Laws, rules and regulations, not Alerts, specify the requirements for practice and violating them constitutes professional misconduct. Not adhering to this Alert may be interpreted as professional misconduct only if the conduct also violates pertinent law, rules and regulations, some citations of which are listed at the end of this Alert.
Alert 5: Exceptions to Supervision Requirements for Physical Therapist Assistants
Education Law provides exemptions for the requirement of on-site supervision of a physical therapist assistant (PTA) by a physical therapist (PT) in the following settings.
Residential Health Care Facilities, Diagnostic and Treatment Centers, and Certain Facilities and Programs Authorized in the Mental Hygiene Law (Education Law section 6738[b])
- Supervision of a PTA by a licensed PT must be continuous but not necessarily on-site when the supervising PT has determined, through patient/client evaluation, the setting of goals and the establishment of a treatment plan, that the physical therapy is a maintenance program, as defined in Title XVIII of the Federal Social Security Act.
- Under this exemption, if the supervising licensed PT has evaluated the patient, set goals and established a treatment plan, and the program is one of maintenance, the PTA need not be under the on-site supervision of the PT.
- This exemption applies to:
- residential health care facilities, as defined in Article 28 of Public Health Law;
- diagnostic and treatment centers licensed under Article 28 of Public Health Law, whose principal mission is to provide services to individuals with developmental disabilities; and
- facilities, as defined in section 1.03 of the Mental Hygiene Law;
- monitored programs of the Office for People with Developmental Disabilities (OPWDD), as defined in section 13.15(a) of the Mental Hygiene Law. That section applies to a broad range of programs, including day care, out-patient, and other settings regulated by OPWDD. The qualifications of a particular program may be confirmed with OPWDD Office of Counsel at 518-474-7700.
- The exemption does not apply when the patient/client is a child under the age of 5 years or the patient/client’s condition requires multiple adjustments of sequences and procedures due to rapidly changing physiological status or response to treatment.
- Please note that the supervising PT is still responsible for the patient/client.
Home Care Services (Education Law section 6738[c])
For the purposes of the provision of PTA services in a home care services setting, whether such services are provided by a home care services agency or under the supervision of a PT licensed pursuant to Article 136 of the Education Law, continuous supervision of a PTA, who has had direct clinical experience for a period of not less than two years, by a licensed PT must not be construed as requiring the physical presence of such licensed PT at the time and place where such services are performed.
“Continuous supervision,” in the context of home care services must include the following:
- the licensed PT’s setting of goals, establishing a plan of care and determining whether the patient/client is appropriate to receive the services of a PTA subject to the licensed PT’s evaluation;
- an initial joint visit with the patient/client by the supervising licensed PT and the PTA;
- periodic treatment and evaluation of the patient/client by the supervising licensed PT, as indicated in the plan of care and as determined in accordance with patient/client need, but in no instance may the interval between treatments by the PT exceed every six patient/client visits or 30 days, whichever occurs first; and
- a final evaluation by the supervising licensed PT to determine if the plan of care should be terminated.
For purposes of home care services, the number of PTAs supervised in the home care services setting by a licensed PT must not exceed the ratio of two PTAs to one licensed PT.
The above provisions relating to home care services provided by PTAs do not include early intervention services. A PTA, with appropriate training, may provide early intervention services only under the on-site supervision of a PT.
This exemption in Education Law section 6738(c) is repealed, effective June 30, 2022, unless renewed by the Legislature. It has been periodically renewed in the past.
Physical Therapy Services in Public or Private Primary and Secondary Schools and Preschool Children (Education Law section 6738[d])
When a PTA provides services in public or private primary or secondary schools or for preschool children, “continuous supervision” by a PT does not require the physical presence of the PT at the time and place where such services are performed if the PTA has not less than two years direct clinical experience providing age appropriate physical therapy services.
According to section 6738(d) of Education Law, “continuous supervision” in the context of public or private primary or secondary schools or for preschool children public must include the following:
- the licensed PT’s setting of the goals, establishing a plan of care, and determining on an initial and ongoing basis whether the patient/client is appropriate to receive the services of a PTA;
- determining the frequency of joint visits with the patient/client by both the supervising licensed PT and the PTA, except that in no instance may the interval, between joint visits, be more than every 90 calendar days;
- an initial joint visit with the patient/client by the supervising licensed PT and PTA;
- periodic treatment and evaluation of the patient/client by the supervising licensed PT as indicated in the plan of care and as determined in accordance with patient/client need, except that in no instance may the interval between such treatment exceed every 12th visit or 30 days whichever occurs first; and
- notification of the supervising licensed PT by the PTA whenever there is a change in status, condition or performance of the patient/client.
The above provisions relating to children/students do not apply to the provision of physical therapy services when a child s condition requires multiple adjustments of sequences and procedures due to rapidly changing physiologic status or response to treatment.
This exemption in Education Law section 6738(d) is repealed, effective June 30, 2025, unless renewed by the Legislature. It has been periodically renewed in the past.
A PTA may provide treatment to children in early intervention programs and other children under five only under on-site supervision by a PT.
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Citations of Pertinent Law, Rules or Regulations:
Education Law, Section 6738(b) – definition of physical therapist assistant
Education Law, Section 6738(c) – definition of physical therapist assistant
Education Law, Section 6738(d) – definition of physical therapist assistant
Public Health Law, Section 2801 – definitions
Mental Hygiene Law section 13.15(a) – programs of the office for people with developmental disabilities
Regulations of the Commissioner, Section 77.6 – supervision of physical therapist assistants
§ 40.173. Supervision of physical therapist assistant by licensed physical therapist.
(a) General rule. A physical therapist assistant may provide patient care services only under the supervision of a licensed physical therapist. Except as otherwise provided in the act or this subchapter, a physical therapist assistant may provide patient care services only under the direct on-premises supervision of a licensed physical therapist.
(b) Supervision generally. The required level of supervision depends upon the following factors:
(1) The performance of selected acts and services by the physical therapist assistant is the responsibility of the licensed physical therapist at all times.
(2) Supervision shall be based upon the following:
(i) The complexity and acuity of the patient’s needs.
(ii) The proximity and accessibility of the licensed physical therapist to the certified physical therapist assistant.
(iii) The amount of supervision available in the event of an emergency or critical event.
(iv) The type of practice setting in which the service is provided.
(3) The supervising licensed physical therapist may determine and require that the physical therapist assistant provide services under greater supervision than would otherwise appear to be required under section 9.1(c)(3) of the act (63 P. S. § 1309.1(c)(3)) or this section, including requiring that the physical therapist assistant provide services under direct on-premises supervision.
(c) Practice setting. A physical therapist assistant holding a current certificate of authority to provide services under indirect supervision may do so in accordance with this section and section 9.1(c) of the act.
(1) When care is delivered to an individual in an acute care hospital, acute inpatient rehabilitation center, long-term acute care hospital setting or as otherwise required by Federal or State law or regulation, the physical therapist assistant shall be under the direct on-premises supervision of a licensed physical therapist.
(2) When care is provided to an individual in a preschool, primary school, secondary school or other similar educational setting, a licensed physical therapist shall make an onsite visit and examine the patient at least every four patient visits or every 30 days, whichever occurs first.
(3) When care is provided to an individual in an early intervention setting, a licensed physical therapist shall make an onsite visit and examine the patient at least every four patient visits or every 30 days, whichever occurs first.
(4) When care is provided to a patient in a physical therapy independent private practice outpatient facility, a licensed physical therapist shall provide direct on-premises supervision for a physical therapist assistant for at least 50% of the hours worked by the physical therapist assistant during the calendar week unless otherwise required under Federal law. The physical therapist shall be immediately available by telecommunication when not providing direct on-premises supervision.
(5) When care is provided to a patient in an outpatient facility of a practice owned or affiliated with a hospital or healthcare system, a licensed physical therapist shall provide direct on-premises supervision for a physical therapist assistant for at least 50% of the hours worked by the physical therapist assistant during the calendar week unless otherwise required under Federal law. The physical therapist shall be immediately available by telecommunication if not providing direct on-premises supervision.
(6) For home health care, a licensed physical therapist shall make an onsite visit and actively participate in the treatment of the patient at least every seven patient visits or every 14 days, whichever occurs first. For purposes of this paragraph, active participation includes examination of the patient. Multiple visits on a single date constitute only a single patient visit in determining whether the licensed physical therapist is required to make an onsite visit.
(7) For care provided in a long-term care nursing facility, skilled nursing facility or extended care facility, a licensed physical therapist shall make an onsite visit and actively participate in the treatment of the patient at least every seven patient visits or every 14 days, whichever occurs first. For purposes of this paragraph, active participation includes examination of the patient. Multiple visits on a single date constitute only a single patient visit in determining whether the licensed physical therapist is required to make an onsite visit.
(d) Emergency situations. The emergency situation provisions of section 9.1(i) of the act apply only to those current certified physical therapist assistants who are authorized by the Board under section 9.1(c)(4) of the act and § 40.165 (relating to authorization to provide services as a physical therapist assistant under indirect supervision) to provide services under supervision of a licensed physical therapist other than direct on-premises supervision.
Authority
The provisions of this § 40.173 issued under 3(a) of the Physical Therapy Practice Act (63 P. S. § 1303(a)); and section 16 of the act of July 4, 2008 (P. L. 293, No. 38).
Source
The provisions of this § 40.173 adopted December 21, 2012, effective December 22, 2012, 42 Pa.B. 7652.
Cross References
This section cited in 49 Pa. Code § 40.152 (relating to definitions); and 49 Pa. Code § 40.181 (relating to refusal, suspension or revocation of certification).
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