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]