VIRGINIA ACTS OF ASSEMBLY -- CHAPTER
An Act to amend and reenact §§ 54.1-3482 and 54.1-3482.1
of the Code of Virginia, relating to direct access to physical therapy.
[S 776]
Approved
Be it enacted by the General Assembly of Virginia:
1. That §§ 54.1-3482 and 54.1-3482.1 of the Code of
Virginia are amended and reenacted as follows:
§54.1-3482. Practice of physical therapy; certain experience
and referrals required; physical therapist assistants.
A. It shall be unlawful for a person to engage in the practice
of physical therapy except as a licensed physical therapist, upon the referral
and direction of a licensed doctor of medicine, osteopathy, chiropractic,
podiatry, or dental surgery, a licensed nurse practitioner as
authorized practicing in accordance with his practice
protocol agreement, or a licensed physician assistant acting under
the supervision of a licensed physician, except as provided in this section.
B. A physical therapist who has completed a doctor of
physical therapy program approved by the Commission on Accreditation of
Physical Therapy Education or who has obtained a certificate of
authorization pursuant to §54.1-3482.1 may evaluate and treat a patient for no
more than 14 30 consecutive business days after an
initial evaluation without a referral under the following conditions: (i)
the patient is not receiving care from any licensed doctor of medicine,
osteopathy, chiropractic, podiatry, or dental surgery, a licensed nurse
practitioner practicing in accordance with his practice agreement, or a
licensed physician assistant acting under the supervision of a licensed physician
for the symptoms giving rise to the presentation at the time of the
presentation to the physical therapist for physical therapy services or (ii)
the patient at the time of presentation to a physical therapist for physical
therapy services is not being currently cared for, as attested to in writing by
the patient, by is receiving care from a licensed doctor of medicine,
osteopathy, chiropractic, podiatry, or dental surgery, a licensed nurse
practitioner practicing in accordance with his practice agreement, or a
licensed physician assistant acting under the supervision of a licensed
physician at the time of his presentation to the physical therapist for the
symptoms giving rise to the presentation for physical therapy services and (a)
the patient identifies a licensed doctor of medicine, osteopathy,
chiropractic, podiatry, or dental surgery, a licensed nurse
practitioner as authorized practicing in accordance with
his practice protocol agreement, or a licensed physician
assistant acting under the supervision of a licensed physician for the
symptoms giving rise to the presentation; (ii) the patient identifies a
practitioner from whom the patient intends to seek treatment if the condition
for which he is seeking treatment does not improve after evaluation and
treatment by the physical therapist during the 14-day period of treatment;
(iii) from whom he is currently receiving care; (b) the
patient gives written consent for the physical therapist to release all
personal health information and treatment records to the identified
practitioner; and (iv) (c) the physical therapist notifies the
practitioner identified by the patient no later than three 14
days after treatment commences and provides the practitioner with a copy of the
initial evaluation along with a copy of the patient history obtained by the
physical therapist. Evaluation and treatment may not be initiated by a
physical therapist if the patient does not identify a licensed doctor of
medicine, osteopathy, chiropractic, podiatry, dental surgery, licensed nurse
practitioner as authorized in his practice protocol, or a licensed physician
assistant acting under the supervision of a licensed physician to manage the
patient's condition. Treatment for more than 14 30
consecutive business days after evaluation of such patient shall only be
upon the referral and direction of a licensed doctor of medicine, osteopathy,
chiropractic, podiatry, or dental surgery, a licensed nurse
practitioner as authorized practicing in accordance with
his practice protocol agreement, or a licensed physician
assistant acting under the supervision of a licensed physician. A physical
therapist may contact the practitioner identified by the patient at the end of
the 14-day 30-day period to determine if the practitioner will
authorize additional physical therapy services until such time as the patient
can be seen by the practitioner. A physical therapist shall not perform an
initial evaluation of a patient under this subsection if the physical therapist
has performed an initial evaluation of the patient under this subsection for
the same condition within the immediately preceding three months
60 days. For the purposes of this subsection, business days means Monday
through Friday of each week excluding state holidays.
C. After completing a three-year period of active practice
upon the referral and direction of a licensed doctor of medicine, osteopathy,
chiropractic, podiatry, dental surgery, licensed nurse practitioner as
authorized in his practice protocol, or a licensed physician assistant acting
under the supervision of a licensed physician, a A physical
therapist who has not completed a doctor of physical therapy program
approved by the American Physical Therapy Association or who has not obtained a
certificate of authorization pursuant to §54.1-3482.1 may conduct a
one-time evaluation, that does not include treatment, of a
patient who does not meet the conditions established in (i) through (iv) of
subsection B without the referral and direction of a licensed doctor of
medicine, osteopathy, chiropractic, podiatry, or dental surgery, a licensed
nurse practitioner as authorized practicing in accordance with
his practice protocol agreement, or a licensed physician
assistant acting under the supervision of a licensed physician; if appropriate,
the physical therapist shall immediately refer such patient to the appropriate
practitioner.
D. Invasive procedures within the scope of practice of
physical therapy shall at all times be performed only under the referral and
direction of a licensed doctor of medicine, osteopathy, chiropractic, podiatry,
or dental surgery, a licensed nurse practitioner as authorized
practicing in accordance with his practice protocol
agreement, or a licensed physician assistant acting under the supervision
of a licensed physician.
E. It shall be unlawful for any licensed physical therapist to
fail to immediately refer any patient to a licensed doctor of medicine,
osteopathy, chiropractic, podiatry, or dental surgery, or a licensed nurse
practitioner as authorized practicing in accordance with his
practice protocol, whose agreement when such patient's medical
condition is determined, at the time of evaluation or treatment, to be beyond
the physical therapist's scope of practice. Upon determining that the patient's
medical condition is beyond the scope of practice of a physical therapist, a
physical therapist shall immediately refer such patient to an appropriate
practitioner.
F. Any person licensed as a physical therapist assistant shall
perform his duties only under the direction and control of a licensed physical
therapist.
G. However, a licensed physical therapist may provide, without
referral or supervision, physical therapy services to (i) a student athlete
participating in a school-sponsored athletic activity while such student is at
such activity in a public, private, or religious elementary, middle or high
school, or public or private institution of higher education when such services
are rendered by a licensed physical therapist who is certified as an athletic
trainer by the National Athletic Trainers' Association Board of Certification
or as a sports certified specialist by the American Board of Physical Therapy
Specialties; (ii) employees solely for the purpose of evaluation and
consultation related to workplace ergonomics; (iii) special education students
who, by virtue of their individualized education plans (IEPs), need physical
therapy services to fulfill the provisions of their IEPs; (iv) the public for
the purpose of wellness, fitness, and health screenings; (v) the public for the
purpose of health promotion and education; and (vi) the public for the purpose
of prevention of impairments, functional limitations, and disabilities.
§54.1-3482.1. Certain certification required.
A. The Board shall promulgate regulations establishing
criteria for certification of physical therapists to provide certain physical
therapy services pursuant to subsection B of §54.1-3482, without
referral from a licensed doctor of medicine, osteopathy, chiropractic,
podiatry, or dental surgery, a licensed nurse practitioner as
authorized practicing in accordance with his practice
protocol agreement, or a licensed physician assistant acting under
the supervision of a licensed physician. The regulations shall include but not
be limited to provisions for (i) the promotion of patient safety; (ii) an
application process for a one-time certification to perform such
procedures; and (iii) minimum education, training, and experience
requirements for certification to perform such procedures; and (iv)
continuing education requirements relating to carrying out direct access duties
under §54.1-3482.
B. The minimum education, training, and experience
requirements for certification shall include evidence that the applicant has
successfully completed (i) a doctor of physical therapy program approved by
the American Physical Therapy Association; (ii) a transitional program in
physical therapy as recognized by the Board; or (iii) (ii)
at least three years of active practice with evidence of continuing education
relating to carrying out direct access duties under §54.1-3482.
C. In promulgating minimum education, training, and
experience criteria, the Board shall consult with an advisory committee
comprised of three members selected by the Medical Society of Virginia and
three members selected by the Virginia Physical Therapy Association. All
members of the advisory committee shall be licensed by the Board of Physical
Therapy or the Board of Medicine and shall engage in clinical practice. The
committee shall have a duty to act collaboratively and in good faith to
recommend the education, training, and experience necessary to promote patient
safety. The advisory committee shall prepare a written report of its
recommendations and shall submit this report to the Board of Physical Therapy
and shall also submit its recommendations to the Board of Medicine for such
comments as may be deemed appropriate, prior to the promulgation of draft
regulations. The advisory committee may meet periodically to advise the Board
on the regulation of such procedures.
D. In promulgating the regulations required by this
section, the Board shall take due consideration of the education, training, and
experience requirements adopted by the American Physical Therapy Association
and the American Medical Association.
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