CHAPTER 201
PRACTICE OF PHYSICAL THERAPISTS
AND PHYSICAL THERAPIST ASSISTANTS
645—201.1(148A,272C) Code of ethics for physical therapists and physical therapist assistants.
	201.1(1) Physical therapy. The practice of physical therapy shall minimally consist of:
	a. 	Interpreting all referrals;
	b. 	Evaluating each patient;
	c. 	Identifying and documenting individual patient’s problems and goals;
	d. 	Establishing and documenting a plan of care;
	e. 	Providing appropriate treatment;
	f. 	Determining the appropriate portions of the treatment program to be delegated to assistive personnel;
	g. 	Appropriately supervising individuals as described in rule 645—201.4(272C);
	h. 	Providing timely patient reevaluation;
	i. 	Maintaining timely and adequate patient records of all physical therapy activity and patient responses consistent with the standards found in rule 645—201.2(147).
	201.1(2) A physical therapist shall:
	a. 	Not practice outside the scope of the license;
	b. 	Inform a referring practitioner when any requested treatment procedure is inadvisable or contraindicated and shall refuse to carry out such orders;
	c. 	Not continue treatment beyond the point of possible benefit to the patient or treat a patient more frequently than necessary to obtain maximum therapeutic effect;
	d. 	Not directly or indirectly request, receive, or participate in the dividing, transferring, assigning, rebating, or refunding of an unearned fee;
	e. 	Not profit by means of credit or other valuable consideration as an unearned commission, discount, or gratuity in connection with the furnishing of physical therapy services;
	f. 	Not obtain third-party payment through fraudulent means. Third-party payers include, but are not limited to, insurance companies and government reimbursement programs. Obtaining payment through fraudulent means includes but is not limited to:
	(1)	Reporting incorrect treatment dates for the purpose of obtaining payment;
	(2)	Reporting charges for services not rendered;
	(3)	Incorrectly reporting services rendered for the purpose of obtaining payment that is greater than that to which the licensee is entitled; or
	(4)	Aiding a patient in fraudulently obtaining payment from a third-party payer;
	g. 	Not exercise undue influence on patients to purchase equipment, products, or supplies from a company in which the physical therapist owns stock or has any other direct or indirect financial interest;
	h. 	Not permit another person to use the therapist’s license for any purpose;
	i. 	Not verbally or physically abuse a patient or client;
	j. 	Not engage in sexual misconduct. Sexual misconduct includes the following:
	(1)	Engaging in or soliciting a sexual relationship, whether consensual or nonconsensual, with a patient or client;
	(2)	Making sexual advances, requesting sexual favors, or engaging in other verbal conduct or physical contact of a sexual nature with a patient or client;
	k. 	Adequately supervise personnel in accordance with the standards for supervision found in rule 645—201.4(272C);
	l. 	Assist in identifying a professionally qualified licensed practitioner to perform the service, in the event that the physical therapist does not possess the skill to evaluate a patient, plan the treatment program, or carry out the treatment.
	201.1(3) Physical therapist assistants. A physical therapist assistant shall:
	a. 	Not practice outside the scope of the license;
	b. 	Not obtain third-party payment through fraudulent means. Third-party payers include but are not limited to insurance companies and government reimbursement programs. Obtaining payment through fraudulent means includes but is not limited to:
	(1)	Reporting incorrect treatment dates for the purpose of obtaining payment;
	(2)	Reporting charges for services not rendered;
	(3)	Incorrectly reporting services rendered for the purpose of obtaining payment that is greater than that to which the licensee is entitled; or
	(4)	Aiding a patient in fraudulently obtaining payment from a third-party payer;
	c. 	Not exercise undue influence on patients to purchase equipment, products, or supplies from a company in which the physical therapist assistant owns stock or has any other direct or indirect financial interest;
	d. 	Not permit another person to use the physical therapist’s or physical therapist assistant’s license for any purpose;
	e. 	Not verbally or physically abuse a patient or client;
	f. 	Not engage in sexual misconduct. Sexual misconduct includes the following:
	(1)	Engaging in or soliciting a sexual relationship, whether consensual or nonconsensual, with a patient or client; and
	(2)	Making sexual advances, requesting sexual favors, or engaging in other verbal conduct or physical contact of a sexual nature with a patient or client;
	g. 	Work only when supervised by a physical therapist and in accordance with rule 645—201.4(272C). If the available supervision does not meet the standards in rule 645—201.4(272C), the physical therapist assistant shall refuse to administer treatment;
	h. 	Inform the delegating physical therapist when the physical therapist assistant does not possess the skills or knowledge to perform the delegated tasks, and refuse to perform the delegated tasks;
	i. 	Sign the physical therapy treatment record to indicate that the physical therapy services were provided in accordance with the rules and regulations for practicing as a physical therapist or physical therapist assistant.
[ARC 7979C, IAB 5/15/24, effective 7/1/24]
645—201.2(147) Recordkeeping.
	201.2(1) A licensee shall maintain sufficient, timely, and accurate documentation in patient records. A licensee’s records shall reflect the services provided, facilitate the delivery of services, and ensure continuity of services in the future.
	201.2(2) A licensee who provides clinical services shall store records in accordance with state and federal statutes and regulations governing record retention and with the guidelines of the licensee’s employer or agency, if applicable. If no other legal provisions govern record retention, a licensee shall store all patient records for a minimum of five years after the date of the patient’s discharge, or, in the case of a minor, three years after the patient reaches the age of majority under state law or five years after the date of discharge, whichever is longer.
	201.2(3) Electronic recordkeeping. The requirements of this rule apply to electronic records as well as to records kept by any other means. When electronic records are kept, the licensee shall ensure that a duplicate hard-copy record or a backup, unalterable electronic record is maintained.
	201.2(4) Correction of records.
	a. 	Hard-copy records. Notations shall be legible, written in ink, and contain no erasures or whiteouts. If incorrect information is placed in the record, it must be crossed out with a single nondeleting line and be initialed by the licensee.
	b. 	Electronic records. If a record is stored in an electronic format, the record may be amended with a signed addendum attached to the record.
	201.2(5) Confidentiality and transfer of records. Physical therapists and physical therapist assistants shall preserve the confidentiality of patient records. Upon receipt of a written release or authorization signed by the patient, the licensee shall furnish such physical therapy records, or copies of the records, as will be beneficial for the future treatment of that patient. A fee may be charged for duplication of records, but a licensee may not refuse to transfer records for nonpayment of any fees. A written request may be required before transferring the record(s).
	201.2(6) Retirement or discontinuance of practice. If a licensee is the owner of a practice, the licensee shall notify in writing all active patients and shall make reasonable arrangements with those patients to transfer patient records, or copies of those records, to the succeeding licensee upon knowledge and agreement of the patient.
	201.2(7) Nothing stated in these rules shall prohibit a licensee from conveying or transferring the licensee’s patient records to another licensed individual who is assuming a practice, provided that written notice is furnished to all patients.
[ARC 7979C, IAB 5/15/24, effective 7/1/24]
645—201.3(147) Telehealth visits. A licensee may provide physical therapy services to a patient utilizing a telehealth visit if the physical therapy services are provided in accordance with all requirements of this chapter.
	201.3(1) “Telehealth visit” means the provision of physical therapy services by a licensee to a patient using technology where the licensee and the patient are not at the same physical location for the physical therapy session.
	201.3(2) A licensee engaged in a telehealth visit shall utilize technology that is secure and HIPAA-compliant pursuant to the Health Insurance Portability and Accountability Act of 1996, PL 104–191, August 21, 1996, 110 Stat. 1936, and any amendments as of December 8, 2023, and that includes, at a minimum, audio or video equipment or both, that allows two-way real-time interactive communication between the licensee and the patient. A licensee may use non-real-time technologies to prepare for a physical therapy session or to communicate with a patient between physical therapy sessions.
	201.3(3) A licensee engaged in a telehealth visit shall be held to the same standard of care as a licensee who provides in-person physical therapy. A licensee shall not utilize a telehealth visit if the standard of care for the particular physical therapy services cannot be met using technology.
	201.3(4) Any physical therapist or physical therapist assistant who provides a physical therapy telehealth visit to a patient located in Iowa shall be licensed in Iowa or have a compact privilege issued by the physical therapy compact commission.
	201.3(5) Prior to the first telehealth visit, a licensee shall obtain informed consent from the patient specific to the physical therapy services that will be provided in a telehealth visit. At a minimum, the informed consent shall specifically inform the patient of the following:
	a. 	The risks and limitations of the use of technology to provide physical therapy services;
	b. 	The potential for unauthorized access to protected health information; and
	c. 	The potential for disruption of technology during a telehealth visit.
	201.3(6) A licensee shall only provide physical therapy services using a telehealth visit in the areas of competence wherein proficiency in providing the particular service using technology has been gained through education, training, and experience.
	201.3(7) A licensee shall identify in the clinical record when physical therapy services are provided utilizing a telehealth visit.
[ARC 7979C, IAB 5/15/24, effective 7/1/24]
645—201.4(147) Delegation by a supervising physical therapist. A supervising physical therapist may delegate the performance of physical therapy services to a physical therapist assistant only if done in accordance with the statutes and rules governing the practice of physical therapy. A physical therapist assistant may assist in the practice of physical therapy only to the extent allowed by the supervising physical therapist. The supervisory requirements stated in this rule are minimal. It is the professional responsibility and duty of the supervising physical therapist to provide the physical therapist assistant with more supervision if deemed necessary in the supervising physical therapist’s professional judgment.
	201.4(1) Supervision requirements. A supervising physical therapist who delegates the performance of physical therapy services to a physical therapist assistant shall provide supervision to the physical therapist assistant at all times when the physical therapist assistant is providing delegated physical therapy services. Supervision means that the physical therapist shall be readily available on site or telephonically any time the physical therapist assistant is providing physical therapy services so that the physical therapist assistant may contact the physical therapist for advice, assistance, or instruction.
	201.4(2) Functions that cannot be delegated. The following are functions that only a physical therapist may provide and that cannot be delegated to a physical therapist assistant:
	a. 	Interpretation of referrals;
	b. 	Initial physical therapy evaluation and reevaluations;
	c. 	Identification, determination, or modification of patient problems, goals, and plans of care;
	d. 	Final discharge evaluation and establishment of a discharge plan;
	e. 	Delegation of and instruction in the physical therapy services to be rendered by a physical therapist assistant or unlicensed assistive personnel, including but not limited to specific tasks or procedures, precautions, special problems, and contraindicated procedures; and
	f. 	Timely review of documentation, reexamination of the patient, and revision of the plan of care when indicated.
	201.4(3) Physical therapist responsibilities. At all times, the supervising physical therapist shall be responsible for the physical therapy plan of care and for all physical therapy services provided, including all physical therapy services delegated to a physical therapist assistant. In addition, the supervising physical therapist shall:
	a. 	Be responsible for the evaluation and development of a plan of care for use by the physical therapist assistant; and
	b. 	Not delegate a physical therapy service that exceeds the competency or skill set of the physical therapist assistant; and
	c. 	Ensure that a physical therapist assistant holds an active physical therapist assistant license issued by the board or a compact privilege; and
	d. 	Ensure that a physical therapist assistant is aware of how the supervising physical therapist can be contacted telephonically or by virtual means when the physical therapist is not providing on-site supervision; and
	e. 	Arrange for an alternate physical therapist to provide supervision when the physical therapist has scheduled or unscheduled absences during time periods in which a physical therapist assistant will be providing delegated physical therapy services; and
	f. 	Ensure that a physical therapist assistant is informed when a patient’s plan of care is transferred to a different supervising physical therapist; and
	g. 	Directly participate in physical therapy services upon the physical therapist assistant’s request for a reexamination, when a change in the plan of care is needed, prior to any planned discharge, and in response to a change in the patient’s medical status; and
	h. 	Hold regularly scheduled meetings with the physical therapist assistant to evaluate the physical therapist assistant’s performance, assess the progress of a patient, and make changes to the plan of care as needed. The frequency of meetings should be determined by the supervising physical therapist based on the needs of the patient, the supervisory needs of the physical therapist assistant, and any planned discharge. The supervising physical therapist shall provide direction and instruction to the physical therapist assistant that are adequate to ensure the safety and welfare of the patient.
	201.4(4) Physical therapist assistant responsibilities. A physical therapist assistant shall only provide physical therapy services under the supervision of a physical therapist. In addition, the physical therapist assistant shall:
	a. 	Only provide physical therapy services that have been delegated by the supervising physical therapist; and
	b. 	Only provide physical therapy services that are within the competency and skill set of the physical therapist assistant; and
	c. 	Consult the supervising physical therapist if the physical therapist assistant believes that any procedure is not in the best interest of the patient; and
	d. 	Contact the supervising physical therapist regarding any change or lack of change in a patient’s condition that may require assessment by the supervising physical therapist; and
	e. 	Refer inquiries that require interpretation to the supervising physical therapist; and
	f. 	Ensure that the identification of the supervising physical therapist is included in the documentation for any visit when physical therapy services were provided by the physical therapist assistant; and
	g. 	Only sign a treatment record if the provision of physical therapy services was done in accordance with the statutes and rules governing the practice of a physical therapist assistant.
	201.4(5) Ratio. A physical therapist shall determine the number of physical therapist assistants who can be supervised safely and competently and shall not exceed that number; but in no case shall a physical therapist supervise more than four physical therapist assistants per calendar day. A physical therapist assistant who performs any delegated physical therapy services on behalf of the supervising physical therapist on a particular day shall be counted in determining the maximum ratio, regardless of the location of the physical therapist assistant or the number of patients treated.
	201.4(6) Minimum frequency of direct participation by a supervising physical therapist. A supervising physical therapist shall use professional judgment to determine how frequently the physical therapist needs to directly participate in physical therapy services when delegating to a physical therapist assistant, the frequency of which shall be based on the needs of the patient. Direct participation can occur through an in-person or telehealth visit. The supervising physical therapist shall ensure that the patient record clearly indicates which visits included direct participation by the supervising physical therapist. The following are the minimum standards, which are expected to be exceeded when dictated by the supervising physical therapist’s professional judgment, for the required frequency of direct participation by the supervising physical therapist when physical therapy services involve delegation to a physical therapist assistant:
	a. 	Hospital inpatient and skilled nursing. For hospital inpatients and skilled nursing patients, a supervising physical therapist must directly participate in physical therapy services a minimum of once per calendar week. A calendar week is defined as Sunday through Saturday.
	b. 	All other settings. In all other settings, a supervising physical therapist must directly participate in the provision of physical therapy services at least every eighth visit or every 30 calendar days, whichever comes first.
	201.4(7) Unlicensed assistive personnel. A physical therapist is responsible for patient care provided by unlicensed assistive personnel under the physical therapist’s supervision. A physical therapist is responsible for ensuring the qualifications of any unlicensed assistive personnel and shall maintain written documentation of their education or training. Unlicensed assistive personnel may assist a physical therapist assistant in the delivery of physical therapy services only if the physical therapist assistant maintains in-sight supervision of the unlicensed assistive personnel and the physical therapist assistant is primarily and significantly involved in the patient’s care. Unlicensed assistive personnel shall not provide independent patient care unless each of the following standards is satisfied:
	a. 	The physical therapist has direct participation in the patient’s treatment or evaluation, or both, each treatment day;
	b. 	Unlicensed assistive personnel may provide independent patient care only while under the on-site supervision of the physical therapist;
	c. 	Documentation made in a physical therapy record by unlicensed assistive personnel shall be cosigned by the physical therapist; and
	d. 	The physical therapist provides periodic reevaluation of any unlicensed assistive personnel’s performance in relation to the patient.
[ARC 7979C, IAB 5/15/24, effective 7/1/24]
These rules are intended to implement Iowa Code chapters 147, 148A and 272C.
[Filed 11/26/03, Notice 9/17/03—published 12/24/03, effective 1/28/04]
[Filed ARC 3590C (Notice ARC 3435C, IAB 11/8/17), IAB 1/17/18, effective 2/21/18]
[Filed 11/26/03, Notice 9/17/03—published 12/24/03, effective 1/28/04]
[Filed ARC 3590C (Notice ARC 3435C, IAB 11/8/17), IAB 1/17/18, effective 2/21/18]
[Filed ARC 7979C (Notice ARC 7546C, IAB 1/24/24), IAB 5/15/24, effective 7/1/24]