1 The Missouri Practice Act A RESOURCE TO

1 The Missouri Practice Act A RESOURCE TO Good practice

Presented by: Members of the Advisory Commission for Physical Therapists u William Hopfinger PT, Chair St. Louis u Judi Pastorino, PTA, Secretary Columbia u Tamara Burlis, PT, Member St. Louis u Jim Dronberger, PT, Member Kansas City u Vacancy 2

Mission Statement Board of Healing Arts u“To protect the citizens of the State through the licensing of physicians and other health designated professionals, assessing their competence to practice and their moral character, and to investigate all complaints against its licensees in a fair and equitable manner. ” 3

Physical Therapy Advisory Commission serves the Board of Healing Arts and its mission u Primary role is to protect the public from incompetence, misconduct, gross negligence, fraud, misrepresentation or dishonesty u Licenses only “qualified” professionals by examination and evaluation of minimum competency u Enforces standards by implementing legislation and administrative rules 4

Licensing Boards vs. Professional Associations u Missouri State Board of Healing Arts Federation of State Boards of Physical Therapy 5

6 “The Practice Act”

www. mopt. org MYMPTA > ASSOCIATION DOCUMENTS > PRACTICE ACT M 7

http: //pr. mo. gov/physicaltherapists. asp 8

Statutes and Rules u. Statute = Law (if it starts with 334, it’s a statute) u Shall” – means you have to do this u “Must” – means you have to do this u “May” – means you should probably do this u. Rules = Statements promulgated through a formal process that further define statutes. These can be found in the Code of State Regulations. (if it starts with 20 CSR 2150… it’s a rule) 9

Statutes 334. 500 Starts here Definitions 334. 506 Physical therapists may provide certain services without prescription or direction of an approved health care provider, when--limitations 334. 507 Continuing education requirements 334. 510 License required, effective when 334. 520 Board to license 10

Statutes – let’s look at this one 334. 506 Physical therapists may provide certain services without prescription or direction of an approved health care provider, when--limitations 11

Statute 334. 506. 1 12 u u As used in this section, "approved health care provider" means a person holding a current and active license as a physician and surgeon under this chapter, a chiropractor under chapter 331, a dentist under chapter 332, a podiatrist under chapter 330, a physician assistant under this chapter, an advanced practice registered nurse under chapter 335, or any licensed and registered physician, chiropractor, dentist, or podiatrist practicing in another jurisdiction whose license is in good standing.

Statute 334. 506. 1 13 u u As used in this section, "approved health care provider" means a person holding a current and active license as a physician and surgeon under this chapter, a chiropractor under chapter 331, a dentist under chapter 332, a podiatrist under chapter 330, a physician assistant under this chapter, an advanced practice registered nurse under chapter 335, or any licensed and registered physician, chiropractor, dentist, or podiatrist practicing in another jurisdiction whose license is in good standing.

Statute 334. 506. 1 14 u u As used in this section, "approved health care provider" means a person holding a current and active license as a physician and surgeon under this chapter, a chiropractor under chapter 331, a dentist under chapter 332, a podiatrist under chapter 330, a physician assistant under this chapter, an advanced practice registered nurse under chapter 335, or any licensed and registered physician, chiropractor, dentist, or podiatrist practicing in another jurisdiction whose license is in good standing.

Statute 334. 506. 1 15 u u As used in this section, "approved health care provider" means a person holding a current and active license as a physician and surgeon under this chapter, a chiropractor under chapter 331, a dentist under chapter 332, a podiatrist under chapter 330, a physician assistant under this chapter, an advanced practice registered nurse under chapter 335, or any licensed and registered physician, chiropractor, dentist, or podiatrist practicing in another jurisdiction whose license is in good standing.

Statute 334. 506. 1 16 u u As used in this section, "approved health care provider" means a person holding a current and active license as a physician and surgeon under this chapter, a chiropractor under chapter 331, a dentist under chapter 332, a podiatrist under chapter 330, a physician assistant under this chapter, an advanced practice registered nurse under chapter 335, or any licensed and registered physician, chiropractor, dentist, or podiatrist practicing in another jurisdiction whose license is in good standing.

Statute 334. 506. 1 17 u u As used in this section, "approved health care provider" means a person holding a current and active license as a physician and surgeon under this chapter, a chiropractor under chapter 331, a dentist under chapter 332, a podiatrist under chapter 330, a physician assistant under this chapter, an advanced practice registered nurse under chapter 335, or any licensed and registered physician, chiropractor, dentist, or podiatrist practicing in another jurisdiction whose license is in good standing.

Statute 334. 506. 1 18 u u As used in this section, "approved health care provider" means a person holding a current and active license as a physician and surgeon under this chapter, a chiropractor under chapter 331, a dentist under chapter 332, a podiatrist under chapter 330, a physician assistant under this chapter, an advanced practice registered nurse under chapter 335, or any licensed and registered physician, chiropractor, dentist, or podiatrist practicing in another jurisdiction whose license is in good standing.

Statute 334. 506. 2 Shall not initiate treatment for a new injury or illness without a prescription u 19

Statute 334. 506. 3 May provide educational resources and training, develop fitness or wellness programs for asymptomatic persons, or provide screening and consultative services u 20

Statute 334. 506. 4 u 21 May examine and treat without the prescription and direction any person with a recurring self-limited* injury within one year of diagnosis or chronic illness* that has been previously diagnosed. The physical therapist shall: u 1. Contact patient’s current health care provider within seven days of initiating physical therapy services. u* To be defined…

Let’s look at the rules for a minute u 22 20 CSR 2150 -3. 200 u Recurring self-limiting injury = injury that occurs multiple times with a repeat of signs and symptoms for the initially diagnosed injury and does not precipitate additional injury or illness.

Let’s look at the rules for a minute u u 23 20 CSR 2150 -3. 200 Chronic Illness = the diagnosis of a disease process, illness or disability with a specified set of signs and symptoms and the continuation or progression of continued signs and symptoms consistent with the original diagnosis for >6 months

Statute 334. 506. 4 u 24 May examine and treat without the prescription and direction any person with a recurring self-limited* injury within one year of diagnosis or chronic illness* that has been previously diagnosed. The physical therapist shall: u 1. Contact patient’s current health care provider within seven days of initiating physical therapy services.

Statute 334. 506. 4 (continued) u 25 May examine and treat without the prescription and direction any person with a recurring self-limited injury within one year of diagnosis or chronic illness that has been previously diagnosed. The physical therapist shall: u 2. PT may not change an existing physical therapy referral available to the physical therapist without u the approval of the patient’s current health care u provider u

Statute 334. 506. 4 (continued) u 26 May examine and treat without the prescription and direction any person with a recurring self-limited injury within one year of diagnosis or chronic illness that has been previously diagnosed. The physical therapist shall: u u 3. PT will refer to an approved health care provider any patient whose medical condition at time of the examination or treatment is beyond the scope of the practice of physical therapy

Statute 334. 506. 4 (continued) u 27 May examine and treat without the prescription and direction any person with a recurring self-limited injury within one year of diagnosis or chronic illness that has been previously diagnosed. The physical therapist shall: u 4. Refer to an approved health care provider any patient u whose condition for which physical therapy services are u rendered under this subsection has not been u documented to be progressing toward documented u treatment goals after six visits or fourteen days, u whichever comes first

Statute 334. 506. 4 (continued) u 28 May examine and treat without the prescription and direction any person with a recurring self-limited injury within one year of diagnosis or chronic illness that has been previously diagnosed. The physical therapist shall: u 5. PT will notify the patient’s current approved health care u provider prior to the continuation of treatment if treatment u rendered under this subsection is to continue beyond thirty u days. The physical therapist shall provide such notification for each u successive period of thirty days.

Statute 334. 506. 5 u 29 The provision of physical therapy services of evaluation and screening pursuant to this section shall be limited to a physical therapist and any authority for evaluation and screening granted with this section may not be delegated. u Upon each re-initiation of services a PT shall provide a full PT evaluation prior to treatment. . Treatment may be delegated to a PTA only if patient’s current health care provider has been so informed as part of PT’s seven day notification

Statute 334. 506. 6 u 30 No person licensed to practice, or applicant for licensure, as a physical therapist or physical therapist assistant shall make a medical diagnosis.

Statute 334. 506. 7 u 31 A physical therapist shall only delegate physical therapy treatment u (1) to a physical therapist assistant or u (2) to a person in an entry level of a professional education program approved by the Commission for Accreditation of Physical Therapists and Physical Therapist Assistant Education (CAPTE) who satisfies supervised clinical education requirements related to the person's physical therapist or physical therapist assistant education. The entry-level person shall be under onsite supervision of a physical therapist.

Continuing Education 32 u 20 CSR 2150 -3. 20 (Rule) • 30 hours required by all PTs and PTAs • 24 -month reporting period begins January 1 of an even-number year and ends December 31 of odd-number year • Extra hours cannot be carried over to next reporting period • Failure to obtain and report continuing education = license will not be renewed

Continuing Education (CE) u 33 20 CSR 2150 -3. 203 (Rule) u Acceptable continuing education is defined as education obtained for the purpose of maintaining, expanding and/or developing new and/or improved skills and knowledge directly related to the practice of physical therapy, which contributes to professional competence of the licensee. u

Continuing Education (CE) u u 34 20 CSR 2150 -3. 203 (Rule) Missouri BOHA and/or PT Advisory Commission will not preapprove courses or activities. The burden is on the licensee. However, courses are automatically acceptable if obtained as follows: u APTA (or any of its components including state chapters) u AMA (must at least in part relate to practice of PT) u AOA (must at least in part relate to practice of PT) u FSBPT

Continuing Education (CE) 35 u 20 CSR 2150 -3. 201 (Rule) u Licensee who fails to obtain and report in a timely fashion shall not engage in the practice of physical therapy unless an extension is granted. (see reference section re: extensions) u For a lapsed license, PT/PTA must submit documentation confirming completion of all continuing education hours during the period the license was not current.

Continuing Education (CE) u 36 20 CSR 2150 -3. 201 (Rule) u u All licensees shall retain records documenting attendance and completion of the required thirty hours for a minimum of four years after reporting period. u u Records shall document title, date, location, course sponsor and number of hours earned. u The board may conduct an audit to verify compliance. Licensees shall assist this audit by providing timely and complete responses.

Supervision of Physical Therapist Assistants u 37 334. 650. 2 A licensed physical therapist shall direct and supervise a physical therapist assistant. The physical therapist shall retain ultimate authority and responsibility for the physical therapy treatment. The licensed physical therapist shall have the responsibility of supervising the physical therapy treatment program.

Supervision of Physical Therapist Assistants 38 334. 650. 2 (continued) u u No physical therapist may establish a treating office in which the physical therapist assistant is the primary care provider. u No licensed physical therapist shall have under their direct u supervision more than four full-time equivalent physical therapist assistants and shall be predicated by the following factors: u ► the complexity and acuity of the patient, u ► proximity and accessibility to the PT u

Supervision of Physical Therapist Assistants 39 u 20 CSR 2150 -3. 090 u A licensed PT must direct and supervise a PTA at all times. The PT holds responsibility of supervision of the PT treatment program. The following responsibilities are maintained by the PT: (A) Interpretation of referrals (B) Initial examination and problem identification (C) Development or modification of a plan of care which includes the PT treatment goals (D) Determination of which tasks require PT and which can be delegated to PTA…(continued)

Supervision of Physical Therapist Assistants u 40 20 CSR 2150 -3. 090 (continued) A licensed PT must direct and supervise a PTA at all times. The PT holds u responsibility of supervision of the PT treatment program. The following u responsibilities are maintained by the PT: u u (E) Delegation and instruction of the services to be rendered by a PTA (F) Timely renew of treatment documentation, re-evaluation of the patient and the patient’s treatment goals, at least every 30 days with revision of the plan of care as needed. (G) Patient care and management shall include accurate documentation and billing of the services provided.

Supervision of Physical Therapist Assistants u 41 20 CSR 2150 -3. 090 When supervising a PTA, the following requirements must be u maintained: u u (A) The initial visit, evaluation and treatment plan must be made by a PT (B) There must be regularly scheduled reassessments by the PT every 30 days

Supervision of Physical Therapist Assistants u 42 20 CSR 2150 -3. 090 (continued) When supervising a PTA, the following requirements must be u maintained: u u u (C) There must be conferences with the PT and PTA regarding patients at least weekly or more often. Evidence of PT conferences with the PTA need to be documented at least every 30 days (D) A licensed PT must be accessible by telecommunication to the PTA at all times while the PTA is treating patients

Supervision of Physical Therapist Assistants u 43 20 CSR 2150 -3. 090 (continued) When supervising a PTA, the following requirements must be u maintained: u u (E) A supervisory visit should include an on-site reassessment of the patient, plan of care, assessment for utilization of outside resources. On-site defined as wherever it is required to have an on-site licensed PT to provide services.

Licensure u Qualifications for license—examinations, scope u 334. 530. 1 44 PT candidate shall be at least 21 years old (PTA candidate must be at u least 19 years old per 334. 655) u u Candidate shall furnish evidence of good moral character Candidate shall furnish evidence of successful completion of program u in PT approved by the Commission on Accreditation in Physical u Therapy Education (CAPTE) u

Licensure 45 u Jurisprudence Examination u 334. 530. u The applicant shall pass a test administered by the board on the statutes and rules related to the practice of physical therapy in Missouri. u The Jurisprudence examination will consist of 20 Questions o o 10 True/False 10 Multiple Choice o The examination is Open Book: must achieve a score of at least 75% to pass

Medical Records 46 u This issue is part of the Practice Act u 334. 602. 1 Physical therapists and physical therapist assistants shall provide documentation in order that an adequate and complete patient record can be maintained. All patient records shall be legible and available for review and shall include at a minimum documentation of the following information: (1) Identification of the patient, including name, birth date, address, and telephone number; (2) The date or dates the patient was seen; (3) The current status of the patient, including the reason for the visit; (continued) u u u

Medical Records u This issue is part of the Practice Act u 334. 602. 1 (continued) u u u u (4) Observation of pertinent physical findings; (5) Assessment and clinical impression of physical therapy diagnosis; (6) Plan of care and treatment; (7) Documentation of progress toward goals; (8) Informed consent; (9) Discharge summary 47

Medical Records 48 u 334. 602. 1 u Patient records remaining under the care, custody, and control of the licensee shall be maintained by the licensee of the board, or the licensee's designee, for a minimum of seven years from the date of when the last professional service was provided.

Medical Records 49 u 334. 602. 1 u Any correction, addition, or change in any patient record shall be clearly marked and identified as such, and the date, time, and name of the person making the correction, addition, or change shall be included, as well as the reason for the correction, addition, or change.

Disciplinary Process 50 u u Complaints addressed to the Board of Healing Arts must be typed or handwritten and signed by the complainant. u Complainant must be identified by name and address. u Anonymous Complaints – May be investigated, based on type of complaint

Disciplinary Process u 51 INVESTIGATIVE PROCESS n n u Complaint received by the board Reviewed by Board’s Complaint Review Committee for the purpose of determining the type of investigation to be conducted Licensee is notified (except in cases involving fraud or sexual misconduct) Licensee, Complainant and Witnesses, if applicable, are interviewed and supporting documentation is obtained (continued)

Disciplinary Process u INVESTIGATIVE PROCESS (continued) Investigation completed/report submitted n Reviewed by Advisory Commission n Reviewed by Board of Healing Arts n Complaint process takes approximately 6 months to complete n 52

Disciplinary Process 53 u. ACTIONS THE BOARD MAY TAKE THAT ARE NOT PUBLIC n. Close case n. Request further investigation n. Direct appearance before Advisory Commission or Board n. Letter of Concern (private communication between the Board & Licensee)

Disciplinary Process u. ACTIONS THE BOARD MAY TAKE THAT BECOME PUBLIC u Offer Settlement Agreement or File Complaint at Administrative Hearing u Commission possibly resulting in: n. Reprimand n. Probation (Up to 10 years) n. Restriction n. Suspension (Up to 3 years) n. Revocation (Up to 7 years) n. Automatic revocation hearing resulting from a felony conviction or revocation in another state (see Reference Material) 54

Disciplinary Process 55 u u 334. 614. 1 The board shall at least quarterly publish the names and addresses of all PT/PTAs whose licenses have been disciplined u u 334. 614. 2 Board should prepare and make available to the public a report on disciplinary matters submitted where the board recommends disciplinary action. If board decides no action should be taken, a report shall be prepared and forwarded to complaining party.

Reference Material u The following section expands on the following topics: u ► Advisory Commission u ► Statues and Rules u ► Owned Physical Therapy Services (POPTS) u ► Continuing Education u ► Clear and Present Danger u ► Competency u ► Revocation of license u ► Therapists who predominant language is not English u ► Licensure and testing 56

Reference Material 57 u About the PT Advisory Commission: u. Appointed by the Governor with the advice and consent of the Senate; u. Must be a citizen of the United States; and a resident of the State of Missouri u. Four members - licensed to practice as a physical therapist u. One member - licensed to practice as a physical therapist assistant

Reference Material 58 u Things to know when reviewing a statute u When was the statute revised? u At the end of each section there is in parentheses a record of when the document was last changed. u Example: (A. L. 2008 S. B. 788) u A. L. . = Amended Law

Reference Material 59 u Statute Revision Process u Commission drafts proposed language with assistance from board staff and legal counsel u Reviewed by: u Board of Healing Arts u Division of Professional Registration u Department of Insurance, Etc. u Governor’s Office

Reference Material u Statute Revision Process (continued) u House Sponsor obtained u Senate Sponsor obtained u House & Senate Committee hearings held u Obtain approval by both House & Senate u Signed by Governor u u 60

Reference Material 61 u Administrative Rule Process: u Rulemaking authority. 334. 687. For purposes of this section, the licensing of physical therapists and physical therapist assistants shall take place within processes established by the state board of registration for the healing arts through rules. u The board of healing arts is authorized to adopt rules establishing licensing and renewal procedures, supervision of physical therapist assistants, and former licensees who wish to return to the practice of physical therapy, fees, and addressing such other matters as are necessary to protect the public and discipline the profession.

Reference Material 62 u. Administrative Rule Process: u Commission drafts proposed rule with assistance from board staff and legal counsel u Reviewed by: u. Board u. Division of Professional Registration u. Department of Insurance, Etc. u. Governor’s Office u. Secretary of State’s Office

Reference Material u. Administrative Rule Process: u Published in Missouri Register u 30 Day Comment Period u Commission reviews comments and may or may not make changes subject to Board approval u Files Final Order of Rulemaking with Secretary of State u Approximately 6 - 9 month process u Joint Committee on Administrative Rules may suspend an order of rulemaking and hold a hearing 63

Reference Material 64 u Physician Owned Physical Therapy Services (POPTS) u 334. 253. 1. u A physician may not make a referral to an entity for the furnishing of any physical therapy services with whom the physician, physician's employer, or immediate family member of such referring physician has a financial relationship. A financial relationship exists if the referring physician, the referring physician's employer, or immediate family member: u (1) Has a direct or indirect ownership or investment interest in the entity whether through equity, debt, or other means; or u (2) Receives remuneration from a compensation arrangement from the entity for the referral.

Reference Material u 65 Physician Owned Physical Therapy Services (POPTS) u 334. 253. 2 u The following financial arrangements shall be exempt from disciplinary action under this section: u (1) When the entity with whom the referring physician has an ownership or investment interest is the sole provider of the physical therapy service within a rural area;

Reference Material u 66 Physician Owned Physical Therapy Services (POPTS) u 334. 253. 2 u The following financial arrangements shall be exempt from disciplinary action under this section: u (2) When the referring physician owns registered securities issued by a publicly held corporation or publicly traded limited partnership, the shares of which are traded on a national exchange or the over-the-counter market, provided that such referring physician's interest in the publicly held corporation or publicly traded limited partnership is less than five percent and the referring physician does not receive any compensation from such publicly held corporation or publicly traded limited partnership other than as any other owner of the shares of such publicly held corporation or publicly traded limited partnership;

Reference Material u 67 Physician Owned Physical Therapy Services (POPTS) u 334. 253. 2 u The following financial arrangements shall be exempt from disciplinary action under this section: u (3) When the referring physician has an interest in real property resulting in a landlord-tenant relationship between the physician and the entity in which the equity interest is held, unless the rent is determined, in whole or in part, by the business volume or profitability of the tenant or is otherwise unrelated to fair market value;

Reference Material u 68 Physician Owned Physical Therapy Services (POPTS) u 334. 253. 2 u The following financial arrangements shall be exempt from disciplinary action under this section: u (4) When the indirect ownership in the entity is by means of a bona fide debt incurred in the purchase or acquisition of the entity for a price which does not in any manner reflect the potential source of referrals from the physician with the indirect interest in the entity and the terms of the debt are fair market value, and neither the amount or the terms of the debt in any manner, directly or indirectly, constitutes a form of compensating such physician for the source of his business;

Reference Material u 69 Physician Owned Physical Therapy Services (POPTS) u 334. 253. 2 u The following financial arrangements shall be exempt from disciplinary action under this section: u (5) When such physician's employer is a HMO as defined in subdivision (6) of section 376. 960, RSMo, and such HMO owns or controls other organizations which furnish physical therapy services so long as the referral is to such owned or controlled organization and the physician does not also have a direct or indirect ownership or investment interest in such organization, physical therapy services or the health maintenance organization and the referring physician does not receive any remuneration as the result of the referral;

Reference Material u 70 Physician Owned Physical Therapy Services (POPTS) u 334. 253. 2 u The following financial arrangements shall be exempt from disciplinary action under this section: u (6) When such physician's employer is a hospital defined in section 197. 020, RSMo, and such hospital owns or controls other organizations which furnish physical therapy services so long as the referral is to such owned or controlled organization and the physician does not also have a direct or indirect ownership or investment interest in such organization, physical therapy service, or the hospital and the referring physician does not receive any remuneration as the result of the referral.

Reference Material u 71 Physician Owned Physical Therapy Services (POPTS) u 334. 613. 2(18) (grounds for discipline) u Any candidate for licensure or person licensed to practice as a PT/PTA paying or offering to pay a referral fee or, notwithstanding section 334. 010 to the contrary, practicing or offering to practice professional physical therapy independent of the prescription and direction of a person licensed and registered as a physician and surgeon under this chapter, as a physician assistant under this chapter, as a chiropractor under chapter 331, as a dentist under chapter 332, as a podiatrist under chapter 330, as an advanced practice registered nurse under chapter 335, or….

Reference Material u 72 Physician Owned Physical Therapy Services (POPTS) u 334. 613. 2(18) (grounds for discipline) u Any candidate for licensure or person licensed to practice as a PT/PTA paying or offering to pay a referral fee or, notwithstanding section 334. 010 to… u …any licensed and registered physician, chiropractor, dentist, podiatrist, or advanced registered nurse practicing in another jurisdiction, whose license is in good standing

Reference Material u 73 Physician Owned Physical Therapy Services (POPTS) u 334. 613. 2(18) (grounds for discipline) u Any candidate for licensure or person licensed to practice as a PT/PTA who requests, receives, participates or engages directly or indirectly in the division, transferring, assigning, rebating or refunding of fees received for professional services or profits by means of credit or other valuable consideration such as wages, an unearned commission, discount or gratuity with any person who referred a patient, or with any relative or business associate of the referring person

Reference Material 74 u Continuing Education: u 20 CSR 2150 -3. 20 u u An hour of CE is defined as a minimum of 50 minutes and up to a maximum of 60 minutes spent in actual attendance at and completion of an approved CE activity.

Reference Material 75 Continuing Education: u u 20 CSR 2150 -3. 201 (Rule) - Exemptions: u u PT/PTAs are exempt from (½) of the total continuing education hours required, for the year in which the licensee graduated from a PT/PTA program. u Military called to active duty for a majority of the reporting period will be exempt from obtaining continuing education. The licensee must submit written documentation from military authorities verifying active duty.

Reference Material 76 Continuing Education: u u 20 CSR 2150 -3. 202 (Rule) - Extensions: u u An extension must be requested prior to December 31 and shall be accompanied by the processing fee of $50, sufficient documentation and justification supporting reason why an extension is needed. u Licensee should not engage in active practice until receiving written authorization from the board.

Reference Material 77 Continuing Education: u u 20 CSR 2150 -3. 202 (Rule) - Extensions: u u (1)(B) Illness Extensions may be granted for personal illness and/or personal disability of a nature which prevents from engaging in active practice for at least a majority of the reporting period. u u Written documentation from treating physician specifying the nature of illness or disability and limitations that resulted. Shall submit written documentation and evidence as to number of CE hours earned and plan for completing balance of hours needed.

Reference Material u 78 Continuing Education: 20 CSR 2150 -3. 202 (Rule) - Extensions: u u (2) If granted an extension, the PT/PTA shall complete the balance of hours by February 28 and submit written documentation by March 10 th. Failure to do this will be grounds for disciplinary action u (3) Violation of this rule shall constitute misconduct, fraud, misrepresentation, dishonesty, unethical conduct or unprofessional conduct.

Reference Material u Continuing Education: u 20 CSR 2150 -3. 203 (Rule) u 79 Criteria to qualify for acceptable continuing education: (A) Organized program of learning with specified goals and objectives u (B) Course instructor must have education, training and/or level of experience to be considered qualified or expert u (C) Subject matter integrally relates to practice of physical therapy u

Reference Material u u 80 Continuing Education: 20 CSR 2150 -3. 203 (Rule) u Courses automatically acceptable if obtained as follows: u Academic Coursework at accredited college or university in subject matter directly related to the practice of physical therapy n n Earn grade C or above 1 semester credit hour = 10 hours of CE 1 trimester credit hour = 8 hours of CE ¼ credit hour = 7 hours of CE

Reference Material u 81 Continuing Education: u 20 CSR 2150 -3. 203 (Rule) u PROOF: o Require written documentation or certificate of attendance that includes name, date, time, location, sponsor, actual continuing education hours o PT/PTA shall retain course outline and/or goals objectives o Academic Coursework: Official Transcript indicating successful completion of coursework of at least a “C”

Reference Material 82 Continuing Education: other forms of CE u 20 CSR 2150 -3. 203 (Rule) u u Participation and completion of a recognized post-graduate clinical residency program One hour of CE for each hour of participation Proof: Certificate of completion with signature of the program director identifying the licensee as a participant in a specified clinical residency program and specifically detailing actual hours of the licensee’s participation in the program.

Reference Material 83 Continuing Education: other forms of CE u 20 CSR 2150 -3. 203 (Rule) u u APTA or other nationally recognized physical therapy association specialty certification or specialty recertification. u 30 hours of CE for the reporting period in which the specialty certification or recertification was awarded. u Proof: Official documentation confirming the specific licensee as successfully passing the specialty certification or recertification.

Reference Material 84 Continuing Education: other forms of CE u 20 CSR 2150 -3. 203 (Rule) u Professional program presentations presented by licensee in subject matter directly related to practice of physical therapy delivered in a lecture and/or demonstration format other than academic curricula. u ► First time shall be creditable for 3 hours of CE for each hour of actual presentation time. (i. e. 3: 1) u ► Maximum shall not exceed 15 hours during 2 year reporting period. u ► Second time creditable for 1 hour of CE for each hour of actual presentation time. (i. e. , 1: 1) u

Reference Material 85 Continuing Education: other forms of CE u 20 CSR 2150 -3. 203 (Rule) u Professional program presentations (continued) u u Presentations given more than 2 times in any 2 year reporting u period is not acceptable for CE hours. u u u Proof: Written announcement of a presentation schedule and/or brochure identifying the licensee as the presenter and meets criteria and integrally relates to the practice of physical therapy).

Reference Material 86 Continuing Education: other forms of CE u 20 CSR 2150 -3. 203 (Rule) u u Participation in research activities which result in publication in professional peer-reviewed physical therapy or medical publication Creditable for 5 hours of CE Proof: Copy of the publication or manuscript specifically identifying the licensee as a participant in the research activities necessary consistent with the topic presented, along with a copy of the cover of the professional presentation.

Reference Material 87 Continuing Education: other forms of CE u 20 CSR 2150 -3. 203 (Rule) u u Abstract publications and/or presentations u Creditable for 2 hours of CE provided such abstract is accepted for presentation at a professional physical therapy conference or for publication in a peer-reviewed physical therapy or medical publication. u Proof: Copy of abstract publication or presentation as accepted for presentation at a professional physical therapy conference or publication specifically identifying the licensee as the author.

Reference Material u 88 Continuing Education: other forms of CE u 20 CSR 2150 -3. 203 (Rule) (5) Publication of a chapter in a peer-reviewed physical therapy of medical publication u Creditable for 5 hours of CE u Proof: Copy of the chapter as published

Reference Material u u u 89 Continuing Education: other forms of CE 20 CSR 2150 -3. 203 (Rule) Videotaped presentation reviews which identify a specific sponsor, sponsoring group or agency, provided that the videotaped presentation meets criteria u Proof: Certificate of completion of a videotaped presentation review

Reference Material u 90 Continuing Education: other forms of CE u 20 CSR 2150 -3. 203 (Rule) u Home Study Courses u Creditable for the number of hours specified on the certificate on completion u Proof: Certificate of completion

Reference Material 91 Continuing Education: other forms of CE u 20 CSR 2150 -3. 203 (Rule) u u u Grand Rounds Creditable for each hour of actual attendance Proof: u Certificate identifying the licensee’s attendance and the subject matter presented to include the number of hours present bearing signature of the facility administrator who conducted/presented the Grand Round u

Reference Material 92 Continuing Education: other forms of CE u 20 CSR 2150 -3. 203 (Rule) u u CPR – shall only be applicable once during each two year reporting period u Creditable for each hour of actual attendance Proof: u Copy of CPR certification/recertification including date and number of u hours in actual attendance u

Reference Material u u u 93 Continuing Education: other forms of CE 20 CSR 2150 -3. 203 (Rule) All licensed physical therapists who act as a clinical instructor for a student enrolled in a CAPTE accredited physical therapist or physical therapist assistant program or who supervise an American Physical Therapy Association approved physical therapist resident or fellow will be granted 1 contact hour for every 120 total hours of supervision. (assuming 8 hr. day, this = 15 days)

Reference Material u u u 94 Continuing Education: other forms of CE 20 CSR 2150 -3. 203 (Rule) Clinical instructors or licensed PT’s and PTA’s who supervise a physical therapist in a residency or fellowship program shall be eligible for CE. The maximum total of contact hours per reporting period shall be 5. A certificate of completion of these hours from the academic institution or residency or fellowship program shall be the necessary documentation to submit proof.

Reference Material u Continuing Education: other forms of CE 20 CSR 2150 -3. 203 (Rule) u u u 95 For PTA supervisors: all licensed physical therapists assistants who act as a clinical instructor for a student enrolled in a CAPTE accredited physical therapists assistant program will be granted 1 contact hour for every 120 total hours of supervision. The maximum total of contact hours per reporting period shall be 5. A certificate of completion of these hours from the academic institution shall be the necessary documentation to submit proof.

Reference Material 96 u. Clear and present danger u 334. 615 u This section discusses the action the board may take should a PT/PTA present a clear and present danger to the public health and safety u

Reference Material 97 u. Determination of Competency u 20 CSR 2150 -3. 085 u Whenever board has reason to believe that a PT/PTA is unable to practice with reasonable skill and safety, the board may hold a hearing to determine whether probable cause exists to re-examine to establish competency, examine a pattern and practice of professional conduct, or examine to determine mental or physical competency or both

Reference Material 98 u Automatic revocation of license u u 334. 616. 1 When licensee has been found guilty or plead guilty in a felony criminal prosecution for any offense reasonably related to the qualifications, functions or duties of their profession or for any felony offense, an essential element of which is fraud, dishonesty or an act of violence, or for moral turpitude. u u 334. 616. 2 Anyone who has been denied a license, permit or certificate to practice in another state shall automatically be denied a license to practice in Missouri

Reference Material 99 u Applicant from country in which predominant language is not English u 20 CSR 2150 -3. 010 u. Rule change (September 2015 – Missouri Register): if a therapist is “from a country in which the predominate language is not English” but has graduated from a physical therapy program in the United States, he/she is not required to take the Test of English as a Foreign Language (TOEFL). u. Additionally, “any applicant who has graduated from a physical therapy program outside the United States shall provide documentation that the primary language of instruction in the physical therapy program was English” to avoid having to take the TOEFL.

Reference Material 100 u Applicant from country in which predominant language is not English u 20 CSR 2150 -3. 010 (A)TOEFL (Test of English as a Foreign Language) with total score of 550 (B)Certificate of current TOEFL computer based testing certificate obtained score of 220 and current TSE (Test of Spoken English) (C)Current TOEFL internet based test certificate with scores of: Writing 24; Speaking 26; Reading Comprehension 21; Listening Comprehension 18, and a total score of 89

Reference Material 101 Examination for licensure: u The Missouri requirement that the licensure examination be passed within 3 attempts – has been eliminated. u u However, the exam can only be taken 3 times in a calendar year, and u FSBPT limits the number of attempts to six