Texas PT Practice Act

You are the only PT in a large clinic with several techs, students, ATC's, and PTA's. Because of this, you spend most of your day doing evaluations and re-evaluations, and most patient treatment is monitored by the other staff. A patient has complained to the state board that they are unsupervised during their treatment sessions. Who is in violation of the law? Who is in violation of the APTA Code of Ethics?

1. Violation of the law: The PT (they are in charge in the clinic supervision, and has not been monitoring the pts)

-Techs: can't be punished through the Practice Act bc they do not have a license (can't violate the law bc they technically don't exist)

-ATs: unlicensed personnel in the eye of the TX state board, like techs

-PTAs: they are licensed personnel subject to the state law according to the TX board

2. Violation of Code of Ethics: code says you should adequately supervise the patients, and really is only binding on PTs and PTAs

What does the PT Practice Act say about Initiation of PT services (with or without direct access—since 1971 when practice act was written)?

-Referral can be from MD, DDS, DC, DPM, PA, ANP

-PT may evaluate without referral

-PT may give instructions to asymptomatic persons without referral (health, wellness, fitness)

-PT may provide emergency medical care without referral

-Referral may be written or verbal (verbal must be recorded and signed by PT or PTA)

2019 Provisions: A PT may treat a patient without referral for 10 consecutive business days if the PT....

1. has been licensed to practice PT for one year

2. is covered by professional liability insurance

3. has a DPT or 30 CCUs of differential Dx

-PT who has completed residency or fellowship gets 15 days

-Must obtain a signed disclosure form prescribed by the board

2025 Direct Access Provisions: PT can treat for 30 calendar days if....

-Licensed for 1 year

-Covered by liability insurance

-Has a DPT or 30 CCUs of differential diagnosis coursework

What does the PT Practice Act say about Evaluation and Screening?

-Treatment may not be initiated before completion of evaluation

-A patient receiving treatment must be re-evaluated by a PT at least every 60 days (usually do every 30 but due to insurance)

-PTA's may screen patients as possible candidates for PT services, but only a PT may determine if services are necessary

What does the PT Practice Act say about PT students?

Nothing

What does the Practice Act say about PT care plan development and implementation?

-Must have written care plan for each patient

-Must update care plan at each re-evaluation

-Care plan and goals can only be changed by a PT

-PTA can’t provide treatment without a care plan

-PTA can modify treatment indicated in care plan

-PT or PTA must interact with patient during each treatment session

A PTA is working with a patient and wants to add squats to the exercise plan for strengthening. Can they do that?

It depends on how the PT wrote the care plan.

If it said something general like "LE muscle strengthening," then yes, but if it said "Quad sets and SLR," then that is the only exercise they can have them do.

What does the practice at say about Documentation of Treatment?

-Progress notes must include name of supervising PT

-PTA may not sign progress notes that modify care plans

-PT aides may not document in permanent record (except quantitative data)

What does the Practice Act say about discharging patients?

-PT must sign discharge summary

-PTA may provide clerical assistance with discharge summary (aka can write the whole thing, PT must still sign)

What does the Practice Act say about what a PTA may do when covering role delineation?

screen patient, provide care identified in care plan, teach

What does the Practice Act say about what a PTA may NOT do when covering role delineation? (know these)

perform evaluative procedures, alter care plan or goals, recommend assistive devices, sign progress notes that modify care plan or goals

What does the Practice Act say about what a PT aide may do when covering role delineation?

perform services as assigned by a PT or PTA within the scope of on-the-job training with onsite PT or PTA supervision

Can a PT aide do a ultrasound on a pt?

Yes, they can do therapeutic US, NOT diagnostic.

Can a PT aide do a manual therapy on a pt?

Practice Act doesn't say anything about this specifically, but if they hurt the pt, the PT is at risk.

Can a PT aide do dry needling on a pt?

Technically they could because the law doesn't say they can't, but if pt gets hurt PT is liable.

What does the Practice Act say about what a PT aide may NOT do when covering role delineation?

perform any evaluative procedures, initiate PT treatment, provide care without onsite supervision of a PT or PTA, or document in the permanent record

What are the supervision requirements according to the PT practice act?

-A supervising PT is responsible for the patient’s care

-A supervising PT must be on call for the PTA when services are provided

-The supervising PT must hold documented conferences with the PTA regarding the patient

-A supervising PT or PTA is responsible for the PT services provided by a PT aide

-A PT or PTA must be onsite and in reasonable proximity when a PT aide is interacting with patients

Can a PT in San Antonio supervise a PTA in Corpus Christi?

Technically is legal because "on call", but dangerous because they are far. Doesn't specifically state what is "too far".

What are the licensure requirements according to the PT Practice Act?

1. Graduation from CAPTE accredited program

2. Pass the NPTE

3. Pay required fees

What does the PT Practice Act say about Temporary Licensure?

1. Valid from graduation until you take the exam

2. Must have onsite licensed PT supervision

What are the Practice Act licensure renewal requirements?

-Every 2 years on your birth month

-Pay fees

-Pass jurisprudence exam

-Background check and fingerprinting

-Complete 30 CCUs

What does the Practice Act say about Telehealth?

-PT's and PTA's may provide Telehealth

-PT Can do evals and re-evals

-Subject to same standard of care

-Must be 1:1

-Must use HIPAA compliant platform

-Can't supervise aides via telehealth