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NEW JERSEY REGISTER
VOLUME 38, ISSUE 14
ISSUE DATE: JULY 17, 2006
RULE PROPOSALS
LAW AND PUBLIC SAFETY
DIVISION OF CONSUMER AFFAIRS
State Board Of Physical Therapy Examiners

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

Rules of the State Board of Physical Therapy Examiners

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

Authority: N.J.S.A. 45:9-37.18.

Calendar Reference: See Summary below for explanation of exception to calendar requirement.

Proposal Number: PRN 2006-220.

Submit comments by September 15, 2006 to:
Susan Gartland, Executive Director
State Board of Physical Therapy Examiners
PO Box 45014
Newark, NJ 07101

The agency proposal follows:

Summary

The State Board of Physical Therapy Examiners (the Board) proposes to readopt N.J.A.C. 13:39A with amendments. These rules are scheduled to expire on December 19, 2006 pursuant to N.J.S.A. 52:14B-5.1.

In compliance with N.J.S.A. 52:14B-5.1, the Board undertook a thorough review of the existing provisions of N.J.A.C. 13:39A in order to delete unnecessary or unreasonable rules and to propose new rules that the Board believes are needed to clarify and assist the regulation of physical therapists and physical therapist assistants. The Board believes that the rules proposed for readoption are necessary, reasonable, understandable and responsive to the purposes for which they were originally promulgated. These rules have had a beneficial impact on the regulation and conduct of physical therapists and physical therapist assistants. The following summarizes each subchapter in N.J.A.C. 13:39A and the amendments proposed to the existing rules.

Throughout the proposal, the Board proposes to amend the phrases "physical therapist" and "physical therapist assistant" to "licensed physical therapist" and "licensed physical therapist assistant." These terms more accurately identify the individuals to whom these rules apply. The Board also proposes to amend the phrase "continuing professional education" to "continuing education" and the phrase "credit hours" to "credits."

Subchapter 1 sets forth the organization and administration of the Board. It sets forth requirements for electing officers to the Board, allows the chairperson to act prior to a Board meeting and sets forth the fees the Board may charge. The Board proposes to amend N.J.A.C. 13:39A-1.3 to clarify language and to correctly refer to the certificate of registration, which is the document issued every two years when a licensed physical therapist or physical therapist assistant renew licensure, and the wall license, which is the document issued to physical therapists and physical therapist assistants when they are initially licensed. The Board proposes to delete N.J.A.C. 13:39A-1.3(a)9, the certification of eligibility for examination fee. The Board no longer charges this fee. The Board also proposes to amend N.J.A.C. 13:39A-1.3(a)11 (recodified as (a)10) to reflect that the Board charges a fee whenever a licensee requests a new certificate of registration because the licensee changed his or her name.

Subchapter 2 sets forth practice standards for physical therapists and physical therapist assistants. It provides definitions for the terms used throughout N.J.A.C. 13:39A, the scope of practice for physical therapists, the scope of practice for physical therapist assistants, standards for delegating to unlicensed persons and standards for referring patients to other health care professionals. The Board proposes to amend the definition of "physical therapy diagnosis" in N.J.A.C. 13:39A-2.1 for clarification to change "efficacious" to "effective." The Board proposes to delete the phrase "and is consistent with physician direction" in relation to diagnostic testing, from N.J.A.C. 13:39A-2.2(c)1. Physical therapists are no longer required to obtain physician direction and this phrase is no longer relevant to physical therapy practice.

Subchapter 3 sets forth recordkeeping requirements for licensees. The subchapter also sets forth standards for fees that a licensee may charge for professional services, requirements for displaying the Board-issued license, requirements for notification to the Board of change of address and prohibitions against professional misconduct and sexual misconduct. The Board proposes to amend N.J.A.C. 13:39A-3.1(c)8 to require licensees to also document a patient's current status in the patient's record.  N.J.A.C. 13:39A-3.5 is proposed for amendment to clarify language. The rule currently states that licensees shall display the biennial renewal certificate. The correct title for this Board-issued document is the "certificate of registration." The Board proposes to amend this rule to correct the title of this document. The rule is also proposed for amendment to require that the original, current certificate of registration be displayed.

 N.J.A.C. 13:39A-3.9 is proposed for amendment to clarify language and to require that the writing on a name tag be at least one-quarter inch in size. The definitions in N.J.A.C. 13:39A-3.10 are proposed for amendment so that they conform to the terms defined in N.J.A.C. 13:39A-2.1.  N.J.A.C. 13:39A-3.10 currently states that a patient-therapist relationship is ongoing unless physical therapy is terminated in writing or if the last physical therapy was rendered more than three months ago. The Board believes that, in order to protect patients from inappropriate behavior on the part of licensees, the standard for an ongoing patient-therapist relationship should be more stringent than the current standard. The Board proposes to amend N.J.A.C. 13:39A-3.10(c) so that a patient-therapist relationship is ongoing unless it is terminated in writing and the last physical therapy was rendered more than three months ago.

Subchapter 4 sets forth the acts that constitute unlicensed practice and prohibits licensees from aiding or abetting unlicensed practice.

Subchapter 5 sets forth standards for issuing licenses to applicants. These rules set forth eligibility standards for obtaining licenses as physical therapists and physical therapist assistants, examination standards for licensure, and procedures for obtaining a license through endorsement.  N.J.A.C. 13:39A-5.3 sets forth eligibility standards for obtaining a license as a physical therapist assistant. The Board proposes to recodify this section as N.J.A.C. 13:39A-5.2 so that it follows N.J.A.C. 13:39A-5.1, which sets forth such standards for physical therapists. Existing N.J.A.C. 13:39A-5.2 is proposed for recodification as N.J.A.C. 13:39A-5.3. The Board proposes to amend N.J.A.C. 13:39A-5.1 through 5.3 to reflect the proposed new codification.

 N.J.A.C. 13:39A-5.7 requires applicants from non-English speaking countries to successfully pass the Test of English as a Foreign Language (TOEFL). The Board proposes to amend this rule to allow applicants to take either TOEFL or the TOEFL Internet Based Test (TOEFL IBT). The Board proposes new N.J.A.C. 13:39A-5.7(b) to set forth the passing scores on TOEFL and TOEFL IBT.  N.J.A.C. 13:39A-5.7(c) permits the Board to waive the TOEFL requirement for good cause. The Board is allowed to personally interview applicants for a waiver. The Board believes granting a TOEFL waiver is subjective. Due to the changes to TOEFL, the waiver process is no longer appropriate as an appearance before the Board does not indicate whether a candidate has sufficiently mastered written and spoken English. The Board proposes to delete the waiver provision.

 N.J.A.C. 13:39A-5.8 allows applicants to retake the licensing examination once without filing another application, as long as the applicant is scheduled to retake the examination within two years of the initial date of application to the Board. An applicant retaking the examination is required to pay the examination fee to the Board. The Board proposes to amend this rule to clarify language, remove gender specific language and to remove the provision that limits an applicant to retaking the examination once. The Board also proposes to delete the provision that requires an applicant to pay the examination fee to the Board. The Board no longer charges this fee.

Subchapter 5A sets forth standards for renewing licensure. The rules require licensees to renew licensure every two years. The rules also impose penalties for failure to renew, set forth procedures by which inactive licenses may be reactivated and set forth procedures by which suspended licenses may be reinstated.  N.J.A.C. 13:39A-5A.3(d) is proposed for amendment to reflect the recodification of N.J.A.C. 13:39A-5.2.

Subchapter 6 sets forth standards for issuing temporary licenses to physical therapists and physical therapist assistants licensed in another state in cases of medical emergency or teaching assignment. The rules require the supervision of a temporary visiting licensed physical therapist assistant by a New Jersey licensed physical therapist.

Subchapter 7 sets forth supervision requirements for physical therapist assistants. The rules set forth the responsibilities of designated licensed physical therapist supervisors and licensed physical therapist assistants.

Subchapters 7A and 7B are reserved subchapters.

Subchapter 8 sets forth requirements for advertising.  N.J.A.C. 13:39A-8.1(i) requires that a licensed physical therapist who advertises certification in a specialty area possess certification from the American Board of Physical Therapy Specialties or other Board-recognized national certifying body. The only organization that the Board recognizes as a national certifying body is the American Board of Physical Therapy Specialties. Accordingly, the Board proposes to delete the phrase "or other Board recognized national certifying body" from N.J.A.C. 13:39A-8.1(i).

Subchapter 9 imposes continuing education requirements on licensees. Licensees are required to complete 30 credits every biennial period as a requirement of renewal. The Board proposes to amend N.J.A.C. 13:39A-9.2(a) to require that the 30 credits of continuing education include four credits of jurisprudence and professional ethics.  N.J.A.C. 13:39A-9.2(c) defines an hour of continuing education as 50 minutes of instruction. The Board has found that this definition has caused confusion for licensees. The Board is amending this provision to define an hour of continuing education as 60 minutes of instruction.

 N.J.A.C. 13:39A-9.3(d) allows a licensed physical therapist or licensed physical therapist assistant to obtain 15 credits of continuing education for being awarded a clinical specialization in any specialty area recognized by the American Physical Therapy Association. Licensed physical therapist assistants cannot obtain a clinical specialization. The Board proposes to delete licensed physical therapist assistants from N.J.A.C. 13:39A-9.3(d). The Board also proposes to amend N.J.A.C. 13:39A-9.3(d) to allow licensed physical therapists to obtain continuing education credits for obtaining certification or recertification in a specialty area and to recognize that the American Board of Physical Therapy Specialties certifies clinical specialties, not the American Physical Therapy Association.

The Board proposes to delete N.J.A.C. 13:39A-9.3(e). This subsection allows the Board to review and approve courses that have not been pre-approved. The Board intended that this provision would apply when a licensee has been audited to determine if he or she complied with continuing education requirements. The Board proposes to move this provision to proposed new N.J.A.C. 13:39A-9.4(e), which follows the provision that sets forth the Board's authority to perform such an audit.

The Board proposes new N.J.A.C. 13:39A-9.3(e). This new subsection would allow licensed physical therapists to obtain 15 continuing education credits for successfully completing a residency approved by the American Physical Therapy Association.

The Board has determined that the comment period for this proposal shall be 60 days; therefore, pursuant to N.J.A.C. 1:30-3.3(a)5, this proposal is excepted from the rulemaking calendar requirement.

Social Impact

The rules proposed for readoption have had a beneficial impact on society by establishing licensure procedures and standards of practice for physical therapists and physical therapist assistants. Regulatory authority over physical therapists and physical therapist assistants protects 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 is 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.

Subchapter 2 benefits licensees and the public by setting forth definitions, standards of practice, and rules for delegation and referrals to other health care professionals. The rules proposed for readoption and the proposed amendments clearly set forth what licensees are permitted and not permitted to do.

Subchapter 3 benefits the public and licensees by setting forth the requirements for patient records. The rules proposed for readoption 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 licensees only charge reasonable fees. The public will also benefit from the provision requiring licensees to discuss and make certain that patients understand financial agreements before treatment begins. The provisions in the subchapter dealing with sexual misconduct have a positive impact upon the public by increasing confidence in the physical therapy profession and by setting forth the parameters of appropriate conduct. The rules also provide protection to patients, employees and co-workers of licensed physical therapists from sexual harassment and sexual contact. Patients are able to receive physical therapy services without fear of unwanted sexual contact or harassment. Employees and co-workers are granted workplace protection for unwanted advances and harassment, creating a safer and more productive workplace environment. The proposed amendment to N.J.A.C. 13:39A-3.10 ensures that a patient-therapist relationship is terminated before a licensee and former patient engage in sexual contact.

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 N.J.A.C. 13:39A-5.7 will benefit applicants who received their education in a non-English speaking country. These amendments allow applicants to take the Test of English as a Foreign Language Internet Based Test, which increases the availability of the examinations such applicants are required to pass.

Subchapter 5A benefits licensees by clearly setting forth the procedures that must be filed when they renew licensure. Subchapter 6 benefits society by setting forth procedures by which out-of-State physical therapists and physical therapist assistants may work in New Jersey during emergencies or teaching assignments. Subchapter 7 benefits the public by ensuring that licensed physical therapist assistants are properly supervised.

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.

Subchapter 9 benefits licensees and the public by ensuring that licensees maintain a current knowledge base regarding the practice of physical therapy. This leads to better prepared physical therapists and physical therapist assistants who will provide safer and more effective services for their patients. The amendments to Subchapter 9 require licensees to take continuing education credits in jurisprudence and professional ethics, which will assist licensees in providing appropriate professional services. The proposed amendments recognize new methods by which licensees may satisfy continuing education requirements, which will facilitate the completion of continuing education requirements.

Economic Impact

The rules proposed for readoption and the proposed amendments will impose costs on licensed physical therapists and licensed physical therapist assistants. The fee schedule in Subchapter 1 is projected to yield revenues sufficient to cover expenses incurred by the Board for the functions it performs. The rules proposed for readoption will 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. 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 treatment.

Maintenance of patient records as mandated in Subchapter 3 will have an economic impact on licensees. Licensees will incur costs when they establish and maintain detailed records for every client for seven years from the date of the last entry. Licensees will also incur costs in order to comply with computer recordkeeping requirements. 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 educated in a foreign country where English is not the primary language. These individuals are required to take either the Test of English as a Foreign Language (TOEFL) or the Test of English as a Foreign Language Internet Based Test (TOEFL IBT) and will have to pay the test fee.

The regulation of advertising practices in Subchapter 8 may limit the ability of licensed 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.

The continuing education requirements of Subchapter 9 will impose costs on licensees. Every licensee is required to complete continuing education every biennial period. The costs for obtaining this education is borne by licensees.

Federal Standards Statement

A Federal standards analysis is not required because there are no Federal laws or standards applicable to the rules proposed for readoption with 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 Board does not believe that the rules proposed for readoption with amendments will have any impact on the agriculture industry of this State.

Regulatory Flexibility Analysis

The Board believes that the approximately 5,040 physical therapists and 1,255 physical therapist assistants licensed in New Jersey could be deemed "small businesses" under the Regulatory Flexibility Act (the Act), N.J.S.A. 52:14B-16 et seq.

The costs imposed on small businesses by the rules proposed for readoption with amendments are the same costs that are imposed on all businesses as outlined in the Economic Impact above. The Board believes that licensees will not need to employ the professional services to comply with the rules proposed for readoption or the proposed amendments. The rules contain no reporting requirements; however, the rules contain recordkeeping and compliance requirements which are described in the Summary and Economic Impact above.

As the compliance and recordkeeping requirements contained in the rules proposed for readoption with amendments are necessary to adequately regulate licensees and protect the heath, safety and welfare of consumers who use their services, the Board believes that the rules must be uniformly applied to all licensed physical therapists and licensed physical therapist assistants and no exemptions are provided based on the size of the licensee's business.

Smart Growth Impact

The Board believes that the rules proposed for readoption with amendments will have no impact on the achievement of smart growth and implementation of the State Development and Redevelopment Plan, otherwise known as the State Plan.

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

Full text of the proposed amendments follows (additions indicated in boldface thus; deletions indicated in brackets [thus]):

13:39A-1.3   Fees and charges

(a) The following fees shall be charged by the New Jersey State Board of Physical Therapy Examiners:

1. Application fee for Licensed Physical Therapist and Licensed Physical Therapist Assistant............$ 125.00

2. Initial licensure fee, Licensed Physical Therapist:

i. If paid during first year of biennial renewal period:...................$ 110.00

ii. If paid during second year of biennial renewal period:.............$ 55.00

     Initial licensure fee, Licensed Physical Therapist Assistant:

i. If paid during first year of biennial renewal period:..................$ 100.00

ii. If paid during second year of biennial renewal period:............$ 50.00

3. Biennial renewal fee:

i. Licensed Physical Therapist..................................................$ 110.00

ii. Licensed Physical Therapist Assistant..................................$ 100.00

4.-6. (No change.)

7. Duplicate [license] certificate of registration.....................$ 25.00

8. Duplicate wall [certificate] license.......................................$ 40.00

[9. Certification of eligibility for examination (for persons not yet
seeking the issuance of a temporary license)............................$ 25.00]

[10.] 9. (No change in text.)

[11.] 10. Change of name and/or address with new certificate of registration fee........... $ 25.00

[12.] 11. Continuing [professional] education provider submission fee........... $ 100.00

[13.] 12. (No change in text.)

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

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" means the presence of the supervising licensed physical therapist on site, available to respond to any consequence occurring during any treatment procedure.

. . .

"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] effective care for the purpose of achieving the patient's goals.

. . .

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

 (a)-(b) (No change.)

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

1. The diagnostic testing is clinically supported and is specific to that individual patient's impairments, functional limitations, or disability[, and is consistent with physician direction];

2.-4. (No change.)

(d) A licensed physical therapist shall not bill a patient or third party for diagnostic testing that lacks demonstrated medical value and a level of general acceptance by the relevant provider community and which fails to provide sufficient clinical data to alter the plan of care.

(e) (No change.)

 113:39A-2.3   Authorized role of a licensed physical therapist assistant

(a) A licensed physical therapist assistant may initiate physical therapy treatment only at the direction of and under the direct supervision of a licensed physical therapist. A licensed physical therapist assistant shall not initiate physical therapy treatment upon the direction of a physician or other authorized health care provider without the direct supervision of a licensed physical therapist.

(b) A licensed physical therapist assistant shall document treatments in the patient record. The supervising licensed 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 licensed physical therapist.

 (d) (No change.)

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

(a) 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 licensed physical therapist, including transporting the patient, positioning of the patient and assisting with the undressing and dressing of the patient.

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

1.-7. (No change.)

 113:39A-2.5   Referral of patients and consultation standards for licensed physical therapists

(a) A licensed physical therapist shall refer a patient to a health care professional licensed to practice dentistry, podiatry or medicine and surgery in this State, or other appropriate licensed health care professional:

1. When the licensed physical therapist during the examination, evaluation or intervention has reason to believe that physical therapy is contraindicated or symptoms or conditions are present that require services outside the scope of practice of the licensed physical therapist; or

2. (No change.)

(b) Not more than 30 days from the date of initial treatment of functional limitation or pain, a licensed physical therapist shall inform the patient's licensed health care professional of record regarding the patient's plan of care. In the event there is no identified licensed health care professional of record, the licensed physical therapist shall recommend that the patient consult with a licensed health care professional of the patient's choice. In a school setting, the schedule of physical therapy services shall be reported to the child study team by the licensed physical therapist within 30 days of the date of initial treatment.

(c) (No change.)

13:39A-3.1   Patient records

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

(b) (No change.)

(c) The patient record shall include, in addition to personal identifying information, consents and disclosures, at least the following information:

1.-7. (No change.)

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 and current status;

19.-14. (No change.)

(d) (No change.)

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

(a) Fees for physical therapy services shall be reasonable and commensurate with fees of licensed 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)-(e) (No change.)

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] original, current certificate of registration and the following notices in a public area in [any] all offices [or] and health care [facility] facilities at which the licensee practices physical therapy:

11.-2. (No change.)

(b) A licensee shall not alter, deface or obscure the information on the [biennial renewal] certificate of registration in any manner including, but not limited to, the licensee's address.

13:39A-3.8   Violative acts; professional misconduct

(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 licensed physical therapist does not charge the patient for such items;

2. (No change.)

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, for the purpose of obtaining clearance for physical therapy. Nothing in this section shall preclude a licensed physical therapist from charging a patient for a physical therapy examination and evaluation conducted prior to referral;

4. (No change.)

5. Representing services as therapeutic, or permitting the representation of services as therapeutic, when, although the services are within the licensee's scope of practice, no therapeutic outcome is expected; for example, educational activities, preventative sports conditioning, fitness/wellness programs, etc. Nothing herein shall preclude a licensed physical therapist from using or permitting the use of his or her professional education degree, title or license in connection with educational, preventative or other appropriate activities or from accepting reasonable fees or payment for such activities, provided that no claim of therapeutic outcome is made or charged for;

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

7.-9. (No change.)

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 licensed physical therapist or licensed physical therapist assistant are based solely upon the services reflected in the patient record;

11.-12. (No change.)

13:39A-3.9   Identification of licensees

All licensees shall conspicuously wear [an identification] a name tag using the term "physical therapist" or "physical therapist assistant," as appropriate, whenever acting in that capacity. The letters on the tag shall be at least one-quarter inch in size.

13:39A-3.10   Sexual misconduct

(a) The purpose of this section is to identify for licensees of the State Board of Physical Therapy Examiners conduct which shall be deemed sexual misconduct.

(b) As used in this section, the following terms have the following meanings unless the context clearly indicates otherwise:

"Licensee" means any person licensed to engage in practice as a physical therapist or physical therapist assistant as regulated by the State Board of Physical Therapy Examiners.

"Patient" means any person who is the recipient of physical therapy examination, evaluation, instruction or treatment rendered by a licensee.

"Patient-therapist relationship" means a relationship between a licensed physical therapist or a licensed physical therapist assistant and a patient wherein the licensee owes a continuing duty to the patient to render physical therapy services consistent with his or her training and experience.

. . .

(c) A licensee shall not engage in sexual contact with a patient with whom he or she has a patient-therapist relationship. The patient-therapist relationship is ongoing for purposes of this section, unless:

1. Physical therapy is terminated by way of written notice to the patient and is documented in the patient record; [or] and

2. The last physical therapy was rendered more than three months ago.

(d)-(k) (No change.)

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 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 licensed physical therapist, licensed physical therapist assistant, M.D., D.O., 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] intervention by any person who does not hold a license as a physical therapist, a physical therapist assistant, an M.D., D.O., 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 licensed physical therapist, licensed physical therapist assistant, M.D., D.O., D.P.M., D.D.S. or D.M.D.;

3.-4. (No change.)

13:39A-4.2   Aiding and abetting unlicensed practice

It shall be unlawful for a licensee to aid or assist any unlicensed person engaging in any of the practices identified at N.J.A.C. 13:39A-4.1.

13:39A-5.1   Licensing requirements for a physical therapist

(a) To be eligible for licensure as a physical therapist in New Jersey, an applicant shall:

1.-5. (No change.)

6. Have successfully completed the written examination as set forth in N.J.A.C. 13:39A-[5.2]5.3.

(b) In addition to meeting the requirements of (a)1 and 2 above, an applicant for licensure who is a graduate of a foreign school of physical therapy shall:

1.-3. (No change.)

4. Successfully complete a written examination as set forth in N.J.A.C. 13:39A-[5.2]5.3.

(c) (No change.)

13:39A-[5.3]5.2   Licensing requirements for a physical therapist assistant

(a) To be eligible for licensure as a physical therapist assistant in New Jersey an applicant shall:

1.-3. (No change.)

4. Have completed a two-year physical therapist assistant program from an accredited college or university approved for the education and training of physical therapist[s] assistants by an accrediting agency recognized by the Council on Post Secondary Accreditation and the United States Department of Education;

5. Have completed all clinical education requirements necessary for graduation from a physical therapist assistant program approved for the education and training of physical therapist[s] assistants by an accrediting agency recognized by the Council on Post Secondary Accreditation and the United States Department of Education; and

6. Have successfully completed the written examination as set forth in N.J.A.C. 13:39A-[5.2]5.3.

13:39A-[5.2]5.3   Examination standards for applicants for licensure as physical therapists and physical therapist assistants

(a) Applicants for licensure as physical therapists and physical therapist assistants submitting satisfactory proof of educational credentials as set forth in N.J.A.C. 13:39A-5.1 and [5.3]5.2, respectively, shall be approved to take the National Physical Therapy Examination or the National Physical Therapist Assistant Examination, as applicable, administered by the Federation of State Boards of Physical Therapy and the State jurisprudence examination.

(b)-(d) (No change.)

(Agency Note: N.J.A.C. 13:39A-5.3 is proposed for recodification with amendments as N.J.A.C. 13:39A-5.2.)

13:39A-5.7   Language comprehension requirements

(a) 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, or New Zealand shall submit to the Board evidence of attainment of a passing score [of at least 220] on the Test of English as a Foreign Language (TOEFL) examination or Test of English as a Foreign Language Internet Based Test (TOEFL IBT) examination, which test shall have been taken within the two years immediately preceding the filing of the application for licensure in New Jersey.

(b) A passing score on the TOEFL examination shall be a score of at least 220. A passing score on the TOEFL IBT examination shall be a score of at least 24 on the writing portion, at least 26 on the speaking portion, at least 18 on the listening portion and at least 21 on the reading portion.

[(b)] (c) (No change in text.)

[(c) 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 request to the Board which demonstrates good cause for the granting of the waiver. In such cases the Board may also require a personal interview with the applicant.]

13:39A-5.8   Re-examination of applicants for licensure as physical therapists and physical therapist assistants

An examinee who fails the examination on [his] the first attempt, may retake the examination [once in this state,] without filing another application, provided [he] the examinee is rescheduled for the examination within two years of [his] the initial date of application [and he pays the required examination fee to the Board]. If any examinee fails the examination on [his] the second attempt, in the Board's discretion, [he] the examinee may be required to re-submit an application before being rescheduled for another examination.

113:39A-5A.2   Change of licensure status: inactive to active

(a) (No change.)

(b) A person who seeks to reactivate his or her license shall complete 30 credits of continuing [professional] education per biennial renewal period that the licensee has been on inactive status up to a maximum of 60 credits. Of the continuing [professional] education required under this subsection, 30 credits must be taken within two years immediately preceding reactivation and the remainder must be taken within four years immediately preceding reactivation.

13:39A-5A.3   Reinstatement of suspended license

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

(c) An individual whose license has been automatically suspended for failure to renew pursuant to N.J.A.C. 13:39A-5A.1(d) shall complete 30 credits of continuing [professional] education per biennial renewal period that the licensee has been suspended up to a maximum of 60 credits. Of the continuing [professional] education required under this subsection, 30 credits must be taken within two years immediately preceding reinstatement and the remainder must be taken within four years immediately preceding reinstatement.

(d) An individual whose license has been automatically suspended for failure to renew pursuant to N.J.A.C. 13:39A-5A.1(d) for a period of five or more years shall successfully complete the examination required for initial licensure as set forth in N.J.A.C. 13:39A-[5.2]5.3.

(e) (No change.)

13:39A-6.2   Responsibilities of a temporary visiting licensed physical therapist assistant

(a) A temporary visiting licensed physical therapist assistant shall not render care unless the temporary visiting license holder receives direct supervision from his or her designated supervising licensed physical therapist.

(b) A temporary visiting licensed physical therapist assistant shall obtain the signature of the supervising licensed physical therapist indicating that the supervising licensed physical therapist reviewed the plan of care with the temporary visiting licensed physical therapist assistant and the date when that review took place. The supervising licensed physical therapist's signature in the patient record shall serve as evidence that the plan of care has been reviewed with the temporary visiting licensed physical therapist assistant by the supervising licensed physical therapist.

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

SUBCHAPTER 7.    SUPERVISION OF LICENSED PHYSICAL THERAPIST ASSISTANTS

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

(a) (No change.)

(b) The maximum licensed physical therapist to licensed physical therapist assistant ratio shall be one licensed physical therapist to two licensed physical therapist assistants at any one time.

(c) The supervising licensed physical therapist shall retain responsibility for the physical therapy care of the patient being treated by the licensed physical therapist assistant. The licensed physical therapist assistant shall be responsible for patient care within the limits of his or her scope of practice.

(d) In the event of a change of the supervising licensed physical therapist, the subsequent supervisor shall assume responsibility for the ongoing supervision of any licensed physical therapist assistant(s) providing care to the patient and shall become the designated supervisor.

(e) In an emergency situation which causes the unanticipated absence of the supervising licensed physical therapist, a licensed physical therapist assistant may continue 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) (No change.)

13:39A-7.2   Responsibilities of designated licensed physical therapist supervisor

(a) The licensed 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 licensed physical therapist assistant is rendering care. The licensed physical therapist supervisor shall be constantly available through electronic communications for consultation or for recall to the area where the licensed physical therapist assistant is rendering care.

(b) The supervising licensed physical therapist's professional judgment shall ultimately determine the safe provision of physical therapy services being rendered by the licensed physical therapist assistant(s).

(c) The supervising licensed physical therapist shall cosign the licensed physical therapist assistant's notes contemporaneously with the services rendered.

(d) The supervising licensed physical therapist shall review the plan of care with the licensed physical therapist assistant:

1. Before a licensed physical therapist assistant provides care to a patient for the first time;

2. Before the licensed physical therapist assistant implements a new or revised plan of care; and

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 licensed 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 licensed physical therapist and the licensed physical therapist assistant and need not require separate or additional notes.

13:39A-7.3   Responsibilities of licensed physical therapist assistant

(a) A licensed physical therapist assistant shall not render nor continue to render care unless he or she has obtained ongoing direction from his or her designated supervisor.

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

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

13:39A-8.1   Advertising and solicitation practices

(a) The following words and terms, when used in this section, shall have the following meanings unless the context clearly indicates otherwise.

1.-4. (No change.)

5. The term "fee schedule" refers to the fees charged for services or goods offered by a licensed physical therapist.

6.-7. (No change.)

8. "Routine professional service" refers to a service which a licensed physical therapist, licensed physical therapist assistant or professional association routinely performs.

(b)-(h) (No change.)

(i) Any licensed physical therapist advertising certification in a specialty area shall possess certification by American Board of Physical Therapy Specialties [or other Board-recognized national certifying body].

13:39A-8.2   Advertising free or discounted services; required disclosures

(a) An advertisement offering a fee reduction shall state the reduced fee and the licensed physical therapist's usual fee for each service for which a reduction is advertised. The usual fee shall be the fee charged for the advertised service for a period of not less than 90 days prior to the advertised reduction.

(b) (No change.)

(c) Except for those services specifically excluded in the advertisement offering free services, the licensed physical therapist shall not charge for any service whatsoever rendered during a period of 72 hours from the time the free service was rendered.

SUBCHAPTER 9.    CONTINUING [PROFESSIONAL] EDUCATION

13:39A-9.1   Licensure renewal: continuing [professional] education requirement

(a) Effective February 1, 2006, a licensee shall complete the continuing [professional] education requirement as specified in N.J.A.C. 13:39A-9.2 by January 31, 2008, for the biennial licensure period beginning February 1, 2008.

(b) A licensee applying for biennial licensure renewal shall complete, during the preceding biennial period, the continuing [professional] education requirement as specified in N.J.A.C. 13:39A-9.2.

(c) Upon biennial license renewal, a licensee shall attest that he or she has completed the continuing [professional] education requirement of the types and number of [hours] credits specified in N.J.A.C. 13:39A-9.3. Falsification of any information submitted on the renewal application may require an appearance before the Board and may result in disciplinary action.

13:39A-9.2   Credit hour requirements

(a) Except as provided in (b) below, each applicant for biennial license renewal as a licensed physical therapist and as a licensed physical therapist assistant shall complete during the preceding biennial period a minimum of 30 credits [hours] of continuing [professional] education, which shall include four credits of jurisprudence and professional ethics.

(b) An applicant for biennial license renewal as a licensed physical therapist or as a licensed physical therapist assistant who receives an initial license in the first year of a biennial period shall complete a minimum of 15 of the 30 required credits of continuing [professional] education for that biennial renewal period. An applicant for biennial license renewal as a licensed physical therapist or as a licensed physical therapist assistant who receives an initial license in the second year of a biennial period shall be exempt from completing continuing [professional] education credits for that biennial renewal period.

(c) For the purposes of this subchapter, [a credit] an hour of continuing [professional] education means [50] 60 minutes of time spent in learning activities exclusive of breaks, meals or vendor exhibits.

(d) Any continuing [professional] education courses, programs or seminars directed or ordered by the Board to be taken by a licensee as all or part of a disciplinary or remedial measure or to remediate a deficiency in continuing [professional] education credits for a prior biennial renewal period shall not qualify to fulfill the mandatory continuing [professional] education requirements required for biennial renewal.

13:39A-9.3   Acceptable course offerings; credit hour calculation

(a) The Board shall grant continuing [professional] education credit, at a rate of one credit for each hour of attendance unless otherwise specified in this section, only for courses, programs or seminars that have been successfully completed and have significant educational or practical content which deal with matters related to the practice of physical therapy or with the professional responsibilities or ethical obligations of licensees, such as the following:

1.-9. (No change.)

(b) All courses, programs or seminars offered by the following sources and providers shall be pre-approved, and a licensee shall be allowed the number of credits as follows:

1. Successful completion of a post-graduate course in a physical therapy program leading to a Doctor of Physical Therapy (DPT) degree for the licensed physical therapist or a three-credit course in an entry level physical therapy program for the licensed physical therapist assistant. Such programs must be in institutions of higher learning which are accredited by the United States Department of Education or the Council on Postsecondary Accreditation or their approved agencies: three credits for each course credit awarded; or

2. (No change.)

(c) The Board shall grant a maximum of 10 of the mandatory 30 continuing [professional] education credits required in a biennial renewal period of licensed physical therapists and licensed physical therapist assistants from any or all of the following:

1.-5. (No change.)

(d) A licensed physical therapist [or physical therapist assistant] who is [awarded clinical specialization in any of the American Physical Therapy Association (APTA) specialty areas] certified or re-certified in a clinical specialty by the American Board of Physical Therapy Specialties shall receive 15 continuing [professional] education credits for the biennial licensure period in which it takes place.

[(e) The Board shall review and approve courses, programs and seminars, which are not pre-approved pursuant to (b) above, if the courses, programs and seminars meet the requirements of (a) above and the providers meet the requirements of N.J.A.C. 13:39A-9.6.]

(e) A licensed physical therapist who successfully completes a residency approved by the American Physical Therapy Association (APTA) shall receive 15 continuing education credits for the biennial licensure period in which the residency takes place.

(f)-(g) (No change.)

(h) Continuing [professional] education courses, programs and seminars shall be offered on a nondiscriminatory basis. Membership organizations may discount the cost of attending continuing [professional] education courses, programs and seminars for dues-paying members.

13:39A-9.4   Documentation of continuing [professional] education credit

(a) Each licensee shall maintain a record of all continuing [professional] education activity completed and shall submit evidence of completion of the credit requirements to the Board upon request. Each licensee shall obtain from the continuing [professional] education course, program or seminar provider and retain for a period of at least four years following the license renewal a record of attendance which shall include, at a minimum, the following:

1.-5. (No change.)

6. The number of continuing [professional] education [hours and] credits awarded; and

7. (No change.)

(b)-(c) (No change.)

(d) The Board shall monitor compliance with the mandatory continuing [professional] education requirement by conducting a random audit of licensees, who, upon request, shall provide proof of successful completion of continuing [professional] education credits.

(e) During the audit performed pursuant to (d) above, the Board shall review any course that has not been pre-approved pursuant to N.J.A.C. 13:39A-9.3(b) and shall approve the course if it meets the requirements of N.J.A.C. 13:39A-9.3(a) and the provider meets the requirements of N.J.A.C. 13:39A-9.6.

13:39A-9.5   Waiver of continuing [professional] education requirements

(a) The Board may waive, extend or otherwise modify the time period for completion of the continuing [professional] education requirements on an individual basis for reasons of hardship, such as illness, disability or active service in the military.

(b) A licensee who seeks a waiver, extension or modification of the time period for the completion of the continuing [professional] education requirements shall provide to the Board in writing, no less than two months prior to the end of the licensure period, the specific reasons for requesting the waiver, extension or modification and such additional information as the Board may require in support of the request.

13:39A-9.6   Responsibilities of continuing [professional] education providers

(a) All providers of continuing [professional] education not included in N.J.A.C. 13:39A-9.3(b) shall:

1.-5. (No change.)

 



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