-2. (No change.)

3. Forward the records to the attention of the specific individual <<+or entity+>> identified and mark the material "Confidential."

(e) A <<-licensee->> <<+licensed physical therapist+>> shall not withhold or delay providing a record because the patient failed to pay for services rendered.

<< NJ ADC 13:39A-3.4 >>

13:39A-3.4 Financial arrangements with clients and third party payors

(a) <<-Fees for physical therapy services shall be reasonable and shall be commensurate with the status and experience of the physical therapist when compared with fees of physical therapists of like status and experience offering like services or treatment in the geographic area and shall be in accordance with the provisions of N.J.A.C. 13:39A-3.6 prohibiting excessive fees.->> <<+Fees for physical therapy services shall be reasonable and commensurate with fees of physical therapists offering like services or intervention in the geographic area and shall be in accordance with the provisions of N.J.A.C. 13:39A-3.6 prohibiting excessive fees.+>>

(b) Prior to the initiation of physical therapy <<-treatment->>, the <<+ licensed+>> physical therapist <<+or the licensed physical therapist's designee+>> shall explain to the patient in an understandable manner the financial arrangements. The information provided to the patient shall include, but not be limited to:

1.-4. (No change.)

(c) A <<+licensed+>> physical therapist shall not require a patient or a third party payor to pay:

1.-3. (No change.)

4. A fee for any physical therapy <<+examination,+>> evaluation, <<- treatment->> <<+intervention+>> or other services not documented in a <<-patient chart->> <<+patient's permanent record+>> in a manner consistent with N.J.A.C. 13:39A-3.1(a); or

5. (No change.)

(d) A <<-licensee->> <<+licensed physical therapist+>> shall provide a copy of a written fee schedule to any interested person upon request<<-;->><<+.+>>

(e) A <<-licensee->> <<+licensed physical therapist+>> shall include on all bills submitted to a patient or third party payor the licensee's <<- current->> license number.

<< NJ ADC 13:39A-3.5 >>

13:39A-3.5 Display of notice of licensure; notification of availability of fee information

(a) Every licensee shall conspicuously display his or her biennial renewal certificate and the following notices in a public area in any office or health care facility at which the licensee practices physical therapy:

1. "Physical therapists and physical therapist assistants are licensed by the Board of Physical Therapy, an agency of the Division of Consumer Affairs. Any member of the public may notify the Board of any complaint relative to the practice conducted by a physical therapist or physical therapist assistant. The Board address is: Division of Consumer Affairs, Board of Physical Therapy, Post Office Box 45014, 124 Halsey Street, Newark, New Jersey 07101, Tel: <<- (201)->> <<+(973)+>> 504-6455."

2. (No change.)

(b) (No change.)

<< NJ ADC 13:39A-3.6 >>

13:39A-3.6 Prohibition on excessive fees; overutilization

(a) A licensee <<-of the Board of Physical Therapy->> shall not charge an excessive fee for services. A price is excessive when, after review of the facts, a licensee of ordinary prudence would be left with a definite and firm conviction that the price is so high as to be manifestly unconscionable or overreaching under the circumstances.

(b) Factors which may be considered in determining whether a price is excessive include, but are not limited to, the following:

<<-i.->><<+1.+>> (No change in text.)

<<-ii.->><<+2.+>> The novelty and difficulty of the professional <<-treatment->> <<+intervention+>>;

<<-iii.->><<+3.+>> The skill required to perform the <<- treatment->> <<+intervention+>> properly;

Recodify existing iv. and v. as <<+4. and 5.+>> (No change in text.)

<<-vi. The experience, reputation and ability of the licensee performing the services;->>

<<-vii.->><<+6.+>> The nature and circumstances under which the services were provided (for example, emergency, home visit).

(c) A <<+licensed+>> physical therapist shall not <<-render treatment->> <<+provide intervention+>> or conduct testing which in light of the patient's history and findings are unwarranted and unnecessary.

(d) A <<+licensed+>> physical therapist shall not charge a fee to a patient or a third party payor for <<-a treatment->> <<+an intervention+>> or other physical therapy <<-service->> which is unwarranted and unnecessary <<-pursuant to (c) above->>.

(e) (No change.)

<< NJ ADC 13:39A-3.8 >>

13:39A-3.8 Violative acts; professional misconduct

<<-(a) The following words and terms, when used in this section, shall have the following meanings:->>

<<-1. (Reserved)->>

<<-2. "Referral" means the forwarding of a patient for professional services by one health care professional to another health care professional or health care entity which provides or supplies professional service, or the request for establishment of a plan of care by a health care professional, including the provision of professional services or other health care devices.->>

<<-3. (Reserved)->>

<<-(b)->><<+(a)+>> The following acts or practices shall be among those deemed to be violative of N.J.S.A. 45:9-37.11 et seq., and to constitute professional misconduct pursuant to N.J.S.A. 45:1-21(e):

1. Accepting, or agreeing to accept, from any person, firm or corporation any fee, commission, rebate, gift or other form of remuneration for prescribing, ordering or promoting the sale of a device, appliance or other item or service; except that nothing in this section shall preclude a licensed physical therapist from accepting a product or commodity which can be used as a sample by patients, provided that the physical therapist does not charge the patient for <<+such+>> items <<-so obtained->>;

2. (Reserved)

3. Charging any patient a fee for making a referral to a physician or other health care professional authorized to direct the initiation of physical therapy <<-treatment->>, for the purposed of obtaining clearance for physical therapy. Nothing in this section shall preclude a physical therapist from charging a patient for a physical therapy <<+examination and+>> evaluation conducted prior to referral;

4.-5. (No change.)

6. Rendering <<-treatment->> <<+an intervention+>> when, in the exercise of his or her professional judgment, the physical therapist may deem such treatment to be unnecessary. The physical therapist shall notify the referring professional in writing that treatment is to be terminated and the reason(s) for such termination; <<-or->>

7. Aiding or abetting the unlicensed practice of physical therapy<<-.->><<+;+>>

<<+8. Falsifying or altering any patient records for the purpose of obtaining payment for services which were not rendered;+>>

<<+9. Authorizing the submission of any bill for professional services which were not rendered, or which were rendered merely for the purpose of obtaining additional reimbursement;+>>

<<+10. Failure by a licensed physical therapist to assure that any bills for services rendered under his or her professional license accurately represents the services rendered and that charges submitted for services rendered by a physical therapist or physical therapist assistant are based solely upon the services reflected in the patient record; or+>>

<<+11. Failure to produce a hard copy of a complete patient record upon request.+>>

SUBCHAPTER 4. UNLICENSED PRACTICE

<< NJ ADC 13:39A-4.1 >>

13:39A-4.1 Acts amounting to unlicensed practice

(a) For the purpose of the Board's construction of N.J.S.A. 45:9-37.10, the following acts or practices shall be deemed to be the unlicensed practice of physical therapy:

1. Offering physical therapy examination<<+, evaluation,+>> instruction or <<-treatment->> <<+intervention+>> by means of advertisement or solicitation by any person who does not hold a license as a physical therapist, a physical therapist assistant, M.D., D.O.<<+,+>> D.P.M.<<+, D.D.S. or D.M.D.+>> (to the extent authorized by N.J.S.A. 45:5-7), even if that person has been instructed or directed to offer that treatment or render that treatment by a physical therapist, physical therapist assistant, M.D., <<-or->> D.O. <<-or->><<+,+>> D.P.M.<<+, D.D.S. or D.M.D.;+>>

2. The use of the words physical therapy, physical therapist, physiotherapy, physiotherapist or such similar words or their related abbreviations in connection with the offering of physical therapy agents measures and services which are utilized in the rendition of physical therapy treatment by any person who does not hold a license as a physical therapist, a physical therapy assistant, an M.D., D.O., <<-or->> D.P.M.<<+, D.D.S. or D.M.D.+>> even if that person has been instructed or directed to use such terminology by a physical therapist, physical therapist assistant, M.D., D.O. <<- or->><<+,+>> D.P.M.<<+, D.D.S. or D.M.D.;+>>

3. Billing any patient or third party payor for "physical therapy" or "physiotherapy" in connection with the use of physical therapy agents, measures or services, if the individual who personally rendered the services does not hold a license to practice physical therapy<<+,+>> medicine <<- and->><<+,+>> surgery<<+,+>> or podiatry; <<+or+>>

4. (No change.)

SUBCHAPTER 5. CREDENTIALING OF APPLICANTS

<< NJ ADC 13:39A-5.1 >>

13:39A-5.1 Educational credentials for applicants for licensure as physical therapists

(a) Applicants for <<+physical therapy+>> examination shall submit to the Board satisfactory proof of:

1. (No change.)

2. With respect to foreign <<-trained->> <<+educated+>> applicants for licensure as physical therapists, the applicant shall demonstrate satisfactory evidence of graduation from a physical therapy program that is substantially equivalent to a physical therapy program approved for the education and training of physical therapists by an accrediting agency recognized by the Council on Post-secondary Accreditation and the United States Department of Education. The applicant shall <<-show->> <<+ present evidence of+>> successful completion of course work with a minimum <<-of 45 credits of general education and 60 credits of professional education->> of <<+a bachelor's degree in physical therapy awarded by an institution which is approved by the foreign applicant's Ministry of Education/Health for the education of physical therapists. The applicant shall have completed a minimum of 120 semester hour credits, with a minimum of 50 semester hour credits in general education and a minimum of 60 semester hour credits in professional education+>>. General education courses shall include, but not be limited to, mathematics, physical science <<+which includes a one semester course in physics and a one semester course in chemistry,+>> biological science, humanities, social science and behavioral science. The professional component of the program shall include, but not be limited to, <<-human anatomy, pathology, physiology, neurologic science and clinical practice->> <<+basic health sciences, clinical sciences, clinical education and related professional courses+>>.

<<+3. Applicants for licensure as a physical therapist who have completed their education subsequent to January 1, 2002 shall demonstrate satisfactory evidence of graduation from a physical therapy program that is substantially equivalent to a physical therapy program approved for the education and training of physical therapists by an accrediting agency recognized by the Council on Post-Secondary Accreditation and the United States Department of Education. The applicant shall demonstrate successful completion of coursework beyond the bachelor's degree leading to a degree or certificate in physical therapy being awarded by an institution which is approved by that country's Ministry of Education/Health for the education of physical therapists. The applicant's transcript shall show a bachelor's degree with a minimum of 120 semester hour credits, with a minimum of 60 semester hour credits of professional education, 29 of which must be completed post-baccalaureate. The transcript must show general education which shall include, but not be limited to, mathematics, physical science which included a two semester class in physics and a two semester course in chemistry, biological science, humanities, social science and behavioral science. The professional component of the program shall include, but not be limited to, basic health services, clinical sciences, clinical education and related professional courses.+>>

(b) Proof of eligibility for licensure in the foreign country where the requisite education was obtained shall be submitted <<+to the Board+>> by the credentialing agency on behalf of all foreign <<-trained->> <<+ educated+>> applicants seeking licensure in this State <<-to the Board->>.

<< NJ ADC 13:39A-5.2 >>

13:39A-5.2 Examination standards for applicants for licensure as physical therapists

<<+(a)+>> Applicants for licensure as physical therapists submitting satisfactory proof of educational attainment as set forth in N.J.A.C. 13:39A-5.1 shall be admitted to take the written examination administered by the Board or such standardized examination as the Board may select pursuant to N.J.S.A. 45:9-37.25.

<<+(b)+>> Upon satisfactory passage of such examination, an applicant shall be deemed eligible for licensure. Satisfactory passage of the examination shall be attained upon receipt of a score of at least 600 based on a scale of 200 to 800.

<<+(c)+>> Applicants <<-must->> <<+shall+>> pass <<-every portion->> <<+all portions+>> of the examination at the same sitting <<-and will->><<+. Applicants shall+>> not be permitted to <<-take->> <<+retake+>> only those portions of the examination which previously have been failed.

<< NJ ADC 13:39A-5.3 >>

13:39A-5.3 Educational credentials for applicants for licensure as physical therapist assistants

<<-(a) ->>Applicants for examination as physical therapist assistants shall submit to the Board satisfactory proof of <<-:1. Graduation->> <<+ graduation+>> from a physical therapist assistant program which has been approved for the education and training of physical therapist assistants by an accrediting agency recognized by the Council on Post-secondary Accreditation and the United States Department of Education<<+.+>> <<-, or:->>

<<-2. Successful completion in an approved physical therapy program, of at least 90 credits, of which 45 or more shall be in courses relating to the practice of physical therapy, including course work in clinical practice, and at least 40 of which shall be in courses of general academic study. English General College Equivalent A level courses will be accepted toward the necessary credits in general education.->>

<< NJ ADC 13:39A-5.4 >>

13:39A-5.4 Examination standards for applicants for licensure as physical therapist assistants

<<+(a)+>> Applicants for licensure as physical therapist assistants submitting satisfactory proof of educational attainment as set forth in N.J.A.C. 13:39A-5.3 shall be admitted to take the written examination administered by the Board or such standardized examination as the Board may select pursuant to N.J.S.A. 45:9-37.25.

<<+(b)+>> Upon satisfactory passage of such examination, an applicant shall be deemed eligible for licensure. Satisfactory passage of the examination shall be attained upon receipt of a score of at least 600 based on a scale of 200 to 800.

<<+(c)+>> Applicants <<-must->> <<+shall+>> pass <<-every portion->> <<+all portions+>> of the examination at the same sitting <<-and will->><<+. Applicants shall+>> not be permitted to <<-take->> <<+retake+>> only those portions of the examination which previously have been failed.

<< NJ ADC 13:39A-5.5 >>

13:39A-5.5 Endorsement

Applicants possessing a valid license issued by another state may be deemed eligible for licensure in New Jersey without <<-the->> examination if the criteria for licensure in <<-that->> <<+the other+>> state are deemed by the Board to be substantially equivalent to those required in New Jersey and the applicant has not previously failed the examination administered by the Board. Nothing herein shall preclude the Board, in its discretion, from deeming an applicant, who possesses a license issued by another jurisdiction, who has failed the examination administered by the Board, to be eligible for licensure.

<< NJ ADC 13:39A-5.7 >>

13:39A-5.7 Language comprehension requirements

<<+(a)+>> <<-Any->> <<+An+>> applicant for licensure as a physical therapist or a physical therapist assistant who has received his or her physical therapy training in a country other than the United States of America, the United Kingdom, the Republic of Ireland, Canada except Quebec Province, Australia, New Zealand, Jamaica, Nigeria or Ghana, shall submit to the Board evidence of attainment of a score of at least <<-550->> <<+213+>> on the Test of English as a Foreign Language (TOEFL) examination, which test shall have been taken within the two years immediately preceding the filing of the application for licensure <<+in New Jersey+>>.

<<+(b)+>> <<-Such evidence must->> <<+The TOEFL examination score shall+>> be submitted with the application for licensure.

<<+(c)+>> <<-This->> <<+The TOEFL+>> requirement may be waived for applicants who have received their training in countries other than those listed <<+in (a)+>> above upon submission of a written <<- application->> <<+request+>> to the Board <<-demonstrating->> which demonstrates good cause for the granting of the waiver. In such cases the Board may also require a personal interview with the applicant.

<< NJ ADC 13:39A-5.9 >>

13:39A-5.9 Non-appearance at examination

Failure to appear at any scheduled examination shall be deemed <<-to be->> a failure <<+of the examination+>> unless, in the Board's discretion, good cause <<+such as health, accident, disability or military service+>> has been shown for the <<-absence->> <<+applicant's failure to appear+>>.

SUBCHAPTER 6. TEMPORARY LICENSES FOR PHYSICAL THERAPISTS

<< NJ ADC 13:39A-6.1 >>

13:39A-6.1 Temporary license

(a) Any person deemed eligible to sit for <<-his or her->> <<+the+>> initial examination for licensure as a physical therapist or a physical therapist assistant, may apply for the issuance of a temporary license to practice physical therapy under <<+the+>> supervision <<+of a New Jersey licensed physical therapist+>> by indicating such on the initial application for examination.

(b) At the time of submission of the initial application for licensure <<- and examination for licensure->> in this State, the candidate shall disclose in writing any physical therapy licensure examinations taken in other jurisdictions which the applicant <<+has+>> failed.

<< NJ ADC 13:39A-6.2 >>

13:39A-6.2 Expiration of temporary license

(a) A temporary license issued to a person who has applied for licensure automatically expires <<+120 days from the date of issuance or+>> upon notification by the Board of the candidate's <<-failing->> <<+failure of the+>> examination <<-results->> in this State or <<+the failure of+>> the same standardized examination <<+taken+>> in another state <<-in which he has taken the examination->>.

<<-(b) A temporary license, issued to a person who takes the first available examination as scheduled after receipt of the temporary license, shall expire on the date the licensee is notified by the Board of the failure.->>

<<-(c) A temporary license issued to a person who does not take the first available examination as scheduled after receipt of the temporary license, shall expire on that examination date. At that time the candidate shall not practice physical therapy and shall refrain from practicing physical therapy thereafter, until the person successfully attains unrestricted licensure.->>

<<+(b) Upon expiration of the temporary license, the candidate shall not practice physical therapy and shall refrain from practicing physical therapy thereafter until the person successfully attains licensure.+>>

<< NJ ADC 13:39A-6.3 >>

13:39A-6.3 Renewal; consequences of second failure; notice of examination in another jurisdiction

<<+(a)+>> The holder of a temporary license <<-receiving notice that he or she->> <<+who+>> has failed <<+in this State or in any other state+>> the first examination for which he or she has been scheduled, <<- in this State or any other state, may renew->> <<+may have+>> his or her temporary license <<+renewed by the Board+>> for a period not to exceed <<-six months->> <<+120 days+>>, by completing a renewal application form and paying the renewal fee <<+as set forth in N.J.A.C. 13:39A-1.3+>>.

<<+(b)+>> <<-However, if->> <<+If+>> the holder of <<- the->> <<+a+>> temporary license <<-upon retaking the->> <<+fails a subsequent+>> examination in this State or the same standardized examination in any other state, <<-fails it,->> within the <<-six-month->> <<+120 day+>> period, he or she <<-will be required to->> <<+shall+>> immediately surrender <<-his->> <<+the temporary+>> license to the Board.

<<+(c)+>> Holders of temporary licenses <<-are required to give notice to->> <<+shall notify+>> the Board of their intention to take the examination in other states or jurisdictions and the results of those out-of- State examinations <<-must->> <<+shall+>> be reported to the Board within 10 days of receipt of notification of failure.

<< NJ ADC 13:39A-6.5 >>

<<-13:39A-6.5 (Reserved)->>

SUBCHAPTER 7. SUPERVISION OF PHYSICAL THERAPIST ASSISTANTS

<< NJ ADC 13:39A-7.1 >>

13:39A-7.1 Supervision requirement; physical therapist assistant

(a) (No change.)

(b) The maximum <<+physical+>> therapist<<-/->> <<+to physical therapist+>> assistant ratio shall be one physical therapist to two physical therapist assistants at any one time.

(c)-(d) (No change.)

(e) In <<+an emergency situation which causes+>> the unanticipated absence of the supervising physical therapist, a licensed physical therapist assistant <<-in the State of New Jersey->> may continue <<-working for one business day in the absence of direct supervision->> <<+to render services to only those patients for which the licensed physical therapist assistant has previously participated in the intervention for established plans of care not to exceed the regularly scheduled operational hours of that particular day+>>.

<<+(f) Every effort shall be made by the licensed physical therapist and/or the licensed physical therapist assistant to obtain direct supervision in the care described in (e) above.+>>

<< NJ ADC 13:39A-7.2 >>

13:39A-7.2 Responsibilities of designated <<+physical therapist+>> supervisor

(a) The <<+physical therapist+>> supervisor shall be in the same building or, where physical therapy is rendered in several contiguous buildings, in one of the contiguous buildings, while the physical therapist assistant is rendering care. The <<+physical therapist+>> supervisor shall be constantly available through electronic communications for consultation or for recall to the <<-immediate->> area <<+where the licensed physical therapist assistant is rendering care+>>.

(b) The supervising physical therapist's professional judgment shall ultimately determine the safe provision of physical therapy services being rendered by the physical therapist assistant(s) <<-at the contiguous buildings->>.

(c) (No change.)

(d) The supervising physical therapist shall review the plan of care with the physical therapist assistant <<-as follows->>:

1. Before a physical therapist assistant provides care to a <<- specific->> patient for the first time;

2.-3. (No change.)

(e) At least once every 30 days after initial review of a new or revised plan of care with the <<+licensed physical therapist+>> assistant, the supervising physical therapist shall document in the patient record that he or she has reviewed the patient's progress and plan of care with the assistant, including the dates when those reviews took place. Such documentation may be incorporated into progress notes written by the physical therapist and the physical therapist assistant and need not require separate or additional notes.

<< NJ ADC 13:39A-7.3 >>

13:39A-7.3 Responsibilities of physical therapist assistant

(a) (No change.)

(b) A physical therapist assistant shall obtain the signature of the designated <<+physical therapist+>> supervisor indicating that the designated supervisor reviewed the plan of care and the date when that review took place. The supervising physical therapist's signature in the record shall serve as evidence that the plan of care has been reviewed by the supervising physical therapist.

(c) At least once every 30 days after the initial review of a new or revised plan of care with the supervising physical therapist, the physical therapist assistant shall document in the patient record that the patient's progress and plan of care were reviewed with the supervising physical therapist including the dates when those reviews took place. Such documentation may be incorporated into progress notes <<+or treatment notes+>> written by the physical therapist and the physical therapist assistant and need not require separate or additional notes.

SUBCHAPTER 7A. SUPERVISION OF TEMPORARY LICENSED PHYSICAL THERAPISTS AND PHYSICAL THERAPIST ASSISTANTS

<< NJ ADC 13:39A-7A.1 >>

13:39A-7A.1 Supervision requirement; temporary licensed physical therapist; temporary licensed physical therapist assistant

(a)-(e) (No change.)

(f) In the <<-unanticipated->> absence of the supervising physical therapist, a physical therapist or physical therapist assistant holding a temporary license in the State of New Jersey <<-may continue for one business day in the absence of direct supervision->> <<+shall not provide services+>>.

<< NJ ADC 13:39A-7A.2 >>

13:39A-7A.2 Responsibilities of designated supervisor

(a) The <<+physical therapist+>> supervisor shall be subject to those responsibilities set forth in N.J.A.C. 13:39A-7.2, as they relate to the supervision of temporary licensed physical therapists and/or temporary licensed physical therapist assistants.

(b) (No change.)

<< NJ ADC 13:39A-7A.3 >>

13:39A-7A.3 Responsibilities of temporary licensed physical therapist; temporary licensed physical therapist assistant

(a)-(b) (No change.)

(c) At least once every 30 days after the initial review of a new or revised plan of care with the supervising physical therapist, the temporary licensed physical therapist or temporary licensed physical therapist assistant shall document in the patient record that the patient's progress and plan of care was reviewed with the supervising physical therapist, including the dates when those reviews took place. Such documentation may be incorporated into progress notes <<+or treatment notes+>> written by the physical therapist and the temporary licensed physical therapist or the temporary licensed physical therapist assistant and need not require separate or additional notes.

SUBCHAPTER 8. ADVERTISING

<< NJ ADC 13:39A-8.1 >>

13:39A-8.1 Advertising and solicitation practices

(a)-(d) (No change.)

(e) The Board may require a <<+licensed+>> physical therapist to substantiate the truthfulness of any assertion or representation set forth in an advertisement. <<-Failure of a physical therapist to provide factual substantiation to support a representation or assertion shall be deemed professional misconduct.->>

(f)-(i) (No change.)

<< NJ ADC 13:39A-8.5 >>

13:39A-8.5 Use of professional credentials and certifications

(a) (No change.)

(b) A licensee shall use the designation "physical therapist" or "physical therapist assistant" or the abbreviation "PT" or "PTA" in conjunction with the use of his or her name and license number. Academic degree designations may be <<-interposed between->> <<+placed after+>> the name and the title.

(c) (No change.)


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Posted May 2001