PT Practice Act Modernization: Frequently Asked Questions TST

Frequently Asked Questions about PT Practice Modernization

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  • The changes made to section 486, Florida Statutes are derived from The Model Practice Act for the Practice of Physical Therapy 6th Edition, as developed by the Federation of State Boards of Physical Therapy. It is regarded as the preeminent standard and most effective tool available for legislative change when revising and modernizing physical therapy practice acts. The continuing movement to update Physical Therapy Practice Acts helps ensure that legislatures provide the legal authority to fully protect the public while allowing for the effective regulation of the profession.
  • Additionally, FPTA formed a task force to provide input and direction towards developing these changes. The task force was made up of volunteers from our membership, the Board of Directors, and our legislative team.

By modernizing the language of the Practice Act, definitions of practice are updated to more accurately reflect the current state of practice while also adding clarity and protections to the practice of physical therapy.

The language in the definition of physical therapy assessment was broadened to include evaluation of “the movement system” instead of only “musculoskeletal or neuromuscular” systems. As changed, the definition now represents the true scope of what physical therapists are trained to do. The movement system describes the collection of systems (cardiovascular, pulmonary, endocrine, integumentary, nervous, and musculoskeletal) that interact to move the body or its component parts. Additionally, the physical therapy assessment definition was expanded to expressly include the therapist’s ability to evaluate not only motor power, but also motor control.

  • This definition was significantly altered to eliminate outdated and confusing language and to specifically identify the scope of practice to include treatment, prevention, and rehabilitation of “disability, injury, disease, or other health condition by alleviating impairments, functional movement limitations, and disabilities, by designing, implementing, and modifying treatment interventions through therapeutic exercise; functional movement training in self-management and in-home, community, or work integration or reintegration; manual therapy; massage; airway clearance techniques; maintaining and restoring the integumentary system and wound care; physical agent or modality; mechanical or electrotherapeutic modality; patient-related instruction;” etc. Now expressly identified in the new definition are manual therapy, airway clearance and wound care, as well as other clarifying language that brings the definition more in line with modern practice.
  • Eliminated were descriptions of how physical therapists use the physical, chemical, and other properties of air, electricity, and water, as well as other references to radiant energy, visible and infrared rays, and acupuncture when no penetration of the skin occurs under non-existent criteria established by the Board of Medicine. The meaning of the previous definition was the source of much confusion by the Administrative Law Judge during the rule challenge about dry needling – where it was made clear to those involved that the definition was in sore need of revision.
  • Lastly, the definition was revised to make plain that the practice of physical therapy does not authorize a physical therapist to perform acupuncture, in addition to the already present prohibition against performing chiropractic spinal manipulation.

The Legislature also defined “dry needling” in subsection 12 and “myofascial trigger point” in subsection 13. More specifically, the Legislature clarified in these definitions to note that dry needling is not acupuncture by differentiating dry needling as a skilled intervention based on Western Medicine that uses filiform needles to stimulate a myofascial trigger point for the evaluation and management of neuromusculoskeletal conditions, pain, movement impairments and disabilities. A myofascial trigger point is defined as an irritable section of soft tissue often associated with a palpable nodule in a taut band of muscle fibers.

Section 486.025, F.S. – “Powers and Duties of the Board of Physical Therapy Practice” – was revised to add responsibility to the Board to establish minimum standards of practice for the performance of dry needling by physical therapists who wish to avail themselves of this modern treatment tool. The revision additionally clarified the Board’s ability to personally inspect a school offering physical therapy courses and its courses.

  • The Legislature established a new statute in the Physical Therapy Practice Act to address dry needling. It is found at Section 486.117, F.S – “Physical therapist; performance of dry needling.” Here, the Legislature mandated that the Board of Physical Therapy engage in rulemaking to set the minimum standards for the performance of dry needling, but also included very specific criteria for the Board to include in the rule.
  • The statutory criteria are:
    - Completion of 2 years of practice as a licensed physical therapist;
    - Completion of 50 hours of face-to-face continuing education from an approved, accredited CE provider on dry needling to include specific subject matter on the theory of dry needling, safe handling and disposal of needles, indications and contraindications, psychomotor skills (including a determination from a physical therapist instructor that the licensee has the requisite psychomotor skills to safely needle), and postintervention care, including adverse event reporting and recording;
    - Completion of at least 25 sessions of dry needling performed under the supervision of a licensed physical therapist who has practiced dry needling for at least 1 year and who documents that the PT has successfully completed the supervised sessions and needs no further supervised sessions to dry needle, OR completion of 25 sessions of dry needling as a physical therapist licensed in another state or in the military.
  • The new statute also mandates that patients consent to dry needling, that dry needling cannot be delegated to anyone other than a properly trained and licensed physical therapist, and requires that the Department of Health track certain statistics related to the performance of dry needling, including the number of adverse incidents. 

This is not addressed in the new statute. However, during the legislative session, lawmakers discussed the ability to use telehealth to complete the supervision. During its initial discussion, the Board also seemed interested in allowing telehealth for supervision, but wanted to ensure that any telehealth allowed required the session to be synchronous and not asynchronous. There is no published guidance on this issue currently. Remember, if you choose to use a telehealth vehicle in patient care, patient privacy and consent are important factors to be addressed.

  • If a physical therapist already has the requisite training and experience outlined in the statute and can demonstrate compliance in writing if requested, then he or she may practice dry needling immediately.
  • If a physical therapist does not meet the current statutory requirements, he or she must wait until he or she can demonstrate compliance with each of the published criteria.
  • The Board of Physical Therapy has begun a rulemaking process to complete regulations for the minimum standards of performing dry needling. That process will take months and could add requirements for the physical therapist to perform dry needling. Once those rules are finalized, then all physical therapists who want to dry needle will need to meet both the statutory and rule requirements.

Overall, the standards were developed from a review of other state statutes and regulations, and from the experiences of PTs who have practiced dry needling. However, negotiating the standards during the legislative process was pivotal to our success.

  • The timeline started at the Board’s special hearing on rule development for dry needling on June 26. The board will continue development at its hearing on August 28. Once the Board adopts the final rule and procedures, including forms, etc., the rule will be reviewed by the state’s rule review process. Additionally, the rule can be challenged by outside interests.
  • We estimate at this point that the final adoption and approval of the rule will occur sometime during the fall.

By modernizing the language of the Practice Act, definitions of practice are updated to more accurately reflect the current state of practice while also adding clarity and protections to the practice of physical therapy. The modernization of the language in the Physical Therapy Practice Act now aligns with contemporary practice and more clearly defines the practice and interventions used to treat patients, clients and society. This includes the integration of the movement system and its components, which better identifies the practice of physical therapy for educating the public, other providers and payers.

  • Upon denial of the Dry Needling Rule in 2019, the FPTA Board of Directors created a special task force to develop a legislative option. The task force recommendations were vetted by legal counsel and the lobbying team, and then negotiations were conducted with special interests we believed would have concerns. These groups included the Florida Orthopedic Society, Florida Medical Association, Florida Osteopathic Medical Association, Florida Chiropractic Association, Florida Occupational Therapy Association, and others. FPTA also negotiated continuously with the Florida State Oriental Medical Association and Florida Acupuncture Association to find agreement on dry needling.
  • Along the way, FPTA advocacy and communications strategies using social media systems generated over 40,000 individual messages to legislators and the Governor. HB 467 and SB 792 passed all six committees and the full House of
    Representatives unanimously and passed the Senate 39-1.

 

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