Learning Outcomes
- List two sources of law that govern physical therapy practice in Indiana.
- Identify the clinical scope of physical therapy practice in Indiana based on the most recent Indiana Physical Therapy Practice Act.
- Describe how to maintain and renew your Physical Therapy license including continuing competence requirements needed for license renewal.
Introduction
Physical therapy practice in each state is established by that state's practice act. That state's practice act is decided both by the legislature with administrative input and then also the state board of physical therapy. It is important to note that laws and rules, as well as standards and policies, can change at any time. It is the licensee’s responsibility to stay abreast of changes, and the best way to do that is through the Indiana Board of Physical Therapy as well as through the American Physical Therapy Association (APTA).
Regulation of Physical Therapy in the State of Indiana is through the Indiana Code (Practice Act 25-27, Chapter 1-2), the Indiana Administrative Code which are the Rules (Title 842 Indiana Board of Physical Therapy Article 1: Physical Therapists and Physical Therapist Assistants), the Indiana Board of Physical Therapy, and the Indiana Professional Licensing Agency. The Practice Act and the Administrative Code do overlap somewhat which you will notice as we go through the act and code below.
In Indiana, physical therapists are able to practice based upon the Physical Therapy Practice Act, which is a statute, or a formal written enactment by a legislative body declaring, commanding, or prohibiting something. The Indiana Physical Therapy Board Regulates the practice of physical therapy in the state of Indiana. Read the Practice Act in its entirety and become familiar with it; this course today will only be an overview and will touch on a few key highlights. If you practice in multiple states, it is important to note that there are different practice acts in each state, so what may be okay to perform in that state may not be law in another.
Statutes
A statute is the written will of the legislative body to solemnly express according to the forms necessary to constitute the law of the state. The primary role of the courts is to carry out the legislature's intent. In our case, legislative acts declare what the practice of physical therapy is – that is, what actions physical therapists can perform, and what actions are prohibited.
Indiana Physical Therapy Practice Act and The Indiana Administrative Code
The Indiana Physical Therapy Practice Act is contained in Indiana Code 25-27. The Indiana Physical Therapy Practice Act is available at https://www.in.gov/pla/professions/physical-therapy-board/licensure-law-and-administrative-rules/ The direct link is here: Chapter 1. Regulation. The Indiana Administrative Code may be found here.
As noted, the board may adopt new rules or amend existing ones between complete editions and if so, will list those on its website. There have been some recent changes in the past few years, and is important to keep up to date with changes to the practice act. There have also been recent changes to the Indiana Administrative Code. Before 2019, it was housed in Title 844 under the Medical Licensing Board Article 6. It is now under 842 Indiana Board of Physical Therapy Article 1: Physical Therapists and Physical Therapist Assistants.
The legislative purpose and intent of the Practice Act are to protect public health and safety and welfare and to provide the state administrative control and supervision over the practice of physical therapy.
Article 27 Physical Therapists, Chapter 1 Regulation of Physical Therapists
Definitions 25-27-1-1
Definitions give us a common framework from which to begin a discussion on a particular topic or issue. Please review the definitions as provided by the Indiana Practice act below for understanding throughout the rest of the course
- Physical therapy- care and services provided by or under the direction and supervision of a physical therapist that includes any of the following:
- (A) Examining, evaluating, and conduct testing (as defined in subdivision (16)) on patients with mechanical, physiological, or developmental impairments, functional limitations, and disabilities or other health and movement-related conditions in order to determine a physical therapy diagnosis
- (B) Alleviating impairments, functional limitations, and disabilities by designing, implementing, and modifying treatment interventions that may include therapeutic exercise, functional training in the home, community, or work integration or reintegration that is related to physical movement and mobility, manual therapy, including soft tissue and joint mobilization or manipulation, therapeutic massage, prescription, application, and fabrication of assistive, adaptive, orthotic, protective, and supportive devices and equipment, including prescription and application of prosthetic devices and equipment, airway clearance techniques, integumentary protection and repair techniques, debridement and wound care, physical agents or modalities, mechanical and electrotherapeutic modalities, and patient-related instruction.
- Using solid filiform needles to treat neuromusculoskeletal pain and dysfunction (dry needling), after completing board-approved continuing education and complying with applicable board rules. However, a physical therapist may not engage in the practice of acupuncture unless the physical therapist is licensed under IC 25-2.5
- Reducing the risk of injury, impairment, functional limitation, and disability, including the promotion and maintenance of fitness, health, and wellness in populations of all ages
- Engaging in administration, consultation, education, and research
- Physical therapist- a person who is licensed under this chapter to practice physical therapy.
- Physical therapist assistant- a person who is certified under this chapter and assists a physical therapist in selected components of physical therapy treatment interventions
- Board- refers to the Indiana board of physical therapy
- Physical therapy aide- support personnel who perform designated tasks related to the operation of physical therapy services
- Person- an individual
- Sharp debridement- removal of foreign material or dead tissue from or around a wound, without anesthesia and with generally no bleeding, through the use of sharp medical instruments such as a sterile scalpel, scissors, forceps, tweezers to expose health tissue, prevent infection and promote healing.
- Spinal manipulation- a method of skillful and beneficial treatment by which a physical therapist uses direct thrust to move a joint of the patient's spine beyond its normal range of motion, but without exceeding the limits of anatomical integrity.
- Tasks- activities that do not require the clinical decision-making of a physical therapist or the clinical problem solving of a physical therapist assistant.
- Competence- the application of knowledge, skills, and behaviors required to function effectively, safely, ethically, and legally within the context of the patient's role and environment.
- Continuing competence- the process of maintaining and documenting competence through ongoing self-assessment, development, and implementation of a personal learning plan and subsequent reassessment.
- State- a state, territory, or possession of the United States, the District of Columbia, or the Commonwealth of Puerto Rico.
- Direct supervision- means that a physical therapist or physical therapist assistant is physically present and immediately available to direct and supervise tasks that are related to patient management.
- General supervision- supervision provided by a physical therapist who is available by telecommunication.
- Onsite supervision- supervision provided by a physical therapist who is continuously onsite and present in the department or facility where services are provided. The supervising therapist must be immediately available to the person being supervised and maintain continued involvement in the necessary aspects of patient care.
- Conduct testing- standard methods and techniques used to gather data about a patient, including, subject to section 2.5(c) of this chapter, electrodiagnostic and electrophysiologic tests and measures. The term does not include x-rays.
- Physical therapy diagnosis- a systematic examination, evaluation, and testing process that culminates in identifying the dysfunction toward which physical therapy treatment will be directed. The term does not include a medical diagnosis.
Unlawful Practices, Providing Mandated School Services 25-27-1-2
Sec 2. (a). It is unlawful for a person or business entity to do the following (unless noted elsewhere in the practice act and under IC 25-27-2):
- (1) Practice physical therapy without obtaining a license first from the board allowing the person to practice physical therapy in the state of Indiana.
- (2) Profess to be or promote an employee to be a physical therapist, physiotherapist, doctor of physiotherapy, doctor of physical therapy, or registered physical therapist or to use the initials "P.T.", "D.P.T.", "L.P.T.", or "R.P.T.", or any other letters, words, abbreviations, or insignia indicating that physical therapy is provided by a physical therapist unless physical therapy is provided by or under the direction of a physical therapist.
- (3) Advertise services for physical therapy or physiotherapy services, unless the individual performing those services is a physical therapist.
(b) Except as provided in subsection (e) and section 2.5 of this chapter, it is unlawful for a person to practice physical therapy other than upon the order or referral of a physician, podiatrist, psychologist, chiropractor, dentist, nurse practitioner, or physician assistant holding an unlimited license to practice medicine, podiatric medicine, psychology, chiropractic, dentistry, nursing, or as a physician assistant, respectively. It is unlawful for a physical therapist to use the services of a physical therapist assistant except as provided under this chapter. For the purposes of this subsection, the function of teaching, doing research, providing advisory services, or conducting seminars on physical therapy; is not considered to be a practice of physical therapy.
(c) Except as otherwise provided in this chapter and IC 25-27-2, it is unlawful for a person to profess to be or act as a physical therapist assistant or to use the initials "P.T.A." or any other letters, words, abbreviations, or insignia indicating that the person is a physical therapist assistant without first obtaining from the board a certificate authorizing the person to act as a physical therapist assistant. It is unlawful for the person to act as a physical therapist assistant other than under the general supervision of a licensed physical therapist who is in responsible charge of a patient. However, nothing in this chapter prohibits a person licensed or registered in this state under another law from engaging in the practice for which the person is licensed or registered. These exempted persons include persons engaged in the practice of osteopathic medicine, chiropractic, or podiatric medicine.
(d) Except as provided in section 2.5 of this chapter, this chapter does not authorize a person who is licensed as a physical therapist or certified as a physical therapist assistant to:
- evaluate any physical disability or mental disorder except upon the order or referral of a physician, podiatrist, psychologist, chiropractor, physician assistant, nurse practitioner, or dentist;
- practice medicine, surgery (as described in IC 25-22.5-1-1.1(a)(1)(C)), dentistry, optometry, osteopathic medicine, psychology, chiropractic, or podiatric medicine; or
- prescribe a drug or other remedial substance used in medicine.
(e) Upon the referral of a licensed school psychologist, a physical therapist who is licensed under this article and an employee or contractor of a school corporation may provide mandated school services to a student that are within the physical therapist's scope of practice.
Evaluations and Treatment without a referral; exceptions; testing certification 27-1-2.5
Sec. 2.5
A physical therapist may evaluate and treat an individual during a period not to exceed forty-two calendar days beginning with the date of the initiation of treatment without a referral from a provider (except in regards to performing spinal manipulation-see below). However, if the individual needs additional treatment from the physical therapist after forty-two calendar days, the physical therapist is to obtain a referral from the individual's provider.
A physical therapist may not perform spinal manipulation of the spinal column or the vertebral column unless:
- the physical therapist is acting on the order or referral of a physician, an osteopathic physician, or a chiropractor; AND
- the referring physician, osteopathic physician, or chiropractor has examined the patient before issuing the order or referral.
A physical therapist who conducts testing using electrophysiologic or electrodiagnostic testing must obtain and maintain the American Board of Physical Therapy Specialties Clinical Electrophysiologic Specialist Certification.
Practice of Certain Occupations or Professions and First Aid Not Prohibited 27-1-3.1
Sec. 3.1. This chapter does not prohibit any of the following:
- The practice of any occupation or profession for which a person is licensed, certified or registered in Indiana by a state agency. The persons who are exempted by this subdivision include persons licensed, certified, or registered to practice osteopathic medicine, chiropractic, or podiatric medicine.
- The practice of any health care occupation or profession by a person who is practicing within the scope of the person's education and experience.
- The performance of any first aid procedure incidental to a person's employment or volunteer duties.
- The performance of an emergency first aid procedure by any person.
Except as provided in section 2(a)(3) of this chapter, the provision of the following by a chiropractor licensed under IC 25-10:
- Physical therapy modality services
- Physical rehabilitation services
- Therapeutic procedures
- Tests and measurements
- Therapeutic devices
- Physiotherapy, as included in the chiropractic licensure examination
Exempt persons 27-1-3.3
Sec. 3.3. The following persons are exempt from the licensure or certification requirements of this article:
- Students on Clinical Affiliations. A person in an entry level professional education program approved by the board who is satisfying supervised clinical education requirements related to the person's physical therapist education while under onsite supervision of a physical therapist.
- Armed Forces. A physical therapist who is practicing in the armed forces of the United States, United States Public Health Service, or United States Department of Veterans Affairs under federal regulations for jurisdiction licensure of health care providers. However, if the person, while federally employed as a physical therapist, engages in the practice of physical therapy outside the course and scope of federal employment, the person must obtain a license under this chapter.
- Teaching Classes such as weekend classes. A physical therapist who is licensed in another state or credentialed to practice physical therapy in another country, if the person is teaching, demonstrating, or providing physical therapy services in connection with an educational seminar. However, the exemption under this subdivision may not exceed sixty (60) days in a calendar year.
- Travel with an athletic team. A physical therapist who is licensed in another state or credentialed in another country if the person by contract or employment is providing physical therapy to patients affiliated with or employed by established athletic teams, athletic organizations, or performing arts companies temporarily practicing, competing, or performing in Indiana. However, the exemption under this subdivision may not exceed sixty (60) days in a calendar year.
- Assistance in declared local or national disaster. A physical therapist who is licensed in another state and who provides physical therapy during a declared local or national disaster or emergency. However, the exemption may not exceed sixty (60) days following the declaration of the emergency. To be eligible for the exemption the physical therapist must notify the board of the person's intent to practice.
- Forced to leave due to local or national disaster. A physical therapist licensed in another state who is forced to leave the person's residence or place of employment due to a declared local or national disaster or emergency and due to the displacement seeks to practice physical therapy. However, the exemption may not exceed sixty (60) days following the declaration of the emergency. To be eligible for the exemption the physical therapist must notify the board of the person's intent to practice.
Sharp Debridement Referral 25-27-1-3.5
Sec. 3.5. A physical therapist may not perform sharp debridement unless the physical therapist is referred by a physician, osteopath, or podiatrist.
Indiana Board of Physical Therapy 27-1-4
Sec. 4 created the Indiana board of physical therapy to regular the practice of physical therapy in the state of Indiana.
The board is comprised of three physical therapists, one physical therapist assistant, and one Indiana resident who is not associated with physical therapy in any way, other than as a consumer.
Beginning July 1, 2019, the governor shall make each appointment for a term of four (4) years (IC 25-1-6.5). A member of the board may not serve more than eight years in a ten-year period. Each physical therapist and physical therapist assistant appointed must have an unrestricted license or certificate issued under this chapter; have had not less than five years experience in the actual practice of physical therapy immediately preceding appointment, and be a resident of Indiana and actively engaged in the state in the practice of physical therapy during incumbency as a member of the board.
A majority member vote is required to take action on any measure and the board meets at least quarterly.
Determination of Qualifications; Administration of Examinations; Standards for Competent Practice 25-27-1-5
Pass upon the qualifications of physical therapists who apply for licensure and physical therapist assistants who apply for certification.
Provide all examinations either directly or by delegation by approving and utilizing the services of a testing company or agent to prepare, conduct, and score examinations.
Determine the applicants who successfully pass examinations.
License and certify qualified applicants.
Adopt rules concerning the competent practice of physical therapy to the board.
Adopt rules establishing standards for the competent practice of physical therapy
- Adopt rules concerning a continuing competency requirement for the renewal of a license for a physical therapist and a certificate for a physical therapist assistant.
The Indiana Board of Physical Therapy is sometimes confused with the Indiana Chapter of the APTA. They are two separate entities and have different roles in Indiana.
As mentioned earlier, the mission of the Indiana Board is to protect the public. The mission of the Indiana Chapter of the APTA is to maximize the lifelong health, function, and well-being of people in Indiana and advance the practice of physical therapy through advocacy, collaboration, and education.
The Indiana Board of Physical Therapy posts committee minutes and agendas which include disciplinary actions on their website. These are public documents.
Obtaining Licensure 25-27-1-6 through 25-27- 1-6.4
In these sections, rules for obtaining a license or certificate for those educated inside and outside of the United States are included.
Every applicant for a license as a physical therapist or certification as a physical therapist assistant must present evidence that there is no conviction for a crime that will directly affect the applicant's ability to practice competently and he or she has not had disciplinary action initiated by the licensing agency of another state or jurisdiction on the grounds that the applicant was unable to practice as a physical therapist or physical therapist assistant without endangering the public.
The applicant has 15 days to appeal the board's decision to deny licensure or certification after the applicant receives the notification of the board's decision. An administrative hearing will be set after receiving the appeal by the board.
An applicant for a license as a physical therapist or a certification as a physical therapist assistant must do the following:
- Complete the application, including payment of any fees
- Submit proof of graduation from the appropriate professional education program (physical therapist or physical therapist assistant) accredited by a national accreditation agency approved by the board.
- Pass an examination by the board
- Submit to a national criminal history background check and meet any other requirements established by the board.
Educated Outside the United States
An applicant for a license as a physical therapist or physical therapist assistant who has been educated outside the United States must do all of the above plus the following:
Provide satisfactory evidence that the applicant's education is substantially equivalent to the education of a physical therapist or physical therapist assistant educated in an accredited entry-level program as determined by the board by any of the following:
Providing evidence of graduation outside the United States from a professional education program accredited by the same accrediting agency that the board approves for programs within the United States.
Do the following:
Provide evidence of graduation from a physical therapist or physical therapist assistant education program that prepares the applicant to engage in physical therapy without restriction.
Provide evidence that the applicant's school is recognized by its own ministry of education.
Undergo a credentials evaluation as directed by the board to determine if the candidate meets uniform criteria for educational requirements established.
- Complete any additional education required by the board.
- Pass a board-approved English proficiency examination if the applicant's native language is not English.
Complete supervised clinical practice with a restricted license if required by rule
Examination/Reexamination; Examination Security 25-27-1-7
In order to sit for the examination, the applicant must meet the standards of the testing company or national organization employed to administer the examination and the requirements adopted. The board may employ a testing company or a national organization to administer the examination within Indiana.
The physical therapist examination must test the applicant's entry-level competence related to physical therapy theory, examination and evaluation, diagnosis, prognosis, treatment intervention, prevention, and consultation.
The physical therapist assistant examination must test the applicant's requisite knowledge and skills in the technical application of physical therapy services.
An applicant for a license to practice physical therapy or for a certificate to act as a physical therapist assistant may take the respective examination not more than six times.
An applicant for licensure or certification must agree to abide by any security and copyright provisions related to the examination. If the board determines that an applicant has violated the agreement or engaged in or attempted to engage in any other conduct that subverts or undermines the integrity of the examination process or validity of examination results, the board may disqualify the applicant from taking or retaking the examination. The disqualification by the board may be permanent or for a specified period of time. A determination by the board may be appealed. The board will report any violation of security and copyright related to the examination or subversion or attempts to subvert the national examination to the Federation of State Boards of Physical Therapy.
Issuance of license; Renewal; Reinstatement; Temporary Nonrenewable Permit; Retirement From Practice 25-27-1-8
Issuance. The board will license a physical therapist or certify a physical therapist assistant who successfully passes the examination and is qualified as determined by the chapter.
Renewal. Licenses or Certificates issued by the board expire on June 30 of even-numbered years specified by the Indiana professional licensing agency. A renewal fee that is set by the board must be paid biennially on or before the date determined by the Indiana professional licensing agency. If the fee is not paid by that date, the license or certificate is automatically invalid without action by the board. A reinstatement fee is set up by the board.
Reinstatement. An expired license or certificate can be reinstated up to three years after the original expiration date if the penalty fee (set by the board) is paid, renewal fees for the biennium are paid, and the individual demonstrated evidence of continuing competence.
If a license or certificate has been expired for longer than three years, the holder may be reexamined by the board. The board may adopt rules setting requirements for reinstatement of an expired license or certificate and are subject to change. Currently, those rules are on the website and include a reinstatement fee, a completed reinstatement document (which is on the website to download), a letter of work history detailing employment since your Indiana license expired, verification of any other state license held, and proof of continuing education totaling 22 hours with 2 hours in ethics and Indiana jurisprudence. These hours must have been obtained within the last 24 months.
Permit. The board will not issue more than two temporary permits to a physical therapist or physical therapist assistant. A person holding a temporary permit may practice physical therapy only under the onsite supervision of a licensed physical therapist who is responsible for the patient.
The board will issue a temporary permit to any person once they pay the fee set by the board and the following have been met:
- have a valid license to practice as a physical therapist from another state or a valid certificate from another state to practice physical therapist assistant OR
- has been approved by the board to take the examination for PT licensure or PTA certification has not failed the examination previously in any state, and has graduated from a physical therapy school or a two-year college education program for physical therapist assistants that meet the standards set by the board. The applicant must take the examination within the time limits set by the board.
A temporary permit expires when the applicant becomes licensed or certified, or approved for endorsement licensing or certification by the board, or when the application for licensure has been disapproved, whichever occurs first. An application for licensure or certification is disapproved and any temporary permit based upon the application expires when the applicant fails to take the examination within the time limits set by the board or when the board receives the notification of the applicant's failure to pass any required examination in Indiana or any other state.
Retirement. A holder of a license or certificate who wishes to retire from practice is to notify the board in writing. Upon receipt of the notice, the board will make a record that the license or certificate holder is retired and release the person from further payment of renewal fees.
If a license or certificate is retired, but the holder would like it reinstated, a written request is to be sent to the board. The board may impose conditions it considers appropriate to the surrender or reinstatement of a surrendered license or certificate. A license or certificate may not be surrendered to the board without the written consent of the board if any disciplinary proceedings are pending against a holder of a license or certificate under this chapter.
Foreign applicants; license or certificate by endorsement; fee 25-27-1-9
The board may register and furnish a license to or certify by endorsement any applicant who presents evidence satisfactory to the board of being duly licensed to practice physical therapy or to act as a physical therapist assistant in another state if the applicant is otherwise qualified as required in section 6 of this chapter. However, the board shall register and furnish a license or certificate by endorsement to any applicant who is licensed to practice physical therapy or to act as a physical therapist assistant in another state if:
- the applicant is qualified under sections 6
- has successfully passed a licensure examination in another state equal to or exceeding the examination standards of Indiana
- paid a fee determined by the board
The board may license a physical therapist or certify as a physical therapist assistant any person who has graduated as a physical therapist or physical therapist assistant, whichever is appropriate, in a foreign country from an educational program approved by the board if the applicant has successfully passed the physical therapy licensure or physical therapist assistant certification examination, paid a fee determined by the board, and presents satisfactory evidence to the board that the applicant :
- does not have a conviction for
- an act that would constitute a ground for disciplinary sanction or
- a crime that has a direct bearing on the applicant's ability to practice competently; and
- has not been the subject of a disciplinary action initiated by the licensing agency of another state or jurisdiction on the grounds that the applicant was unable to practice as a physical therapist or physical therapist assistant without endangering the public
25-27-1-13 Physical Therapist Duties; Supervision
A physical therapist is responsible for managing all aspects of the physical therapy care of each patient. A physical therapist role is the following:
- Perform the initial evaluation, determination of a physical therapy diagnosis, prognosis, plan of treatment intervention, and documentation of each encounter with each patient.
- Periodic re-evaluation and documentation of each patient
- Complete the documented discharge of the patient, including the patient's response to treatment intervention at the time of discharge.
- Provide all treatment intervention for the patient that requires the education, skills, and knowledge of a physical therapist
- Determine the appropriate use of physical therapist assistants for safe, effective, efficient patient care.
- Assure the qualifications of all physical therapist assistants and physical therapy aides under the physical therapist's direction and supervision.
Supervision. A physical therapist assistant works under a physical therapist's supervision. A physical therapist assistant documents the care that the physical therapist assistant provides.
A physical therapist may use physical therapy aides for designated tasks. A physical therapy aide works under the direct supervision of a physical therapist. Tasks related to patient services must be assigned to a physical therapy aide by a physical therapist or physical therapist assistant.
Documentation and Billing 27-1-14
A physical therapist is responsible for the accurate documentation and billing that the physical therapist provides. In a like manner, the physical therapist assistant is responsible for the accurate documentation and billing that the physical therapist assistant provides.
Physical Therapy Plan of Care 25-27-1-15
Confidentiality; Exceptions 25-27-1-17
Except in cases in which the physical therapist or physical therapy assistant has a duty to report information as required by law, information relating to the physical therapist-patient relationship is confidential and may not be communicated to a third party who is not involved in the patient's care without the written authorization of the patient.
License and Certificate Display and Verification 25-27-1-18
Every physical therapist and physical therapist assistant is to display a copy of their license or certificate in a location the public is able to view, be able to produce a copy of the license or certificate upon request, or notify a patient on how the patient may verify the therapist's license or certificate online.
Chapter 2. Physical Therapy Licensure Compact
Purpose/Objective 25-27-2-1
The compact is the most recent update to the practice act, effective January 1, 2022.
The purpose of this Compact is to facilitate the interstate practice of physical therapy with the goal of improving public access to physical therapy services. The practice of physical therapy occurs in the state where the patient or client is located at the time of the patient or client encounter. The Compact preserves the regulatory authority of states to protect public health and safety through the current system of state licensure.
This Compact is designed to achieve the following objectives:
- Increase public access to physical therapy services by providing for the mutual recognition of other member state licenses
- Enhance the states' ability to protect the public's health and safety;
- Encourage the cooperation of member states in regulating multi-state physical therapy practice;
- Support spouses of relocating military members;
- Enhance the exchange of licensure, investigative, and disciplinary information between member states and
- Allow a remote state to hold a provider of services with a compact privilege in that state accountable to that state's practice standards.
Definitions 25-27-2-2
As mentioned earlier, definitions give us a common framework from which to begin a discussion on a particular topic or issue. Please review the definitions as provided by the compact, as these are used in the discussion of the compact and may help understand the language in the upcoming areas.
- "Active Duty Military" means full-time duty status in the active uniformed service of the United States, including members of the National Guard and Reserve on active duty orders pursuant to 10 U.S.C. Chapter 1209 and 10 U.S.C. Chapter 1211.
- "Adverse Action" means disciplinary action taken by a physical therapy licensing board based upon misconduct, unacceptable performance, or a combination of both.
- "Alternative Program" means a nondisciplinary monitoring or practice remediation process approved by a physical therapy licensing board. This includes, but is not limited to, substance abuse issues.
- "Compact privilege" means the authorization granted by a remote state to allow a licensee from another member state to practice as a physical therapist or work as a physical therapist assistant in the remote state under its laws and rules. The practice of physical therapy occurs in the member state where the patient or client is located at the time of the patient or client encounter.
- "Data system" means a repository of information about licensees, including examination, licensure, investigative, compact privilege, and adverse action.
- "Encumbered license" means a license that a physical therapy licensing board has limited in any way.
- "Executive Board" means a group of directors elected or appointed to act on behalf of, and within the powers granted to them by, the Commission.
- "Home state" means the member state that is the licensee's primary state of residence.
- "Investigative information" means information, records, and documents received or generated by a physical therapy licensing board pursuant to an investigation.
- "Member state" means a state that has enacted the Compact.
- "Party state" means any member state where a licensee holds a current license or compact privilege or is applying for a license or compact privilege.
- "Physical Therapy Compact Commission" or "Commission" means the national administrative body whose membership consists of all states that have enacted the Compact.
- "Physical therapy licensing board" or "licensing board" means the agency of a state that is responsible for the licensing and regulation of physical therapists and physical therapist assistants.
- "Remote state" means a member state other than the home state, where a licensee is exercising or seeking to exercise the compact privilege.
- "Rule" means a regulation, principle, or directive promulgated by the Commission that has the force of law.
- "State" means any state, commonwealth, district, or territory of the United States of America that regulates the practice of physical therapy.
State Participation in Compact 25-27-2-3
To participate fully in the compact, the state must:
- Participate fully in the Compact Commission's Data Base
- Have a mechanism in place for receiving and investigating complaints about licensees
- Notify the commission, in compliance with the terms of the compact and rules, of any adverse action or the availability of investigatory information regarding a licensee
- Utilize the NPTE
- Comply with the rules of the Commission
- Have continuing competence requirements as a condition for license renewal
- Fully implement a criminal background check requirement, within a time frame established by rule, by receiving the results of the Federal Bureau of Investigation record search on criminal background checks and use the results in making licensure decisions
- Have the authority to obtain biometric-based information from each physical therapy licensure applicant and submit this information to the Federal Bureau of Investigation for a criminal background check
Compact Privilege 25-27-2-4
(a)To utilize compact privilege under the terms of the Compact, the licensee is to do the following:
- hold a license in the home state
- have no encumbrance on any state license
- be eligible for a compact privilege in any member state in accordance with subsections (d), (g), and (h);
- have not had any adverse action against any license or compact privilege within the previous two years
- notify the Commission that the licensee is seeking the compact privilege within a remote state(s);
- pay any applicable fees, including any state fee, for the compact privilege;
- meet any jurisprudence requirements established by the remote state(s) in which the licensee is seeking a compact privilege; and
- report to the Commission adverse action taken by any non-member state within thirty (30) days from the date the adverse action is taken.
(b) The compact privilege is valid until the expiration date of the home license. The licensee must comply with the requirements of subsection (a) to maintain the compact privilege in the remote state.
(c) A licensee providing physical therapy in a remote state under the compact privilege shall function within the laws and regulations of the remote state.
(d) A licensee providing physical therapy in a remote state is subject to that state's regulatory authority. A remote state may, in accordance with due process and that state's laws, remove a licensee's compact privilege in the remote state for a specific period of time, impose fines, and take any other necessary actions to protect the health and safety of its citizens. The licensee is not eligible for a compact privilege in any state until the specific time for removal has passed and all fines are paid.
(e) If a home state license is encumbered, the licensee shall lose the compact privilege in any remote state until the following occur:
- the home state license is no longer encumbered and
- two years have elapsed from the date of the adverse action.
(f) Once an encumbered license in the home state is restored to good standing, the licensee must meet the requirements of subsection (a) to obtain a compact privilege in any remote state.
(g) If a licensee's compact privilege in any remote state is removed, the individual shall lose the compact privilege in any remote state until the following occur:
- the specific period of time for which the compact privilege was removed has ended;
- all fines have been paid; and
- two years have elapsed from the date of the adverse action.
(h) Once the requirements of subsection (g) have been met, the licensee must meet the requirements in subsection (a) of this chapter to obtain a compact privilege in a remote state.
Active Duty Military Personnel and Spouses 25-27-2-5
A licensee who is active duty military or is the spouse of an individual who is active duty military may designate one of the following as the home state:
- home of record
- permanent change of station (PCS); or
- state of current residence if it is different than the PCS state or home of record.
Adverse Actions 25-27-2-6
Home state. A home state shall have exclusive power to impose adverse action against a license issued by the home state.
A home state may take adverse action based on the investigative information of a remote state so long as the home state follows its own procedures for imposing adverse action.
Member state. Nothing in this Compact shall override a member state's decision that participation in an alternative program may be used in lieu of adverse action and that such participation shall remain nonpublic if required by the member state's laws. Member states must require licensees who enter any alternative programs in lieu of discipline to agree not to practice in any other member state during the term of the alternative program without prior authorization from such other member state.
Any member state may investigate actual or alleged violations of the statutes and rules authorizing the practice of physical therapy in any other member state in which a physical therapist or physical therapist assistant holds a license or compact privilege.
Remote state. A remote state shall have the authority to:
- Take adverse actions against a licensee's compact privilege in the state;
- Issue subpoenas for both hearings and investigations that require the attendance and testimony of witnesses, and the production of evidence. Subpoenas issued by a physical therapy licensing board in a party state for the attendance and testimony of witnesses, and the production of evidence from another party state, shall be enforced in the latter state by any court of competent jurisdiction, according to the practice and procedure of that court applicable to subpoenas issued in proceedings pending before it. The issuing authority shall pay any witness fees, travel expenses, mileage, and other fees required by the service statutes of the state where the witnesses and evidence are located; and
- If otherwise permitted by state law, recover from the licensee the costs of investigations and disposition of cases resulting from any adverse action taken against that licensee.
Joint Investigations.
- In addition to the authority granted to a member state by its respective physical therapy practice act or other applicable state law, a member state may participate with other member states in joint investigations of licensees.
- Member states shall share any investigative, litigation, or compliance materials in furtherance of any joint or individual investigation initiated under the Compact.
Establishment of Physical Therapy Compact Commission 25-27-2-7
The Compact member states established a joint public agency known as the Physical Therapy Compact Commission. Each member state shall have and be limited to one delegate selected by that member state's licensing board. The delegate shall be a current member of the licensing board, who is a physical therapist, physical therapist assistant, public member, or the board administrator.
Meetings and Voting. Any delegate may be removed or suspended from office as provided by the law of the state from which the delegate is appointed. The member state board shall fill any vacancy occurring in the Commission. Each delegate shall be entitled to one vote with regard to the rules and creation of bylaws and as well as the opportunity to participate in the business and affairs of the Commission. A delegate shall vote in person or by such other means as provided in the bylaws. Meetings may also be attended remotely. Meetings are annually and additional can be set up according to the bylaws.
Duties of the Compact Commission.
- Establish bylaws
- Promulgate rules
- Establish budget, maintain financial records, borrow money
- Sell, convey, mortgage, pledge, lease, exchange, abandon, or otherwise dispose of any property real, personal, or mixed
- Accept any and all appropriate donations and grants of money, equipment, supplies, materials, and services, and to receive, utilize, and dispose of the same; provided that at all times the Commission shall avoid any appearance of impropriety and conflict of interest
- Elect executive board
- Terminate a state from the compact
- Establish committees and task forces
- Purchase and maintain insurance and bonds
- Provide and receive information from, and cooperate with, law enforcement agencies
- Hire employees, elect or appoint officers, fix compensation, define duties, grant such individuals appropriate authority to carry out the purposes of the Compact, and to establish the Commission's personnel policies and programs relating to conflicts of interest, qualifications of personnel, and other related personnel matters
Executive Board. Elected by the Compact Commission and the Executive Board and has the power to act on behalf of the Commission. Meet annually or more often if necessary.
- There are 9 members.
- 7 elected from the membership of the Commission
- 1 from FSBPT and 1 from APTA. Both are non-voting, ex officio members of the commission
Duties of the Executive Board.
- Recommend to the entire Commission changes to the rules or bylaws, changes to this Compact legislation, fees paid by Compact member states such as annual dues, and any commission Compact fee charged to licensees for the compact privilege
- Prepare and recommend the budget
- Maintain financial records on behalf of the Commission
- Monitor Compact compliance of member states and provide compliance reports to the Commission
- Establish other committees as necessary
- Ensure Compact administration services are appropriately provided
Data System; Requirements for Submitting Data 25-27-2-8
The commission provides a coordinated database and reporting system containing licensure, adverse action, and investigative information on all licensed individuals in member states. The Commission will notify all member states of any adverse action taken against a licensee or an individual applying for a license, and adverse action information pertaining to a licensee in any member state will be available to any other member state.
Indiana Professional Licensing Agency
The Indiana Professional Licensing Agency can be found at this web address: https://www.in.gov/pla/. The Indiana Professional Licensing Agency has many duties and functions for at least forty professions in the state of Indiana. It is the central location and agency for the initial and renewal of licensure. On this website, you are able to renew your license, search and verify licenses, order and print licenses, receive a digital certification of licenses, download license files, view any license litigation, update your address, track your application, and file a complaint.
TITLE 842 Indiana Board Of Physical Therapy Article 1. Physical Therapists and Physical Therapist Assistants
Definitions 842 IAC 1-1-1, 1-6-1
Some of these terms mentioned in the code are duplicates that also are present in the practice act and will not be mentioned again here.
"Bureau" refers to the health professions bureau.
"Committee" refers to the Indiana physical therapy committee
"Contact hour" means a unit of measure for a continuing competency activity where 1 (one) contact hour equals at least 50 minutes in a learning activity.
"Direct supervision" means that the supervising physical therapist or physician at all times shall be available and under all circumstances shall be absolutely responsible for the direction and the actions of the person supervised when services are performed by the physical therapist's assistant or holder of a temporary permit issued under IC 25-27-1-8(d). For the holder of a temporary permit issued under IC 25-27-1-8(d), unless the supervising physical therapist or physician is on the premises to provide constant supervision, the holder of a temporary permit shall meet with the physical therapist or physician at least once each working day to review all patients' treatments. This meeting must include the actual presence of the physical therapist or physician and the holder of a temporary permit. The patient's care shall always be the responsibility of the supervising physical therapist or physician. Reports written by the holder of a temporary permit for inclusion in the patients' record shall be countersigned by the physical therapist or physician who may enter any remarks, revisions, or additions as the physical therapist or physician deems appropriate.
With respect to the supervision of physical therapist's assistants under IC 25-27-1-2(c), unless the supervising physical therapist or physician is on the premises to provide constant supervision, the physical therapist's assistant shall consult with the supervising physical therapist or physician at least once each working day to review all patients' treatments. The supervising physical therapist or physician shall examine each patient not less than:
- every fourteen days for inpatients in either a hospital or comprehensive rehabilitation facility;
- the earlier of every ninety days or six physical therapy visits for patients in a facility for the mentally retarded and developmentally disabled and school system patients; and the earlier of every thirty days or every fifteen physical therapy visits for all other patients to review the patients' treatment and progress.
If this daily consultation is not face-to-face, the physical therapist or physician may not supervise more than the equivalent of three full-time physical therapist's assistants. A consultation between a supervising physical therapist or a physician and the physical therapist's assistant may be in person, by telephone, or by a telecommunications
device for the deaf, so long as there is interactive communication concerning patient care.
"Physical therapist's assistant" means a person who is registered by the committee to assist in the practice of physical therapy under the direct supervision of a licensed physical therapist or under the direct supervision of a physician by performing those assigned physical therapy procedures identified in subsection (i)(3), but not those specified in subsection (i)(1) or (i)(2).
(i) "Physical therapy" includes, but is not limited to, such measures as the following:
- (1) Performing and interpreting tests and measurements of neuromuscular, musculoskeletal, cardiac, and pulmonary functions as a part of treatment, interpretation of physician referrals, initial patient evaluation, initial and ongoing treatment planning, periodic reevaluation of the patient, and adjustment of the treatment plan.
- (2) Planning initial and subsequent treatment programs on the basis of test findings and within the orders of a referring practitioner who is licensed to practice medicine, osteopathic medicine, dentistry, podiatry, or chiropractic.
(3) Administering treatment through the use of physical, chemical, or other properties of heat or cold, light, water, electricity, massage, mechanical devices, and therapeutic exercise, which includes all types of physical rehabilitative techniques and procedures.
"Practitioner" means a person holding a license to practice physical therapy; a person holding a certificate to practice as a physical therapist assistant; or a person holding a temporary permit issued by the committee.
"Professional incompetence" may include, but is not limited to, a pattern or course of repeated conduct by a practitioner demonstrating a failure to exercise such reasonable care and diligence as is ordinarily exercised by practitioners in the same or similar circumstances in the same or similar locality.
Mandatory Registration; Renewal 842 IAC 1-4-1
Every licensed physical therapist and certificate holding physical therapist assistant is to renew on or before July 1 of each even-numbered year. A licensee's failure to receive notification of upcoming renewal due to failure to notify the board, committee, or the licensing committee of a change of address does not excuse the licensee or certificate holder from renewing.
Address; Change of Name 842 IAC 1-4-2
If you change your name, address, or phone number, you are responsible for providing the Indiana Board of Physical Therapy with a current address, telephone number, and name change within 30 days of the change. It is also recommended to update your email with the Indiana Professional Licensing Agency as well as that is how you will receive your renewal notice if you have an email on file.
Continuing Competency Requirements 842 IAC 1-7-1 and License or Certification Period; Number of Hours Required 842 IAC 1-7-3
Twenty-two hours of continuing competency activities are required for the biennial renewal period. At least ten (10) hours must be in category I courses and two (2) hours must be in an ethics and Indiana jurisprudence course as it relates to the practice of physical therapy. A physical therapist or physical therapist's assistant may not earn more than ten (10) category II credit hours towards the requirements under this section and two of those hours must be in an ethics and Indiana jurisprudence course as it relates to the practice of physical therapy in the state of Indiana.
Continuing competency hours must be obtained within the biennial renewal period and cannot be carried over from one renewal period to another. No continuing competency activity is required when a license or certification is valid for less than twelve months. If the license or certification is valid for twelve to twenty-three months, twelve hours of continuing competency activities are required for renewal, which shall include the two hours of an ethics and Indiana jurisprudence course as it relates to the practice of physical therapy.
Responsibilities of licensees 842 IAC 1-7-2
- Certify completion of continuing competency activities required by this rule at the time of license or certification renewal.
- Retain verification of completion of continuing competency activities for three years after the last renewal date.
- Present proof of completion of continuing competency activities at the request of the committee in a format that is verifiable by the committee.
Category I Continuing Competency Activities and Category II Continuing Competency Activities Defined 842 IAC 1-7-4
Category 1. continuing competency activities includes the following and must be at least one contact hour in length and be relevant to the practice of physical therapy:
- Formally organized courses
- Workshops
- Seminars
- Symposia
- Home study programs, including approved computer, audio, and video instructional programs, designed by committee-approved organizations and subject to committee verification and approval procedures.
- Approved "for credit" courses that are related to the practice of physical therapy from an approved organization as defined in IC 25-1-4-0.2.
The following conversion will be used for category I continuing competency credit:
- One semester hour equals fifteen (15) contact hours.
- One quarter hour equals ten (10) contact hours.
- One trimester hour equals twelve and one-half (12.5) hours.
Category 2. continuing competency activities include the following:
- Professional research/writing. A licensee or certificate holder may receive continuing competency credit for publication of scientific papers, abstracts, or review articles in peer-reviewed and other professional journals; publication of textbook chapters; and poster or platform presentations at conferences sponsored by any approved entity up to a maximum of ten hours per biennium.
- The following conversion will be used for continuing competency credit:
- Ten hours for each refereed article.
- Three hours for each nonrefereed article, abstract of published literature or book review.
- Eight hours for each published textbook chapter.
- Five hours for each poster or platform presentation or review article.
- Teaching as an adjunct responsibility at an accredited PT or PTA program. Two (2) hours of credit for each academic credit hour awarded by the accredited PT or PTA program for the first time the course is taught up to a maximum of ten (10) hours per biennium.
- Participation as a presenter in an approved workshop, continuing education course, seminar, or symposium. Two contact hours for each one hour of presentation for the first event, with a maximum of ten hours per biennium.
- Supervision of physical therapist students or physical therapist's assistant students from accredited programs in full-time clinical internships or residency programs. One contact hour for every forty hours of supervision with a maximum of ten contact hours per biennium.
- In-house or in-service seminars related to the practice of physical therapy. One credit hour for each hour of in-service. Maximum of four hours per biennium. Documentation shall consist of a description of the topic, date, duration, and the name of the presenter.
- Actively participating with professional organizations related to the practice of physical therapy, with one credit hour for each six months service as an officer, delegate, or committee member, for a maximum of six hours per biennium.
- Certification of clinical specialization by the American Board of Physical Therapy Specialties (ABPTS) or another organization approved by the Indiana physical therapy committee: ten hours maximum per biennium. Credit may be awarded only in the year that certification or recertification is obtained.
- Certificate of Advanced Proficiency for the PTA by the APTA: five hours maximum per biennium to be awarded. Credit may be awarded only in the year that certification or recertification is obtained.
- Attendance at INAPTA state or district meetings that are at least one hour in length, for a maximum of one hour per meeting, for a maximum of four hours per biennium.
- Other scholarly or educational, or both, activities related to the practice or management of physical therapy and not described above, with approval from the committee.
Standards of professional conduct and competent practice 844 IAC 6-7-2
All practitioners licensed in Indiana shall be responsible for having knowledge of these standards of conduct and practice
Remuneration for Service. Fees charged by a practitioner for his or her professional services shall be reasonable and shall reasonably compensate the
practitioner only for services actually rendered. A practitioner shall not enter into an agreement for, charge, or collect an illegal or clearly excessive fee. Factors that are to be considered in determining the reasonableness of a fee include (not all-inclusive):
- Difficulty or uniqueness, or both, of the services,performed and the time, skill, and experience required
- Fee customarily charged in the locality for similar practitioner services
- Amount of the charges involved
- Quality of performance
- Nature and length of the professional relationship with the patient
- Experience, reputation, and ability of the practitioner in performing the kind of services involved
A practitioner shall not pay, demand, or receive compensation for the referral of a patient except for a patient referral program operated by a professional society or association. A practitioner shall not base his fee upon the uncertain outcome of a contingency, whether such contingency is the outcome of litigation or any other occurrence or condition that may happen.
Advertisement. Physical therapy services may be advertised through the public media if the advertisement is dignified and is confined to the existence, scope, nature, and field of practice of physical therapy. If the advertisement is by radio, cable, or TV, it needs to be prerecorded and approved for broadcast by the practitioner, and a recording and transcript of the actual transmission is to be retained for a period of 5 years from the last broadcast date. Cannot use any form of public communication containing a false, fraudulent, misleading, deceptive, or unfair statement by either the practitioner or specific health care provider affiliated with the practitioner.
Patient Care. The practitioner is to maintain patient confidentiality of all knowledge and information regarding the patient. Confidentiality includes the patient's diagnosis, treatment, and prognosis unless required by law or when authorized by the patient or those responsible for the patient’s care. The practitioner is to give a truthful, candid, and reasonably complete account of the patient's condition to the patient or to those responsible for the patient's care, unless that information is detrimental to the physical or mental health of the patient or those responsible for the patient's care.
Never abandon a patient. Give reasonable written notice to both the patient and the referring provider when withdrawing from a case so that another referral may be made. Unless in an emergency circumstance, if withdrawing from a case, comply with a patient’s written request for health records.
Exercise reasonable care and diligence in the treatment of patients based upon generally accepted scientific principles, methods, treatments, and current professional theory and practice.
A practitioner shall maintain adequate patient records
Disciplinary Action. A practitioner shall not:
- Engage in sexual misconduct, including making sexual advances, requesting sexual favors, and engaging in verbal conduct or physical contact of a sexual nature with patients, clients, or coworkers.
- Engage in the performance of substandard care due to a deliberate or negligent act or failure to act (regardless of whether there was an actual injury to the patient).
- Practice as a physical therapist or work as a physical therapist's assistant when physical or mental abilities are impaired by the use of controlled substances, other habit-forming drugs, chemicals, or alcohol.
- Attempt to preclude, prohibit, or otherwise prevent the filing of a complaint against him or her by a patient or other practitioner for any alleged violation of the Indiana Code.
- Attempt to exonerate himself or herself from or limit his or her liability to a patient for his or her personal malpractice except that a practitioner may enter into agreements that contain informed, voluntary releases or waivers of liability, or both, in settlement of a claim made by a patient or by those responsible for a patient's care.
- Have a felony conviction, or who has pled no contest or any other finding of guilt as to such felony, in this or any other state, territory, or country, which demonstrates impaired judgment or risk to the public in the practitioner's future provision of physical therapy service.
- Interfere with, or refuse to cooperate in, an investigation or disciplinary proceeding by willful misrepresentation of facts or the use of threats or harassment against any patient or witness to prevent them from providing evidence in a disciplinary proceeding or any legal action.
- Aid or abet a person not licensed or certified in this state who directly or indirectly performs activities requiring a license or certificate.
Discontinuing/Leaving a Practice.
If retiring, discontinuing the practice of physical therapy; or leaving or moving from a community; a practitioner:
- Shall not sell, convey, or transfer patient records to any other practitioner for anything of value
- Must notify all of his/her active patients in writing, or by publication once a week for 3 consecutive weeks in a community newspaper that he/she intends to discontinue his/her physical therapy practice in the community and shall notify the referral source of each active patient.
- Make reasonable arrangements with his/her active patients for the transfer of records or copies to the referring provider who shall make the records/copies available to the next practitioner or to a program conducted by a professional society or association. The term "active patient" applies and refers to a person whom the practitioner has examined, treated, cared for, or consulted with during two year period prior to retirement, discontinuation of the practice of physical therapy, or leaving or moving from a community.
That completes our review of the Indiana jurisprudence for physical therapists and assistants.
Kelly, C. (2022, March). Indiana Jurisprudence. PhysicalTherapy.com, Article 4824. Retrieved from: http://www.physicaltherapy.com
