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Tennessee Jurisprudence for Physical Therapists and Physical Therapist Assistants

Tennessee Jurisprudence for Physical Therapists and Physical Therapist Assistants
Calista Kelly, PT, DPT, ACEEAA, Cert. MDT
September 8, 2022

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Learning Objectives

After this course, the participant will be able to: 

  • Explain how to access the most recent TN Physical Therapy Practice Act 
  • Identify at least two statutes that affect the practice of physical therapy in Tennessee
  • Describe the role of regulations on the practice of physical therapy in Tennessee
  • Explain the role of the attorney general in publishing opinions affecting the practice of physical therapy in Tennessee
  • Describe the role of the Board of Physical Therapy in the practice of physical therapy in Tennessee

Introduction

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 Tennessee Board of Physical Therapy and the American Physical Therapy Association (APTA).

In Tennessee, physical therapists 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. Read the Practice Act in its entirety and become familiar with it; this course today will only be an overview and touch on a few key highlights.

Statutes

A statute is the written will of the legislative body to solemnly express according to the forms necessary to constitute the state's law. 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.

Tennessee Physical Therapy Practice Act

The Tennessee Physical Therapy Practice Act is contained in Title 63, Chapter 13, Parts 1, 3, and 4 of the Tennessee Code Annotated. This chapter shall be known and may be cited as the Occupational and Physical Therapy Practice Act. When this Title was first enacted, it compiled both the Occupational and Physical Therapy Practice Acts, so there will be some overlap between our Physical Therapy Practice Act and the Occupational Therapy Practice Act. 

The latest edition is available from the Tennessee Board of Physical Therapy here.  As noted, the board may adopt new rules or amend existing ones between complete editions, and if so, it will also list those on its website.

The legislative purpose and intent of the Practice Act are “to protect the public health and safety and welfare and to provide the state administrative control and supervision over the practice of physical therapy and, of course, occupational therapy." 

Physical Therapy Practice Act Part 1: Definitions

Definitions give us a common framework from which to begin a discussion on a particular topic or issue.  These definitions are found in Title 63, Chapter 13, Part 1 (General Provisions) of the Tennessee Code.

63-13-103 (12) Onsite Supervision

The term onsite supervision means either the supervising physical therapist or supervision physical therapist assistant must:

(A) Be continuously onsite and present in the department or facility where assistive personnel are performing services;

(B) Available immediately to assist the person being supervised 

(C) Be involved continuously in the appropriate aspects of the treatment session in which a component of treatment is delegated to the assistive personnel.   

63-13-103(13): Physical Therapist

The definition of a physical therapist is a person who is licensed according to Title 63, Chapter 13 to practice physical therapy.

63-13-103(14): Physical Therapist Assistant

A physical therapist assistant (PTA) is a person who meets the requirements of this chapter for licensure as a physical therapist assistant and who performs physical therapy procedures and related tasks that have been selected and delegated only by the supervising physical therapist.

63-13-103(15): Physical Therapy

Physical therapy is treatment provided by or under the direction and supervision of a physical therapist who is licensed, according to Chapter 13. 

63-13-103(16): Physical Therapy Assistive Personnel

(A) Other assistive personnel means other trained or educated healthcare personnel not defined as a PTA or physical therapy aide who perform specifically designated tasks related to physical therapy under the supervision of a physical therapist. At the discretion of the supervising physical therapist, and if properly credentialed and not prohibited by any other law, "other assistive or support personnel" may be identified by the title specific to their training or education.

(B) Physical therapy aide, inclusive of the terms "aide," "technician," and "transporter," means a person trained by and under the direction of a physical therapist who performs designated and supervised routine physical therapy tasks.

63-13-103(17): Practice of Physical Therapy means: 

A) Examining, evaluating, and testing individuals with mechanical, physiological, and developmental impairments, functional limitations and disabilities, or other health and movement-related conditions to determine a physical therapy treatment, diagnosis, prognosis, a plan of therapeutic intervention and to assess the ongoing effect of an intervention.

B)  Alleviating impairments and functional limitations by designing, implementing, and modifying therapeutic interventions that include, but are not limited to, therapeutic exercise, functional training, manual therapy, therapeutic massage, assistive and adaptive orthotic, prosthetic, protective and supportive equipment, airway clearance techniques, debridement and wound care, physical agents or modalities, dry needling, mechanical and electrotherapeutic modalities, and patient-related instruction.

C) Reducing the risk of injury, impairments, functional limitation, and disability, including the promotion and maintenance of fitness, health, and quality of life in all age populations, and

D) Engaging in administration, consultation, education, and research.

63-13-103 (18) Restricted Physical Therapist Assistant License

A license for which the committee has placed any restrictions due to action imposed by the committee.

63-13-103 (19) Restricted Physical Therapy License

A restricted physical therapy license is a license that the committee placed restrictions or conditions, or both, as to the scope of practice, place of practice, supervision of practice, duration of license status, or type of condition of the patient the licensee may provide services.  

63-13-103(20): Supervision

The supervising physical therapist is to be readily available to the physical therapist assistant being supervised. When the physical therapist assistant is practicing in an off-site setting, the supervising physical therapist will be immediately accessible by telecommunications. Patient conferences will be regularly scheduled and documented, and supervisory visits will be made as further outlined in the rules and regulations.

63-13-104 Unauthorized Practice of Medicine-Scope of Practice

Physical Therapists are not allowed to practice medicine, osteopathy, podiatry, chiropractic, or nursing.  The scope of physical therapy practice is under the referral of a licensed medical doctor, chiropractor, dentist, or doctor of podiatry or osteopathy.  That referral may be a written or an oral referral.  Exceptions are stated in 63-13-303.  The scope of practice of physical therapy does not include interventions of direct thrust.  A physical therapist or physical therapist assistant shall not move a joint of the patient's spine beyond its normal range of motion without exceeding the limits of anatomical integrity as an intervention.  

Physical Therapy Practice Act Part 3: Licensure of Physical Therapists and Assistants

Part 2 of this Chapter deals with Occupational Therapy; therefore, we will not cover its contents and move to Part 3: Licensure of Physical Therapists and Assistants. 

63-13-301: License Requirement

The only person that can perform physical therapy and who can present to the public as a physical therapist in the state of Tennessee is someone who is licensed under this chapter. To be licensed under this chapter, the physical therapist must hold a degree from a professional physical therapy program accredited by a national accreditation agency recognized by the United States department of education and by the board of physical therapy. 

63-13-302: Referrals; Ethical Standards

Physical therapists must adhere to the recognized standards of ethics of the physical therapy profession. It also commands a physical therapist to refer any person under the therapist's care to appropriate health practitioners after consultation with their referring practitioner if the physical therapist has reasonable cause to believe that symptoms or conditions require services beyond the scope of physical therapy or when physical therapy treatment is contraindicated. 

63-13-303: Exceptions to Referral Requirements

This section gives direct access or limited direct access to patients or prospective patients to be treated by a physical therapist initially without the need for a referral.  Again, physical therapy is only to be conducted under the written or oral referral of a licensed doctor of medicine, chiropractic, dentistry, podiatry, or osteopathy.  However, the physical therapist may conduct an initial evaluation of a patient without a referral, and the physical therapist can provide physical assessments or instructions, including exercise recommendations, to any asymptomatic person.  Health fairs would seem to fall under this exception where no referral was needed.

Subsection three states that in emergencies (including minor emergencies), a physical therapist is allowed to provide any assistance to the best of the therapist's ability without the referral of a referring practitioner.  Emergency medical care means providing care when there is a sudden onset of a medical condition manifesting in acute symptoms of sufficient pain and severity that, in the absence of medical attention, could result in either the emergency patient having their health in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part.  The physical therapist will refer the person to the appropriate healthcare practitioner immediately after assisting the individual.  

Subsection four outlines how we can treat a patient without a referral within the scope of physical therapy practice.  This would be what most people consider to be the allowance of direct access for our patients.  Several sections must be met for a patient to be treated as a "direct access" patient.  Those sections that must be met are:

  • (A) The patient's physician has been notified
  • (B) If there is no progress made as determined by clinical evidence by the physical therapist within 30 days following the patient's initial visit, the PT will refer to the appropriate healthcare practitioner and will not provide additional physical therapy services.  
  • (C) Physical therapy services cannot continue beyond 90 days without consulting the patient's appropriate healthcare practitioner.  
  • (D) A previously diagnosed patient with chronic, neuromuscular, or developmental conditions and physical therapy is being provided for problems associated with one of those prior diagnosed conditions, then sections B and C do not apply above. 
  • (E) If at any time, the PT believes that the patient's symptoms or condition require treatment beyond the scope of PT practice, progress is not being achieved, or PT treatment is contraindicated, the physical therapist is to refer the patient to the appropriate healthcare professional.  

A physical therapist cannot practice physical therapy other than upon the referral by a referring practitioner discussed previously unless the person meets these specific conditions: 

  • Holds a doctorate degree from a professional physical therapy program that is accredited by a national accreditation agency recognized by the United States Department of Education and by the board of physical therapy OR
  • Has completed:
    • At least three years of experience as a licensed physical therapist AND
    • A professional physical therapy program of at least 15 credit hours designed to enable the physical therapist to recognize conditions that require timely referral to an appropriate healthcare practitioner who qualifies as a referring practitioner.  That program must be approved by the board and offered by a higher learning institution that is accredited by a national accreditation agency recognized by the United States Department of Education.

​It is unprofessional conduct for a physical therapist to initiate physical therapy services to a patient that violates the above. 

63-13-304: Board Powers

The Board has the power and authority to evaluate the qualifications of applicants for licensure, adopt passing scores for the physical therapy examination, issue licenses to those that are qualified under this chapter, regulate the practice of physical therapy by interpreting and enforcing this code including disciplinary action, adopt and revise rules, as it deems necessary and appropriate for the discharge of its obligation under this section, establish requirements for assessing continuing competence of licensees, and assess all license and registration fees. The board of physical therapy will establish minimum competency requirements that a physical therapist needs to demonstrate to practice dry needling.  

63-13-305: Claims and Practices of other Licensed Professionals-Exemptions from licensure.

Nothing in this specific chapter shall restrict a licensed or certified person under any other law of the state of Tennessee from engaging in the profession they are licensed or certified, provided that the person does not claim to be a physical therapist or physical therapist assistant or a provider of physical therapy.  

The following people are exempt from licensure as a physical therapist or physical therapist assistant under this chapter:

  • A student who is pursuing a course of study leading to a degree as a physical therapist or PTA in a professional education program approved by the Board and is satisfying supervised clinical education requirements related to physical therapy education. 
  • A physical therapist or PTA while practicing in the United States armed services, United States public health service, or veterans administration as based on requirements under federal regulations for state licensure of health care providers. 
  • A physical therapist or PTA licensed in another United States jurisdiction or a foreign-educated/internationally trained physical therapist credentialed in another country performing physical therapy as part of teaching or participating in an educational seminar of no more than 60 days in a calendar year.
  • A physical therapist or PTA licensed in another United States jurisdiction who is temporarily performing physical therapy for members of established athletic teams, athletic corporations, or performing arts companies that are training, competing, or performing in Tennessee does not require Tennessee licensure.  However, according to this subdivision, a person performing physical therapy in this state shall agree to use the secretary of state for service of process according to title 20, chapter 2, part 2.

A physical therapist licensed by the Tennessee chapter practicing dry needling shall not constitute the practice of acupuncture under chapter 6, part 10. 

Nothing in this chapter shall be construed as restricting persons licensed under any other state law from performing physical agent modalities for which they have received education and training.

63-13-306: Applications, Examinations

As a licensed clinician, you are already aware that an applicant for licensure must file the application as required by the board and pay a non-refundable application fee and the examination cost.  Both fees are to be included with the written or online application.  All fees are established by the board.  

After the application process has been completed, the applicant (PT or PTA applicant) will take the examination for the appropriate licensure. 

Examinations are available within the state at such time and place as the board determines, and the board determines the passing score.

Applicants who do not pass the examination on the first attempt may retake the examination one additional time without reapplication for licensure up to a total of six attempts. Applications are active for twelve months.  After twelve months, applicants must submit a new application with all fees.  

63-13-307: Qualifications of Applicants, Reciprocity

To seek licensure as a PT or PTA, the applicant must have the following requirements:

  • Be of good moral character
  • Have completed the application process
  • Be a graduate of one of the professional physical therapy or PTA programs accredited by an accreditation agency recognized by the United States department of education and approved by the board
  • Successfully passed the examination approved by the board. 

The board shall issue a license to the physical therapist or assistant with a valid, unrestricted license from another United States jurisdiction.

Subsection 307(d) addresses foreign-born or internationally trained therapists.  Applicants who have been educated outside of the United States must meet the following requirements:

  • (2) Be of a good moral character
  • (3) Complete the application process
  • (4) Provide satisfactory evidence that the education is substantially equivalent to the requirements of physical therapists educated in accredited educational programs as determined by the board. If the board determines that a foreign-educated applicant's education is not substantially equivalent, it may require the completion of additional coursework before proceeding with the application process.

Additionally, the applicant must provide the following:

  • (5) Written proof that the school of physical therapy education is recognized by its ministry of education
  • (6) Written proof of authorization to practice as a physical therapist without limitations in the country where the professional education occurred
  • (7) Proof of legal authorization to reside and seek employment in the United States or its territories
  • (8) Educational credentials that were evaluated by a board-approved credential evaluation agency
  • (9) Passed the board-approved English proficiency examinations if the applicant's native language is not English
  • (10) Participated in and completed an interim supervised clinical practice period before licensure
  • (11) Successfully passed the examination approved by the board

If you are a foreign-educated physical therapist applicant who is a graduate of a professional physical therapy education program accredited by an agency approved by the board, the requirements listed in subdivisions 4, 5, 8, and 10 above may be waived. 

In determining the qualifications of an applicant for licensure as a physical therapist or as a physical therapist assistant, only a majority vote of the board of physical therapy shall be required

63-13-308: License Renewal, Name Change, Retirement, Inactive Status, and Exemption from Continuing Education

A physical therapist or PTA licensed in Tennessee shall renew the license as specified in the rules. An individual who fails to renew the license by the expiration date cannot practice in the state of Tennessee.

A physical therapist or PTA licensed in another jurisdiction that is a member state of the Physical Therapy Licensure Compact is eligible to become a licensee for compact privileges in the state of TN, subject to requirements in 63-13-402, which is discussed later in this course.  

Each licensee shall report a name change or changes in business and home address within 30 days of the change to the board.

Any licensee who has retired or may retire is not required to register as required by this section if they file an affidavit on a form to be furnished by the board.  This affidavit states the date on which the person retired from practice and any other facts the board considers necessary to verify retirement. If that person wants to return to practice, they have to apply for licensure with the board again and meet the continuing education requirements that are established by the board, except for good and sufficient reasons as determined by the board.

A licensee can place their license in an inactive status by filing the proper forms with the board and paying a biennial fee. To return to active practice, an application for re-licensure and continuing education requirements (established by the board) must be met.  Exceptions may be made and will be determined by the board. 

63-13-309: Reinstatement of License, Failure to Renew License

Reinstatement of a lapsed license following a renewal deadline will require payment of a renewal fee, a late renewal penalty fee, and a reinstatement fee.  Reinstatement of a license that has lapsed for more than three consecutive years requires reapplying for a license and paying fees according to the board's rules.  The individual has to demonstrate competency to practice physical therapy or perform an internship under a restricted license or take remedial courses determined by the board or a combination of these.  It is up to the board's discretion.  The board may also require the individual to take an examination. 

If a licensee fails to renew and pay the biennial renewal fee within 60 days after the renewal is due, the license is revoked without further notice or hearing.  Any person whose license is revoked in this way may apply in writing to the board for reinstatement, and it is up to the board to reinstate such person once all required fees are paid. 

63-13-310: Unlawful Use of Titles or Designations Indicating Licensure

A physical therapist shall use the letters "PT" or "DPT" in connection with their name to denote licensure.  

It is unlawful for any person or business to use the words "physical therapy," "physical therapist," "physiotherapy," "physiotherapist," "registered physical therapist," licensed physical therapist," "doctor of physical therapy," or the letters "PT," "LPT," "DPT," OR "RPT" or any other words or abbreviations indicating or implying that physical therapy is being provided or supplied including the billing of services labeled as physical therapy unless by or under the direction of the physical therapist.  

According to the statute, a physical therapist assistant shall use the letters "PTA" to denote licensure.  

No person shall use the title "physical therapist assistant" or the letters "PTA" in connection with the person's name or any other words or abbreviations implying that the person is a physical therapist assistant unless the person is licensed as a physical therapist assistant.  

63-13-311: Supervision of Students and Assistive Personnel

The supervision of PTAs and assistive personnel is an important section for us.  Many issues that go before the board pertain to supervision or the lack thereof.   Physical therapists are responsible for the patient care given by assistants, other assistive personnel, and students on clinical affiliations under their supervision.  However, the physical therapist may delegate to the PTA,  assistive personnel, and clinical students selected tasks or procedures that fall within their scope of education or training.

PTAs shall be under the supervision of physical therapists at all times; likewise, physical therapy students and PTA students must be under the supervision of physical therapists at all times. 

Physical Therapy aides, other assistive personnel, and clinical students require on-site supervision of a licensed physical therapist or a physical therapist assistant while providing patient care activities.   

63-13-312: Denial, Suspension, or Revocation of Licenses

The board has the authority and power to deny, suspend, or revoke the license of a licensee who is guilty of violating any of the provisions of this practice act or is guilty of the following acts or offenses:

  • Practicing physical therapy in violation of chapter 13 or any rule or written order by the board,
  • Practicing or offering to practice beyond the scope of physical therapy practice as defined in this chapter,
  • Making false or misleading statements or representations, being guilty of fraud or deceit in obtaining admission to practice, or being guilty of fraud or deceit in the licensee's practice,
  • Engaging in the performance of substandard care by a physical therapist or PTA due to ignorance, incompetence, or a deliberate or negligent act or failure to act, regardless of whether actual injury to the patient is established.
  • Inadequately supervising or delegating duties that exceed the scope of practice for assistive personnel.
  • Conviction of a felony or any offense involving moral turpitude in the state of TN or any other state or country.
  • Practicing when mental abilities are impaired by controlled substances or alcohol.
  • Disciplinary action to practice physical therapy in another state or territory of the United States for any reason that would be grounds for discipline in the state of Tennessee.
  • Engaging in sexual misconduct which can include:
    • Sexual relationship (consensual or nonconsensual) while a PT or PTA/patient relationship exists.
    • Making sexual advances, requesting sexual favors, or engaging in verbal conduct or physical contact of a sexual nature with patients
    • Intentionally viewing a completely or partially disrobed patient during treatment, if not related to patient diagnosis or treatment under current standards.  
  • Found to directly or indirectly participating in dividing, transferring, assigning, rebating, or refunding an unearned fee or profiting from means of a credit or valuable consideration.  This can be a discount or gratuity in connection with physical therapy services.  
  • Not following the standards of ethics of the physical therapy profession. 
  • Charging unreasonable or fraudulent fees for services performed or not performed
  • Making misleading, deceptive, untrue, or fraudulent representations in the practice of the profession
  • Being under a current judgment of mental incompetency rendered by a court of competent jurisdiction
  • Aiding or abetting a person not licensed in this state who performs activities requiring a license
  • Failing to report any act or omission of a licensee, applicant, or any person which violates this chapter to the board
  • Failure to maintain confidentiality without prior written consent
  • Promoting unnecessary devices or treatment interventions, or services for financial gain
  • Providing unwarranted treatment interventions or continuing treatment beyond the point of reasonable benefit
  • Failing to maintain adequate patient records, which contain a minimum of an evaluation of objective findings, a physical therapy treatment diagnosis, a plan of care including desired outcomes, a treatment record, a discharge plan including intervention results, and sufficient patient identifiers.  
  • Interfering with, or refusing to cooperate in, an investigation or disciplinary proceeding, including willful misrepresentation of facts or by the use of threats or harassment against any patient or witness.
  • Division of fees or agreeing to split fees for professional services with any person for bringing or referring a patient outside the scope of 63-13-315 (below)
  • Receiving commissions in any form on fees for professional service, references, consultations, or any other services supplied to patients
  • Practicing physical therapy with a mental or physical condition that does not allow the licensee to practice safely and with the needed skill.  

The list in its entirety can be found in the statute here.

63-13-313: Disciplinary Actions of the Board

Upon proof of a violation, the disciplinary action from the board can be to deny a license, permanently or temporarily withhold issuance of a license, suspend a license, issue a letter of reprimand, revoke a license, refuse to issue or renew, or impose civil penalties. In addition, the board may, at its discretion, can assess and collect the reasonable costs incurred in a disciplinary hearing when action is taken against a person's license.

63-13-314: Administrative Procedure of Disciplinary Actions

All proceedings for disciplinary action against a licensee shall be conducted following the Uniform Administrative Procedures Act, compiled in Title 4, Chapter 5.  The board retains jurisdiction to modify or refuse to modify, upon request of any party, any of its orders issued according to this section.

63-13-315: Penalties

A person commits a Class B misdemeanor if the person engages in an activity requiring a license and who fails to obtain the required license, violates any other provision of this chapter, or who uses any word, title, or representation implying that the person is licensed to engage in the practice of physical therapy. A person claims to be a physical therapist when using a title, letters, or any description of services that incorporate one or more of the terms and designations mentioned earlier. 

The board may authorize an investigation of any person to determine if the person engaged in the unlawful practice of physical therapy. The board may, through the office of the attorney general and reporter, apply for injunctive relief to enjoin any person from committing an act in violation of this chapter.

A person who aids or requires another person to directly or indirectly violate this chapter or rules allows the use of a license issued by the board by any person other than the licensee or who acts with the intent to violate or evade this chapter or rules is subject to a civil penalty of not more than $1,000 for each violation.

63-13-316: Peer Assistance Program, Fees

Instead of a disciplinary proceeding, the board may permit a licensee to actively participate in a board-approved peer assistance program.   This is more of a private way to address certain violations. 

Some of the circumstances which would qualify for a peer assistance program would be:

  • The board has evidence that the licensee is impaired.
  • The licensee has not been convicted of a felony relating to a controlled substance in a court of law in the United States.
  • The licensee enters into a written agreement with the board for a restricted license and complies with all the terms of the agreement, including making progress in the program and adhering to any limitations on the licensee's practice.
  • The licensee signed a waiver allowing the peer assistance program to release information to the board if the licensee does not comply with the requirements of this section or is unable to practice with reasonable skill or safety.

The board will establish fees for this section.

63-13-317: Disclosures to Patient, Confidentiality, Complaints, and Display of Licensure

The patient must be made aware of any financial arrangements connected to the referral process by the physical therapist.  Any financial interest in products endorsed and recommended to patients must be disclosed in writing by the physical therapist. The licensee also has the responsibility to ensure that the patient has knowledge of freedom of choice in services and products.

Importantly, information relating to the physical therapist-patient relationship is confidential and may not be communicated to a third party not involved in that patient's care without the prior written consent of the patient. Physical therapist-patient confidentiality does not extend to cases in which the physical therapist must report information as required by law.

Any person may submit a complaint regarding any licensee or any other person potentially in violation of this chapter. Confidentiality shall be maintained subject to the law.

The department is to keep all information relating to complaints filed against licensees confidential until the information becomes public record as required by law. 

Each licensee must display a copy of their license or current renewal verification in a location accessible to public view at the licensee's place of employment.

63-13-318: Board of Physical Therapy

This section covers the Board of Physical Therapy itself, not its extent of governance.  The Board consists of five members appointed by the governor who are all residents of Tennessee.  Three of the members must be licensed physical therapists who have had at least five years of experience either teaching or in practice.  One member of the board is a licensed PTA with five years of experience in either clinical practice or teaching a physical therapist assistant curriculum, and one member of the board is a person who is not engaged in the practice of physical therapy and is not professionally or commercially associated with the healthcare industry. 

To determine qualified persons to fill board positions, the governor shall consult with interested physical therapy groups.  Those groups, including the Tennessee Physical Therapy Association, may submit lists of potential nominees to the governor.  

All board members are reimbursed for actual expenses incurred during official duties of the board and are entitled to a per diem of $100 per day for each day conducting the business of the board.    

The Board meets at least annually and selects a chair and a secretary.  Meeting are held as frequently as required.  A quorum of the board is at least three members.

All regular appointments to the board are for a three-year term, and the members will serve until a successor is appointed.  According to the code, the governor should ensure that at least one member is fifty-five years of age or older, one member is a racial minority, and the gender balance reflects the balance of the state's population.  

The governor can remove a board member for misconduct, incompetence, or neglect of duty. 

Part 4 Physical Therapy Licensure Compact

63-13-401 Short Title

This part of the practice act is known as the "Physical Therapy Licensure Compact."

63-13-402 Compact 

The state of Tennessee entered into the physical therapy licensure compact.  The purpose of the compact is to allow interstate physical therapy practice so that access to physical therapy services is improved.  The practice of physical therapy occurs in the state where the patient/client is located at the time of the service. The regulatory authority of the state is preserved to protect public health and safety through the current state licensure process.  It will also encourage the cooperation of member states to this compact to regulate multi-state therapy practice.  It will support spouses of relocating military members and will also enhance the exchange of information among its members (licensure, investigative and disciplinary information). 

The term "compact privilege" means a remote state has granted a license from another member state of the compact to practice as a PT or PTA in the remote state under its law and rules.  The practice of physical therapy occurs in the member state where the patient/client is located at the time of the patient/client encounter.  

There are many rules required by the compact that the state must uphold to participate. You may find them in 63.13-402 Section 3.  

Compact Privilege Requirements

For the licensee to participate in compact privilege, the licensee needs to hold a license in the home state and have no limitations placed on his/her license in any state.  The licensee must be eligible for a compact privilege in any member state with no prior disciplinary action against any license or compact privilege within the prior two years.  The licensee must notify the commission that he/she is seeking compact privilege within a remote state(s).  Any fees, including any state fee, is to be paid by the licensee.  The licensee must meet any jurisprudence requirements established by the remote state(s) the member is seeking compact privilege and let the commission know if an adverse action is taken on his/her license by a non-state of the compact within 30 days of the adverse action.  

The compact privilege is valid until the expiration date of the home license. To maintain compact privilege in the remote state, the licensee must abide by the requirements mentioned in the paragraph above.  

The licensee providing physical therapy in a remote state is to abide by the laws and regulations of the remote state. The licensee is subject to that state's authority when practicing in that state, and the remote state may impose fines or take any necessary actions to protect the health and safety of its citizens.  Compact privilege is not allowed in any other state until removal action is satisfied by the state taking action on the license and all fines are paid.  

If a licensee's home state licensee is limited in any way by that board, compact privilege is lost in any remote state until the home state license is no longer limited and two years have elapsed from the date of the disciplinary action.  Once those requirements are satisfied, the licensee must meet the compact privilege requirements discussed above to obtain compact privilege in a remote state.  

 If a licensee's compact privilege in any remote state is removed, the licensee will lose compact privilege in any remote state until all fines are paid, the specific period for which the compact privilege was removed has ended, and two years have elapsed from the date of the disciplinary action.  Once those requirements are satisfied, the licensee must meet the compact privilege requirements discussed above to obtain compact privilege in a remote state.  

Active Duty Military Personnel or Their Spouses 

A licensee who is active duty military or the spouse of someone who is active duty military can designate the home state as one of the following: 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.  

The Physical Therapy Commission was established by the compact member states.  Some of the commission's duties are establishing bylaws, establishing the fiscal year and maintaining financial records, create uniform rules to implement and administrate the Compact. The executive board consists of nine members, with seven voting members and two non-voting members. The commission will meet at least once annually and will prepare the budget, maintain financial records, monitor Compact compliance, establish committees if needed, and ensure Compact administration. Meetings are open to the public, and minutes are taken, while specific committees or the Executive Board may meet privately.   For further information on the Commission, please see 63-13-402 in its entirety.  

In April 2017, the PT Compact was officially enacted when ten states joined the PT Licensure Compact. To read this in its entirety, please click here.  Compact privilege was available in Tennessee beginning July 9, 2018.  There are now over 25 states joined in the PT Licensure Compact.  To see those states and others who are working on joining with legislation in progress, please click here. To verify if a PT or PTA has a compact privilege to practice in Tennessee, visit the PT compact commission verification webpage here

  

Regulations

The Board of Physical Therapy promulgates regulations that affect physical therapy.  Regulation is simply a rule or an order prescribed for management or government.  It is a regulating principle, and it is issued by various governmental departments to carry out the intent of the law.

Tennessee rules and regulations are contained in Chapter 1150-01.  The original chapter was filed on June 6th, 1978.  The most recent version of the rules and regulations may be found here.  

1150-01-.01: Definitions

The board defines certain language, and these rules are an additional definition to those definitions that are provided in the Physical Therapy Practice Act.  A complete list of definitions in Chapter 1150-01 can be found here

Number 12 is continuing competence, which is the ongoing application of professional knowledge, skills, and abilities that relate to occupational performance objectives in the range of possible encounters that is defined by that individual scope of practice and practice setting.  This is the reason you are taking part in this course.

Number 26 on the list is manual therapy techniques.  By definition, these techniques consist of a broad group of passive interventions in which the therapists use their hands to administer skilled movements to modulate pain, increase the range of motion of a joint, eliminate or reduce swelling or inflammation, improve contractile or noncontractile tissue extensibility, and improve other various functions. The interventions involve many different techniques (and areas of all joints of the body as necessary), such as the application of graded forces which are not performed beyond the joint's normal range of motion.  

The Board further defines what physical therapy assistive personnel is, including aids, technicians, transporters, et cetera.  The physical therapy treatment diagnosis is the process and the end result of evaluation information based upon examination of the patient, which is then organized into defined clusters, syndromes, or categories to determine the most appropriate intervention strategy.  A physical therapy treatment diagnosis is required in the practice of physical therapy in Tennessee.

1150-01-.02: Scope of Practice and Supervision

Subsection 1(A) states again that the scope of physical therapy is under the written or oral referral of a licensed physician, but the initial evaluation may be conducted without a referral.

The licensed physical therapist who has been licensed for at least one year and satisfies all requirements set by the Board can treat a patient for an injury or condition that was the subject of a prior referral if all of the three conditions are met:

  1. Consult with the referring practitioner within four business days of initiating physical therapy, 
  2. Consults the referring practitioner after ten treatment sessions or 15 calendar days, whichever occurs first, to be able to continue the current episode of care.
  3. The physical therapist commences any episode of treatment within the one-year referral timeframe.

A licensed PT may provide physical assessments or instruction, including exercise recommendations, to an asymptomatic person without the referral of a referring practitioner.  

A licensed PT may provide assistance to a person in an emergency circumstance to the best of his/her ability without a referral, provided that the PT refers to the appropriate healthcare practitioner as soon as possible. Emergency circumstance means where emergency medical care is a true emergency of acute symptoms, including severe pain and inaction would place the patient's health in jeopardy, serious impairment to bodily functions, and/or serious dysfunction of any bodily organ or part.  

Practice of Physical Therapy

The board has defined the rules that the practice of physical therapy is the examination, evaluation, and testing of individuals with mechanical, physiological, and developmental impairments, functional limitations, and disability or other health and movement-related conditions to define physical therapy treatment diagnosis, prognosis, and a plan of therapeutic intervention and to assess the ongoing effect of the intervention.

The practice of physical therapy also involves alleviating impairments and functional limitations by utilizing therapeutic interventions that may include therapeutic exercise, manual therapy, functional training, therapeutic massage, orthotics, prosthetic training, airway clearance techniques, protective and supportive equipment, wound care including debridement, modalities including mechanical, electrotherapeutic and electrophysiologic studies with other terms and concepts that are included in the section. 

Physical Therapy practice includes promoting and maintaining fitness, health, and quality of life for all ages to reduce the risk of injury, impairments, functional limitation, and disability.  Therapists may also practice in administration, consultation, education, and research.  

Diagnostic electromyography must be performed by a licensed physical therapist. The requirements to practice diagnostic electromyography are slightly lower in this course, section 1150-1-.04(4). Invasive kinesiologic electromyography may be performed only in a university setting as part of a research project approved by that university's IRB.  That being said, electromyography may only be performed first and foremost if there is a referral by an allopathic physician, osteopathic physician, dentist, or podiatrist.  The scope of practice also includes treatment to reduce the risk of injury, impairments, functional limitations, and disability by promoting the maintenance of fitness, health, and quality of life throughout the lifespan.  

Substandard Care

In the Practice Act code, there are definitions regarding what occurrences are automatically considered substandard care.  Substandard care (1C) includes:

  1. Overutilization of appropriate physical services or the lack of utilization of appropriate physical therapy services.
  2. Providing treatment intervention that is unwarranted by the condition of the patient.
  3. Providing treatment that is beyond the point of reasonable benefit
  4. Abandoning the care of the patient without informing the patient of further care options
  5. Not practicing by the standards outlined in the “Guide to Physical Therapist Practice.”  This Guide is issued by the American Physical Therapy Association (APTA) (https://www.apta.org/).  The web address for the Tennessee Board of Physical Therapy is www.tn.gov/health/health-program-areas/health-professional-boards/pt-board.html.           

Supervision of the PTA  

Supervision is an area that is ripe for exposure to physical therapists from many different standpoints.  The practice of a licensed PTA must be performed under the supervision of a physical therapist licensed and practicing in Tennessee. 

The physical therapist must perform the initial evaluation and develop a written treatment plan, which includes goals, frequency, and time periods of service.  The physical therapist must perform and document reevaluations, assessments, and modifications in the treatment plan at least every 30 days, and for patients seen longer than 60 days, the physical therapist must inspect the actual act of therapy services rendered at least every 60 days.

The physical therapist may not supervise a PTA that is delivering services at a site further than 60 miles or one hour from the licensed physical therapist.  The supervising physical therapist must be available by telephone or other means when the physical therapist assistant is treating patients.  The discharge evaluation is performed by the physical therapist, and the discharge summary must be written by the physical therapist. The licensed physical therapist and the PTA shall be equally responsible and accountable for carrying out the provisions of this paragraph.

Supervision of the Physical Therapy Aide and Assistive Personnel, Including Supervision Ratio.  

Physical therapy aides may be used for designated tasks that do not require clinical decision-making by the physical therapist or clinical problem-solving by the assistant.  Direct supervision must apply to the physical therapy aides. This means that the services are provided under the supervision of an on-site physical therapist or PTA who is licensed in the state of Tennessee. 

A physical therapist may also use other assistive personnel for selected and various other designated tasks consistent with training and education (certified athletic trainer, massage therapists, nationally certified exercise physiologists).  Other assistive personnel requires the on-site supervision of a physical therapist and the co-signing of all related documentation in the patient records by the supervising physical therapist.  

On-site supervision means that the supervising PT or PTA must be continuously on-site and present in the department or facility where the assistive personnel performs services. The supervising PT or PTA must also be immediately available to assist in the performance of the services and maintain continued involvement in appropriate aspects of each treatment session where a part of the treatment is delegated to assistive personnel.

A physical therapist may concurrently supervise no more than the equivalent of three full-time PTAs, and a physical therapist may concurrently supervise no more than the equivalent of two full-time assistive personnel or physical therapy aides.  The PTA may concurrently supervise no more than the equivalent of two full-time physical therapy aids.  

PT and PTAs are to provide direct onsite supervision to volunteers, and volunteers may not provide physical therapy to patients. 

A physical therapist is to provide on-site supervision to physical therapy clinical students at all times, and PTA's are to provide on-site supervision to PTA clinical students at all times.  Both PTs and PTAs should have at least one year of clinical experience before becoming clinical instructors for students.   

1150-01-.03: Necessity of Licensure

A person must hold a license to practice in Tennessee.  It is unlawful for any person who is not licensed in TN to hold himself/herself as a PT or PTA, including advertising on signs, mailboxes, addresses, plates, the internet, telephone listings, etc.  

1150-01-.04: Qualifications for Licensure

The qualifications for licensure are the same as those outlined in The Physical Therapy Practice Act 63-13-307.  

Physical Therapists who wish to perform diagnostic electromyography (invasive needle study of multiple muscles for diagnosis of muscle and nerve disease) must submit to the Board’s administrative office documented evidence of possessing current electrophysiology clinical specialist (ECS) certification from the American Board of Physical Therapy Specialties. Applicants for licensure as a Physical Therapist who seek to perform surface electrophysiological studies (motor and sensory conduction and somatosensory evoked potentials) and kinesiologic studies (invasive needle study of the muscles to determine the degree and character of a muscle during certain movements) according to rule 1150-01-.02 (See Practice of Physical Therapy), while practicing, must submit to the Board’s administrative office documented evidence of possessing the theoretical background and technical skills for the safe and competent performance of such studies. The supervision of applicants who seek to conduct diagnostic electromyography, surface electrophysiological studies, and kinesiologic studies shall be consistent with sound medical practice. 

1150-01-.05: Procedures for Licensure

Procedures for licensure are articulated by the board.  To become a licensed physical therapist, a person must comply with the following procedures and requirements: submit an application packet and respond truthfully and completely.  Applications can be accepted throughout the year, and the nonrefundable application fee must be paid.  You must submit a passport-style photograph, and you must disclose circumstances about a conviction of a crime, the denial of licensure by any other state or country, the loss or restriction of a license, or any kind of civil suit, judgment, or settlement.

The applicant must also request that the results from a criminal background check be submitted directly to the board from a vendor, which they outline in their application packet.  Personal resumes are not accepted and will not be reviewed as part of the application.  Only after all requirements have been met will a license be issued. 

There are additional procedures for licensure by reciprocity.  The person seeking reciprocity must have passed the licensing examination according to Tennessee rules, and the applicant needs to request verification of licensure status from all states in which he/she has been licensed to the Board's office. 

International educated applicants must pass the required exam, have his/her education evaluated and verified by an agency approved by the Board, submit proof of citizenship in the US or Canada or evidence of being able to live and work legally in the US, any current verification of license and current standing shall be sent to the Board.  All documents must be translated into English, and both original and translated certified versions must be submitted to the Board.   

1150-01-.06: Fees

All fees are established and reviewed and can be adjusted by the board from time to time.  The fee schedule is noted in rule 1150-01.-06.

1150-01-.07: Application Review, Approval, and Denial

A procedure is issued by the board for the application review and approval or denial.  Applicants must complete the application process. The board will notify the individual if his or her application is incomplete and the reasoning why it is incomplete. The individual may not sit for the exam until the application is complete.  If the person's completed application is denied, the ruling is final. However, the individual may contest the case under the Tennessee Administrative Procedures Act. 

If a person abandons the application for any reason, the board will deem the application denied and close the application if it has not been completed by the applicant within 12 months after the initial review or if the applicant fails to sit for the written exam within six months after being notified of eligibility to take the examination.

1150-01-.08:  Examinations

All educational requirements must be completed before applying for the examination.  To take the examination, the applicant must contact the Federation of State Boards of Physical Therapy (FSBPT). The test must be taken within 60 days of the date on the eligibility letter by FSBPT. All candidates are thumb-printed and videotaped at the testing session.  The test may be rescheduled up to 2 working days before the scheduled test date.  If a person fails the test, it can be retaken, but the candidate who fails the examination twice has to wait at least three months before reapplying for the examination. If the individual does not pass after 12 months from the exam eligibility date, the application to test will be denied, and the file closed.  The individual can reapply with a new application.  There are no longer individualized remediation programs.  Remediation after two failures included 10 hours of additional clinical training and 10 hours of additional coursework.  This is required after each failure beyond two times before the applicant can be approved for reapplication and testing. 

1150-01-.09: Renewal of a License

The due date for the license renewal is the expiration date indicated on your renewal certificate.  The license may be renewed online (www.tennesseeanytime.org) or on paper by mail. This renewal application is mailed to the last known address the Board has on file. If you do not receive the renewal application, you are still responsible for meeting all requirements for licensure renewal.  

To be eligible for renewal, an individual must submit to the Division of Health Related Boards a completed and signed renewal form, the applicable renewal fees, and a statement attesting to the completion of continuing competency requirements as provided in Rule 1150-01-.12.  Untruthful information on the application may result in license denial or disciplinary action. Reinstatement of an expired license can occur after payment of a reinstatement fee, the renewal fee, and proof of completing continuing competence requirements.  

1150-01-.10: Provisional License

A provisional license can be issued for those persons that were internationally educated and who have complied with the various license qualifications contained in these rules that are issued by the board except the clinical practice period required.  The provisional license can also be issued for either a physical therapist or PTA whose license has been retired or expired for at least three years with no unresolved disciplinary actions.   

Provisional licenses for internationally educated applicants are valid for no fewer than 12 weeks and no more than 48 weeks.  For those whose licenses have been retired or expired for greater than three years, provisional licenses are valid for a time period determined by the Board.  The provisional license may not be renewed. 

A physical therapist with a provisional license must work under the direct supervision of a licensed, on-site physical therapist with at least one year of licensed clinical experience. A PTA with a provisional license must work under the direct onsite supervision of a PT or PTA who is in good standing in TN and has a minimum of one year of clinical experience.  

1150-01-.11: Retirement and Reactivation of a License

To retire a license, a person with an active license must first obtain an affidavit of retirement form from the board's administrative office.  Next, complete and submit that form along with a signed and notarized letter with a statement that they understand that they cannot, in any way, practice or use the letters and titles associated with a physical therapist or physical therapist assistant with their name.  Furthermore, “retiring” a license can be the same as “inactive” status if you decide you no longer wish to practice physical therapy in Tennessee. 

Those who have retired their licenses and wish to reactivate them may submit a written request, including a statement of all relevant educational experiences during the time of inactivity.  The current license fee must be paid, a reinstatement fee if over one year of retired status, and the person must then complete the continuing competence requirements as provided in these rules. 

1150-01-.12: Continuing Competence

The board requires each licensed physical therapist or PTA to participate in a minimum number of experiences to promote continuing competency for the 24 months that precede the licensure renewal month. All applicants for licensure, renewal, reactivation, or reinstatement must demonstrate competency.

Physical therapists are required to have 30 hours every 24 months.  Twenty of those hours must be from Class I activities, and up to 10 hours can be acquired online.  The definition of "online" courses may be found here, and it is important to know the difference.  If there is an interactive potential for the continued competence course and a quiz following the course, that course is not deemed to be "online."  Up to 10 of the thirty required may be from Class II activities. Effective June 29, 2016, and after, physical therapist assistants are required to have 30 hours every two years.  The licensee is limited to 10 hours of online instruction, counting toward the 30 total hours.  Up to 10 hours of the 30-hour requirement may be from Class II activities.  Four hours of the continuing competency requirement must consist of ethics and jurisprudence education for both PTs and PTAs  These four hours; generally, two hours for ethics and two for jurisprudence, are required every renewal cycle.  Jurisprudence is what we are covering today.  Passing the board examination for first-time applicants out of school is sufficient for the continuing competence requirement for the initial license period, except for the ethics and jurisprudence requirement.  

The ethics course has to include the Code of Ethics, Guide for Professional Conduct, Standards of Ethical Conduct for the PTA, Guide for Conduct of the PTA, a model for ethical decision-making, and case analysis.  Jurisprudence courses must include the PT Practice Act, General Rules (Chapter 1150-01, Board policy statements, licensure process and renewal, the scope of practice, offenses that lead to disciplinary action, and supervision. The Board has the ultimate authority in deciding what is approved for ethics and jurisprudence courses.  

Continuing competence coursework is defined as a planned learning experience that is at a level beyond the entry-level requirements for PTs and PTAs, and the content must relate to physical therapy.

Class 1 Courses

Class I courses may include external peer review with verification of acceptable practice recognized by APTA (Credit is 20 hours per review with a max of 1 review per 24-month period), internal peer review with verification of acceptable practice (credit limited to 2 hours per review with two review cap per 24 month period), courses or workshops that are approved for CEUs by CEU granting agencies, courses or workshops approved by health-related organizations, other state Boards of PT  or accredited physical therapy educational institutions, or home-study courses offered through recognized health-related organizations that include objectives and verification of satisfactory completion.  University credit courses will also be considered Class I with 12 hours awarded per semester credit hour), as well as participating as a presenter in CEU courses.  Authorship of a presented scientific poster, platform presentation, or peer-reviewed published article also falls under this category.  Continued competence for authorship is ten hours per event with a maximum of two events each twenty-four month period.  Adjunct teaching a physical therapist or physical therapist assistant credit courses are counted as class one and is based on contact hours not to exceed twenty hours.  The course can only be counted once if taught more than one time.  Continued competence credit is twenty-six hours when obtaining certification of clinical specialization by the American Board of Physical Therapy Specialties (ABPTS) and is recognized only during the twenty-four-month time frame certification was awarded.  Certification by other organizations, such as McKenzie Institute, Ola Grimsby Institute, etc., will be awarded continuing competence credit by the board for up to twenty-six hours in one twenty-four-month period.  The number of hours is determined by the board and only issued during the twenty-four-month period certification occurred.   Completing an advanced degree is also awarded twenty-six hours and recognized only in the twenty-four-month period in which the degree is awarded.  Finally, continued competence hours in class 1 at the rate of five hours credit for each week of a clinical residency program is awarded a maximum of twenty-six hours per program.  

Classes II Courses

Class II courses may include self-instruction from reading literature, which is limited to one hour every two years.  Serving as a clinical instructor in an educational program or residency program or acting as a clinical instructor in a formal, non-academic mentorship qualifies as Class II activities at the rate of one hour per sixteen contact hours. One hour per hour of attendance at a scientific poster session, lecture, or symposium that doesn't qualify for Class I is awarded a maximum of two hours per two-year period. Other Class II activities include participating in a physical therapy study group, attending and/or presenting in-service programs, or serving the physical therapy profession as a delegate to the APTA House of Delegates on a professional board, committee, or task force.  Participating in a study group with two or more PTs/PTAs is limited to one credit hour per renewal period.  Attending or presenting in-service programs is awarded at one hour per eight contact hours with a four-hour maximum for each renewal period.  Serving the profession as a delegate, professional board, or committee is awarded credit at a maximum of one credit hour each renewal period. 

Unacceptable Activities

Unacceptable activities would be attending courses regarding OSHA regulations, which are a federal rule, Tennessee OSHA (TOSHA), which deals with occupational safety and health in Tennessee, cardiopulmonary resuscitation (CPR), safety, meetings for policy decisions, non-educational meetings at conferences, entertainment or recreational activities and visiting exhibits.

Documentation  

All continuing competence activities must be documented and kept for five years from completion.  If the Board requests, the licensee has thirty days to provide evidence of continuing competence.  If a licensee fails to complete the competency requirements or falsifies the documents in any way, the licensee is subject to disciplinary action. Examples of documentation are a signed peer review report, an official program or outline of the course attended or taught, or a copy of the presentation which shows the content and objectives were physical therapy-related and the number of course hours.  It should also include any responsibility in teaching/authoring. Other examples of documentation are a CEU certificate or completion verification of the home study program or a copy of the final grade report if a University credit course has been taken, a specialization certificate, or documentation of self-instruction from reading professional literature.

Reinstatement/Reactivation of an Expired or Retired Licensee 

An individual whose license has expired or has been retired for three years or less needs to submit the application for reinstatement or reactivation with documentation of continued compliance which has to have been initiated and completed within the two years before submission of the application for reinstatement/reactivation. An individual whose license has expired or retired for more than three years needs to submit the application for reinstatement or reactivation with documentation of continued competence, which also has to be initiated and completed within two years before submission of the application for reinstatement/reactivation.  The only difference with having a license retired or expired over three years is that the board has the discretion to require additional education, supervised clinical practice, require successful passage of examinations, and issue a provisional license.

Waive or Extend Continued Competence Requirements 

The Board may waive continuing competence requirements or extend the deadline to complete continuing competence requirements in cases of documented illness, disability, or hardship.  The licensee must request an extension or a waiver in writing with supporting documentation before the end of the twenty-four months period is up.  

1150-01-.13: Advertising

Special care should be taken by physical therapists to avoid misleading the public.  The physical therapist must be mindful that the benefits of advertising depend on its reliability and accuracy. Since advertising by physical therapists is calculated and not spontaneous, reasonable regulation designed to foster compliance with appropriate standards serves the public interest without impeding the flow of useful, meaningful, and relevant information to the public.

Disciplinary action may occur if in the advertisement any of the following occurs: any claims that treatment by a therapist is professionally superior when the superiority of services cannot be substantiated, misleading use of an unearned or non-health degree in any advertisement, promotes services that are not in within the scope of practice of the licensee, appeals to an individual's anxiety in an excessive or unfair manner, personal testimonials regarding quality of service that is not reasonably verifiable, use of personally identifiable information without obtaining patient consent, misrepresentation of licensee's credentials. experience or ability, use of "bait and switch," suppress or omit a fact that would make the advertisement deceptive or misleading, and any communication that would create an unjustified expectation regarding results of treatment as well as other situations that are included in this section.  If you are planning to advertise your clinic, make sure to read and review this section in its entirety.  The rule specifically covers fees in advertising and content, which can be read in entirety in 1150-01.13 here.

1150-01-.14: Code of Ethics

The Board of Physical Therapy has incorporated the current “Code of Ethics” for physical therapists as set forth by the APTA.  This code can be found on the APTA website. 

1150-01-.15: Disciplinary Actions, Civil Penalties, Assessment of Costs, and Screening Panels

Upon a finding by the Board that a physical therapist or PTA has violated any provision of the T.C.A. §§ 63-13-101, et seq., or the rules promulgated thereto, the Board may impose any of the following actions separately or in any combination deemed appropriate to the offense: advisory censure, formal censure, probation, licensure suspension, licensure revocation, or assessment of civil penalty.  Advisory censure is a written action to the PT or PTA for minor or near infractions. Advisory censure does not involve disciplinary action. Formal censure or reprimand is a written action to a PT or PTA for one-time and less severe violations.  It does require disciplinary action. Probation is a formal disciplinary action upon a PT or PTA.  It may require conditions that have to be met before the probation is lifted and/or restrict the individuals' activities during the probationary period. Licensure suspension is a formal disciplinary action that suspends practice for a period of time. Licensure revocation is a disciplinary action that terminates licensure.  After one year of a license being revoked, the board, at its discretion, reinstate a revoked license after conditions and a period of time that the board feels is appropriate.  Of the procedures which are used, the petitioner shall submit a written and signed petition for order modification to the board's administrative office. 

The petitioner would be the physical therapist.  The Board authorizes consultants and administrative staff to make an additional determination on any petition and take action.  The Board relies on various consultants when deciding on any type of proceeding.  The board can impose Type A civil penalties, which can range up to $1,000.00, Type B civil penalties, which can range up to $500.00, and Type C penalties, which range up to $100.00.

Reconsideration and stays deal with a contested case in which the therapist is opposing an action that the Board is wishing to take.  The Board authorizes the member who chaired the Board for a contested case to be the agency member to make the decisions authorized according to rule 1360-04-01-.18 regarding petitions for reconsideration and stays in that case. 

Please refer to this Rule section for a complete outline of the disciplinary policies, as it is lengthy.

1150-01-.16: Duplicate (Replacement) License

A license holder whose “artistically designed” license has been lost or destroyed, or a license holder whose renewal certificate license has been lost or destroyed, may be issued a new license upon receipt of a written request in the Board’s administrative office.  Such request shall be accompanied by an affidavit (signed and notarized) stating the facts concerning the loss or destruction of the original document, accompanied by a recent photograph, signed and notarized, and the required fee. 

1150-01-.17: Change of Address or Name

A change of name or address must be reported to the board no later than 30 days after such a change.  The notice shall provide both the new and old information, as well as the profession and license number. In regards to a name change, a notarized photocopy of the official document involved must be included as well.  

1150-01-.18: Mandatory Release of Client Records

There is a provision for the mandatory release of client records. If the client makes the request or the client has a representative such as the power of attorney, the Board shall provide a complete copy of the client's records or summary of such records, which are maintained by the provider.  This request for records must be honored promptly.  The individual requesting the records is responsible for payment of reasonable costs to the provider for copying and mailing the records.

1150-01-.19: Board Meetings, Officers, Consultants, Records, Complaints, and Declaratory Orders

The Board is charged by law with the responsibility of regulating the practice of physical therapy.  The board has to have meetings at least once annually, which are open to the public.  Three members at all times constitute a quorum. Special meetings may be called by the chair or at the request of two board members.  Each year a Chair and a Secretary are elected.  If a board member has a conflict of interest in any matter pending before the board is to disclose that in writing and will not vote on that matter.  

Responsibilities of the Board include adopting and revising rules, conducting hearings, approving and renewing licenses, appointing designees to assist in performing its duties, and various other jobs as they pertain to the practice of Physical Therapists and PTAs. The board can select a consultant who can (1) recommend whether and what type of disciplinary actions should be taken after complaints are received, and an investigation is conducted, (2) recommend the terms a complaint case or disciplinary action may be settled (board will have to okay before anything becomes effective), and (3) perform any other assignments issued by the majority of the board.

Any applications, requests, notices, and other communications to the Board should be sent to the Board's administrative office.  All correspondence must be received fourteen days before the upcoming board meeting except for disciplinary actions or hearing requests.  All records except those that are confidential by law can be assessed with the supervision of an employee of the Division at the Board's administrative office.  Public records are available to the individual requesting after payment is received for the cost of copying.  Complaints against a licensed PT or PTA are public information after the notice of charges is filed. 

The Board has adopted the Division of Health Related Board's rule 1200-10-01-.11 as its rule governing the declaratory order process.    

1150-01-.20: Consumer Right-to-Know Requirements

You are obligated to report any malpractice.  The threshold amount below which medical malpractice judgments, awards, or settlements in which payments are awarded to complaining parties need not be reported pursuant to the “Health Care Consumer Right-To-Know Act of 1998” shall be ten thousand dollars ($10,000).  If an award or judgment has been made over $10,000.00 for malpractice, it has to be reported to the consumers.

The following criminal convictions must also be reported to the public: conviction of a felony, conviction or adjudication of guilt of any misdemeanor regardless of its classification when the misdemeanor involves sex, alcohol or drugs, physical injury, or threat or injury to any person, abuse or neglect of a minor, or fraud or theft.

To have a misdemeanor that is reported under this rule that has been expunged by a judge expunged on a profile, a copy of the order of expungement signed by the judge must be submitted to the Department.    

1150-01-.21: Professional Peer Assistance

As an alternative to disciplinary action or as part of disciplinary action, the Board may approve and utilize a professional assistance program for situations regarding licensee substance abuse, chemical abuse, or lapses in professional and/or ethical judgments. Information on those referred by the board and who are entering the program is confidential.

1150-01-.22 Dry Needling

To perform this technique, PTs must have 50 hours of in-person educational instruction to include the areas of musculoskeletal and neuromuscular systems, anatomical basis of pain mechanisms, chronic pain, referred pain, trigger points, and universal precautions.  An additional 24 hours of dry needling-specific education in the six areas of dry needling technique, indications and contraindications, documentation, management of adverse effects, practical psychomotor competency, and Occupational Safety and Health Administration Bloodborne Pathogens Protocol.  

Each course must be specific agenda regarding anatomical areas covered in the instruction and have a course level (intro, intermediate, advanced). The courses must be pre-approved or approved by the Board, its consultant, or delegate the approval to another entity.  Any PT who completed the 24hrs of instruction in another state or country must provide documentation to the Board. The Board or its consultant must approve the coursework before that therapist can practice dry needling in the state of TN.  Approved dry needling courses are re-authorized every two years. The policy statement can be found with the list of the most up-to-date approved courses here.  As of Aug 2018, the approved courses are Myopain Seminars, Kinetacore, Institute of Advanced Musculoskeletal Treatments (IAMT)/Results Physiotherapy, Benchmark Rehab Institute, Benchmark Rehab Partners Orthopedic Physical Therapy Residency Program, Evidence in Motion Institute of Health Professionals, Spinal Manipulative Institute/American Academy of Manipulative Therapy, Integrative Dry Needling Institute/American Dry Needling Institute, Systemic Dry Needling/Systemic Dry Needling and Courses by Sue Falsone, The University of Tennessee at Chattanooga, Advanced Manual Therapy, NAIOMT (The North American Institute of Orthopaedic Manual Therapy), Belmont University Competency in Dry Needling,  MS Dry Needling, and Total Motion Release (TMR) Seminars.  

Dry needling is only to be performed by a physical therapist, and they must submit written documentation of appropriate training.  All patients receiving dry needling by approved therapists must receive information from the therapist, which includes a definition and description of the practice of dry needling and a description of the risks, benefits, and possible side effects. 

Physical therapy clinical students who have completed all educational requirements outlined in the rule may practice dry needling under the direct on-site supervision of a physical therapist licensed in TN who has also met the educational requirements.   

Policy Statements

The Board of Physical Therapy is also charged with the duty of issuing policy statements.  A policy statement is an authoritative guide to the meaning of an applicable guideline. Refer to the handout titled Tennessee Policy Statements to read each policy. 

Direct Access Policy 2021

These recent changes were discussed in 63-13-303. The board position is that a PT who is treating a patient without a referral must discontinue PT services and refer the patient to an appropriate healthcare practitioner after thirty days when no progress has been made with that patient.  There were also changes to the qualification requirements of physical therapists who can practice with direct access.  To see this policy statement, please click here.  

Approved and Pre-Approved Dry Needling Courses

Courses in dry needling must be approved by the Board.  They will be reauthorized every two years, as mentioned earlier.  Please refer to the Board for a list of the most up-to-date providers. 

Patient Referrals for Physical Therapy

Nothing is to be construed to prohibit services rendered by physician assistants, registered nurses, or LPNs if such service is rendered under the supervision of a physician.  Just as with physical therapists, physicians, physicians' assistants, and others have various rules that are promulgated by the Secretary of State or by their practice boards. 

The Tennessee Board of Physical Therapy states the following policy: jointly developed protocols may include referral of patients to physical therapy if the referrals to the physical therapist are within any assistant's range of skill and competence, and such referrals are within the scope of practice for the supervising physician.  When the referral for physical therapy is included in the protocols, those referrals, if made by a physician assistant, orthopedic assistant, or advanced practice nurse, are considered referrals by supervising physicians for the purposes as contemplated under the Tennessee code. 

The practice of physical therapy shall be under the written or oral referral of a licensed doctor of medicine of osteopathy.  The Policy Statement for patient referrals to physical therapists can be found here

Physical Therapy Discharge Evaluations/Plans/Summaries

The physical therapy portion of a medical record complies with the Tennessee code when it includes the following: the identification of the patient, the physical therapy evaluation, the physical therapy treatment diagnosis, the plan of care including desired outcomes, the treatment record, results of interventions and the discharge plan, and the discharge plan or summary is required for every physical therapy record.  Accordingly, for the patient record to be complete, we have to include a discharge summary.

The Policy Statement for physical therapy discharge evaluations/plans/summaries can be found here

Educational Equivalency for Foreign-Trained Therapists

This is addressed at length in Rule 1150-01-.04(3).  The Policy Statement can be found here.

Home Health Aides

Monitoring home health aides by physical therapy practitioners is not in itself a violation of the Physical Therapy Practice Act and Rules if no other ethical or practice violations are present. 

The Policy Statement on home health aides can be found here.

Multidisciplinary Health Screenings

The Board resolves that health screenings in disciplines other than in one’s scope of practice are unsafe to the public and may subject that license to disciplinary action by the Board or possible malpractice litigation. 

The Policy Statement can be found here.

Fingerstick Techniques

Performing fingerstick techniques is within the scope of practice for a physical therapist or PTA licensed in Tennessee.

The Policy Statement can be found here.

Criminal Convictions - Applications for Licensure

The following persons are required to appear before the board before any license may issue: any applicant who has a felony conviction, any applicant who is convicted of multiple misdemeanors, and any applicant who has been convicted of a class A or B misdemeanor within five years of the date of application. 

The Policy Statement on criminal convictions can be found here.

Lapsed Licenses

The Board recognizes that an individual may inadvertently allow his/her license to expire.  The individual may go through a reinstatement protocol.

The Policy Statement on lapsed licenses can be found here.

Called to Active Military Duty

The Policy Statement on active military duty can be found here.

Continuing Competency

The Policy Statement on continuing competency can be found here.

Attorney General

In addition to the federal Attorney General, each state has an Attorney General. The Attorney General is the chief law officer of the state.  He or she gives advice and opinions to the governor and to the executive and administrative departments or agencies.  Those opinions are entitled to respectful consideration, but the Attorney General's opinions have no control on an authority upon the state of the law discussed in the opinion.  Opinions published before the year 2000 are not available for digital viewing.  To view those in the year 2000 and later, they may be found here.  To request an opinion in its entirety, call (615) 741-2518.  

Opinion 83-172: Use of Electronic Muscle Exercisers

This first opinion was issued in 1983, and it deals with rules and regulations regarding the operation of electronic muscle exercisers and the licensing requirements and qualifications of an operator of such equipment.  There were no statute rules or regulations directly governing those requirements for those devices then, but under certain circumstances, the equipment must only be operated by a licensed physical therapist.

Opinion 95-033: Advertising and Treatment by Massage Therapists

The next opinion was issued in 1995, and the question presented to the Attorney General was, “May a massage therapist in Tennessee lawfully advertise that he or she ‘treats’ one or more conditions?”  The answer was no.  The Attorney General expressed an opinion that the treatment of any condition through massage constitutes therapeutic massage and only licensed physical therapists and certain other healthcare professionals may lawfully engage in therapeutic massage. 

Opinion 01-002: Membership of a Professional Limited Liability Company for the Practice of Electrolysis

This opinion was dated 2001, and it asked, "Can a medical doctor and a registered nurse who has been trained in electrolysis be members of a professional limited liability company for the practice of electrolysis?"  The last page of this answer references a previous Attorney General opinion that said it was not lawful for a general corporation to engage in the business of providing professional physical therapy services.  That particular opinion was issued in 1994.

Opinion 05-171: Physical and Occupational Therapy Reimbursements under the Medical Fee Schedule

This opinion is dated 2005.  The question was, "Does the method of reimbursing physical and occupational therapy facilities under the medical fee schedule as prescribed by the rules and regulations violate the equal protection provisions of the Tennessee Constitution?"  The answer by the Attorney General was no, and that was pursuant to various other rules and regulations, which are cited in that opinion.

Opinion 07-55: Performance of Spinal Manipulation

In 2007, this landmark opinion was issued.  "Under current law, may physical therapists legally perform spinal manipulation as that term is defined in Tennessee code, annotated 63-43-101?"  The opinion said no.  No personal license under Title 63, including physical therapists, may perform spinal manipulation or spinal adjustment.  In this case, the chiropractors received an opinion that protected one of their practice techniques.

Opinion 12-27: Authority of Physical Therapy Board

In 2012, these questions were presented to the Attorney General regarding the Physical Therapy Board's ability to take action against chiropractors that offered “physical therapy” or used the term “physical therapy” in their practices.  This Attorney General opinion was favorable for physical therapists, stating that the Board could file for injunctive relief and impose civil penalties. 

Board of Physical Therapy: Administrative Hearing Process

Please refer to the Board meeting minutes for this discussion

An administrative hearing is a proceeding before an administrative agency, which may consist of an argument, trial, or both.  The use of procedural rules is more relaxed than in a court hearing.  These minutes are from the May 13th, 2022, board meeting.  Once these minutes were approved by the board, they became public records.  Please know this is an example of what these proceedings look like and not a reflection of our feelings or opinions of this case.

On page two, we see that this is litigation.  It says there are currently seven cases open before the Office of General Counsel.  There is also a list of reports and/or requests from the Office of Investigations with multiple new complaints. Complaints varied from actions in other states, malpractice, unprofessional conduct, violation of order, and two continuing education violations.   

If something occurs where you must go before the board, it may be in your best interest to seek legal counsel as you proceed.

Legislative Updates 

To stay current on the latest legislative updates, please make sure to frequent this page.  

The following went into effect on April 18, 2018:

Public Chapter 754-A member's freedom of speech is not to be infringed by any statute, rules, or statements by a board, commission, or committee.  

The following went into effect on April 24, 2018:

Public Chapter 803-Act sunrises the physical therapy compact and sunsets it for June 30, 2020.  

The following went into effect on July 1, 2018: 

Public Chapter 611-An agency holding a public hearing is to make copies of the rule in "redline" form to people attending the hearing

Public Chapter 638-Prohibits healthcare prescribers from in-person solicitation, telemarketing or telephonic solicitation of victims within 30 days of an accident or disaster for the purpose of marketing their services related to the accident or disaster.  Exceptions are further identified in this chapter.  

Public Chapters 745 and 793- These two chapters work together for the "Fresh Start Act."  Licensing authorities are not allowed to deny an application or renewal for a license/certification/registration due to a past criminal conviction that does not relate to the occupation.  Further information is found in these two chapters.  

Public Chapter 929- All agencies are to turn in a list of all new or changed policies in the prior year to the chairs of the government operations committees on July 1 of each year.  A summary of the policy and justification for the policy instead of a rule should be included.  The act also prohibits any policy or rule that infringes upon an agency member's freedom of speech.  A member of a board or committee may be removed by an agency's appointing authority.  

Public Chapter 1021-Allows for appeals of a contested case hearing to be in the chancery court nearest the person contesting residence or at the person's discretion, in the court nearest the place the action arose or in the chancery course of Davidson County.  Petitions to do so must be filed 60 days after the final order.  

The following went into effect on Jan 1, 2019:

Public Chapter 675-Department of Health is to accept allegations of opioid abuse.  Whistleblower protections have been established so that those allegations in good faith are not terminated or adverse licensure due to the report.  That good faith reporting individual is also immune to any potential civil liability.    

Public Chapter 744-If a medical hardship contributed to the default or delinquency of a student loan, this policy allows for the licensing entity the discretion to not suspend/deny/revoke a license. 

Public Chapter 954-Initial licensure fee for low-income persons who are enrolled in state or federal public assistance programs such as TANF, Medicaid, and SNAP is to be waived.  

The following went into effect on March 19, 2020

Public Chapter 551-This chapter extends the Physical Therapy Licensure Compact to June 30, 2028.  

The following went into effect on March 20, 2020

Public Chapter 594-This chapter was the Department of Health's Accountability Act.  It allows all health-related boards to take action against a licensee who has been disciplined by another state. It expands allowable actions beyond a summary suspension.  The act also states that notification of health practitioner law changes can be done by the online posting of those law changes by the respective boards. That notification must remain online for at least two years following the change of law.  

The following went into effect on June 22, 2020

Public Chapter 738- Chapter 738 states that before authorizing public records destruction, the public record request coordinator must be contacted to ensure those records are not subject to any pending public records request.  Therefore this act does not allow for any destruction of public records if it is known that those records are needed for a pending inquiry.  The regular schedule of records destruction can still occur as long as there is no knowledge by the records custodian of a pending request.  

The following went into effect on July 15, 2020

Public Chapter 790- This chapter makes several changes to the statutes regarding physical therapists.  The statute now includes the term "physiotherapist," and a definition of "competence" has been added.  The new statute makes it clear that a physical therapist will only be licensed under this chapter if he or she holds a degree from physical therapy program accredited by a national accreditation agency recognized by the United States department of education and by the board.  The age requirement has been deleted. The statute also changed to allow a physical therapist to conduct an initial patient visit without a referral instead of just an initial evaluation.  The physical therapist now may treat a patient without a referral if it is within the scope of practice and the following occurs:  

  • The patient's physician is notified.
  • The physical therapist must refer the patient to a healthcare practitioner that qualifies as a referring practitioner if the physical therapist determines no progress has been made in regard to the patient's condition within 30 days after the initial visit.  
  • Therapy services cannot continue beyond 90 days without the patient's healthcare practitioner being consulted.  
  • The 30 and 90-day time frame windows do not apply if the patient was diagnosed by a licensed physician with chronic, neuromuscular, or developmental conditions and the treatment is for symptoms associated with those conditions.
  • The physical therapist must refer the patient to an appropriate healthcare practitioner for the following reasons:  
    • Patient's symptoms or conditions beyond their scope of practice
    • Reasonable therapeutic progress is not being made
    • Physical therapy is contraindicated

It is considered unprofessional conduct to initiate physical therapy services in violation of the conditions discussed in this statute.   

Applications will be active for 12 months, and no more than six attempts can be made to pass the examination.  

A physical therapist (or PT assistant) that is licensed in a member state of the PT Licensure Compact is eligible to become a licensee for compact privileges in Tennessee.

Finally, additional grounds for license denial, suspension, revocation, and discipline were created.  Now included in the statute are: 

  1. A licensee acting in a manner inconsistent with generally accepted standards of physical therapy practice
  2. Practicing physical therapy with a mental or physical condition that impairs the ability of the licensee to practice with skill and safety. 

An amended Telehealth Statute 63-1-155 was amended into law on August 20, 2020.  If a license is held under title 63, telehealth can be practiced.  

Public Chapter 4-Deals with telehealth and reimbursement. 

Section 9 of the public chapter defines "telehealth," "telemedicine," and "provider-based telemedicine" as the use of real-time audio, video, or other electronic medical and telecommunication technology that enable interaction between a healthcare provider and a patient for the purpose of diagnosis consultation, or treatment of a patient at a distant site where there may be no in-person exchange between a healthcare provider and a patient.  No new standards of care are created.  The provider will be held to the same standards as if the treatment was held in person.  

Board Updates on CE

CE Broker

CE Broker is now the official CE tracking system.  Beginning July 1, 2020, it is mandatory for licensees to report proof of completion of their CEs to CE broker, including at the time of license renewal.  The Board will periodically audit proof of completion of CE courses submitted to CE Broker to determine compliance with CE requirements.   

 

That completes our review of the jurisprudent aspects affecting Tennessee's physical therapists and assistants.

Rev 10/22

 

Kelly, C. (2022, September). Tennessee Jurisprudence. PhysicalTherapy.com, Article 4836. Retrieved from: http://www.physicaltherapy.com

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calista kelly

Calista Kelly, PT, DPT, ACEEAA, Cert. MDT

Senior Managing Editor, PhysicalTherapy.com

Calista holds a master’s degree in physical therapy from St. Ambrose University and a doctorate degree (DPT) from the University of Mississippi. She attained a credentialing certificate from the McKenzie Institute in 2011 and the CEEAA credential in 2014 from the Academy of Geriatric Physical Therapy of the American Physical Therapy Association. In 2019, she completed the requirements for the Advanced Credentialed Exercise Expert for Aging Adults (ACEEAA) through the Academy of Geriatric Physical Therapy.  Calista has been licensed as a physical therapist since 2001 and has worked as a clinician in a variety of settings including ICU, outpatient orthopedics/sports medicine, neuro, SNF/LTC, LTACH, wound care, home health, and pediatrics.



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