DEPARTMENT OF REGULATORY AGENCIES State Physical Therapy Board PHYSICAL THERAPIST LICENSURE & PHYSICAL THERAPIST ASSISTANT CERTIFICATION 4 CCR 732-1 [Editor’s Notes follow the text of the rules at the end of this CCR Document.] _________________________________________________________________________ GENERAL RULE PROVISIONS 101. Licensure & Certification Requirements: Credit for Military Experience The purpose of this rule is to outline the conditions and procedures governing the evaluation of an applicant’s military training and experience under § 24-34-102(8.5), C.R.S. A. Education, training, or service gained in military services outlined in § 24-34-102(8.5), C.R.S. that is to be accepted and applied towards receiving either a physical therapist license or a physical therapist assistant certification must be substantially equivalent, as determined by the Board, to the qualifications otherwise applicable at the time of the receipt of the application. It is the applicant’s responsibility to provide timely and complete evidence of the education, training and/or service gained in the military for review and consideration. Satisfactory evidence of such education, training or service will be assessed on a case by case basis. 102. Approved Examinations for Licensing The purpose of this rule is to designate a nationally-recognized examination approved by the Board pursuant to § § 12-41-107, 12-41-111, 12-41-205 and 12-41-207, C.R.S. A. The examination developed by the Federation of State Boards of Physical Therapy (FSBPT) entitled the National Physical Therapy Examination (NPTE) for Physical Therapists is approved as the examination needed in the licensure process. An applicant must achieve a passing score as determined by FSBPT in order to be eligible for licensure as a Physical Therapist. B. The examination developed by FSBPT entitled the National Physical Therapy Examination (NPTE) for Physical Therapist Assistants is approved as the examination needed in the licensure process. An applicant must achieve a passing score as determined by FSBPT in order to be eligible for certification as a Physical Therapist Assistant. PHYSICAL THERAPY LICENSURE RULES 201. Delegation of Duties The purpose of this rule is to clarify the special practice authorities addressed in § 12-41-113, C.R.S. A. A Physical Therapist performing an initial examination and evaluation shall be the therapist of record for that patient unless an authorized Physical Therapist transfers the responsibility to another Physical Therapist through documentation in the patient records. B. Physical Therapists shall rely on their expertise and decision-making capability when determining the most appropriate utilization of an unlicensed person to provide for the delivery of service that is safe, effective, and efficient.

Code of Colorado Regulations 1 C. The Physical Therapist of record must personally perform and cannot delegate to unlicensed individuals the interpretation of referrals, initial examinations and evaluations, diagnosis and prognosis, development and modification of plans of care, determination of discharge criteria, and supervision of all care rendered to the patient/client. These procedures may be transferred to another Physical Therapist through documentation in the patient records. D. The term “wound debridement” as used in section 12-41-113(3), C.R.S., refers to sharp, enzymatic, selective, and pharmacological wound debridement and can only be performed by a licensed Physical Therapist unless otherwise authorized by Colorado law. Physical Therapists may not delegate such wound debridement to unlicensed personnel, but may delegate soft or non-selective wound debridement to Physical Therapist Assistants. 202. Supervision and/or Direction of Persons Not Licensed as a Physical Therapist Pursuant to section 12-41-113(1), C.R.S., the purpose of this rule is to clarify supervision and/or direction provisions for persons not licensed as a physical therapist, which include a physical therapist assistant, certified nurse aide, provisional physical therapist, physical therapy aide, athletic trainer, massage therapist, or student physical therapist or student physical therapist assistant. A. Definitions:

1. “General supervision” means the physical therapist is not required to be on site for direction and supervision, but must be available at least by telecommunications. 2. “Direct supervision” means the physical therapist is physically present on the premises and in the same building.

3. “Immediate supervision” means the physical therapist is physically present or immediately available to support the individual being supervised. B. A physical therapist is responsible for providing adequate or proper supervision and/or direction to a person not licensed as a physical therapist pursuant to section 12-41-115(1)(e), C.R.S. 1. He or she may supervise up to four (4) individuals at one time who are not physical therapists to assist in the physical therapist’s clinical practice. This limit does not include student physical therapists and student physical therapist assistants supervised by a physical therapist for educational purposes.

2. He or she shall regularly evaluate and observe the performance of any person under his or her supervision and/or direction to ensure that the intervention rendered meets the standard of care.

C. A physical therapist shall provide:

1. General supervision to a physical therapist assistant. However, pursuant to section 12- 41-113(2), C.R.S., direct supervision is required if the physical therapist assistant is administering topical and aerosol medications when they are consistent with the scope of physical therapy practice and when any such medication is prescribed by a licensed health care practitioner who is authorized to prescribe such medication. A prescription or order shall be required for each such administration within a plan of care. 2. General supervision to a certified nurse aide in a home health care setting, as part of a physical therapist plan of care.

Code of Colorado Regulations 2 3. Direct supervision to a provisional physical therapist. In addition, the supervising physical therapist must perform records review and co-signature of notes. 4. Direct supervision to a physical therapy aide.

5. Direct supervision to an athletic trainer providing athletic training within a physical therapist plan of care.

6. Direct supervision to a massage therapist providing massage therapy within a physical therapist plan of care.

7. Immediate supervision to a student physical therapist or a student physical therapist assistant.

203. Supervision of Physical Therapist Assistants and Physical Therapy Aides The purpose of this rule is to specify supervisory provisions required by section 12-41-113(1), C.R.S. for physical therapist assistants certified in accordance with section 12-41-204, C.R.S., and physical therapy aides. This rule applies to all physical therapists who utilize physical therapist assistants and/or aides in their practice.

Physical Therapist Assistants A. For the purposes of these rules, physical therapists may supervise physical therapist assistants performing all acts that are included in the practice of physical therapy as defined in section 12- 41-103(6), C.R.S., except for the therapies, procedures or acts that are otherwise prohibited by law.

1. Physical therapist assistants may perform soft or non-selective wound debridement, but may not perform sharp, enzymatic, selective, and pharmacological wound debridement. 2. Physical therapist assistants may not perform dry needling. 3. Physical therapist assistants may not perform joint mobilization, unless the supervising physical therapist has determined that the physical therapist assistant has the necessary degree of education, training and skill for safe patient care. Entry-level education is inadequate; additional formal continuing education (psychomotor and didactic) is required to perform joint mobilization. Thrust, high-velocity techniques are not within the scope of the physical therapist assistants’ practice.

4. Physical therapist assistants may not assist a physical therapist in providing physical therapy to animals.

B. The following condition must be met before a physical therapist can utilize a physical therapist assistant: A physical therapist must be designated and recorded in the patient/client records as responsible for supervising the care and interventions provided by the physical therapist assistant. The designated physical therapist must consistently provide for the planning, evaluating, and supervising of all care rendered to the patient/client. C. The physical therapist is responsible for the performance of all services performed by the physical therapist assistant. This responsibility requires the physical therapist to assure those services are performed with a degree of care and skill appropriate to the physical therapist assistant’s education and training.

Code of Colorado Regulations 3 D. The physical therapist assumes accountability for the acts delegated to or performed by a physical therapist assistant. Before delegating performance of a physical therapy intervention or physical therapy task to a physical therapist assistant working under general supervision, the supervising physical therapist shall ensure that the physical therapist assistant is qualified by education and training to perform the physical therapy intervention or physical therapy task in a safe, effective, and efficient manner.

E. A physical therapist assistant may not supervise other personnel in the provision of physical therapy services to a patient. A physical therapist assistant under the supervision of a licensed physical therapist may act as a clinical instructor of a physical therapist assistant student who is providing physical therapy services.

Physical Therapy Aides F. All individuals not licensed as a physical therapist, not certified as a physical therapist assistant, and not otherwise regulated as a health care professional, shall be considered an aide for the purposes of this rule.

G. A physical therapy aide may participate in limited designated tasks, as assigned by a physical therapist. The supervising physical therapist must participate in patient care on each date of service when a physical therapy aide is involved in care. H. As to recordkeeping, a physical therapy aide may participate only in basic data recording in the medical record.

I. Wound debridement, dry needling, administration of medications, joint mobilization, and treatment on animals shall not be delegated to a physical therapy aide. The supervising physical therapist shall ensure that the physical therapy aide is qualified by education and training to participate in limited designated tasks as assigned by the physical therapist. 204. Authorized Practice of Physical Therapy by a Person Not Licensed In Colorado The purpose of this rule is to outline the following conditions under which a Physical Therapist not licensed in Colorado may practice for a temporary period of time under § 12-41-114(1)(f), C.R.S.: A. The entity wishing to employ or engage the services of a visiting, unlicensed Physical Therapist must notify the Board at least one week prior to the start date and must document the need for employing or engaging the services of a visiting, unlicensed Physical Therapist. This requirement also applies to continuing education courses.

B. The visiting, unlicensed Physical Therapist must possess a current and active license or registration in good standing in another state or country and provide a copy of the license to the Board at least one week prior to practicing in Colorado. 205. Licensing of Foreign-Trained Physical Therapist Graduates of Non-Accredited Programs The purpose of this rule is to establish procedures for determining whether a foreign-trained physical therapist applicant who has graduated from a non-accredited program has substantially equivalent education and training as required pursuant to section 12-41-111(1)(a), C.R.S. A. A foreign-trained applicant who has graduated from a non-accredited program must have education and training in physical therapy substantially equivalent to the entry-level education and training required at accredited physical therapy programs in the United States in effect at the time of the applicant’s graduation. This includes an assessment of the applicant’s general and Code of Colorado Regulations 4 professional education, as well as training in wound debridement and administration of topical medications.

B. Applicants who wish to have their general and professional education considered “substantially equivalent” must submit their credentials to the Foreign Credentialing Commission of Physical Therapy (“FCCPT”) or International Consultants of Delaware (“ICD”). The credentialing agencies shall use the most current version of the Coursework Evaluation Tool for Foreign-Educated Physical Therapists developed by the Federation of State Boards of Physical Therapy (“FSBPT”) to evaluate the applicant’s credentials against the requirements at accredited physical therapy programs in place at the time of the applicant’s graduation. The Board will not accept a credentials evaluation from an organization not listed in this rule. C. All expenses associated with the credential evaluation are the responsibility of the applicant. D. Failure to have a credentials evaluation pursuant to the terms of this rule will result in the Board denying the application.

E. In the event a foreign-trained applicant’s general education is found to be deficient, the applicant may take and pass subject examinations from the College-Level Examination Program (“CLEP”) to overcome the deficiency in general education.

F. In the event a foreign-trained applicant’s professional education is found to be deficient, the applicant shall either:

1. Successfully complete a Board-approved plan to overcome deficiencies, or 2. Overcome the deficiency by obtaining a master or doctorate degree at an accredited physical therapy program.

G. Degrees obtained in a transitional program are not equivalent to a professional entry-level physical therapy degree and will not be accepted for initial licensure. 206. Licensure by Endorsement for Physical Therapists The purpose of this rule is to delineate the requirements for licensure by endorsement for Physical Therapists under § 12-41-109, C.R.S.

A. Licensure by endorsement through internship 1. An applicant seeking licensure by endorsement under the internship provisions of § 12- 41-109(3)(c), C.R.S., shall:

a. arrange for a Colorado-licensed, practicing Physical Therapist (the “supervising Physical Therapist” ) to supervise the internship; and b. ensure that the supervising physical therapist immediately notifies the Board in writing of the establishment of the internship and submits for the Board’s approval a plan for supervision using the Clinical Performance Instrument (“CPI” ); and c. pass an examination substantially equivalent to that specified in § 12-41-107(2), C.R.S.

Code of Colorado Regulations 5 2. The internship shall not commence without the Board’s written approval of the supervising Physical Therapist’s plan for supervision specified in subparagraph (1)(b) of this paragraph.

3. The internship shall consist of:

a. the applicant’s actual practice of physical therapy as defined in § 12-41-103(6), C.R.S.; and b. supervision of the applicant at all times by any Colorado-licensed, practicing Physical Therapist on the premises where physical therapy services are being rendered; and c. a minimum of 240 hours clinical practice within a consecutive six-month period commencing from the Board’s written approval of the plan for supervision. 4. The applicant shall ensure that the supervising Physical Therapist files a written report at the completion of the internship. This report shall indicate whether the applicant demonstrates entry-level performance in all skills assessed by the CPI. Hard copy or electronic copies of the CPI are acceptable.

5. Subject to the provisions of this rule, the Board shall issue a license by endorsement under this paragraph based upon:

a. the Board’s review and approval of the supervising Physical Therapist’s written report; and b. proof that the applicant has passed an examination substantially equivalent to that specified in § 12-41-107(2), C.R.S.

B. Licensure by endorsement through demonstrated competency 1. An applicant seeking licensure by endorsement under the demonstrated competency provisions of § 12-41-109(3)(c), C.R.S., may demonstrate competency by providing proof that:

a. the applicant has passed an examination in another jurisdiction, which examination is substantially equivalent to that specified in § 12-41-107(2), C.R.S.; and b. the applicant has completed sixty-four hours of continuing education related to the practice of physical therapy during the two years immediately preceding the application, provided that the continuing education meets the approval of the Board.

2. An applicant who is unable to demonstrate competency under subparagraph (1) of this paragraph may request to demonstrate competency by any other means. The Board shall consider such a request on a case-specific basis. The decision to approve such a request shall be at the sole discretion of the Board. In considering whether to approve such a request, the Board shall consider public safety, the particular circumstances and hardships faced by the applicant, and such other factors as the Board deems appropriate. If the Board grants a license under this subparagraph (2), the Board may subject said license to such lawful conditions as the Board finds are necessary to protect the public.

Code of Colorado Regulations 6 3. Subject to the provisions of this rule, the Board shall issue a license by endorsement under this paragraph following demonstration of the applicant’s competency. 207. Reinstatement or Reactivation of an Expired or Inactive Physical Therapist License The purpose of this rule is to establish the qualifications and procedures for applicants seeking reinstatement of an expired physical therapist license or reactivation of an inactive physical therapist license pursuant to sections 12-41-112 and 12-41-112.5, C.R.S. A. An applicant seeking reinstatement or reactivation of a physical therapist license shall complete a reinstatement or reactivation application and pay a fee as established by the Director. B. If the license has been expired or inactive for two years or less: 1. Effective November 1, 2016, and if:

a. The licensee was practicing in Colorado until his/her license expired on October 31, 2016, the applicant shall demonstrate continuing professional competency pursuant to section 12-41-114.6, C.R.S. and Rule 213, or b. The licensee was practicing outside of Colorado until his/her license expired on October 31, 2016, the applicant may demonstrate continuing professional competency through an option listed in section C below. 2. Effective November 1, 2018, all applicants must demonstrate continuing professional competency pursuant to section 12-41-114.6, C.R.S. and Rule 213 for the two years immediately preceding the date the application is received. C. If the license has been expired or inactive for more than two years, but less than five years, an applicant must establish “competency to practice” pursuant to section 24-34-102(8)(d)(II), C.R.S., by submitting one of the following:

1. Verification of an active, valid physical therapist license in good standing from another state, along with proof of clinical physical therapy practice in that state which includes a minimum of an average of 400 hours per year for the two years immediately preceding the date of application. The work experience must be attested as to the number of hours. 2. Evidence of completing an average of 15 points of Professional Development Activities (PDA) pursuant to Rule 213.C.2.a-c for each year the license has been expired or inactive.

a. The Board may accept 1.25 points for each month the license is expired or inactive, and b. All points must be Category I, and directly related to the physical therapist’s clinical practice.

3. Completion of the Federation of State Boards of Physical Therapy’s (FSBPT) Practice Review Tool (PRT), or its equivalency as determined by the Board, and a. Submitting a Candidate Feedback Report, or its equivalency as determined by the Board, with an overall performance reporting of “sufficiently qualified” to be considered and accepted by the Board; or Code of Colorado Regulations 7 b. Successfully completing a Board approved plan to overcome deficiencies in any area(s) rated “needs improvement” in the Candidate Feedback Report. This includes submitting an appropriate plan to address the deficiencies noted in the attached report for Board consideration and approval before proceeding, and the plan must include only Category I activities.

4. Any other means as approved by the Board.

D. An applicant seeking to reinstate or reactivate a license that has been expired or inactive for more than five years must demonstrate “competency to practice” as required in section 24-34- 102(8)(d)(II), C.R.S., by submitting one of the following: 1. Verification of an active, valid physical therapist license in good standing from another state, along with proof of clinical physical therapy practice in that state which includes a minimum of an average of 400 hours per year for the two years immediately preceding the date of application. The work experience must be attested as to the number of hours. 2. Evidence of completing an average of 15 points of Professional Development Activities (PDA) pursuant to Rule 213.C.2.a-c for each year the license has been expired or inactive.

a. The Board may accept 1.25 points for each month the license is expired or inactive, and b. All points must be Category I, and directly related to physical therapy clinical practice.

3. Completion of the Federation of State Boards of Physical Therapy’s (FSBPT) Practice Review Tool (PRT), or its equivalency as determined by the Board, and a. Submitting a Candidate Feedback Report, or its equivalency as determined by the Board, with an overall performance reporting of “sufficiently qualified” to be considered and accepted by the Board; or b. Successfully completing a Board approved plan to overcome deficiencies in any area(s) rated “needs improvement” in the Candidate Feedback Report. This includes submitting an appropriate plan to address the deficiencies noted in the attached report for Board consideration and approval before proceeding, and the plan must include only Category I activities.

4. Practice for six months on probationary status with a practice monitor subject to the terms established by the Board.

5. Completion of a 240-hour internship within 6 consecutive months using the Physical Therapist Clinical Performance Instrument (“CPI) as the professional standard and measure of continued competency. Satisfactory completion of the internship shall require both 240 hours of internship practice and successful demonstration of entry-level performance on all skills on the CPI on electronic or paper form. 6. Any other means as approved by the Board.

E. An applicant for reinstatement or reactivation who has actively practiced in Colorado on an expired or inactive license in violation of section 12-41-106, C.R.S., is subject to denial of application, disciplinary action, and/or other penalties as authorized in the Physical Therapy Code of Colorado Regulations 8 Practice Act at section 12-41-101 et seq., C.R.S., and in accordance with section 24-34-102 et seq., C.R.S.

208. Use of Titles Restricted The purpose of this rule is to clarify the use of titles and educational degrees under § 12-41-104, C.R.S. A. Obtaining a physical therapy license does not automatically entitle or confer upon the licensee the right to use the title “Dr.” or “Doctor” .

B. A licensed Physical Therapist can use the title “Doctor” or “Dr.” only when such licensee has, in fact, been awarded a physical therapy doctorate degree (D.P.T.), or another academic or clinical doctorate degree (e.g., Ph.D., Sc.D.) from an accredited program by a nationally recognized accrediting agency as required in § 6-1-707, C.R.S., pertaining to the use of titles and degrees. C. A Physical Therapist holding a doctorate degree may include the title “Doctor” or “Dr.” only when accompanied by the words of the conferred degree following his/her legal name and after the title “P.T.” , for example: “Dr. Jane/John Doe, P.T., D.P.T.” or “Dr. Jane/John Doe, P.T., Ph.D.” D. A Physical Therapist not holding a physical therapy doctorate or transitional doctorate degree may not use the title D.P.T.

209. Declaratory Orders The purpose of this rule is to establish procedures for the handling of requests for declaratory orders filed pursuant to the Colorado Administrative Procedures Act at § 24-4-105(11), C.R.S. A. Any person or entity may petition the Board for a declaratory order to terminate controversies or remove uncertainties as to the applicability of any statutory provision or of any rule or order of the Board.

B. The Board will determine, at its discretion and without notice to petitioner, whether to rule upon such petition. If the Board determines that it will not rule upon such a petition, the Board shall promptly notify the petitioner of its action and state the reasons for such decision. C. In determining whether to rule upon a petition filed pursuant to this rule, the Board will consider the following matters, among others:

1. Whether a ruling on the petition will terminate a controversy or remove uncertainties as to the applicability to petitioner of any statutory provisions or rule or order of the Board; 2. Whether the petition involves any subject, question or issue that is the subject of a formal or informal matter or investigation currently pending before the Board or a court involving one or more petitioners;

3. Whether the petition involves any subject, question or issue that is the subject of a formal or informal matter or investigation currently pending before the Board or a court but not involving any petitioner;

4. Whether the petition seeks a ruling on a moot or hypothetical question or will result in an advisory ruling or opinion; and 5. Whether the petitioner has some other adequate legal remedy, other than an action for declaratory relief pursuant to CRCP 57, which will terminate the controversy or remove Code of Colorado Regulations 9 any uncertainty as to the applicability to the petitioner of the statute, rule, or order in question.

D. Any petition filed pursuant to this rule shall set forth the following: 1. The name and address of the petitioner and whether the petitioner is licensed pursuant to Title 12, Article 41.

2. The statute, rule, or order to which the petition relates. 3. A concise statement of all of the facts necessary to show the nature of the controversy or uncertainty and the manner in which the statute, rule, or order in question applies or potentially applies to the petitioner.

E. If the Board determines that it will rule on the petition, the following procedures shall apply: 1. The Board may rule upon the petition based solely upon the facts presented in the petition. In such a case:

a. Any ruling of the Board will apply only to the extent of the facts presented in the petition and any amendment to the petition.

b. The Board may order the petitioner to file a written brief, memorandum, or statement of position.

c. The Board may set the petition, upon due notice to petitioner, for a non- evidentiary hearing.

d. The Board may dispose of the petition on the sole basis of the matters set forth in the petition.

e. The Board may request the petitioner to submit additional facts in writing. In such event, such additional facts will be considered as an amendment to the petition. f. The Board may take administrative notice of facts pursuant to the Colorado Administrative Procedures Act at § 24-4-105(8), C.R.S., and may utilize its experience, technical competence, and specialized knowledge in the disposition of the petition.

2. If the Board rules upon the petition without a hearing, it shall promptly notify the petitioner of its decision.

3. The Board may, at its discretion, set the petition for hearing, upon due notice to petitioner, for the purpose of obtaining additional facts or information or to determine the truth of any facts set forth in the petition or to hear oral argument on the petition. The hearing notice to the petitioner shall set forth, to the extent known, the factual or other matters that the Board intends to inquire.

4. For the purpose of such a hearing, to the extent necessary, the petitioner shall have the burden of proving all the facts stated in the petition; all of the facts necessary to show the nature of the controversy or uncertainty; and the manner in which the statute, rule, or order in question applies or potentially applies to the petitioner and any other facts the petitioner desires the Board to consider.

Code of Colorado Regulations 10 F. The parties to any proceeding pursuant to this rule shall be the Board and the petitioner. Any other person may seek leave of the Board to intervene in such a proceeding, and leave to intervene will be granted at the sole discretion of the Board. A petition to intervene shall set forth the same matters as are required by Section D of this Rule. Any reference to a "petitioner" in this rule also refers to any person who has been granted leave to intervene by the Board. G. Any declaratory order or other order disposing of a petition pursuant to this rule shall constitute agency action subject to judicial review pursuant to the Colorado Administrative Procedures Act at § 24-4-106, C.R.S.

210. Requirements for Physical Therapists to Perform Physical Therapy on Animals The purpose of this rule is to implement the requirements of § 12-41-103.6(2)(b)(II), C.R.S., regarding the authority of Physical Therapists to treat animals.

A. A Physical Therapist must have the knowledge, skill, ability and documented competency to perform an act that is within the scope of practice for Physical Therapists. B. The Director shall maintain a data base of all Physical Therapists that are qualified pursuant to this rule to practice physical therapy on animals in this state. C. All Physical Therapists that choose to practice physical therapy on animals shall provide the Board with such therapist’s name, current address, education and qualifications to perform physical therapy on animals for inclusion in the data base referenced in part B of this rule. Information in the data base shall be open to public inspection at all times. Forms for Physical Therapists to provide such information shall be provided by the Board. D. A Physical Therapist that desires to perform physical therapy on animals must comply with the following educational requirements:

1. Minimum of 80 contact hours over and above entry-level human physical therapy program course work for non-human animals, to include:

a. FOUNDATION/CLINICAL SCIENCES i. Gross and applied non-human animal anatomy/physiology ii. Wound healing and response of tissues to disuse and remobilization in the non-human animal iii. Animal behavior iv. Animal restraint v. Zoonotic and infectious diseases b. EXAMINATION/EVALUATION/PROGNOSIS/PT DIAGNOSIS i. Medical and surgical management of orthopedic, neurological, critically injured, geriatric, arthritic and obese non-human animals ii. Gait and other movement analyses c. INTERVENTION/PLAN OF CARE/OUTCOME Code of Colorado Regulations 11 i. Therapeutic exercise applied to non-human animals ii. Therapeutic modalities iii. Outcome assessment and documentation d. CLINICAL EXPERIENCE i. Documented successful completion of a minimum of 120 hours under the supervision of a licensed physical therapist listed in the data base maintained by DORA to perform physical therapy of animals or a licensed veterinarian.

E. Prior to performing physical therapy on an animal, the Physical Therapist shall obtain veterinary medical clearance of the animal by a Colorado-licensed Veterinarian and must document such clearance in the animal patient’s record.

F. Veterinary medical clearance means:

1. The Veterinarian has previously examined the animal patient and has provided a differential diagnosis if appropriate.

2. The Veterinarian has cleared the animal for physical therapy. G. It is expected that the Physical Therapist and the Veterinarian will continue professional collaboration as necessary for the well-being of the animal patient. H. Once veterinary medical clearance has been received, the Physical Therapist is responsible for developing the plan of care for the animal patient’s physical therapy. I. The animal patient’s record must include the verbal or written veterinary medical clearance. If verbal clearance is received, the Physical Therapist must document the verbal clearance in the animal patient’s record, including the name of the veterinarian, date and time clearance was received.

J. Complaints against Physical Therapists alleging a violation related to animal physical therapy will be forwarded to the Colorado State Board of Veterinary Medicine for its review and advisory recommendation to the State Physical Therapy Board. The State Physical Therapy Board retains the final authority by statute for decisions related to discipline of any physical therapist. 211. Requirements for Physical Therapists to Perform Dry Needling A. Dry needling (also known as Trigger Point Dry Needling) is a physical intervention that uses a filiform needle to stimulate trigger points, diagnose and treat neuromuscular pain and functional movement deficits; is based upon Western medical concepts; requires an examination and diagnosis, and treats specific anatomic entities selected according to physical signs. Dry needling does not include the stimulation of auricular or distal points. B. Dry needling as defined pursuant to this rule is within the scope of practice of physical therapy. C. A Physical Therapist must have the knowledge, skill, ability, and documented competency to perform an act that is within the Physical Therapist’s scope of practice. Except as part of a course of study on dry needling pursuant to paragraph D.2 of this Rule, a Physical Therapist shall not perform dry needling unless competent to do so.

Code of Colorado Regulations 12 D. To be deemed competent to perform dry needling, a Physical Therapist must: 1. have practiced for at least two years as a licensed Physical Therapist; and 2. have successfully completed a dry needling course of study that consists of a minimum of 46 hours of in-person (i.e. not online) dry needling training. E. A provider of a dry needling course of study must meet the educational and clinical prerequisites as defined in this rule, paragraph D above and demonstrate a minimum of two years of dry needling practice techniques. The provider is not required to be a Physical Therapist. F. Physical Therapists performing dry needling in their practice must have written informed consent for each patient where this technique is used. The patient must sign and receive a copy of the informed consent form. The consent form must, at a minimum, clearly state the following information:

1. Risks and benefits of dry needling; and 2. Physical Therapist’s level of education and training in dry needling; and 3. The Physical Therapist will not stimulate any distal or auricular points during dry needling. G. When dry needling is performed, it must be clearly documented in the procedure notes and must indicate how the patient tolerated the technique, as well as the outcome after the procedure. H. Dry needling shall not be delegated and must be directly performed by a qualified, licensed Physical Therapist.

I. Dry needling must be performed in a manner consistent with generally accepted standards of practice, including clean needle techniques, and the guidelines and recommendations of the Centers for Disease Control and Prevention (“CDC” ).

J. The Physical Therapist shall supply written documentation, upon request by the Board, which substantiates appropriate training as required by this Rule. Failure to provide written documentation, upon request, is a violation of this Rule, and is prima facie evidence that the Physical Therapist is not competent and not permitted to perform dry needling 212. Inactive License Status for Physical Therapists The purpose of this rule is to outline the conditions and procedures governing inactive licensure status under § 12-41-112.5, C.R.S.

A. A licensed Physical Therapist may request inactive licensure status from the Board. The request must be made in the manner prescribed by the Board.

B. A Physical Therapist with an inactive license must not engage in any act or conduct that constitutes the practice of physical therapy while the Physical Therapist’s license is inactive. C. A Physical Therapist with an inactive license is exempt from the professional liability insurance requirements of § 12-41-114.5, C.R.S.

D. A Physical Therapist may apply for reactivation of an inactive license by successfully completing all of the following steps:

Code of Colorado Regulations 13 1. Complete an application for reactivation and pay a reactivation fee as established by the Director; and 2. Submit proof, in a manner prescribed by the Board, that a physical therapy license held in any other state or jurisdiction is in good standing (if applicable); and 3. Demonstrate compliance with the Board’s continuing professional competency rules with respect to license reactivation.

E. Inactive license status will not prevent the Board from investigating complaints or imposing discipline against a Physical Therapist in accordance with the Physical Therapy Practice Act, § 12-41-101 et seq., C.R.S.

F. If the Board has commenced investigation of a complaint or initiated disciplinary proceedings against a Physical Therapist with an inactive license, the Board may defer action on any pending request to reactivate the license.

G. The Board need not reactivate an inactive license if the Physical Therapist has committed any act that would be grounds for discipline under §12-41-115, C.R.S. H. Except as noted above, a Physical Therapist with an inactive license remains subject to all provisions of the Physical Therapy Practice Act and the Board’s rules. 213. Continuing Professional Competency The purpose of this rule is to establish a continuing professional competency program pursuant to section 12-41-114.6, C.R.S., wherein a physical therapist shall maintain and demonstrate continuing professional competency in order to renew, reinstate, or reactivate a license to practice physical therapy in the state of Colorado.

Furthermore, pursuant to section 12-41-114.6(2), C.R.S., records of assessment or other documentation developed or submitted in connection with the continuing professional competency program are confidential and not subject to inspection by the public or discovery in connection with a civil action against a physical therapist. A person or the Board shall not use the records or documents unless used by the Board to determine whether a physical therapist is maintaining continuing professional competency to engage in the profession.

A. Definitions 1. Assessment of Knowledge and Skills (AKS): an objective third-party assessment that compares a licensee’s knowledge, skills, and abilities to the standards for entry-level practice.

2. Continuing Professional Competency: the ongoing ability of a physical therapist to learn, integrate, and apply the knowledge, skills, and judgment to practice as a physical therapist according to generally accepted standards and professional ethical standards. 3. Continuing Professional Development (CPD): the Board program through which a licensee can satisfy the continuing professional competency requirements in order to renew, reinstate, or reactivate a license.

4. Learning Plan: a Board approved form through which a licensee documents his/her goals and plans of learning that were developed from his/her Reflective Self-Assessment (RSAT), which is defined below, and AKS (when appropriately applied). Code of Colorado Regulations 14 5. Professional Development Activities (PDA): learning activities undertaken to increase the licensee’s knowledge and skill or hone existing knowledge and skill for the purpose of continuing professional development.

6. Reflective Self-Assessment Tool (RSAT): a reflective practice tool in which a licensee can reflect upon his/her knowledge and skills pertaining to the foundational areas of physical therapy practice taking into account the licensee’s current level and area of practice.

B. Continuing Professional Competency Requirements 1. Effective after the 2014 license renewal, or upon the completion of the first renewal of a license thereafter, the licensee shall demonstrate continuing professional competency in order to renew a license by:

a. Participation in the Continuing Professional Development (CPD) program; b. Participation in a program of continuing professional competency through a Colorado state agency or department, including continuing competency requirements imposed through a contractual arrangement with a provider as set forth in section 12-41-114.6(1)(c), C.R.S. This status is hereafter known as “Deemed Status” as described in section D of this rule; or c. Receiving an exemption for military service as defined in section 12-70-102, C.R.S. Military exemptions must be approved by the Division of Professions and Occupations. Licensees seeking a military exemption shall submit a request in writing with evidence that the licensee’s military service meets the criteria established in section 12-70-102, C.R.S., and section E of this rule. 2. A licensee shall attest at the time of the renewal of a license to his/her compliance with continuing professional competency requirements.

C. Continuing Professional Development Program 1. The Continuing Professional Development (CPD) program entails the following: a. The licensee shall complete the Reflective Self-Assessment Tool (RSAT) once per 2-year renewal period. A licensee shall use the Board approved form. i. The execution of a Learning Plan once per 2-year renewal period that is based upon the licensee’s Reflective Self-Assessment Tool (RSAT) or Assessment of Knowledge and Skills (AKS). A licensee shall use the Board approved form.

ii. Accrual of 30 points of Professional Development Activities (PDA) per 2- year renewal period.

b. The completion of an Assessment of Knowledge and Skills (AKS) once every 10 years.

2. Professional Development Activities (PDA)

a. Professional Development Activities must be relevant to the licensee’s practice as a physical therapist and pertinent to his/her Learning Plan. The Board will not pre-approve specific courses or providers. The licensee shall determine which Code of Colorado Regulations 15 activities and topics will meet his/her Learning Plan, and select an appropriate provider.

b. Professional Development Activities are separated into Category I, Category II, and Category III activities and each category has a corresponding point value. Points are used in lieu of continuing education units (CEU) or contact hours to allow credit for non-continuing education type activities. c. Points will be accepted if the activity is included in the Board’s Professional Development Activities List. The Board may accept or reject activities submitted for consideration that are not identified on its list.

d. A minimum of 15 of the required 30 points must be Category I activities. e. Professional Development Activities will only apply for one 2-year renewal period. 3. The completion of an Assessment of Knowledge and Skills (AKS) which meets Board criteria once every ten years.

a. The ten year cycle will commence upon the renewal of a license in 2014 or upon the first renewal of a license thereafter.

b. The ten year cycle will not be changed by the expiration or inactivation of a license that is expired or inactive for less than five years. Physical therapists with licenses expired or inactive for more than five years shall commence a new ten year cycle upon the first renewal of a license in active status. c. An AKS must meet the following criteria:

i. Be drafted and validated by qualified physical therapists and psychometricians;

ii. Be comprised of evidence based practice;

iii. Be maintained for relevancy and advancements in and affecting the profession; and iv. Provide feedback to the participant/licensee regarding his/her performance and suggested learning opportunities to enhance his/her knowledge and skills.

d. Administrative Approval. The Board finds the following AKSs to have met the criteria established in section C.3.c of this rule, and are administratively approved by the Board:

i. Any Practice Review Tool (PRT) administered by the Federation of State Boards of Physical Therapy (FSBPT).

ii. If the AKS is not listed as administratively approved by the Board in this rule, then additional documentation demonstrating the AKS satisfies the Board criteria will be required prior to registering and completing the AKS.

e. The licensee may count the completion of an AKS as a Category I activity toward a mandatory 30 PDA points for the corresponding 2-year renewal period in Code of Colorado Regulations 16 compliance with the State Physical Therapy Board’s Professional Development Activities List for assigned point values.

f. Credit for a maximum of two AKSs may be applied to the requisite PDA points during a single ten-year cycle.

4. Audit of Compliance. The following documentation is required for an audit of compliance of a licensee’s Continuing Professional Development:

a. The Learning Plan that is signed and executed which contains the licensee’s goals in the form and manner as approved by the Board.

b. A certificate of completion or other report issued by the AKS provider indicating the name of the licensee, AKS title, content, and the licensee’s date of completion.

c. Documentation of 30 points of Professional Development Activities in compliance with the State Physical Therapy Board’s Professional Development Activities List for documentation requirements for PDAs.

d. The Board may accept or reject Professional Development Activities (PDA) that do not meet the criteria established by the Board for PDA or standards of quality as defined in the State Physical Therapy Board’s Professional Development Activities List, Standards of Quality for Category I Continuing Education Activities, and this rule.

D. Deemed Status. A licensee who satisfies the continuing professional competency requirements of a Colorado state agency or department pursuant to section 12-41-114.6(1)(c), C.R.S., shall meet the following criteria:

1. In order to renew a license, a licensee shall attest to his/her Deemed Status; 2. To qualify, the program continuing professional competency must be substantially equivalent to the CPD program administered by the Board and must include, at a minimum, every two years the following components:

a. An assessment of knowledge and skills;

b. Thirty (30) contact hours of learning activities; and c. Demonstration of completion of continuing competency activities. 3. Licensees claiming Deemed Status are subject to an audit of compliance. To satisfy an audit of compliance, the licensee shall submit appropriate evidence of participation in a qualifying program through submission of:

a. A letter from the Colorado state agency or department or contractual entity specifying that the licensee has completed the continuing professional competency program, or b. Other documentation approved by the Board which reflects the licensee’s completion of a program of continuing professional competency. E. Military Exemption. Pursuant to section 12-70-102, C.R.S., licensees who have been called to federally funded active duty for more than 120 days for the purpose of serving in a war, Code of Colorado Regulations 17 emergency or contingency may request an exemption from the continuing professional competency requirements for the renewal, reinstatement, or reactivation of his/her license for the 2-year renewal period that falls within the period of service or within six months following the completion of service.

1. Military exemptions must be approved by the Division of Professions and Occupations. Licensees seeking a military exemption shall submit a request in writing with evidence that the licensee’s military service meets the criteria established in section 12-70-102, C.R.S.

2. After being granted a military exemption, in order to complete the renewal process, a licensee shall attest to his/her military exemption.

F. Records Retention. A licensee shall retain documentation demonstrating his/her compliance for two complete 2-year renewal periods.

G. Non-Compliance. Falsifying an attestation or other documentation regarding the licensee’s compliance with continuing professional competency requirements constitutes the falsification of information in an application and may be grounds for discipline pursuant to sections 12-41- 115(1)(k) and (r), C.R.S.

H. Reinstatement and Reactivation. A licensee seeking to reinstate or reactivate a license which has been expired or inactivated for two years or less shall meet the competency requirements outlined in Rule 207.B.

214. Reporting Criminal Convictions, Judgments, and Administrative Proceedings The purpose of this rule is to delineate the procedures a licensee must adhere to when an act enumerated in §12-41-115, C.R.S. has occurred.

A. A licensee must inform the Board, in a manner prescribed by the Board, within 90 days of any of the following events:

1. The conviction of a felony under the laws of any state or of the United States, or of any level of crime related to the practice of physical therapy. A guilty verdict, a plea of guilty, a plea of nolo contendere, or the imposition of a deferred sentence accepted by the court is considered a conviction.

2. A disciplinary action imposed by another jurisdiction that licenses physical therapists including, but not limited to, a citation, sanction, probation, civil penalty, or a denial, suspension, revocation, or modification of a license, whether it is imposed by consent decree, order, or in some other manner, for any cause other than failure to pay a license fee by the due date.

3. Revocation or suspension by another state board, municipality, federal or state agency of any health services related license, other than a license as a Physical Therapist. B. Any award, judgment, or settlement of a civil action or arbitration in which there was a final judgment or settlement for malpractice of physical therapy. C. The notice to the Board must include the following information: 1. If the event is an action by a governmental agency:

a. the name of the agency, Code of Colorado Regulations 18 b. its jurisdiction, c. the case name, d. the docket, proceeding, or case number by which the event is designated, and e. a copy of the consent decree, order, or decision.

2. If the event is a conviction of a crime described above: a. the court, b. its jurisdiction, c. the case name, d. the case number, e. a description of the matter or a copy of the indictment or charges, f. any plea or verdict accepted or entered by the court, and g. a copy of the imposition of sentence related to the conviction and the completion of all terms of the sentence;

3. If the event concerns a civil action or arbitration proceeding: a. the court or arbitrator, b. the jurisdiction, c. the case name, d. the case number, e. a description of the matter or a copy of the complaint or demand for arbitration, and f. a copy of the verdict, the court decision or arbitration award, or, if settled, the settlement agreement and court’s order of dismissal.

4. The licensee notifying the Board may submit a written statement with the notice to be included with the licensee’s records.

215. Provisional Physical Therapist License The purpose of this rule is to establish the qualifications and procedures for applicants seeking a provisional license to practice as a physical therapist pursuant to section 12-41-107.5, C.R.S. A. A provisional license may be issued only one time and cannot be renewed or reinstated. B. An applicant is not eligible to be issued a provisional physical therapist license if he or she has failed the National Physical Therapy Exam (NPTE).

Code of Colorado Regulations 19 C. Pursuant to section 12-41-107.5, C.R.S., a provisional physical therapist license expires no later than 120 days after it is issued. However, if the individual issued a provisional license fails the NPTE after the license was issued, then the license expires within three (3) business days of his/her failing results being sent to the candidate.

D. A provisional physical therapist shall purchase and maintain professional liability insurance, or be insured under a supervising physical therapist, for the amounts specified in section 12-41- 114.5(1), C.R.S., unless the provisional physical therapist is exempted pursuant to section 12-41- 114.5(3), C.R.S.

PHYSICAL THERAPIST ASSISTANT RULES 301. Supervision Required for Physical Therapist Assistant Practice The purpose of this rule is to clarify supervision parameters pursuant to § 12-41-203(2), C.R.S. Physical Therapist Assistants (“P.T.A.” ) shall not provide physical therapy services unless the Physical Therapist Assistant works under the general supervision of a licensed Physical Therapist. 302. Supervision by Physical Therapist Assistants of Others Prohibited The purpose of this rule is to clarify supervisory parameters pursuant to § 12-41-103.6(2)(b), C.R.S. A Physical Therapist Assistant may not supervise other personnel in the provision of physical therapy services to a patient. A Physical Therapist Assistant under the supervision of a licensed Physical Therapist may act as a clinical instructor of a Physical Therapist Assistant student who is providing physical therapy services.

303. Certification of Foreign-Trained Physical Therapist Assistant Graduates of Non-Accredited Programs The purpose of this rule is to establish procedures for determining whether a foreign-trained physical therapist assistant applicant who has graduated from a non-accredited program has substantially equivalent education and training as required pursuant to section 12-41-207(1)(a), C.R.S. A. A foreign-trained applicant who has graduated from a non-accredited program must have education and training as a physical therapist assistant substantially equivalent to the entry-level education and training required at accredited physical therapist assistant programs in the United States in effect at the time of the applicant’s graduation. This includes but is not limited to an assessment of the applicant’s foundational studies and applied and technical education, as well as training in soft tissue and non-selective wound debridement and administration of topical medications.

B. Applicants who wish to have their foundational studies and applied and technical education considered “substantially equivalent” must submit their credentials to the Foreign Credentialing Commission of Physical Therapy (“FCCPT”) or International Consultants of Delaware (“ICD”). The credentialing agencies shall use the most current version of the Coursework Tool for Foreign Educated Physical Therapist Assistants developed by the Federation of State Boards of Physical Therapy (“FSBPT”) to evaluate the applicant’s credentials against the requirements at accredited physical therapist assistant programs in place at the time of the applicant’s graduation. The Board will not accept a credentials evaluation from an organization not listed in this rule. C. All expenses associated with the credentials evaluation are the responsibility of the applicant. Code of Colorado Regulations 20 D. Failure to have a credentials evaluation pursuant to the terms of this rule will result in the Board denying the application.

E. In the event a foreign-trained applicant’s foundational studies are found to be deficient, the applicant may take and pass subject examinations from the College-Level Examination Program (“CLEP”) to overcome the deficiency in general education. F. In the event a foreign-trained applicant’s applied and technical education is found to be deficient, the applicant shall either:

1. Successfully complete a Board-approved plan to overcome deficiencies, or 2. Overcome the deficiency by obtaining an associate degree from an accredited physical therapist assistant program.

304. Certification by Endorsement for Physical Therapist Assistants The purpose of this rule is to delineate the requirements for certification by endorsement under § 12-41- 206, C.R.S.

A. Certification by endorsement through internship.

1. An applicant seeking certification by endorsement under the internship provisions of § 12- 41-206(3)(c), C.R.S., shall:

a. arrange for a Colorado-licensed, practicing Physical Therapist (the “supervising Physical Therapist” ) to supervise the internship; and b. ensure that the supervising Physical Therapist immediately notifies the Board in writing of the establishment of the internship and submits for the Board’s approval a plan for supervision using the physical therapist assistant Clinical Performance Instrument (“CPI” ); and c. have passed an examination, which examination is substantially equivalent to that specified in § 12-41-205(1)(b), C.R.S.

2. The internship shall not commence without the Board’s written approval of the supervising Physical Therapist’s plan for supervision specified in subparagraph (1)(b) of this paragraph.

3. The internship shall consist of:

a. the applicant’s actual practice of physical therapy as defined in § 12-41-103(6), C.R.S.; and b. direct supervision of the applicant at all times by the Board-approved Colorado- licensed, practicing Physical Therapist; and c. a minimum of 240 hours clinical practice within a consecutive six-month period commencing from the Board’s written approval of the plan for supervision. 4. The applicant shall ensure that the supervising Physical Therapist files a written report at the completion of the internship. This report shall indicate whether the applicant successfully demonstrates entry level performance in all skills assessed by the CPI. Hard copy or electronic copies of the CPI are acceptable.

Code of Colorado Regulations 21 5. Subject to the provisions of this rule, the Board shall issue a certification by endorsement under this paragraph based upon:

a. the Board’s review and approval of the supervising physical therapist’s written report; and b. proof that the applicant has passed an examination, which examination is substantially equivalent to that specified in § 12-41-205(1)(b), C.R.S. B. Certification by endorsement through demonstrated competency 1. An applicant seeking certification by endorsement under the demonstrated competency provisions of § 12-41-206(3)(c), C.R.S., may demonstrate competency by providing proof that:

a. The applicant has passed an examination, which examination is substantially equivalent to that specified in § 12-41-205(1)(b), C.R.S.; and b. the applicant has completed sixty-four hours of continuing education related to the practice of physical therapy during the two years immediately preceding the application, provided that the continuing education meets the approval of the Board.

2. An applicant who is unable to demonstrate competency under subparagraph (1) of this paragraph may request to demonstrate competency by any other means. The Board shall consider such a request on a case-specific basis. The decision to approve such a request shall be at the sole discretion of the Board. In considering whether to approve such a request, the Board shall consider public safety, the particular circumstances and hardships faced by the applicant, and such other factors as the Board deems appropriate. If the Board grants certification under this subparagraph (2), the Board may subject said certification to such lawful conditions as the Board finds are necessary to protect the public.

3. Subject to the provisions of this rule, the Board shall issue a certification by endorsement under this paragraph following demonstration of the applicant’s competency. 305. Reinstatement of an Expired Certification for Physical Therapist Assistants The purpose of this rule is to establish the qualifications and procedures for reinstatement of expired certification pursuant to § 12-41-208, C.R.S.

A. An applicant seeking reinstatement of an expired Physical Therapist Assistant certification shall complete a reinstatement application and pay a reinstatement fee as established by the Director. B. If the certification has been expired for more than two years, but less than five years, an applicant must establish “competency to practice” under § 24-34-102(8)(d)(II)(A) & (D), C.R.S., as follows by submitting:

1. Verification of an active, valid physical therapist assistant license, certification or registration in good standing from another state, along with proof of clinical physical therapy practice in that state with a minimum of 400 hours per year for the two years immediately preceding the date of application. The work experience shall be attested as to the number of hours; or Code of Colorado Regulations 22 2. Evidence of completing an average of thirty-two hours per year in physical therapy continuing education courses since the date the certification expired. C. An applicant seeking to reinstate a certification that has been expired for more than five years must demonstrate “competency to practice” as required in § 24-34-102(8)(d)(II)(B) & (F), C.R.S., by one of the following methods:

1. Verification of an active, valid physical therapist assistant license, certification or registration in good standing from another state, along with proof of clinical physical therapy practice in that state with a minimum of 400 hours per year for the two years immediately preceding the date of application. The work experience shall be attested as to the number of hours; or 2. Practice for six months on probationary status with a practice monitor subject to the terms established by the Board; or 3. Completion of a 240-hour internship within 6 months using the physical therapist assistant Clinical Performance Instrument (CPI) as the professional standard and measure of continued competency. Satisfactory completion of the internship shall require both 240 hours of internship practice and successful demonstration of entry-level performance on all skills on the CPI on electronic or paper form; or 4. Any other means as approved by the Board.

D. An applicant for reinstatement who has actively practiced in Colorado on an expired certification in violation of § 12-41-204, C.R.S., is subject to denial of application, disciplinary action, and/or other penalties as authorized in the Physical Therapy Practice Act at § 12-41-201 et seq., C.R.S., and in accordance with § 24-34-102 et seq., C.R.S.

_________________________________________________________________________ Editor’s Notes History Rules 7, 10, 11 eff. 11/30/2007.

Rule 6 eff. 03/30/2011.

Rules 1 - 11 emer. rule repealed eff. 03/09/2012.

Rules 1 - 11 emer. rule eff. 03/09/2012.

Rules 1 - 11, 303, 304 emer. rule eff. 04/02/2012.

Rules 301, 302, 305, 306 emer. rule eff. 06/01/2012.

Rules 1 - 11 repealed eff. 06/30/2012.

Rules 201 - 211, 301 - 305 eff. 06/30/2012.

Rules 101 – 102, 212, 214 eff. 01/30/2013.

Rule 215 emer. rule eff. 06/02/2014.

Code of Colorado Regulations 23 Rules 202 – 203, 205, 215, 303 eff. 09/14/2014.

Rules 207 and 213 eff. 11/01/2014.

Code of Colorado Regulations 24