645—200.6 (272C) Supervision requirements.
	 200.6(1) Physical therapist supervisor responsibilities. The supervisor shall:
	  a.   	 Provide supervision to a PTA.
	  b.   	 Provide on-site supervision or supervision by telecommunication as long as the physical therapy services are rendered in accordance with the minimum frequency standards set forth in subrule 200.6(4).
	  c.   	 Assume responsibility for all delegated tasks and shall not delegate a service which exceeds the expertise of the PTA.
	  d.   	 Provide evaluation and development of a treatment plan for use by the PTA.
	  e.   	 Supervise not more than the equivalent of two full-time PTAs, not to exceed four part-time PTAs, who are providing physical therapy per calendar day, including supervision by telecommunication.
	  f.   	 Rescinded IAB 12/19/07, effective 1/23/08.
	  g.   	 Ensure that a PTA under the PT’s supervision has a current license to practice as a PTA.
	  h.   	 Rescinded IAB 12/19/07, effective 1/23/08.
	  i.   	 Ensure that the signature of a PTA on a physical therapy treatment record indicates that the physical therapy services were provided in accordance with the rules and regulations for practicing as a PTA.
	 200.6(2) The following are functions that only a physical therapist may provide and cannot be delegated to a PTA:
	  a.   	 Interpretation of referrals;
	  b.   	 Initial physical therapy evaluation and reevaluations;
	  c.   	 Identification, determination or modification of patient problems, goals, and care plans;
	  d.   	 Final discharge evaluation and establishment of the discharge plan;
	  e.   	 Assurance of the qualifications of all assistive personnel to perform assigned tasks through written documentation of their education or training that is maintained and available at all times;
	  f.   	 Delegation of and instruction in the services to be rendered by the PTA or other assistive personnel including, but not limited to, specific tasks or procedures, precautions, special problems, and contraindicated procedures; and
	  g.   	 Timely review of documentation, reexamination of the patient and revision of the plan when indicated.
	 200.6(3) Supervision of other assistive personnel. PTs are responsible for patient care provided by assistive personnel under their supervision. Physical therapy aides and other assistive personnel shall not provide independent patient care unless each of the following standards is satisfied:
	  a.   	 The supervising PT has physical participation in the patient’s treatment or evaluation, or both, each treatment day;
	  b.   	 The assistive personnel may provide independent patient care only while under the on-site supervision of the supervising PT;
	  c.   	 Documentation made in physical therapy records by unlicensed assistive personnel shall be cosigned by the supervising PT; and
	  d.   	 The PT provides periodic reevaluation of assistive personnel’s performance in relation to the patient.
	 200.6(4) The PT must provide patient evaluation and participate in treatment based upon the health care admission or residency status of the patient being treated. Participation shall include direct client contact according to the following schedule:

Patient’s Health Care Residency
or Admission Status	Maximum of Physical Therapist
Delegation (whichever comes first)	
Hospital, acute care	3 visits or 2 consecutive calendar days	
Hospital, non-CARF	3 visits or 2 consecutive calendar days	
Hospital, CARF-accredited beds	4 visits or 4 consecutive calendar days	
Skilled nursing	4 visits or 7 consecutive calendar days	
Home health	4 visits or 9 consecutive calendar days	
Nursing facility	9 visits or 9 consecutive calendar days	
Iowa educational agency	4 visits or 29 consecutive calendar days	
Other facility/admissions status	4 visits or 9 consecutive calendar days	
Calendar days include weekends and holidays.
	 200.6(5) Physical therapist assistant responsibilities. The physical therapist assistant:
	  a.   	 Shall provide only those services for which the PTA has the skills necessary and shall consult the supervising physical therapist if the procedures are believed not to be in the best interest of the patient;
	  b.   	 Shall gather data relating to the patient’s disability, but not interpret the data as it pertains to the plan of care;
	  c.   	 Shall communicate any change, or lack of change, which occurs in the patient’s condition and which may need the assessment of the PT;
	  d.   	 Shall provide physical therapy services only under the supervision of the physical therapist;
	  e.   	 Shall provide treatment only after evaluation and development of a treatment plan by the physical therapist;
	  f.   	 Shall refer inquiries that require interpretation of patient information to the physical therapist;
	  g.   	 May have on-site or immediate telecommunicative supervision as long as the physical therapy services are rendered in accordance with the minimum frequency standards set forth in subrule 200.6(4); and
	  h.   	 May receive supervision from any number of physical therapists.
	  i.   	 Shall record on every patient chart the name of the PTA’s supervisor for each treatment session.
The signature of a PTA on a physical therapy treatment record indicates that the physical therapy services were provided in accordance with the rules and regulations for practicing as a PTA.
	 200.6(6) Other assistive personnel. Physical therapy aides and other assistive personnel may assist a PTA in providing patient care in the absence of a PT only if the PTA maintains in-sight supervision of the physical therapy aide or other assistive personnel and the PTA is primarily and significantly involved in that patient’s care.