PTA 1500-043WHITNEY SMITH

OBJECTIVE #3:DIRECTION AND

SUPERVISION

DIRECTION/SUPERVISION

There are many rules and regulations for any physical

therapist personnel concerning direction/supervision

and what they can and cannot do. Things like where

you live, practice, and where you were licensed depict

what rules and regulations you must follow. These

rules generally come from the APTA, state regulations,

and third-party payers. Knowing these rules and

regulations is very important in being a successful PTA

and to provide the “best practice.”

STATE REGULATIONS

There are many federal laws that affect the provision of physical

therapy. These laws are usually referred to as a state’s physical

therapy practice act. The practice acts are there to protect the

public and ensure the competence of those providing the services.

The Federation of State Boards of Physical Therapy (FSBPT) has

developed a Model Practice Act, which is considered to be a

“preeminent standard” for states to follow as they update and clarify

their practice acts.

STATE REGULATIONS

The regulation of a PTA is designed to ensure that those providing care

to the public will do it safely. There are three different levels of

regulation that might be used for PTAs.

Registration: Usually there is no requirement for specific training or

education.

Certification: Usually requires some type of specific education and

passing an examination.

Licensure: The highest level of oversight due to the risk of the

public. Those who are licensed generally are subject to discipline by

a state board if they fail to meet regulatory standards.

S TAT E R E G U L AT I O N S - P H Y S I C A L S U P E R V I S I O N

The practice act should describe the type of supervision

exercised by the PT while the PTA is working. It also may

describe things such as face-to-face interaction between the PT

and PTA.

Many practice acts also may have restrictions on the number of

PTAs that a PT can supervise.

Physical supervision also includes what PTA are allowed to

perform in the clinic, and what the PT can not delegate to

others.

APTA RULES

Although the APTA has many positions and documents

concerning the responsibilities of a PTA, they are not legal

binding. According to the APTA their guidelines represent the

“best practice”, and if not followed could be used against a

practitioner if a lawsuit is filed.

The best way to access these policies is either accessing the

APTA: PTA Direction Algorithm, PTA Supervision Algorithm, or

on the APTA’s web site (www.apta.org) under the PTA link.

APTA RULES

The APTA’s viewpoints are classified into three categories, each has its own levels of

expectation of compliance.

Guidelines: least binding, considered a “statement of advice”

Positions: considered to be “a firmly held association stance or point of view.”

Standards: highest level of expectation because they are “a binding statement used to

judge quality of action for activity” and often pertain to “right and wrong” conduct.

Along with the expectations the APTA have three types of supervision for PTAs including:

General Supervision: PT is not required to be in the same building as the PTA while the

PTA is delivering interventions.

Direct Supervision: Requires the on-site presence of the PT and daily interaction

between the supervising PT and each patient being seen by the supervisee.

Direct Personal Supervision: Not only requires the PT to be physically present but also

to continuously direct and supervise the person who is performing the tasks.

THIRD-PARTY PAYER

Requirements of a third-party payer should be heavily

considered as they affect the PTAs ability to participate in the

patient care. If the PTA does not match the requirements set

by the payer, the provider is likely not to be paid or even

charged with fraud.

Examples would be found in the Medicare system.

Third-party payers usually control things such as

supervision, participation, and licensing requirements for

them to reimburse the provider.

COMPARE/CONTRAST

As you can see, the rules and regulations

concerning direction and supervision can vary

depending on which group (APTA, state, etc.) you

are concentrating on. Even though there are some

regulations that are similar it’s important you know

the regulations for each one so that you don’t run

into any problems or violations that could cause you

to lose your license or to lose patients.