Physical Therapy

Frequently Asked Practice Questions

Introduction To Practice Questions

As a newly licensed physical therapist or certified physical therapist assistant you may have questions about the practice of your profession. The following may help you answer some of the most common questions. This information is based upon the questions submitted to the State Board for Physical Therapy by licensed or certified professionals like you.

1. The scopes of practice for the professions of physical therapy and physical therapist assistant are defined in the law. Does that mean that I can do everything that falls within the legal scope of practice of my profession?

   Part 29 of the Rules of the Board of Regents requires that licensees practice within the scope defined in law and within their personal scope of competence. If you are not competent to provide a service that you are legally allowed to provide, then you may not provide that service. As a licensed professional, it is your responsibility to practice within the scope of your abilities and expertise. If you practice outside your personal scope of competence, you can be charged with professional misconduct.

2. How long must I maintain patient records?

   All patient records must be kept for six years. Records for children must be kept until the child is 22, even if that means keeping the records for more than six years.

3. Must I wear an identification badge when I am providing physical therapy services in a healthcare setting?

   You must wear an identification badge indicating your name and your professional title if you are practicing as an employee of a hospital, clinic, group practice or multi-professional facility, or at a commercial establishment offering health services to the public.

4. May I use an "Aide or "Assistant" to provide physical therapy services?

   New York State law restricts the practice of physical therapy to licensed physical therapists or certified physical therapist assistants. Individuals who are not licensed or certified may not provide physical therapy services. Aides may perform non-patient related activities such as secretarial, clerical and housekeeping tasks. Additionally, aides may act as an extra set of hands for the physical therapist or physical therapist assistant who is actually providing the treatment.

5. May I provide physical therapy treatment to animals?

   New York State law restricts the practice of physical therapy to providing services to humans.

6. Can I accept a referral for physical therapy treatment from a physician, dentist, podiatrist or nurse practitioner not licensed in New York?

   In general, out-of-state physicians, dentists, podiatrists or nurse practitioners who are not licensed in New York may not practice in New York and consequently may not issue prescriptions or referrals for physical therapy to be performed in New York by a New York licensed physical therapist. However, one exemption permits practice in New York by a physician who is licensed in a bordering state and who resides near the border of this state. The border vicinity is usually defined as less than 25 miles. Therefore, a physical therapist may accept a referral from such a physician.

7. Can I accept a referral from a physician assistant for physical therapy treatment?

   A physician assistant may perform medical services when under the supervision of a physician. Medical services which may be performed by a physician assistant include a referral to a physical therapist for treatment. In making such a referral, the physician assistant is acting as the agent of the physician.

8. As a physical therapist assistant may I work under the supervision of a physician?

   Only a physical therapist may supervise a physical therapist assistant.

9. What kinds of supervision are required for physical therapist assistants?

   Supervision of a physical therapist assistant by a physical therapist must be on site, that is, in the same building, but not necessarily direct personal supervision, that is, in the same room. For patients on a maintenance care program in residential health care facilities or certain other sites defined by the mental hygiene law, supervision of the physical therapist assistant by the physical therapist must be continuous but not necessarily on site. Continuous but not necessarily on site supervision is also required in home care services settings and in schools.

   In general one physical therapist may supervise no more than four physical therapist assistants. In a home care services setting, a physical therapist may supervise no more than two physical therapist assistants.

   Without exception, the physical therapist is responsible for evaluating the patient, setting patient goals, establishing a plan of care, and determining whether it is appropriate for the patient to receive the services of a physical therapist assistant based on the competencies of the physical therapist assistant and the needs of the patient.

10. As a physical therapist assistant do my notes need to be co-signed by my supervising physical therapist?

    A physical therapist assistant does not need to have notes co-signed by a physical therapist. Physical therapists may read the notes of physical therapist assistants as one facet of their supervisory role. However, a co-signature is not required.

11. If I am unsure about whether something falls within my legal scope of practice, how can I find out?

    You can contact the New York State Board for Physical Therapy at 89 Washington Avenue, Albany, New York 12234, phone 518-474-3817, extension 180, fax 518-402-5944, or e-mail ptbd@mail.nysed.gov.

Direct Access to Physical Therapy Treatment

This Question and Answer document is provided as a guideline to inform you about the new law and regulations that deal with physical therapists providing treatment without a referral from a physician, dentist, podiatrist or nurse practitioner. The law, Chapter 298 of the Laws of 2006, allows physical therapists with three years of practical experience to treat patients without a referral beginning November 23, 2006. It also requires physical therapists treating without a referral to provide certain information to the patient about the possibility that treatment without a referral may not be an expense covered by the patient's health care plan or insurer.

This document is intended to provide answers to the most frequent questions received from licensees and other interested parties regarding the changes to the law. When considering the information provided in the Question and Answer document, please keep in mind that law, rules and regulations, not guidelines, specify the requirements for practice and violating them constitutes professional misconduct.

If you have additional questions, you may contact the State Board by calling (518) 474-3817 ext. 180 or emailing ptbd@mail.nysed.gov.

1. What is the experience requirement?

   To treat patients without a referral a physical therapist must have at least three years of practical experience or the equivalent. The regulations define this experience as 4,320 hours, or 30 hours per week for 48 weeks per year. In addition, the experience must be achieved over a 36-month period; it cannot be accomplished in less time. Part-time experience is acceptable. For example, a physical therapist may have worked only 20 hours per week, which would mean that he/she could treat without referral after four-and-a-half years. Or, a physical therapist may work 36 hours per week for 40 weeks a year.

2. Do I have to register with the Education Department to be eligible?

   While there is no requirement for an additional registration with the Education Department to be eligible to provide treatment without a referral, a physical therapist providing any treatment in New York State must be licensed and registered to practice. The individual physical therapist is responsible for making the determination that he/she is qualified and eligible. However, Section 29.1(b)(1) of the Rules of the Board of Regents requires that a licensee accepting and performing professional responsibilities which the licensee knows or has reason to know that he or she is not competent to perform could result in charges of unprofessional conduct, and Section 29.17 provides that unprofessional conduct includes the failing to meet the requirements of subdivision (d) of Section 6731 of the Education Law and/or Section 77.9 of the rules of the Board of Regents.

3. What information is necessary for the Notice of Advice?

   At the beginning of treatment without a referral, the physical therapist must advise the patient in writing of the possibility that the treatment may not be covered by the patient's health care plan or insurer without a referral from a physician, dentist, podiatrist, or nurse practitioner and that the treatment may be a covered expense if rendered with a referral. The Notice of Advice must contain the following information:

   1. a statement of such advice and a statement attesting that the patient has read the Notice of Advice;
   2. the date treatment will begin;
   3. the patient's name and address;
   4. the patient's signature and date the patient signed the form;
   5. the treating physical therapist's name and address; and
   6. the treating physical therapist's signature and the date the physical therapist signed the form.
      
      
4. Do I have to have a separate form for the Notice of Advice or can it be combined with another form?

   The Notice of Advice form is not required to be a separate form. It can be combined with other forms.

5. Is the Notice of Advice part of the patient's record?

   Yes, it is to be included as part of a patient's record and treated the same as a patient record.

6. Does the Notice of Advice form have to be filled out even if the patient knows he/she will not be using a third party payor or insurance?

   Yes, the Notice of Advice form will still have to be filled out. The requirements for providing treatment without a referral are two:

   1. that the physical therapist providing the treatment have at least three years of practical experience, and
   2. that written notice be provided to the patient, a copy of which is to be kept by the physical therapist, that the treatment "may not be covered by the patient's health care plan or insurer without a referral and that such treatment may be a covered expense if rendered pursuant to a referral".
   
   
7. Is a Notice of Advice form needed in all practice settings?

   Yes. The law covers all treatment settings.

8. What happens if a patient refuses to sign the Notice of Advice form?

   The law requires the patient to sign the Notice of Advice form if treatment will be provided without a referral, and the physical therapist is responsible for ensuring that the patient has signed.

9. What constitutes 10 visits? Is an initial evaluation included in the 10 visits? How is the 30-day period counted?

   The ten visits begin when the first treatment is provided and ends when the patient is discharged from care after a maximum of 10 visits or 30 days. An initial evaluation is not included in the ten visits unless treatment begins at the same time. A patient may be treated again once the episode of care is complete, there is a change in the diagnosis or there is a new event that brings the patient back for treatment.

   1. Evaluation: Section 6731 of the Education Law allows a physical therapist to evaluate a patient without a referral. Therefore, unless a treatment happens at the same visit as the evaluation, it does not count as one of the 10 visits.
   2. Episode of care: An episode of care begins after the initial assessment or evaluation of the patient and the first treatment is provided. It ends when the patient is discharged from care or, for example, when the patient has reached the maximum therapeutic care or has reached the goals set during treatment, the patient decides that care is no longer necessary or wanted, or the patient self-discharges or has another medical event.
   3. Thirty days: The 30-day treatment period begins when the first treatment is provided and ends 30 calendar days thereafter. This time period includes weekends and holidays.
   
   
10. Is treatment without a referral restricted by the academic/professional degree a physical therapist has?

    No. The only requirements to be eligible are three years of practical experience (see number 1 above), and a currently registered New York State physical therapy license.

11. Is the address required by the Notice of Advice form the physical therapist's business address?

    Yes. It is expected that the address be the formal business address where the physical therapist practices.

12. Does the law allow a physical therapist treating without a referral to delegate treatment to a physical therapist assistant, a student or someone on a limited permit?

    Once the physical therapist with the direct access privilege has completed the evaluation, discussed the plan of care with the patient and determined the treatment plan, the care can be provided by a physical therapist assistant, a student or someone on a limited permit. However, only the physical therapist with the direct access privilege may alter the plan of care. Regardless of who provides the care, treatment without a referral is limited to 10 visits or 30 days, whichever occurs first.

13. If the physical therapist treating a patient without a referral is unable to provide treatment, can a physical therapist who does not have the privilege who is covering for the physical therapist provide the treatment?

    Once the physical therapist with the direct access privilege has completed the evaluation, discussed the plan of care with the patient and determined the treatment plan, care can be provided by a physical therapist who does not have the direct access privilege. However, only the physical therapist with the direct access privilege may alter the plan of care. Regardless of who provides the care, treatment without a referral is limited to 10 visits or 30 days, whichever occurs first.

14. Can a physical therapist licensed in another state with three years of practice experience qualify to treat without a referral in New York State?

    Yes. The practical experience can be acquired in another state, but to provide treatment in New York State the physical therapist must have a New York State license.

15. Does the law restrict the population that can be served or the facility where the treatment takes place?

    No. The law does not restrict the provision of treatment to any age level or site. However, there may be other limitations, such as insurance reimbursement or work-place policies that may restrict treatment being provided under direct access.