Physical Therapist Assistants—Direction, Delegation, and Supervision

PURPOSE: The rule provides information regarding supervision of physical therapist assistants by licensed physical therapists. (1) A licensed physical therapist must direct and supervise a physical therapist assistant at all times. The licensed physical therapist holds responsibility of supervision of the physical therapy treatment program. The following responsibilities are maintained by the licensed physical therapist: (A) Interpretation of referrals; (B) Initial evaluation and problem identification; (C) Development or modification of a plan of care which includes the physical therapy treatment goals; (D) Determination of which tasks require the expertise and decision making capacity of the physical therapist, and must be personally rendered by the physical therapist and which tasks may be delegated to the physical therapist assistant; (E) Delegation and instruction of the services to be rendered by the physical therapist assistant, including specific treatment program, precautions, special problems, or contraindicated procedures; (F) Timely review of treatment documentation, reevaluation of the patient and patient’s treatment goals, at least every thirty (30) days and revision of the plan of care when indicated; and (G) A physical therapist’s responsibility for patient care and management shall include accurate documentation and billing of the services provided. (2) The number of physical therapist assistants that a licensed physical therapist can supervise should not exceed four (4) full-time equivalent physical therapist assistants and shall be predicated on the following factors: the complexity and acuity of the patient’s needs, proximity and accessibility to the physical therapist. (3) When supervising the physical therapist assistant, the following requirements must be maintained: (A) The initial visit, evaluation, and treatment plan must be made by a licensed physical therapist; (B) There must be regularly scheduled reassessments of patients by the physical therapist at least every thirty (30) days; (C) There must be conferences with the physical therapist assistant regarding patients, at least weekly or more often, as determined by the complexity and acuity of the patient’s needs. Evidence of conferences with the physical therapist assistant needs to be documented at least every thirty (30) days; (D) A licensed physical therapist must be accessible by telecommunication to the physical therapist assistant at all times while the physical therapist assistant is treating patients; and (E) A supervisory visit should include: an on-site reassessment of the patient, on-site review of the plan of care with appropriate revision or termination, and assessment for the utilization of outside resources. On-site shall be defined as wherever it is required to have an on-site licensed physical therapist to provide services. AUTHORITY: section 334.125, RSMo 2000 and sections 334.500, 334.650, and 334.687, RSMo Supp. 2008.* This rule originally filed as 4 CSR 150-3.090. Original rule filed Dec. 14, 1994, effective June 30, 1995. Amended: Filed Nov. 16, 1998, effective July 30, 1999. Moved to 20 CSR 21503.090, effective Aug. 28, 2006. Amended: Filed July 11, 2007, effective Jan. 30, 2008. Amended: Filed March 30, 2009, effective Nov. 30, 2009. *Original authority: 334.125, RSMo 1959, amended 1993, 1995; 334.500, RSMo 1969, amended 1993, 1995, 1996, 2008; 334.650, RSMo 1996; and 334.687, RSMo 2008.