PURPOSE: The rule provides information regarding supervision of physical therapist assistants by licensed physical therapists.

1. (1) A licensed physical therapist must direct and supervise a physical therapist assistant at all times. The licensed physical therapist holds responsibility of supervision of the physical therapy treatment program. The following responsibilities are maintained by the licensed physical therapist:

   1. (A) Interpretation of referrals;
   2. (B) Initial evaluation and problem identification;
   3. (C) Development or modification of a plan of care which includes the physical therapy treatment goals;
   4. (D) Determination of which tasks require the expertise and decision making capacity of the physical therapist, and must be personally rendered by the physical therapist and which tasks may be delegated to the physical therapist assistant;
   5. (E) Delegation and instruction of the services to be rendered by the physical therapist assistant, including specific treatment program, precautions, special problems, or contraindicated procedures;
   6. (F) Timely review of treatment documentation, reevaluation of the patient and patient’s treatment goals, and revision of the plan of care when indicated; and
   7. (G) Establishment of discharge plans are the responsibility of the physical therapist; documentation of discharge status must be signed or co-signed by the physical therapist.
2. (2) The number of physical therapist assistants that a licensed physical therapist can supervise shall be predicated on the following factors: the complexity and acuity of the patient’s needs, proximity and accessibility to the physical therapist.

3. (3) When supervising the physical therapist assistant where direct supervision by the physical therapist is available, the following requirements must be maintained:

   1. (A) The initial visit, evaluation, and treatment plan must be made by a licensed physical therapist; and
   2. (B) There must be regularly scheduled reassessments of patients by the physical therapist and conferences with the physical therapist assistant regarding patients, the frequency of which is determined by the complexity and acuity of the patient’s needs.

4. (4) When supervising the physical therapist assistant where direct supervision by the physical therapist is not available, the following requirements must be maintained:

   1. (A) A licensed physical therapist must be accessible by telecommunication to the physical therapist assistant at all times while the physical therapist assistant is treating patients;
   2. (B) The initial visit must be made by a licensed physical therapist for evaluation of the patient and establishment of a plan of care;
   3. (C) There must be regularly scheduled and documented conferences with the physical therapist assistant regarding patients, the frequency of which is determined by the needs of the patient and the needs of the physical therapist assistant;
   4. (D) A supervisory visit by the licensed physical therapist will be made every thirty

5. (30) days or at a higher frequency when in accordance with the needs of the patient, upon the physical therapist assistant’s request for reassessment, when a change in treatment plan of care is needed prior to any planned discharge, and in response to any change in the patient’s medical status;

   1. (E) A supervisory visit should include: an on-site reassessment of the patient, on-site review of the plan of care with appropriate revision or termination, and assessment for the utilization of outside resources. On-site shall be defined as wherever it is required to have an on-site licensed physical therapist to provide services; and
   2. (F) No physical therapist may establish a treating office in which the physical therapist assistant is the primary care provider.

AUTHORITY: sections 334.500 and 334.650, RSMo Supp. 1997.* This rule originally filed as 4 CSR 150-3.090. Original rule filed Dec. 14, 1994, effective June 30, 1995. Amended: Filed Nov. 16, 1998, effective July 30, 1999. Moved to 20 CSR 2150-3.090, effective Aug. 28, 2006. *Original authority: 334.500, RSMo 1969, amended 1993, 1995, 1996 and 334.650, RSMo 1996.