172 Neb. Admin. Code, ch. 137, § 008

Current through June 17, 2024

Section 172-137-008 - REQUIREMENTS FOR SUPERVISION OF PHYSICAL THERAPIST ASSISTANTS

A physical therapist supervising a physical therapist assistant must meet the following requirements of supervision

(A) A physical therapist may provide general supervision for no more than 2 physical therapist assistants at any point in time during the physical therapist's work day;

(B) All physical therapy services performed by a physical therapist assistant under the general supervision of a supervising physical therapist:

(i) All telecommunications must be documented in the medical records of patients under care of the supervising physical therapist; and

(ii) When the supervising physical therapist is unavailable, they must transfer responsibility of all patient care to another qualified physical therapist who will assume responsibility for all patient care including those being rendered by the physical therapist assistant under general supervision; and

(C) The supervising physical therapist maintains primary responsibility for all patient care services including those rendered by a physical therapist assistant under general supervision;

(D) A supervising physical therapist must re-evaluate or re-examine each patient and the plan of care of the patient receiving physical therapy services from a physical therapist assistant a minimum of least 1 time every 30 calendar days under general supervision. More frequent re-evaluations or re-examinations by the supervising physical therapist may be warranted, dependent upon the following parameters:

(i) Patient complexity and acuity;

(ii) Upon request by the physical therapist assistant;

(iii) When a change in treatment plan is warranted;

(iv) Any significant change in the medical status of the patient; and

(v) Upon request by the patient; and

(E) The supervising physical therapist must provide final documentation for discharge of patient care being rendered by a physical therapist assistant under general supervision, including patient response to treatment at the time of discharge; and

(F) The physical therapist assistant may participate in the discharge process for patient care by providing subjective and objective patient information to the supervising physical therapist.

008.01GENERAL SUPERVISION OF THE PHYSICAL THERAPIST ASSISTANT IN SATELLITE CLINICS. A physical therapist may supervise a physical therapist assistant in a satellite clinic under general supervision. Satellite clinics include but are not limited to:

(1) Rehabilitation facilities;

(2) Acute care facilities;

(3) Skilled nursing facilities;

(4) Nursing homes;

(5) Schools-based settings;

(6) Outpatient clinics;

(7) Home health; and

(8) Client preventative facilities.

008.01(A)SUPERVISION OF A PHYSICAL THERAPIST ASSISTANT IN A SATELLITE CLINIC. When a physical therapist assistant is rendering physical therapy services in a satellite clinic, the following requirements apply as well as 172 NAC 137-009, items 1-6:

(i) A supervisory visit with the physical therapist will be made every 30 days or at a higher frequency if warranted. More frequent re-evaluations or re-examinations by the supervising physical therapist may be warranted, dependent upon the following parameters:

(1) Patient complexity and acuity;

(2) Upon request by the physical therapist assistant;

(3) When a change in treatment plan is warranted;

(4) Any significant change in the medical status of the patient; and

(5) Upon request by the patient; and

(ii) A supervisory visit as defined in 172 NAC 137-002 may occur in any clinical setting where the supervising physical therapist renders patient care. The on-site visit must include:

(1) Direct patient contact for the purpose of reevaluation or re-examination of patient status;

(2) A review of the plan of care with revision and or termination of treatment as warranted; and

(3) A re-assessment for utilization of outside resources for physical therapy services; and

(iii) The supervising physical therapist must provide final documentation for discharge of patient care being rendered by a physical therapist assistant in a satellite clinic under general supervision, including patient response to treatment at the time of discharge. The physical therapist assistant may participate in the discharge process for patient care by providing subjective and objective patient information to the supervising physical therapist; and

(iv) A physical therapist is not authorized to establish a satellite clinic for the purpose of rendering physical therapy services staffed solely by a physical therapist assistant.

008.02REQUIREMENTS FOR THE ASSIGNMENT OF SERVICES TO PHYSICAL THERAPIST ASSISTANTS. It is the responsibility of the supervising physical therapist to determine which tasks require the clinical reasoning expertise of the physical therapist and which tasks can be safely assigned to the physical therapist assistant under general supervision.

008.02(A)ASSIGNMENT OF SERVICES, PATIENT OR CLIENT MANAGEMENT. Assignment of services related to patient or client management is dependent upon the clinical practice setting in addition to patient complexity and acuity. Clinical practice settings include but are not limited to:

(i) Rehabilitation facilities;

(ii) Acute care facilities;

(iii) Skilled nursing facilities;

(iv) Nursing homes;

(v) School-based settings;

(vi) Out-patient clinics;

(vii) Home health;

(viii) Industrial rehabilitation facilities; and

(ix) Client preventative services.

008.02(B)ASSIGNMENT OF PATIENT OR CLIENT SERVICES TO A PHYSICAL THERAPIST ASSISTANT. Patient complexity and acuity must also be considered when a physical therapist assigns patient or client services to a physical therapist assistant. The supervising physical therapist must exercise professional judgment when determining what services can or cannot be assigned to the physical therapist assistant.

008.02(B)(i)FACTORS IN DIRECT PATIENT CARE. The following factors inherent in direct patient care must be considered by the supervising physical therapist when assigning services, and must be commensurate with the education, training, and experience of the physical therapist assistant under general supervision. These factors apply to all clinical settings where physical therapy services are rendered by a physical therapist assistant under general supervision:

(1) Predictability of action - How confident is the physical therapist assistant in predicting consequences of action related to patient care?

(2) Stability of the environment - How confident is the physical therapist assistant in clinical problem solving issues related to change in patient status?

(3) Observability of patient status - How easy is it to observe or perceive relevant clinical indicators of patient status?

(4) Ambiguity of patient status - How difficult is it to interpret phenomena related to change in relevant clinical indicators? and

(5) Criticality of patient treatment - What consequences exist for a poor choice in patient intervention?

008.03RESPONSIBILITY OF THE SUPERVISING PHYSICAL THERAPIST. For each patient under their care, a physical therapist must:

(A) Be responsible for managing all aspects of physical therapy services provided to the patient and assume legal liability for physical therapy and related services provided under their supervision;

(B) Provide initial evaluation and documentation of the evaluation;

(C) Provide periodic reevaluation and documentation of the reevaluation;

(D) Provide documentation for discharge, including the patient's response to therapeutic intervention at the time of discharge;

(E) Be responsible for accurate documentation and billing for services provided; and

(F) On each date physical therapy services are provided to a patient, a physical therapist must:

(i) Provide all therapeutic interventions that require the expertise of a physical therapist for example, sharp wound debridement and high velocity low amplitude manual therapy techniques; and

(ii) Determine the appropriate use of physical therapist assistants or physical therapy aides.

172 Neb. Admin. Code, ch. 137, § 008

Amended effective 6/20/2020