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New York Physical Therapy Association

Practice Questions and Answers

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Use of Non-Licensed Personel

Q: Can non-licensed personnel (aides) be used in physical therapy settings?

A: To help clarify the issue of proper utilization of athletic trainers (ATC) in physical therapy facilities, NYPTA asked the Executive Secretary of the State Board for Physical Therapy to provide a detailed description of the role and limitations of non-licensed personnel (PT aides) in the physical therapy environment.

Following is a summarization of the State Board’s comments:

  • The "title" of physical therapy aide is not recognized by the New York State Education Department and therefore function as non-licensed personnel. As such, physical therapy aides cannot perform activities within the scope of practice of physical therapy.
  • In long-term care facilities, non-licensed personnel can perform certain patient-related activities. Providing superficial hot and cold applications; assisting with both range-of-motion exercises and exercises to maintain strength and endurance in clients without related pathology; and assisting with walking within the provision of maintenance care to residents is acceptable. However, the non-licensed individual providing such care must have received certification as Nurse Aide (CNA) as well as additional specific training under the direction of a physical therapist.
  • In all other settings, the aide may provide support to the physical therapy service only through non-treatment-related duties. Such activities may include setting up and maintaining treatment areas; preparing equipment; answering telephones; gathering forms for charting; and cleaning. Additionally, aides may act as an extra set of hands for the physical therapist or physical therapist assistant who is actually providing treatment. Aides may assist patients in preparation for treatment. This would include such acts as lowering a patient into a Hubbard tank or performing patient transfers. Of course, performance of patient-related activities is predicated upon the understanding that such individuals have demonstrated their ability to perform the selected activities safely.
  • Unlicensed personnel may not perform physical therapy treatment. This includes ultrasound (the most frequently asked question), no matter how closely that individual is supervised by the PT. (Note: This does not apply to physical therapist assistants, who, while not licensed in New York, are certified in accordance with the Education Law to perform patient-related services under the direction and supervision of a physical therapist.)
  • PT and PTA students may only perform treatment when on a clinical affiliation. Students working in PT services on their own time are considered non-licensed personnel and are subject to the restrictions outlined above.
  • Physical Therapists should be aware that Section 29.1(b)(10) of the Rules of the Board of Regents states that "delegating professional responsibilities to a person when the licensee delegating such responsibilities knows of or has reason to know that such person is not qualified, by training, by experience or by licensure, to perform them"... constitutes unprofessional conduct. Moreover, a person alleged to be engaged in the unauthorized practice of a profession may be found guilty of a Class E felony.

The above rules apply to all non-PT/non-PTA personnel when services are being billed as physical therapy. Any PT/PTA who is aware of violations of these statutes should contact the Office of Professions complaint hotline at 1-800-442-8106 for assistance.
 

Definitions:

Q: What is a professional service corporation?

A: Professional Service Corporation refers to a (1) corporation organized under article fifteen of the business corporation law and (2) any other corporation organized under the business corporation law or under any other predecessor statute, which is authorized by, or holds a license, certificate, registration or permit issued by, the licensing authority pursuant to the education law to render professional services within New York State. This occurs when professionals, in accordance with article fifteen of the business corporation law, form a professional practice by registering with SED and the Department of State. All shareholders of the professional corporation must be licensees of one profession. The PC may only practice that profession. Each partner is liable for his/her professional actions. Each shareholder is only civilly liable to the extent of his/her ownership of the professional corporation.

Q: What is a professional partnership?

A: Professional Partnership means

  1. a partnership without limited partners each of whose partners is a professional authorized by law to render a professional service within the state,
  2. a partnership without limited partners each of whose partners is a professional, at least one of whom is authorized by law to render a professional service within the state, or
  3. a partnership without limited partners authorized by, or holding a license, certificate, registration or permit issued by the licensing authority pursuant to the education law to render a professional service within the state.

This partnership is generally authorized by New York Partnership law. Each partner is individually liable personally for all debts of the partnership.

Q: What is a "no-fault clinic"?

A: According to the Office of the Professions, these facilities are said to provide numerous services to a given patient in the course of one visit. The patient spends a few minutes with each licensee, and the insurer is billed for multiple services. This practice raises a number of issues, some of which include the following:

  • All licensees should strive to provide the highest quality of care. Providing abbreviated or ineffective treatment could lead to charges of unprofessional conduct if such services are determined to be negligent or incompetent services.
  • Elements of good practice should include assessing each patient's condition before you begin a treatment. Appropriate records, for each patient visit, may include your findings after evaluating the patient as well as your notes relating to the patient's treatment.

Q: What does the Department of Health mean by a "reasonable charge for copies of health care records/patient information"?

A: Sections 17 and 18 of the Public Health Law (PHL) have been amended to provide that, as of September 1, 1991, the maximum amount that may be charged for paper copies of health care records and/or patient information furnished pursuant to such sections may not exceed 75 cents per page. The amendment to PHL section 17 also provides that a release of records may not be denied solely because of inability to pay.

For more about the Department of Health's rules on health care records and patient information, please visit their Web site at the following address: http://www.health.state.ny.us/nysdoh/opmc/dohmemo.htm.

March 27, 2001

Working in NYS

Q:  I have a vendor who will send $200.00 each time he supplies my office with a tens unit for a patient.  Is this legal in New York? 

A:  Rules of the Board of Regents, Part 29,  deals with unprofessional conduct.  This practice could be perceived to be inappropriate and could lead to charges of professional misconduct.  It could be interpreted as “exercising undue influence on the patient or client, including the promotion of the sale of services, goods, appliances or drugs in such manner as to exploit the patient or client for the financial gain of the practitioner or of a third party.”  It can lead to charges of misconduct if you are suggesting a specific product or treatment and getting a kickback from a third party.

Q:  I am a physical therapist in a couple of school districts and we have been waiting on the referral from the physicians to start therapy.  We were told by the director of services that with direct access in NY we can treat without a referral.  Is this true; and if so, how long can we treat them without a referral?  Also, is there some place that I can read the new law for my own satisfaction?

A:  A: Direct Access has not changed the need for a referral in the school setting. There are regulations in Part 200 that deal with IEP and CSE (Committee on Special Education) that essentially supercede Direct Access. These regulations state that there must be a referral from the physician on file prior to initiating treatment. As in other settings, an evaluation does not require a physician’s referral. However, in the school setting, parental consent is required to perform an evaluation. 

Q: What steps must a foreign-trained PT take to work as a physical therapist in New York state?

A: In order to work as a PT in New York, foreign-trained physical therapists must possess either a license or a Limited Permit. New York licenses PTs based on approved education and passing scores on the National Physical Therapy Examination (NPTE). All foreign education must be reviewed and approved by our Bureau of Comparative Education before an applicant is eligible to sit for the NPTE.

Foreign-trained applicants must have completed a program of not less than four years of post-secondary study with a baccalaureate-level degree from a recognized institution of higher education. The program should include at least two years of professional physical therapy studies and lead to a degree recognized as preparation in physical therapy by the civil authorities of the country in which the studies were completed.

The studies must include content in the following areas:

  • General Education - Liberal Arts and Sciences (at least 60 credits) including biological sciences, behavioral sciences, chemistry and physics
  • Professional Education - (at least 60 credits) including health sciences, medical sciences, physical therapy theory and practice
  • Clinical Education equivalent to at least 20 weeks or 750 hours

Applicants are eligible to apply for a Limited Permit in physical therapy once their education has been approved, or when they submit an affidavit stating that all educational deficiencies will be made up within one year.

An individual on a Limited Permit must be supervised by a New York State licensed and registered physical therapist. The supervising PT must provide on-site (defined as in the same building) supervision and be readily accessible to provide personal advice and assistance to the permittee.

A Limited Permit is valid for one year from date of issue and may not be renewed or extended.

The Education Department is not authorized to provide information on immigration issues, such as how to obtain a valid visa. All questions regarding immigration status should be referred to the Immigration and Naturalization Service (INS) at 1-800-755-0777.

 

Referrals

Q: Can I accept an out-of-state prescription for a patient to provide physical therapy?

A: In general, an out-of-state physician who is not licensed in New York may not practice medicine in New York and, consequently, may not issue referrals for physical therapy to be performed in New York by New York PTs. However, Section 6526(2) of the Education Law includes an exemption that permits practice in New York by "Any physician who is licensed in a bordering state and who resides near the border of this state, provided such practice is limited in this state to the vicinity of such border and provided such physician does not maintain an office or place to meet patients or receive calls within the state." Physicians practicing under this exemption would be authorized to prescribe physical therapy to be performed in the border area of New York State by New York PTs. This exemption is construed very narrowly, and the border vicinity is very narrowly defined. Physicians that are not covered by this exemption and are neither licensed in New York nor authorized to practice under some other statutory exemption, are not authorized to prescribe physical therapy to be performed in New York by a New York PT.

If you have further questions in this regard, please contact the NYS Board for PT - ptbd@mail.nysed.gov.

Q: For how long is a referral good? I was told it was good for a year unless written otherwise by the prescribing doctor.

A: The physical therapy practice act (Article 136 of the Education Law) states that a referral by a licensed physician, dentist, podiatrist, nurse practitioner, or physician assistant (who works under the supervision of a physician who can refer) is required to render treatment. It does not mention "written" and it does not mention a time limit. In general, the State Board recommends that referrals should be honored within one month from the date written. In addition, if a referral simply states "evaluate and treat," it is generally interpreted as being for one month, depending upon the situation.

Regarding a physician's referral, the State Board has stated that, in general, the law is silent about referrals. Whenever that occurs, it becomes the professional responsibility of the licensee, based upon their professional decision-making, to make a judgment. A month might be a stretch for a patient who has suffered an acute episode. On the other hand, a year might be appropriate for a patient with a chronic condition. What is critical in the decision-making process is that the specific decision must be sound as determined by a peer review (i.e., the PT Board) should the decision be challenged.

The State Board has also advised that, generally, physical therapists in school settings should use a referral for the entire school year.

Medicare regulations require a status report and new referral every 30 days (or sooner if the plan of care was for less than 30 days) as a standard. If a physician's original referral had written "six visits" then a new referral is needed after six visits, either verbal or written.

Other insurance companies might have different requirements. Reimbursement and the practice act are two different things. While there are standards for documentation that would suggest frequent and periodic evaluations and re-evaluations, there is no standard requirement for all insurance companies.

The State Board has recommended that hospitals develop a written policy, insure that the required parties sign on to it (e.g., medicine), and then abide by that policy.

Further questions should be directed to the State Board for Physical Therapy.

Q:  Can physical therapists accept electronic referrals?

A:  While we are able to provide the following general guidance, the actual determination of whether a practitioner acted properly with respect to any particular referral would depend on the circumstances of that situation. 

Section 6731(c) of the Education Law requires that physical therapy treatment, other than treatment provided in accordance with subdivision (d) of that section, be rendered only pursuant to a referral. The term "referral" is not defined in the law. While there is no explicit requirement that a referral contain a signature, it would be necessary for the physical therapist to have some assurance that the referral is legitimate. If the therapist has a reasonable basis for concluding that the referral is legitimate, he or she would be able to provide treatment pursuant to that referral.
 
There is no prohibition against accepting an electronic referral, as long as that referral contains all of the information necessary for the physical therapy treatment to be provided and the physical therapist has a reasonable basis for determining that the referral is legitimate. One way of establishing the legitimacy of a referral would be the inclusion of an electronic signature. Depending upon the circumstances presented, there may be other ways of doing so, as well.
 
(Answer received from Seth Rockmuller, Executive Secretary of the State Board for Physical Therapy).
 
3/30/13

Regulations

Q:  Can I put a patient's treatment on hold, after consulting with the physician, while awaiting for authorization from Workmen's Compensation for additional therapy visits? There have been numerous times that we will get authorization for 6 or 12 visits, and then have waited weeks for additional authorization despite persistent attempts. We often wind up not getting paid for treatment sessions that were done after the first authorized group. Any suggestions?

A:  If The PT chooses to treat without authorization from the comp carrier, then they run the risk of not getting paid for the treatment. Workman’s comp has up to 30 days to authorize visits. What we can do is submit for auth for more sessions when the pt. has 5 sessions remaining. This will help to increase the turn around time and decrease the amount of time patients have to wait. So the answer is yes they can be put on hold, and can resume treatment as long as the have an updated script.

Q: I know there are laws regarding the definition of a PT and PTA in NYS. Are there also laws regarding documentation, ie discharge notes, monthly progress notes, etc... ?

A: The laws of NYS about the practice of physical therapy are contained in the Practice Act. Documentation Guidelines may be found on the APTA website --www.apta.org. Just enter "documentation" in the Search box and there will be several links for you.

Q: How long must a PT retain a patient's medical records?

A: According to the Rules of the Board of Regents in the State of New York, unprofessional conduct shall include "Failing to maintain a record for each patient that accurately reflects the evaluation and treatment of the patient. Unless otherwise provided by law, all patient records must be retained for at least six years. Obstetrical records and records of minor patients must be retained for at least six years, and until one year after the minor patient reaches the age of 21 years."

For more information about professional misconduct in physical therapy please visit the New York State Education Department Office of the Professions, Rules of the Board of Regents.

Q: What are the regulations with regard to reproducing anything in the Guide to PT Practice?

A: Permission to reprint any part of the Guide should be sent to APTA in writing (it can be faxed) advising the part(s) that you want to reproduce and its specific use. It should be addressed to Lois Douthitt, APTA Director of Publications, 1111 North Fairfax St., Alexandria, VA 22314. Fax: (703) 706-3169.


Q: Preventive Physical Therapy Care in New York State

Signing your Name

Q: I’ve graduated with a doctoral degree in physical therapy. How should I sign my name?

A: Education Law, Article 136 - Physical Therapy and Physical Therapist Assistants, Section 6732 Practice of physical therapy and the use of the title "physical therapist" states, Only a person licensed or otherwise authorized under this article shall practice physical therapy or use the title "physical therapist", "physiotherapist" or "mechanotherapist" or the abbreviation of "PT" in connection with his or her name or with any trade name in the conduct of his profession.

Under the Rules of the Board of Regents Part 29 - Unprofessional Conduct, Section 29.2 General provisions for health professions. (a) Unprofessional conduct shall also include...(4) using the word "Doctor" in offering to perform professional services without also indicating the profession in which the licensee holds a doctorate...

The licensure title PT is different from the academic credential of DPT. Only the use of the abbreviation "PT" is protected in law, which means that only a licensed physical therapist can use these initials. The physical therapist must use the regulatory designation of “PT” when signing their name.  The physical therapist may use the term doctor, but as per NYS regulations “must indicate the profession in which the licensee holds a doctorate”. The main concern for the licensee is that the profession in which the licensee holds a doctorate be indicated in some way. Therefore


APTA offers us some guidance as to the order of credentials after your name.
The preferred order is:

1. PT or PTA.
2. Highest earned physical therapy – related degree.
3. Other earned academic degree(s).
4. Specialist certification credentials in alphabetical order (specific to the American Board of Physical Therapy Specialties).
5. Other credentials external to APTA.
6. Other certification or professional honors (eg, FAPTA).
(HOD 06-03017014)

For PTs who have completed a transitional DPT program, their DPT is now their highest earned physical therapy degree and replaces their previous physical therapy degree as their entry-level degree. Therefore, they should no longer include their MSPT, MPT, etc. when listing their credentials.

Q: I’m a student in a physical therapy program. How should I sign my name?

A: NYS does not recognize any student abbreviations after your name. Although APTA supports the use of SPT or SPTA, our practice act does not recognize the use of these initials. Therefore when signing a note, the NY State Board for Physical Therapy recommends signing your name followed by Student PT or Student PTA.

Starting a Practice

Q: What do I need to do to start a new practice?

Basically, you'll need an attorney, an accountant, and the Small Business Administration Web Site. They will be able to advise you about the many things that any small business owner needs to know. Beyond that, from a reimbursement standpoint, you'll need to learn all you can about patients' health insurance. APTA and its Private Practice Section offer a variety of information on this topic on the APTA web site. The AMA also offers an assortment of books on insurance coding and medical practice management.

Join the Private Practice Section. The section provides members with information and resources specifically for practitioners who are the private owners or operators of physical therapy practices. The section offers a newsletter, discounts on business services and insurance programs and a member mentor program, which connects members with experienced private practitioners around the country. The section also offers advice specific to practitioners' needs. Learn more about the section at http://www.ppsapta.org.

You may also want to check out APTA's Consulting Services: .
The service links member with qualified consultants who can provide personalized guidance on a wide range of practice management issues at competitive rates.

3/22/04

What Can I do?

Q:  Can a Physical Therapist possess or administer drugs in an out-patient PT setting?

The following answer is by Claudia Alexander, Executive Secretary of the NYS Board for Physical Therapy:

This issue comes up a lot with questions about iontophoresis. The PT Board and the Pharmacy Board and the Office of Professions have made the following determinations:

Physical therapists may not independently possess prescription drugs. Neither may they administer drugs via most routes of administration. However, the administration of medicinal ions through iontophoresis, a process that promotes absorption of drugs through the skin using an electric current, is permitted within the physical therapy practice act.

When iontophoresis is used with chemicals (drugs) that are designated as prescription drugs, the drugs must be dispensed by a pharmacist for the specific patient. Prescription drugs may not be kept as stock by an individual physical therapist or by a physical therapy department. Section 6808(1) of the Education Law states:

No person, firm, corporation or association shall possess drugs, prescriptions or poisons for the purpose of compounding, dispensing, retailing, wholesaling, or manufacturing, or shall offer drugs, prescriptions or poisons for sale at retail or wholesale unless registered by the department as a pharmacy, store, wholesaler, or manufacturer.

I have consulted with the State Board for Pharmacy and determined that a variety of drugs may be administered through iontophoresis, including anesthetics, antibiotics and even narcotic analgesics. In some cases, devices (patches and controllers) are used. These devices may or may not require a prescription based upon classification by the Federal Food and Drug Administration (FDA). If there are any circumstances where a patch does not contain prescription drugs, physical therapists may sell that product to patient

Q: Can PTs sell products in a physical therapy office that may be related to the practice of physical therapy?

According to the Executive Secretary of the NYS Board for Physical Therapy, selling products in a physical therapy office that may be related to the practice of physical therapy could be a problem. 

There are two sections in the Rules of the Board of Regents, Part 29, that deal with unprofessional conduct where this practice could be perceived to be inappropriate and could lead to charges of professional misconduct.  It could be interpreted as "exercising undue influence on the patient or client, including the promotion of the sale of services, goods, appliances or drugs in such manner as to exploit the patient or client for the financial gain of the practitioner or of a third party; or as permitting any person to share in the fees for professional services, other than: a partner, employee, associate in a professional firm or corporation, professional subcontractor or consultant authorized to practice the same profession, or a legally authorized trainee practicing under the supervision of a licensed practitioner."
     Therefore, it is the Board’s interpretation that selling products, such as ergonomic pocketbooks, could lead to misconduct charges if selling for a profit.  It could also lead to charges of misconduct if you are suggesting a specific product ("promotion of the sale of services, goods, appliances or drugs in such manner as to exploit the patient or client of the financial gain ... of a third party). 

7/2/08

Q: May a physical therapist disconnect a patient’s oxygen supply from a wall mount and connect it to an alternative source?

A:  In an opinion written in June 1998, the State Education Department and the State Board for Physical Therapy determined that it is not uncommon for physical therapists, in consultation with the nursing or respiratory therapy staff, to interrupt the rate of flow of oxygen for certain treatment activities or positioning patients receiving PRN oxygen therapy, or to adjust the flow in relation to the level of activity demanded by the physical therapy intervention in patients with orders that include a range or sliding scale of the flow rate for oxygen administration.

The use of oxygen, its administration, effects and precautions is included in the curricula of professional entry-level physical therapy programs throughout the U.S. and has been for many years. Moreover, oxygen delivery is included as a content area that is tested on the National Physical Therapy Examination. The examination is used as a basis for licensure of physical therapists in every state, as well as additional jurisdictions throughout the world. Physical therapists understand that oxygen is considered a medication that requires an order from an appropriate practitioner before other health-care professionals can administer it.

Of course, it is understood that a physical therapist performing any activity is competent in the execution of that activity. Section 29.1(b)(9) of the Rules of the Board of Regents states that it is unprofessional conduct for licensees to perform professional responsibilities when they know that they are not competent to perform such responsibilities.

3/1/05

Q: I work with golfers improving their physical ability, by conditioning them specifically for that sport. The clients are healthy individuals that are trying to improve their performance. There is no physician referral. There is no insurance reimbursement. What can I do and what can't I do? Is soft tissue mobilization or deep tissue releasing legal for me to do? What about stretching or golf specific exercise?

A: According to the NYS Board for Physical Therapy: Within the provision of physical therapy services, prevention is viewed as consisting of interventions that provide instruction in self-help skills to individuals or groups. Prevention is not performed to ameliorate the presence of pathology. Prevention differs from treatment, in that in prevention, physical therapists and physical therapist assistants (under the direction of a physical therapist) instruct patient/clients in methods and techniques to:

  • promote general health in potentially susceptible populations
  • minimize the potential of injuries, disabilities and diseases
  • limit the degree of disability for individuals with chronic or irreversible debilitating diseases

Examples of prevention activities in which a physical therapist or the physical therapist assistant (with the exception of evaluation) may engage include the following:

  1. Activities that promote general health (performance or conditioning) in well individuals, such as:
    · evaluation of movement with suggestions that modify movement patterns to enhance performance in well individuals e.g. golf swing
    · classes for the well elderly to enhance/maintain balance skills and coordination
    · pre and post-partum classes to teach relaxation and maintain muscle tone and strength
    · exercise programs, including cardiovascular conditioning, to improve fitness in adults or children who are obese or deconditioned.
  2. Activities that prevent (minimize the potential of) the occurrence or reoccurrence of injury, such as:
    · post-acute evaluation of movement with suggestions that modify movement patterns to minimize or eliminate further/repetitive injury e.g. individual with tennis elbow to assess and correct movement during racket swing in tennis
    · back schools, exercises for stretching, strengthening and endurance and postural training to prevent back problems in the absence of acute or recent pathology
    · work place evaluation, exercises for stretching, strengthening, endurance and postural training to prevent job-related disabilities
  3. Activities that limit the degree of disability with chronic or irreversible diseases, such as:
    · aquatic exercise programs, including cardiovascular conditioning and resistive exercise, to maintain flexibility and fitness in individuals with chronic disorders e.g. cerebral palsy, multiple sclerosis, arthritis, etc.

Mobilization is considered treatment and does not fall into a "prevention" mode as it is viewed as treatment.

Ultimately, whether services are regarded as treatment or prevention will depend upon what is done, to whom, for what purpose, and also upon the manner in which the service is represented. Obviously, if the service is advertised as beneficial for the alleviation of a pre-existing disability, injury or disease entity, or is billed to an insurer as a treatment, it cannot simultaneously be termed prevention. When providing preventive care, the physical therapist must maintain a record that appropriately documents the activities undertaken with each client, as would be done with a patient referred by a physician, podiatrist, dentist, or nurse practitioner.

07/25/01

Q: How can non-licensed personnel (aides) be used in physical therapy settings?

A: To help clarify the issue of proper utilization of athletic trainers (ATC) in physical therapy facilities, NYPTA asked Barbara Zittel, PhD, Executive Secretary of the State Board for Physical Therapy, to provide a detailed description of the role and limitations of non-licensed personnel (PT aides) in the physical therapy environment. Dr. Zittel's comments are herein summarized:

  • The "title" of physical therapy aide is not recognized by the New York State Education Department and therefore function as non-licensed personnel. As such, physical therapy aides cannot perform activities within the scope of practice of physical therapy.
  • In long-term care facilities, non-licensed personnel can perform certain patient-related activities. Providing superficial hot and cold applications; assisting with both range-of-motion exercises and exercises to maintain strength and endurance in clients without related pathology; and assisting with walking within the provision of maintenance care to residents is acceptable. However, the non-licensed individual providing such care must have received certification as Nurse Aide (CNA) as well as additional specific training under the direction of a physical therapist.
  • In all other settings, the aide may provide support to the physical therapy service only through non-treatment-related duties. Such activities may include setting up and maintaining treatment areas; preparing equipment; answering telephones; gathering forms for charting; and cleaning. Additionally, aides may act as an extra set of hands for the physical therapist or physical therapist assistant who is actually providing treatment. Aides may assist patients in preparation for treatment. This would include such acts as lowering a patient into a hubbard tank or performing patient transfers. Of course, performance of patient-related activities is predicated upon the understanding that such individuals have demonstrated their ability to perform the selected activities safely.
  • Unlicensed personnel may not perform physical therapy treatment. This includes ultrasound (the most frequently asked question), no matter how closely that individual is supervised by the PT. (Note: This does not apply to physical therapist assistants, who, while not licensed in New York, are certified in accordance with the Education Law to perform patient-related services under the direction and supervision of a physical therapist.)
  • PT and PTA students may only perform treatment when on a clinical affiliation. Students working in a PT services on their own time are considered non-licensed personnel and are subject to the restrictions outlined above.
  • Physical therapists should be aware that Section 29.1(b)(10) of the Rules of the Board of Regents states that "delegating professional responsibilities to a person when the licensee delegating such responsibilities knows of or has reason to know that such person is not qualified, by training, by experience or by licensure, to perform them"... constitutes unprofessional conduct. Moreover, a person alleged to be engaged in the unauthorized practice of a profession may be found guilty of a Class E felony.

The above rules apply to all non-PT/non-PTA personnel when services are being billed as physical therapy. Any PT/PTA who is aware of violations of these statutes should contact the State Education Department Office of Professional Discipline in Albany, 800-442-8106, for assistance.

Q: Can physical therapists treat animals?

A: Current provisions of the Education Law DO NOT authorize the treatment of animals by physical therapists in New York state; this would apply whether a veterinarian provides supervision or not. The only other professionals who may treat animals are veterinary technicians and dentists as both are enabled by statute. If physical therapists or any other professionals wish to treat animals, they would have to seek legislative change. (Source: The New York State Education Department.)

Q: Can a physical therapist supervise a massage therapist?

A:  No, a PT may not supervise a massage therapist. Massage therapists act under their own practice act. They are independent practitioners. They do not need a referral. A PT may employ a massage therapist, BUT, then the massage therapist acts under the supervision of the PT. In this scenario, the massage therapist could only perform PT massages, under a referral for PT treatment.

Q: I am a member of the APTA and work in home care. One of my agencies has begun to require physical therapists to open new cases and supervise the home health aide if the aide has been placed. In other words, no skilled nurse is involved in the case. There are specific criteria for the cases which are opened by the therapist...for example, the patient is medically stable and is on no new medication; however, my concerns are whether a physical therapist practicing in New York is legally allowed to open cases without a skilled nurse first evaluating the patient in the home, and is a physical therapist legally allowed to supervise the home health aide?

A: If there are patients that are medically stable and are “PT only” cases, then it is appropriate for the PT to open the case.  As far as supervision of the home health aide, e.g. supervising a patient’s performance of their home exercise program, ambulation, transfers, etc., you can supervise them for PT-related activities, but if there are more needs than that, then they have to be supervised by the RN.

What can a physical therapist assistant (PTA's) do in New York state?

Q: Can PTAs write discharge summaries?

A: The physical therapist is responsible for the overall care of the patient.  If the PTA has been involved in the care of the patient, then they should contribute to, and co-sign, the discharge summary.

Q: Can PTAs perform and document measurements (e.g., goniometry and MMT)?

A: PTAs are taught how to perform goniometry and MMT. This enables them to accurately identify changes in the patient's status. When it has been identified by the physical therapist that treating a strength and/or ROM deficit is part of the goals and plan of care, it is appropriate for the PTA to take measurements as a part of that plan. In this case, it is not considered a part of an evaluation, but an assessment of the patient's status. This is then communicated to the therapist through documentation. Any changes in the plan or goals would be made at that time if indicated by the status of the patient and determined by the therapist.

Q: Do all notes written by the PTA need to be co-signed?

A: There must be verification that the assistant has been supervised on-site (with the exception of the school-age and preschool-age child, home care and long-term care maintenance patients). The most obvious way to do this is through a signature of the therapist on-site that day. When this is not always practical logistically, then attendance records should be available or another mean to verify that the therapist was on-site and available to the assistant. Please note that there is no statute requiring the co-signature of the PTAs notes by the therapist.

Q: Where can PTAs work without on-site supervision by the physical therapist?

A: In a law passed in March, 1998, the PTA has been granted the ability to work with school-age and preschool-age children (excluding the early intervention population) without the on-site supervision of the therapist.  The effective date of this bill was immediate with a sunset of June 30, 2010.  Assistants may also continue to work in the home care environment with patients again, specifically with the exclusion of the early intervention population. This provision of the practice act is due to sunset on June 30, 2010.  Similarly, in long-term care settings, the PTA can work with those patients that are determined to be maintenance without on-site supervision. In any of these cases, it is the responsibility of the physical therapist to determine the appropriateness of the patient to be delegated.

Q: When is it appropriate for the PTA to make modifications to the Plan of Care?

A: The PTA should recognize adverse and positive patient reactions to treatment. It is considered appropriate for them to modify short-term goals and progress a patient's program. However, this is documented and therefore done in conjunction with the supervising therapist.

Q: Can PTAs work under the supervision of the Physiatrist?

A: No, as it is specifically stated in the Practice Act that the PTA can only work under the supervision of the physical therapist.

Q: Do PTAs need two years of clinical experience before working in a home health care setting?

A: According to Education Law, Article 136, §6738c.:

[Effective until June 20, 2002.] For the purposes of the provision of physical therapist assistant services in a home care services setting, as such services are defined in article thirty-six of the public health law, except that the home care services setting shall not include early intervention services as defined in title two of article twenty-five of the public health law, whether such services are provided by a home care services agency or under the supervision of a physical therapist licensed pursuant to this article, continuous supervision of a physical therapist assistant, who has had direct clinical experience for a period of not less than two years, by a licensed physical therapist shall not be construed as requiring the physical presence of such licensed physical therapist at the time and place where such services are performed. For purposes of this subdivision "continuous supervision" shall be deemed to include: (i) the licensed physical therapist’s setting of goals, establishing a plan of care and determining whether the patient is appropriate to receive the services of a physical therapist assistant subject to the licensed physical therapist’s evaluation.

 

Go to the State web site to get answers to a variety of practice questions

Practice Committee

Practice Committee

Consumer Choice Brochure Available
Form for Practice Questions 
Frequently asked Practice Questions
Guide to PT Practice 
How to get Licensed
Practice Act 
The Role of a PT/PTA
The Office of Professions
APTAs Practice and Patient Care
APTAs Core Ethical Documents

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Albany, NY  12205

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Contact Us

Local: 518-459-4499
Fax: 518-459-8953
Email: bbraun@nypta.org

 

 

© 2011 New York Physical Therapy Association. All Rights Reserved.

The New York Physical Therapy Association (NYPTA) is a non-profit professional organization composed of approximately 5,000 licensed physical therapists (PTs), physical therapist assistants (PTAs) and PT/PTA students. The NYPTA is dedicated to serving the public's health interests, improving the standard of health for people of all ages, and advancing the interests of physical therapists in the State of New York.