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Nevada State Board of Physical Therapy Examiners Board Policy Manual
Nevada State Board of Physical Therapy Examiners Board Policy Manual Table of Contents 1. Applicable Statutes and Administrative Code .......................................................................................... 2 2. Customer Bill of Rights .............................................................................................................................. 2 2. Executive Director Job Description ........................................................................................................... 3 3. Licensing Coordinator Job Description ..................................................................................................... 4 4. Advisory Committee on Continuing Education ......................................................................................... 5 5. Policy on Request for Documents ............................................................................................................. 8 6. Case Assignment Guidelines ..................................................................................................................... 9 7. License Reinstatement Process............................................................................................................... 10 8. License Renewal Process......................................................................................................................... 11 9. Licensure Application Process................................................................................................................. 12 10. Continuing Education Approval Process ............................................................................................... 16 11. Policy on Request for Practice Act Questions ....................................................................................... 17 12. Policy Regarding Contact between Board Members and Members of the Public ............................... 18 13. Policy on Complaints against Board and Staff ...................................................................................... 19 14. Policy on License Verifications .............................................................................................................. 20 15. Adopted Guidelines for Qualified Board Members .............................................................................. 21 16. Policy on the Release of National Examination Scores (PES or NPTE) .................................................. 22 17. Policy of granting licensure without fingerprint report from Nevada Highway Patrol ........................ 23 18. Adopted Guidelines for Board Members, including Appointment of Positions of Chairman, Vice Chairman, Secretary/Treasurer and Board Representative to Advisory Committee on Continuing Education .................................................................................................................................................... 24 19. Per Diem, Lodging & Mileage Policies................................................................................................... 26 20. Policy Regarding Licensee/ Applicant Gifts to Others........................................................................... 27 21. Policy Regarding Advertising of Physical Therapy Services .................................................................. 28 22. Policy Regarding the use of the term “Doctor” by Practitioners of Physical Therapy .......................... 31 23. Policy Regarding the use of the terms “Osteopractic” and “Osteopractor” by Practitioners of Physical Therapy ....................................................................................................................................................... 32 23. Opinion Regarding the performance of Dry Needling and the Practice of Physical Therapy ............... 33 24. NPTE Testing Prior to Graduation ......................................................................................................... 36 1 Current as of April 2014 1. Applicable Statutes and Administrative Code The practice of Physical Therapy within the state of Nevada is governed by NRS: Chapter 640 which can be found online at: http://www.leg.state.nv.us/NRS/NRS-640.html And also by NAC: Chapter 640 which can be found online at: http://www.leg.state.nv.us/NAC/NAC-640.html The following Statutes are also apply to the Nevada State Board of Physical Therapy Examiners: NRS 232A – Boards, Commissions and Similar Bodies NRS 232B – Legislative review of Public Agencies NRS 233B – Nevada Administrative Procedure Act NRS 236 – Holidays And Periods Of Observance NRS 239 – Public Records NRS 241 – Meetings of State and Local Agencies NRS 622 – General Provisions Governing Regulatory Bodies NRS 622A – Administrative Procedures before certain Regulatory Bodies NRS 629 – Healing Arts Generally 2. Customer Bill of Rights Nevada State Board of Physical Therapy Customer Bill of Rights 1. 1. To expect polite and courteous service 2. To always be treated as a priority 3. To expect quality service 4. To have questions about a request answered promptly and helpfully 5. To report any shortcomings in service and expect acknowledgement 6. To compliment exemplary people and service whenever due 7. To have all matters handled in the same manner, for all individuals 2 Current as of April 2014 2. Executive Director Job Description Administrative Functions All operational aspects of the Board office Prepare and manage Board correspondence Follow Board directives Assure priority matters receive prompt and appropriate attention Ensure compliance with all state and federal requirements Maintain database and all office programs Maintain files of licensees, expired licensees, withdrawn applicants, denied applicants, etc. Financial Management Log in all payments Pay bills Reconciles statements Prepare deposits Pay staff, Board members, ACCE File state and federal payroll forms File retirement contribution reports Prepare budget Arrange for bi-annual audit Assist in audit process Review contracts/costs Prepares reports for all meetings Licensure Activities Distribute, receive and process applications Authorize candidates for NPTE Contact with applicants Contact new graduates with NPTE score Process graduate requests Perform annual renewal of licenses Perform annual continuing education audit Pre-review applications for Board approval License upon approval Communications/Reporting/Meetings Website – agendas, licensees, forms, con ed classes, etc. FSBPT National Databank Records Requests Newsletter creation and distribution State requirements Prepare agendas, minutes for Board and ACCE Register and travel plans for members, employees for training, courses, meetings Complaints/Disciplines Maintain complaint database Initiate communication for complaints Prepare cases for review by IBM Prepare subpoenas Forward appropriate cases to DAG Process Consent Decrees 3 Current as of April 2014 Timely notice complaints Be a prepared witness for hearings Ensure collection of imposed fines Ensure licensees comply with Board orders/requirements 3. Licensing Coordinator Job Description The objectives of the Licensing Coordinator are to: answer the multi-line phone system greet and assist walk-ins receive and process incoming mail, faxes, and deliveries process outgoing mail process changes of address data entry of licensure applications and creation of hard files communicate with the licensure applicants as primary contact data entry of continuing education courses and preparation of review sheets assist the Executive Director file loose papers, licensee files, continuing education information, etc. prepare copy projects update FSBPT website with new licensees maintain a clean office environment (vacuuming, dusting) prepare license verifications data entry of completed routine inspection sheets (not complaints) review continuing education audit certificates for course approval status assist Director in calling applicants who have passed the NPTE (Amended 11/14/2013) 4 Current as of April 2014 4. Advisory Committee on Continuing Education Nevada State Board of Physical Therapy Examiners - Amended and Approved by the Board 07/2012 Definition of continuing education Continuing education in physical therapy is a way to formally document participation in activities that are intended to develop and increase the knowledge, skills and professional performance and competence of the licensee. Additionally, continuing education prevents professional obsolescence by staying current with new developments in theory and practice and preventing skill and knowledge deterioration. Clinical Physical Therapy Practice Physical therapy practice implies that the continuing education course must meet criteria in the three categories listed below. 1. The course must address at least one topic that covers an aspect of clinical practice directly related** to 1 patient care along the continuum of active pathology, impairment, functional limitations and disability. 2. The course must be taught by one individual or a team of individuals who hold a comparable level of education as a physical therapist and/or who have: 3. Core knowledge Examination and evaluation Prognosis Diagnosis Clinical decision making Clinical guidelines Evidence-based practice (as defined by Sackett DL, Straus SE, Richardson WS, et al. Evidencebased medicine: how to practice and teach EBM. 2d ed. Edinburgh: Churchill Livingstone, 2000 as found in The Internet Journal of Allied Health Sciences and Practice, Vol. 3, No.4; defined at end of this document) Intervention Wellness, health promotion and fitness Outcomes Psychosocial issues (e.g., mental health, ethics, gender issues, cultural issues including spirituality, racial issues, professionalism as they relate to the practice of physical therapy) Risk Reduction and prevention Technology Exhibited experience in the topic Demonstrated expertise in the topic The course must be sufficiently rigorous to be comparable to at least the current entry level physical therapist or physical therapist assistant practice in any areas of physical therapy practice including: Hospitals (e.g., critical care, intensive care, acute care, and sub-acute care settings) Outpatient clinics 5 Current as of April 2014 4. Rehabilitation settings Skilled nursing extended care, or sub-acute facilities Homes Schools Hospices Corporate of industrial health centers Industrial, workplace, or other occupational environments Athletic facilities Fitness centers and sports training facilities If the course is self-paced (e.g., CD, DVD, book, audio, web-based), then a sufficiently rigorous post-test must be administered. **Courses that are tangential or indirectly related to clinical practice will be reviewed and evaluated on a case by case basis. Non-Clinical Physical Therapy Practice The course must address as least one topic of an aspect of physical therapy practice. Healthcare policy Healthcare administration General healthcare education Healthcare teamwork Physical therapy documentation Physical therapy reimbursement Physical therapy safety issues Physical therapy employment issues Interdisciplinary issues involving physical therapy Physical therapy research Physical therapy case management Medico legal issues Patient satisfaction Language courses directly related to physical therapy practice Courses not likely to receive approval for clinical or non-clinical education credit 1. Courses that are: Beyond the scope of physical therapy practice Clearly under the purview of another discipline Too basic or elementary for entry-level physical therapy or physical therapist assistant clinical practice 6 Current as of April 2014 2. Related to marketing strategies or expanding clinical practice About revenue generating issues About issues related to an area of clinical practice for which the scientific evidence has clearly invalidated the topic About a practice that is not accepted by contemporaneously practicing physical therapists About general self-improvement (e.g., self-help courses, communication improvement courses, business practice improvement courses) Employment law Language courses unrelated to physical therapy practice University coursework unrelated to healthcare Computer education courses Animal physical therapy related courses Training faculty Courses that do not have sufficient documentation including: Course overview and objectives Hour-by-hour timeline (for courses 4 or more hours in length) Bio sketch of the instructor(s) No post-test for non-onsite course Guidelines: Operate on a 50 minute hour Do not consider the lunch break in the units awarded Largest percentage of time will determine if awarded clinical or non-clinical units Maximum of .8 units can be awarded for non-clinical course Maximum renewal units for any course is 1.5 There are no maximum units for "all other purposes" approvals Any course 4 hours or longer requires an hour-by-hour timeline Definition of Evidence Based Practice: Evidence based practice is the integration of best research evidence with clinical expertise and patient values. This definition states that clinical decision-making should be based on three components: 1. 2. 3. Best research Clinical expertise Patient values References: 1. 2. 3. Nevada Physical Therapy Board Practice Act Guide to Physical Therapist Practice. Second Edition. American Physical Therapy Association. Physical Therapy 2001:8(1): 9-746. Sackett. DL. Straus. SE. Richardson. WS Rosenberg. W. Haynes. RB. 2000. Evidence-Based Medicine. How to Practice and Teach EBM (Evidenced Based Medicine). 2nd edition. Churchill Livingtone. NY. 7 Current as of April 2014 5. Policy on Request for Documents Licensees or Expired Licensees Requesting Information: Upon a written and signed request of a licensee, or expired licensee, the Board will provide a copy of a requested item contained in the file of a licensee/expired licensee. The copy will be mailed to the person at their residential address of record. The Board will not fax the information due to the sensitive and private nature of the information on the report, which includes date of birth, social security number, etc. Professional and personal reference letters received in association with an initial application will not be released without the written permission of the author of the letter. It is suggested that the licensee/expired licensee contact the reference directly for a copy of the reference letter. Such requests will be responded to within 3-5 business days. The request 1etter will be initialed by the Board employee who filled the request, along with the date of the response. The original request document will be placed in the licensee/expired licensee file. Request for Disciplinary Documents: Disciplinary documents are public documents and must be provided upon receipt of a written and signed request. Such requests will be responded to within 3-5 business days. The document will be faxed or mailed, depending on the request of the recipient. The request letter will be initialed by the Board employee who filled the request, along with the date of the response. The original request document will be placed in the Records Request folder. Requests for Fingerprinting: If a licensee/expired licensee requests a copy of their fingerprinting report, they must provide a written and notarized request to the Board office. The Board must log the request and distribution information in the fingerprinting dissemination log, along with the original request letter. This is required by federal law. The copy may be mailed to the residential address provided, or by the requestor appearing in the Board office for personal delivery. A copy may not be scanned, faxed or mailed to a business. These provisions are set forth in federal law. Fingerprinting reports are not available to any other individual or entity; only the licensee/expired licensee. Neither Law enforcement nor other licensing jurisdiction may be provided a copy under any circumstances. Created: September 1999 Updated: November 2012 8 Current as of April 2014 6. Case Assignment Guidelines Upon receipt of a complaint, the executive director shall assign a case number and assign an inspector. Cases In the north shall be assigned to a northern area inspector, cases in the south shall be assigned to a southern area inspector. Cases in rural Nevada shall be assigned to an inspector who has the availability to travel to the area. Upon receipt of a completed report by an Inspector, the case file shall be copied and assigned to a board member. Assignment Guidelines: 1. 2. 3. 4. 5. 6. Cases that are clinical in nature shall not be provided to the public member. The chairman shall not be assigned cases unless a quorum* cannot be established otherwise. The chairman must be able to proceed over any hearings that may occur and has other duties that require their involvement each month. Cases involving multiple licensees at one location shall be assigned to the same board member. Assigning to multiple board members would result in the lack of a quorum as the members would be required to recuse themselves as they had knowledge of the case(s). Multiple cases involving the same licensee shall be assigned to the same board member, if an active case is pending at the time of receipt of any subsequent complaints. When possible, cases shall not be assigned to a board member who has worked with the licensee within the immediate past 3 years. When possible, cases shall not be assigned to a board member who was the professor of the licensee within the immediate past 3 years. Due to fact that the Las Vegas area is home to a far greater number of licensees than the northern part of the state, cases cannot be assigned solely based on the practice location of the licensee. This would create an undue burden on those in the north. Additionally, if the Chairman is in the north, this would create a hardship on the member in north who would be required to review the majority, if not all, of the southern cases. Nevada has a relatively small population of licensees and therefore board members may know a licensee through an educational setting, involvement in the professional association, a clinical affiliation, a work setting, a continuing education course, etc. A board member must refuse to be the investigating board member, and recuse himself from any discussion/action at a board meeting, if he/she believes his/her prior or current relationship with the licensee will affect his/her decision in any way. *quorum is 3 members of the board, as cited in NRS 640.030(6} Updated 11/2009 9 Current as of April 2014 7. License Reinstatement Process Per NAC 640.050, a license that which has been expired less than 2 years is eligible for reinstatement. A person who wishes to reinstate their expired license must request the reinstatement in writing, with signature. The request must also include the current residential address of the applicant. Board staff shall generate a reinstatement form to the reinstatement applicant. The form shall include the cost of the reinstatement, the number of continuing education units required and the deadline for the form to be received by the Board. Reinstatement paperwork is processed within 1-3 days of request. Upon receipt of a completed reinstatement form, Board staff verifies the continuing education of the applicant, ensures all reinstatement questions have been answered, ensures the form is signed and dated and that payment is accurate. If the applicant has completed the number of units required, paid the appropriate fee and has not answered "yes" to questions pertaining to arrests, the license shall be reinstated. If the applicant did not attend approved courses, did not provide the appropriate fee, failed to answer the questions, or did not sign the form, staff shall return the form, fee and any attachments to the applicant. The returned items will be mailed with a cover letter explaining what item(s) is missing and how the applicant can rectify. The cover letter shall also include the deadline to file the form. Created: June 2000 10 Current as of April 2014 8. License Renewal Process Annual license renewal is performed via the Board's website. From June 1 to July 31, the site shall include a link for license renewal. The Director shall ensure the link is available and the payment site is working, at least 10 days before the renewal period. A test of renewals will be made by the Director to ensure (a) renewals can be processed, (b) fees can be accepted, (c) payments reach the Paypoint site, (d) renewals are noticed to the data site, (e) email notifications of each renewal is made. A blank renewal form shall also be posted to the website. The form will be available from June 1 thru July 31 only. The Director shall post and remove the form renewal cycle. Licensees may request a paper renewal form by providing a written request, with signature. Requests are accepted via mail or fax. Requests will be processed within 1-3 days of receipt. The renewal form will be created from the information in the database, which is specific to each licensee. The form shall be mailed to the licensee’s residential address of record. Renewals are processed in the order received, irrespective of method of receipt (mail, on-line, hand delivered to Board office). Board staff shall ensure that all renewals are processed as quickly as possible, and within 1-3 days of receipt. The turnaround timeframe in which renewals can be performed is based on the number of renewals received at any given time. Renewals cannot be processed at the Board office, while the licensee waits, unless there are no other renewals to process. This is to ensure a timely and fair process to all licensees. Current licenses are mailed to the licensee at his residential address of record. Licenses will not be faxed or held for pick-up. Updated: June 2012 11 Current as of April 2014 9. Licensure Application Process Application availability: Applications for licensure are available via the Board’s website, via email request, via phone request, or via personal request at the Board office. Applications requested via email or phone will be mailed within 2 business days of request. A copy of the postmarked mailing envelope will be made and filed in the “Mailed Applications” folder. The application number will be listed on the envelope, as well the application type (PT or PTA, exam or endorsement, US or foreigntrained). Applications provided upon personal request at the office will be noted in the “Mailed Applications” folder, including the name of the applicant, type of application and the date provided. Original fingerprinting information is provided in the hard copy applications. It contains the instructions, two fingerprinting cards, and civil applicant waiver. Applicants who obtain their applications via the Board’s website are directed to email the Licensing Coordinator for the fingerprinting information. The Licensing Coordinator will reply with the .pdf file which contains the instructions, sample fingerprinting card and civil applicant waiver. The Licensing Coordinator will print the email request and place in the requested fingerprinting file. The fingerprinting information cannot be posted to the website due to the policies of the FBI and the Nevada Department of Public Safety. They will not allow us to have our account numbers (as assigned by their respective agencies) placed on any public website. Upon receipt of an application: All pages of the application and any received materials are date-stamped. Original fingerprinting cards must be date-stamped on the back of the cards in the area designated by the FBI. The cards may not be date-stamped on their face as the FBI will not accept them. The application is reviewed by the executive director for completeness. If all items have been received and are completed, the application is provided to the Licensing Coordinator to process. Reasons for returning an application: o o o o o o o o o o o Payment not provided Payment incomplete; missing date, signature, etc. Personal information not provided (date of birth, SS#) References not provided Jurisprudence examination not provided or incomplete Not notarized or notary section not completed Educational information not listed or incomplete Incomplete information regarding physical therapy experiences Licenses not listed (for endorsement applicants) Questions not answered (child support, arrests, disciplines in other jurisdictions, etc). Photo not provided 12 Current as of April 2014 Processing an application: A database record in the licensing file is created using the information from the application. Staff enters all information from the application into the database. The information includes details of the application fee, as required by the accountant. A hard file is created to hold the materials. It is this file that will become the file of the licensee. A check-off sheet is placed on the outside of the hard file. The check-off sheet contains the same information as the database record. The jurisprudence examination is graded. A copy of the graded examination is mailed to the applicant. The original is placed in the file of the applicant. The hold file is checked to determine if any application materials arrived prior to the application. The hold file contains information received in which an application has not yet been received. Such information will be held for 6 months from date of receipt. All information received in relation to an application is marked into the database with the date received. The date received is also noted on the check-off sheet. Processing of hard card submission fingerprints: A copy of the cards and fee are made and retained in the application hard file. The original cards and fee are mailed to the Department of Public Safety. The date the cards are mailed is noted in the database as well as the hard file. The original civil applicant waiver is attached to the prints copy and fee copy. Processing of electronic submission of fingerprints: The date the prints were submitted electronically is noted in the database as well as the hard file. The original civil applicant waiver is placed in the hard file. If fingerprint information is submitted prior to an application, a hard file will be created to hold the information. A database record with the status “Fingerprint” will also be created. Processing of received items: As items are received, they are entered into the database as well as noted on the check-off sheet. Transcripts Physical therapy/physical therapist’s assistant’s accreditation is verified using the information from the Commission on Accreditation of Physical Therapy Education. This is to ensure that the program was accredited at the time of graduation. Original transcripts in sealed envelopes are required. For physical therapist applicants who have not graduated from an accredited program, the applicant will obtain a credentials evaluation from the FCCPT that reflects the education is substantially equivalent to an accredited program in place at the time of their graduation. The report is received directly from the FCCPT via email. If the education is not substantially equivalent, the applicant will be contacted and advised to refer to their copy of the evaluation for information on missing courses/credits. 13 Current as of April 2014 PTAs must provide high school transcripts as well. The Board has determined that a GED is acceptable to apply for a PTA license, and therefore an original verification of the GED is required. Scores Scores are received directly from the FSBPT and are noted with the score and either pass/fail based on Nevada policy in place at the time the applicant took the test. If the score is not passing, the applicant shall be notified and advised of the requirement to pass according to Nevada policy. They will be advised they can withdraw their application if they do not want to take the test again. License verifications License verifications must be received directly from the issuing body in a sealed envelope. For jurisdictions that offer a certified verification via email, the Board will accept those as well. References – References must be signed to be accepted, and must be submitted with the application. Language test scores – Must be received directly from the testing service. Copies from the FCCPT or other entity are not accepted. Update to and from applicants: Applicants are encouraged to call or email for their status. The applicant file will be noted with the communication, including the date and the initials of the staff member who communicated with the applicant. Changes of residential address or professional address will be accepted in writing via email, mail or fax. Verbal changes will not be accepted. Applicants are asked about changes of address throughout the licensure process to ensure accurate information is in their file. Request for status from third party – An applicant may sign a release allowing the Board to discuss their application with a specific person, whether that is a recruiter or employer, etc. The Board will not discuss an application with any third party without such a release. Changes of residential address or professional address will be accepted in writing via email, mail or fax. Verbal changes will not be accepted. Applicants are asked about changes of address throughout the licensure process to ensure accurate information is in their file. Completion of application: Once all required items have been received, the application file will be reviewed by the director to ensure all items meet the criteria for licensure. If all items are acceptable, the application, NPTE score and school transcript will be copied. The copy will be scanned and provided via email to two of the Board members for review and signature. The public member shall not review applications for licensure. Upon receipt of both signature pages, the director will issue the license. If the applicant has provided a Nevada employer, a copy of the license will be faxed to that location. A copy of the license will be placed in the file. The 14 Current as of April 2014 original license, parchment permanent license, most recent newsletter and cover letter will be mailed to the licensee at his residential address of record. The cover letter includes the license number and reminders regarding address changes and communicating with Board the office. The file will be provided to the Licensing Coordinator to update the new license on the Federation of State Boards of Physical Therapy website. The file will be presented to the Board members at the next meeting of the Board for ratification by all members, on the record. After ratification, staff shall secure all items into the file and place within the licensure files. Usual reasons for required appearance before the Board. Please refer to NRS 640.160 for complete language. Applicants who have had a 2 or more year absence in practice, or who had a more than 2 year gap in the past and have not worked for at least the immediate past 1 year full-time or 2 years part-time, are required to appear before the Board. Established using NAC 640.050. Applicants who have more than 2 arrests for driving under the influence and/or drug related offenses are required to appear before the Board. Established using NRS 640.160. Applicants who have had their license to practice physical therapy suspended, revoked or in any way limited by another jurisdiction are required to appear before the Board. Established using NRS 640.160. Applicants who fail to disclose an arrest, charge or conviction are required to appear before the Board. This includes an applicant who disclosed information, but the information was not complete. Established using NRS 640.160. Applicant who are requesting to take the NPTE a third or subsequent time. Established using NRS 640.100. MILITARY AND THEIR SPOUSES: In accordance with the Governor’s Executive Order 2012-11, and AB349 of the 2013 legislative session, the applications of active military, their spouses, veterans and surviving spouses will receive priority processing. Additionally, such applicants will be required to provide only their physical therapy school transcript (no undergrad) and only 2 professional references (not 3 professional and 1 personal). Board staff will conduct license verifications via the licensing jurisdictions websites and print the verifications for the applicant’s file. The applicant will receive a 50% reduction in the application fee. The applicant must have their NPTE score transferred to the Board, and fingerprinting remains a requirement. Upon receipt of an application, Boars staff must provide a written status to the applicant. The Board has 10 days from receipt of the fingerprinting results to license the candidate, provided all other information has been received. 15 Current as of April 2014 10. Continuing Education Approval Process Application: The Board Office receives a Continuing Education (Con Ed) application from the Provider for the proposed course. It is opened and date stamped given to the Director. If all information is complete, and the course is not currently approved or pending approval, the Director processes the payment, and returns the course to the licensing assistant for data entry into the continuing education database. o If the course is already approved or pending approval, or if all information is not provided, the director will write a brief letter to the submitter indicating the deficiencies. A copy of the letter is retained, and the original letter and course submission are returned. A course that can be processed is entered into the continuing education database. o If the Course has been approved before, the licensing assistant marks it as Previously Approved (PA)/Pending and list the units awarded previously. If the Course has not been approved before the licensing assistant will enter as NEW. Conduct Meeting: The director contacts all Committee members via email to secure a date for a meeting. Once the date is set, the director creates an agenda. Meetings are scheduled as needed, never more than 90 days apart, to ensure compliance with regulation. The director creates the agenda and posts it to the Board's website; prints the review pages and the licensing assistant makes copies of the agenda and the courses. The agendas are mailed to those on the mailing list. The copied courses are sent to the northern contact. After the Committee Meets: The director writes the approved units to the review form. The licensing assistant will enter the units, date approved, etc. into the Database. The director processes all denied courses into the database, and creates letters to the applicants as to the specifics of the denial. Original letters are mailed. Copies are placed with the submission materials and filed. Upon completion of the data entry of approved courses, the director will print letters to go out to all Providers. The licensing assistant will make copies, send out the original letters via USPS, and place the copies with the submissions. They will be filed in alphabetical order. The director will post the approved courses to the Board's website. Course submissions are kept for 3 years. 16 Current as of April 2014 11. Policy on Request for Practice Act Questions Clarification of any matter within the practice act can be asked at any time, by emailing, calling, faxing, writing, emailing the Board office, or appearing at a regularly scheduled meeting of the Board. Board staff maintains historical information on all matters requested of the Board and can respond to such requests with detailed information. Any person may request clarification of the practice of physical therapy as it pertains to Nevada law. The question may seek to clarify a statute or regulation, to request reconsideration of a previous decision/clarification, or any other matter within the practice act. If a decision by the Board has been rendered on a particular matter, such information will be provided to the requestor. If the requestor would like the Board to address a matter not previously considered, or request reconsideration of a previous decision, the request must be submitted in writing. Requests shall be placed in writing, with signature, to the Board office. The request must reference the specific statute or regulation, if it exists. The matter will be placed on the next available agenda of the Board. Created: September 1999 17 Current as of April 2014 12. Policy Regarding Contact between Board Members and Members of the Public 1. It is the policy of the Nevada State Board of Physical Therapy Examiners (hereinafter, the "BOARD") that licensees and all members of the public are encouraged to communicate with the BOARD, subject to the guidelines set forth herein. 2. Licensees and members of the public are free to communicate directly with members of the BOARD regarding matters over which the BOARD has jurisdiction and/ or control. 3. Licensees and members of the public are encouraged to communicate with the BOARD through the Board office since the majority of issues or questions which arise are likely to be resolved at that level. 4. Members of the BOARD cannot discuss pending disciplinary matters and investigations before the BOARD. 5. Members of the BOARD cannot provide legal advice or any interpretations of any law, statute or regulation on any subject. 6. Members of the BOARD may limit or discontinue a communication with a licensee and/ or member of the public, as they deem appropriate. 7. This policy is meant to eliminate any confusion for licensees and members of the public on the issue of communicating with the BOARD, and is meant to supersede any prior public statements by the BOARD on this issue. VG1 86023v1 05/13/11 18 Current as of April 2014 13. Policy on Complaints against Board and Staff If a complaint is received against a board member, the complaint must be forwarded to the Chairman of the Board and legal counsel to address. If the complaint is against the Chairman of the board, the complaint will go to legal counsel only. The complaint shall be investigated to determine any acts or omissions or illegal conduct. An investigation will include but not be limited to, interviews of all concerned parties and review of any pertinent records of the board and/or submitted by the complainant. If it is determined the complaint was valid, the information will be submitted to the Governor per NRS 640.030(5) which provides that the "Governor may remove any member of the Board for incompetency, neglect of duty, gross immorality or malfeasance in office". The outcome of the complaint will be communicated, in writing, to the complainant. If a written complaint against a staff member is received in the Board office, it shall be immediately forwarded to the Chairman for investigation. The Chairman shall review any pertinent records in the board office and information provided by the complainant. The Chairman shall interview the staff member; the complainant and any other party to the matter (i.e. board staff, recruiters, and employer). If the investigation reveals that staff failed to perform their duties, failed to follow the policies of the board or the requirements of the practice act, the chairman shall place the item for review by the board at the next available meeting of the board. The board will review the complaint details and determine any action to be taken, if any. The outcome of the complaint will be communicated to the complainant. If legal counsel or a board member receives a complaint against staff, it shall be immediately forwarded to the Chairman for investigation. An investigation shall be performed as per paragraph two of this document. If contacted by the Office of Constituent Services, Governor's office or member of the legislature, the executive director shall provide any and all information to assist in the immediate resolution. This may include confirming policies, citing requirements in the practice act, releasing information included in the applicant/licensee file and anything necessary to address the concerns of the person inquiring. The contact information of the Chairman and legal counsel shall be offered to the caller. If the matter is handled by the executive director and no contact with the chairman or counsel was conducted by the caller, the chairman shall be updated that a complaint had been received and the manner in which it was addressed. Complaints must be specific in nature to afford the board member/staff member to address the complaint. The complaint must contain the name of the licensee/applicant, allegation(s) and estimated date(s) of the incident/occurrence. Complaints and comments can be sent directly to the Chairman and Vice Chairman via the “How Are We Doing?" link on the Board's website. People may maintain their anonymity, however to receive a reply or for an investigation to be conducted, specific information must be provided (name, allegation, date of incident), and contact information must accompany the submission. The communications received from this website will be monitored and reviewed by the Chairman and Vice Chairman for any investigations that need to be conducted. Reviewed and Approved 05/2011 19 Current as of April 2014 14. Policy on License Verifications The information contained on license verifications shall include the following: Name; License Number; Profession; Licensure Date; Expiration Date; License Status: Licensed By (Exam or Endorsement); Taken the NPTE; Discipline and Date of Action (if any). A request for license verification must be made in writing and contain the signature of the licensee. The request may be a letter, form from the requesting jurisdiction or other request (fax cover sheet or hand written note) and must contain the name of the licensee, and the complete name and mailing address where the license verification is to be mailed. License verifications shall be processed by the licensing assistant at least once per week to ensure timely receipt. The Executive Director must review and sign all license verifications attesting to be the custodian of records and certifying the information contained on the verification. The license verification must contain the raised seal of the Board. Once reviewed and signed as required, the license verification and addressed and date-stamped mailing envelope are copied. These copies are placed with the original request letter and placed in the licensee's file. The original is mailed. Board staff shall not fax license verifications unless contacted directly by the receiving licensing jurisdiction requesting such. In the event of such request, the original verification will be mailed after the successful fax transmission. Board staff shall not complete specific forms or create individual letters for license verification. The only official license verification to be generated is the license verification from the licensee database. The information is the only certification information provided by the Board. If other information is needed, it must be obtained from the licensee/applicant, or institution which initially generated the information (i.e., NPTE scores, school transcript information, fingerprinting). Created: September 1999 Updated: October 2010 changing title to Executive Director 20 Current as of April 2014 15. Adopted Guidelines for Qualified Board Members In addition to the provisions of NRS 640.030, the following apply to Board member appointments. The Board shall consist of two licensed members from the north and two licensed members from the south. Ideally, one member should represent rural Nevada. The location of the public member is not considered. The Board shall maintain balance based on the following: 1. 2. 3. Gender (a 2:3 balance of all members) Age Practice Type (hospital, outpatient, home health, geriatrics, pediatrics, etc.) The Board shall consider maintaining a balance of educational levels, i.e. Bachelor's degree, Master's Degree and Doctorate Degree of the Board members. The Board will also take into consideration specialty certifications obtained. The Board shall not recommend the appointment of a licensee who has been disciplined by this Board or any other licensing jurisdiction. The Board shall not recommend the appointment of a licensee who is a professor/teacher/instructor at any formal educational institution. The Board shall not recommend the appointment of a licensee who does not actively practice physical therapy in Nevada. The Board shall not recommend the appointment of a licensee who has practiced in the State of Nevada for less than 5 years. The Board shall not recommend the appointment of a licensee who holds a leadership position in the professional association, unless that person agrees to resign from that position in the event of appointment. Updated 3/2009 21 Current as of April 2014 16. Policy on the Release of National Examination Scores (PES or NPTE) Upon a written and signed request of a licensee, or expired licensee, the Board will provide a copy of the examination results of the national examination to the licensee. The copy of the score will be stamped as a copy. The copy will be mailed to the person at their residential address of record, if licensed, or to the address provided in the request letter, if no longer licensed. Upon the personal appearance at the Board office, the materials may be viewed by the public. Any requests for copies must redact the personal information of the licensee, including their address, date of birth, social security number, candidate identification number, etc. As a courtesy, all examination candidates shall be provided with a copy of their score along with their initial licensure information. Non-redacted score reports will not be released to any other person or entity, except in the event of a request from a law enforcement agency or in response to a licensing jurisdiction conducting an investigation pertaining to the licensee. The actual examination score of a licensee may be verbally requested by any member of the public, licensing board, etc. Only the scale score shall be revealed and not the date or location of the test, the candidate identification number, date of birth, school code, breakdown of content areas, etc. The Board shall not create any documents or complete forms providing a score or score information. An official score report can only be generated by the entity that owns and/or controls the examination. Created: September 1999 22 Current as of April 2014 17. Policy of granting licensure without fingerprint report from Nevada Highway Patrol The Nevada State Board of Physical Therapy hereby adopts the policy of granting licensure upon receipt of a completed application, including the fingerprinting report from the Federal Bureau of Investigation, but excluding the results of the fingerprinting report from the Nevada Highway Patrol (NHP). The reason for this change is to ensure continued protection of the public and to ensure that potential licensees are not hindered by the timeframe involved in obtaining reports from the Nevada Highway Patrol. This has been an issue for several years and the source of constant discussion. History Our Board fingerprints all applicants. The applicants send their two completed cards and fee to the Board office. We copy the cards and forward them to the NHP for processing. (We cannot send cards directly to the FBI). Up until a few months ago, the NHP would not forward the second card to the FBI until the NHP had performed its search. The NHP now sends the FBI their card immediately upon receipt. The Board receives the report directly from the FBI within 4 weeks. The NHP report takes up to 12 weeks. Communication with the FBI confirms that their reports cover all of the United States, including Nevada. Any negative findings would be reported by the FBI, therefore there is no need for the report from the NHP as a full report is provided by the FBI. The Board discussed the possibility of allowing applicants to obtain a report on their SS# and name from the FBI. The board would provide a temporary license while awaiting the results of the fingerprinting. This policy avoids the need for that requirement. There is no need to add further responsibilities to the applicants. In addition, this avoids the need to issue temporary licenses under supervision and the tracking of those licenses. Legal counsel has been consulted on this matter and is in agreement with the adoption of this policy. th Adopted this 27 day of July, 2006. Pamela Hogan, PT, OCS FSOM Chairman 23 Current as of April 2014 18. Adopted Guidelines for Board Members, including Appointment of Positions of Chairman, Vice Chairman, Secretary/Treasurer and Board Representative to Advisory Committee on Continuing Education Per the provisions of NRS 640.035, the open meeting law, training from the Attorney General's office, and Board policy, the following apply to Board members. The Board shall elect a Chairman, Vice Chairman, Secretary/Treasurer and Board Representative to the Advisory Committee on Continuing Education. The Chairman shall preside over all meetings of the Board in accordance with the Board Member Training Manual published by the Office of the Attorney General. The Chairman has no individual power or authority over matters the full Board must hear. The Chairman is the main contact for the Executive Director. The Chairman responds to inquiries outside the designated responsibilities of the Executive Director based on law, published opinions and adopted policies only. The Chairman reviews and approves the schedule of the Executive Director, including time off. The Chairman shall attend all meetings as called by the Governor. The Chairman position is not available to the Public Member. Per the Board Member Training Manual, a good Chairman should satisfy certain requirements: punctual; knowledge of basic parliamentary procedure; leadership ability; capable of being personable, yet at the same time be firm and orderly without endeavoring to be merely popular (the leader who see popularity usually fails); ability to handle critical and controversial issues; control of his or her emotions and convictions; impartiality while sitting as the chairman with exercise of common sense and good judgment; ability not to express ill will or negative thoughts about others openly; prepared for the topics on the agenda; knowledgeable about the statutes and regulations the board is charged with enforcing. The Vice Chairman shall preside over Board meetings in the absence of the Chairman. The Vice Chairman has no individual power or authority over matters the full Board must hear. The Vice Chairman shall receive information from the Executive Director regarding time off. The Vice Chairman shall assist in responding to inquiries in the absence of the Chairman, and only based on law, published opinions and adopted policies only. The Vice Chairman position is not available to the Public Member. The Secretary/Treasurer shall meet with the Executive Director once per month to review the bank statements and reconciliations. The Secretary/Treasurer shall affix his/her original signature to the bank statements, in red ink, to indicate review. The Secretary/Treasurer has no individual power or authority over matters the full Board must hear. The Secretary/Treasurer shall review all expense requests over $2,500, except for rent, legal counsel invoices, and financial audits which are set by Board approved contracts. The Chairman position shall be offered to the member who has been on the Board the longest if that person is interested and the Board's needs will be best served with the person in that position. If the Chairman resides in the North, the Vice Chairman position must be held by a Board member from the South, and vice-versa. The Vice Chairman position shall be offered to the member who has been on the Board the second longest period, if that person is interested and the Board's needs will be best served with the person in that position. The Secretary/Treasurer position can be held by any member of the Board who does not hold a position as Chairman or Vice Chairman. It is helpful to have this position held by a person in the south to avoid monthly flight costs to review banking. 24 Current as of April 2014 The Board Representative to the Advisory Committee on Continuing Education shall be a physical therapist as required by NAC 640.490(2). The representative may hold another position on the Board. Any matter under the purview of the Board must be addressed to the full Board at a regularly scheduled Board meeting. This is to ensure all members are aware of matters at the same time and have the opportunity to ask questions. This also ensures the public has the opportunity to participate in the discussions, as is required by statute. Additionally, this ensures the public has equal access to all Board members. The public includes the licensees. Any Board member who wishes to attend or participate in a meeting/conference/workshop/focus group, etc., and whose title is necessary for participation or who will use their title as a Board member, must receive permission from the Board as a whole. This is performed by placing the item on a meeting agenda for discussion and voting. This is necessary to allow for public input, review of the budget, and to determine if the Board desires to be represented and participate in the event. Also, it affords the Board members an opportunity to address what issues they would like addressed at the event. Appearing/attending any event as a Board member means you will be representing the positions of the Board. 25 Current as of April 2014 19. Per Diem, Lodging & Mileage Policies Per Diem policy: For Board members and inspectors, must be at least 50 miles from home (not total of 50 miles total traveled) for per diem to be paid. For other Board staff, must be at least so miles from Board office (not total of so miles total traveled) for per diem to be paid. Maximum reimbursement: Breakfast - $8 Lunch- $12 Dinner- $26 When an overnight stay is required, whether in state or out of state, on the first and last days of travel the rates are reimbursed at 75%. No reimbursement is made for board meetings, unless an overnight stay is required. No reimbursement is made for continuing education meetings. Lodging: Must stay at a Nationwide Lodging Program hotel/motel. Maximum rates reimbursed: Clark County $99 Washoe County $94 Douglas/Carson City $91 All others in state $77 Out of state $99 If a specific course/conference is held in a hotel, the Board may consider reimbursing at a higher rate for the convenience of the attendee. Mileage: Mileage for Board members and Board staff is reimbursed based on actual miles traveled for Board business. Mileage for Board members and Board staff is reimbursed at the state rate as noticed annually. Mileage for Board members is reimbursed for travel to and from the Board office. Mileage is not reimbursed for any Board staff members travelling to or from the Board office, for any reason. Parking: Parking is reimbursed at the actual rate charged. 26 Current as of April 2014 20. Policy Regarding Licensee/ Applicant Gifts to Others NRS 640.160(2)(i) states, as follows: The Board may take [disciplinary] action pursuant to subsection 1 if an applicant or person who has been licensed pursuant to this chapter ...(i) Has entered into any contract or arrangement which provides for the payment of an unearned fee to any person following his or her referral of a patient. Licensees and applicants are directed to use their best professional judgment in adhering to this provision. However, for purposes of this provision, a payment or gift may be considered improper if it is: 1. 2. 3. Made to a person in a position to generate business for the paying party. Related to the volume of business generated; and More than the nominal value-and/or exceeds fair market value---of any legitimate service rendered to the payer, or is unrelated to any services at all other than the referral of patients. The Board does recognize an exception for compensation arrangements that involve nominal amounts of compensation. This exception only applies to non-cash items or services that do not exceed $50 per gift and an aggregate of $300 per year if the licensee and/or applicant providing the compensation makes it available to all similarly situated individuals, regardless of whether these individuals refer patients to them for services, and compensation may in no way take into account the volume or value of the referral or referrals made. (Adopted January 16, 2014.) 27 Current as of April 2014 21. Policy Regarding Advertising of Physical Therapy Services Advertising Guidelines The following guidelines are provided to assist licensees in advertising their services. These guidelines are separated into two categories. One provides samples of appropriate language to use in print ads, web-sites, television commercials and all forms of advertising. There are also examples of language that could be considered to violate the provisions of the practice act section pertaining to advertising. The language in the practice act is as follows: NAC 640.630 Advertising. (NRS 640.050) A licensee shall not advertise treatment by the use of physical therapy or equipment used in the practice of physical therapy in such a manner that the advertising: 1. Contains a testimonial or endorsement by another person; 2. Implies that the physical therapist has skill which is superior to that of another physical therapist; 3. Holds the physical therapist out as a specialist unless the licensee is certified as a specialist by an organization recognized by the Board; 4. Makes any false claim about the efficacy or value of the treatment the licensee administers; or 5. Is false, deceptive or misleading in regard to the fee which is charged or the terms of any credit for the treatment administered. Examples of appropriate advertising: ABC Therapy provides physical therapy services by licensed professionals in a clean, safe and friendly environment. Your concerns are our priority! I received treatment from ABC Therapy for injuries from a car accident. The staff was kind and helped me throughout my visits. I have found ABC Therapy to be a very positive experience. I would not hesitate to recommend them to anyone seeking physical therapy services. The team at ABC Therapy is knowledgeable and helpful. Since beginning therapy, my health has steadily improved. Examples of inappropriate advertising: Joe Smith is a wonderful physical therapist! He has better skills than any therapist in town. Joe Smith will make sure you get better – fast! He guarantees it! From the first day of therapy, I knew Joe Smith was the most competent therapist in town! Adopted: January 29, 2009 28 Current as of April 2014 The following became effective January 2014. This language is from the Healing Arts Law which pertains to all healthcare related Boards in the State of Nevada. NRS 629.076 Standards for advertisements; provider of health care to display specific licensure or certification; penalties; definitions. [Effective January 1, 2014.] 1) Except as otherwise provided in subsection 3: a) An advertisement for health care services that names a health care professional must identify the type of license or certificate held by the health care professional and must not contain any deceptive or misleading information. If an advertisement for health care services is in writing, the information concerning licensure and board certification that is required pursuant to this section must be prominently displayed in the advertisement using a font size and style to make the information readily apparent. b) Except as otherwise provided in subsection 4, a health care professional who provides health care services in this State shall affirmatively communicate his or her specific licensure or certification to all current and prospective patients. Such communication must include, without limitation, a written patient disclosure statement that is conspicuously displayed in the office of the health care professional and which clearly identifies the type of license or certificate held by the health care professional. The statement must be in a font size sufficient to make the information reasonably visible. c) A health care professional shall, during the course of providing health care services other than sterile procedures in a health care facility, wear a name tag which indicates his or her specific licensure or certification. d) A physician or osteopathic physician shall not hold himself or herself out to the public as board certified in a specialty or subspecialty, and an advertisement for health care services must not include a statement that a physician or osteopathic physician is board certified in a specialty or subspecialty, unless the physician or osteopathic physician discloses the full and correct name of the board by which he or she is certified, and the board: i) Is a member board of the American Board of Medical Specialties or the American Osteopathic Association; or ii) Requires for certification in a specialty or subspecialty: (1) Successful completion of a postgraduate training program which is approved by the Accreditation Council for Graduate Medical Education or the American Osteopathic Association and which provides complete training in the specialty or subspecialty; (2) Prerequisite certification by the American Board of Medical Specialties or the American Osteopathic Association in the specialty or subspecialty; and (3) Successful completion of an examination in the specialty or subspecialty. e) A health care professional who violates any provision of this section is guilty of unprofessional conduct and is subject to disciplinary action by the board, agency or other entity in this State by which he or she is licensed, certified or regulated. 2) A health care professional who practices in more than one office shall comply with the requirements set forth in this section in each office in which he or she practices. 3) The provisions of this section do not apply to: a) A veterinarian or other person licensed under chapter 638 of NRS. b) A person who works in or is licensed to operate, conduct, issue a report from or maintain a medical laboratory under chapter 652 of NRS, unless the person provides services directly to a patient or the public. 4) The provisions of paragraph (b) of subsection 1 do not apply to a health care professional who provides health care services in a medical facility licensed pursuant to chapter 449 of NRS or a hospital established pursuant to chapter 450 of NRS. 29 Current as of April 2014 5) As used in this section: a) “Advertisement” means any printed, electronic or oral communication or statement that names a health care professional in relation to the practice, profession or institution in which the health care professional is employed, volunteers or otherwise provides health care services. The term includes, without limitation, any business card, letterhead, patient brochure, pamphlet, newsletter, telephone directory, electronic mail, Internet website, physician database, audio or video transmission, direct patient solicitation, billboard and any other communication or statement used in the course of business. b) “Deceptive or misleading information” means any information that falsely describes or misrepresents the profession, skills, training, expertise, education, board certification or licensure of a health care professional. c) “Health care facility” has the meaning ascribed to it in NRS 449.2414. d) “Health care professional” means any person who engages in acts related to the treatment of human ailments or conditions and who is subject to licensure, certification or regulation by the provisions of this title. e) “Medical laboratory” has the meaning ascribed to it in NRS 652.060. f) “Osteopathic physician” has the meaning ascribed to it in NRS 633.091. g) “Physician” has the meaning ascribed to it in NRS 630.014. (Added to NRS by 2013, 1484, effective January 1, 2014) 30 Current as of April 2014 22. Policy Regarding the use of the term “Doctor” by Practitioners of Physical Therapy It is the position of the BOARD that there is an important distinction that all practitioners must recognize, as between one’s licensing designation and one’s educational designation. Licensing designations are just as they sound; an indication to the public at large as to the statutory “office” or “position” held by that practitioner. In Nevada, licensing designations in physical therapy come in only two (2) varieties: “Physical Therapist”, or “PT”, as abbreviated, and “Physical Therapist’s Assistant”, or “PTA”, as abbreviated. See, NRS 640.021 and NRS 640.0213. Educational designations, however, are varied and are not mandated under the statutes which govern the practice of physical therapy. Indeed, this BOARD possesses no jurisdiction whatsoever over individuals strictly on the basis of their educational designations, but solely their licensing ones. Consequently, practitioners are obligated to disclose their licensing designation in communicating with the public, but are not obligated to disclose, or even mention, their educational designation. Licensees may elect to disclose their education designation, including the term “doctor”, pursuant to the following guidelines. In everyday use, the BOARD now adopts the following guidelines for all practitioners in the State of Nevada who hold a Doctorate Degree in Physical Therapy, in order to prevent public confusion as to this issue: 1) Practitioners must refer to themselves by their licensing designation when communicating with the public, either verbally or in written form. Verbal Examples: John Smith, PT or John Smith, Physical Therapist Written Examples: John Smith, PT or John Smith, Physical Therapist 2) Practitioners may refer to themselves or other practitioners verbally as “Doctor”, when communicating with the public. 3) Practitioners may elect to refer to themselves as “Doctor” in verbal and written communications, but must do so only when also referencing their licensing designation. Verbal Examples: I am Doctor John Smith, your Physical Therapist. Written Examples: Doctor John Smith, PT, or John Smith, Physical Therapist, Doctorate in Physical Therapy or John Smith, PT, Doctorate in Physical Therapy or John Smith, Physical Therapist, DPT). These simple procedures should provide clarity on this issue. Licensees are reminded that the patients must always be made aware of all persons who are treating them at all times. Finally, it is the judgment of the BOARD that these guidelines do not pertain to practitioners in an educational institution or those who hold a designation they have rightfully attained in some other discipline (Example: PhD). Adopted 07/12/2012 31 Current as of April 2014 23. Policy Regarding the use of the terms “Osteopractic” and “Osteopractor” by Practitioners of Physical Therapy At a recent meeting of the State of Nevada Board of Physical Therapy Examiners (hereinafter, the “BOARD”), the issue of the terms “Osteopractic” and “Osteopractor” were discussed to determine the legality of their use by licensees. It is the official policy of the Board that the terms “Osteopractic” and “Osteopractor” are not acceptable terms for licensees to use, in any form, either written or verbal. Licensees may reference their formal education and continuing education; however these terms are not legally acceptable to be utilized by any licensee. Adopted March 28, 2013 32 Current as of April 2014 23. Opinion Regarding the performance of Dry Needling and the Practice of Physical Therapy I. Procedural Introduction Pursuant to NAC 640.480 and NAC 640.490, the Nevada State Board of Physical Therapy Examiners (hereinafter, the "Board") is empowered to create an Advisory Committee on Continuing Education (hereinafter, "ACCE") to review all proposed continuing education courses being offered to Board licensees. This review is to determine whether credits should be awarded for attendance at a particular session and the amount of said credits. See, NAC 640.490. In this review, the central inquiry as to whether credits may be awarded for a given session is whether the subject matter of the session is considered to be part of the "practice of physical therapy" in the State of Nevada. Thus, courses which have this designation are considered "approved" and attendees may claim continuing education credit for their attendance. Conversely, courses which are not "approved" cannot and will not provide attendees with continuing education credit. See, NAC 640.490 and NAC 640.500. On October 2, 2008, the Board was asked to address a recent decision made by the ACCE wherein the ACCE had decided to deny approval for a continuing education course on the topic of Dry Needling (hereinafter, "DN".) After exploring the issue, the Board ultimately upheld the decision of the ACCE and concluded that the denial of credit would stand since DN was not considered by the Board to be within the scope of physical therapy practice in the State of Nevada. In February 2012, the Board received a petition for a declaratory order from one of its licensees pursuant to NAC 640.310, asking that the Board reconsider and reverse its decision of October 2, 2008 to conclude that DN was, in fact, within the scope of physical therapy practice in the State of Nevada. On March 20, 2012, the Board considered the petition in question and ultimately granted it. Thus, the Board will now deem DN to be within the scope of practice of physical therapy in the State of Nevada. The present discussion is intended to provide the factual and legal foundation for this declaratory order, as required under NAC 640.310(2). To be clear, it is not the intention of this document to address or pass upon the practice of acupuncture, or the scope of practice of oriental medicine, as it is defined within NRS and NAC Chapter(s) 634A (See, NRS 634A.020) and regulated by the Nevada State Board of Oriental Medicine. Nor is it the intention of this document to address or pass upon the scope of practice of homeopathic medicine as regulated by the Nevada State Board of Homeopathic Medical Examiners, pursuant to NRS and NAC Chapter(s) 630A. It is the intention of this document to address the practice of DN and the reasoning for the recent declaratory statement from the Board which deems DN to be within the scope of physical therapy practice in the State of Nevada. II. Factual Introduction "Dry Needling", also referred to as "intramuscular stimulation", (hereinafter, "DN") is a therapy for the treatment of muscle pain wherein solid filament needles are inserted through the skin and into the muscle at myofascial "trigger points" (i.e., areas of contraction knots in muscle which are responsible for creating and prolonging sensations of pain) without the use of injection. It is theorized that this practice activates the healing process, thereby leading to relief of pain and restoration of healthy neuromuscular physiology. In approaching this area, it is important to distinguish DN from the ancient practice of acupuncture within traditional Chinese medicine. At a basic level, both procedures involve the insertion of needles to alleviate pain, yet there are also some important differences which distinguish each procedure. Acupuncture arises from and is grounded in ancient rules and theories, while DN is solely based upon modern scientific neurophysiology, anatomy and newer understandings within the discipline of pain science. Additionally, the overall purpose of DN is strictly to provide 33 Current as of April 2014 pain control in the musculoskeletal system while acupuncture is used to address a range of illnesses, other than just pain relief. Furthermore, acupuncture involves the insertion of needles into specific named acupuncture points, which may or may not overlie muscles and 'trigger points'. Thus, acupuncture will always remain a viable treatment option for a range of disorders and pain issues. To be clear, however, the present declaratory order is limited strictly to DN and not acupuncture. III. Statutes Applicable to Discussion NRS 640.022 "Physical Therapy" defined. "Physical Therapy" means the specialty in the field of health which is concerned with prevention of disability and physical rehabilitation of persons having congenital or acquired disabilities. NRS 640.024 "Practice of Physical Therapy" defined. "Practice of physical therapy": 1) Includes: a) The performing and interpreting of tests and measurements as an aid to evaluation or treatment; b) The planning of initial and subsequent programs of treatment on the basis of the results of tests; and c) The administering of treatment through the use of therapeutic exercise and massage, the mobilization of joints by the use of therapeutic exercise without chiropractic adjustment, mechanical devices, and therapeutic agents which employ the properties of air, water, electricity, sound and radiant energy. 2) Does not include: a) The diagnosis of physical disabilities; b) The use of roentgenic rays or radium; c) The use of electricity for cauterization or surgery; or d) The occupation of a masseur who massages only the superficial soft tissues of the body. NAC 640.310 Petition for declaratory order or advisory opinion: Receipt by Board; decision; form. 1) If a petition for a declaratory order or an advisory opinion is received at least 10 days before the next regularly scheduled meeting of the Board, the Board will place the matter on the agenda for that meeting. If the petition is not received before that date, the petition will be placed on the agenda for the following meeting. 2) If the Board grants the petition, it will issue its declaratory order or advisory opinion within 120 days. The Board may schedule a hearing on the petition before issuing its decision. 3) A petition for a declaratory order or an advisory opinion must be in writing. NAC640.320 Copy of declaratory order or advisory opinion sent to petitioner. A copy of the declaratory order or advisory opinion rendered by the Board will be sent to the petitioner. IV. Analysis The Board is specifically empowered by statute to accept petitions from members of the public for declaratory orders. See, NAC 640.310. In this instance, the Board has been asked for a declaratory order on the issue of whether the Board will interpret DN as constituting part of the practice of physical therapy in the State of Nevada. The issue of DN and whether DN constitutes a part of physical therapy practice is one which State regulatory board and agencies are dealing with throughout the United States. According to the American Physical Therapy Association (hereinafter, "APTA"), as of December 2011, eighteen (18) States and the District of Columbia have issued opinions affirming the technique of DN as constituting part of their physical therapists' scope of practice. As of that same date, another six (6) States, including Nevada, have issued opinions to the contrary. Another approach that States have taken is to permit DN as part of physical therapy practice, provided that a physical therapist can demonstrate a relevant educational background or an ability to comply with certain established competency standards. Thus, while the various States have not reached unanimity as to whether DN should be read into each of their respective practice acts, it is clear that the national trend is clearly moving toward acknowledgment of the practice with varying degrees of acceptance. 34 Current as of April 2014 As the Board looks to evaluate whether DN can be construed as part of the practice of physical therapy in Nevada, it is appropriate to first examine statutory sources. A review of the provisions of Nevada's Act reveals no specific reference to "dry needling", "intramuscular stimulation" or similar terms. However, the Act does make reference to " ... the performing and interpreting of tests and measurements as an aid to evaluation or treatment ... " and does authorize " ... the administering of treatment through the use of.. .mechanical devices ... " See, NRS 640.024(l)(a), (c). NRS 640.024 then sets forth a series of treatment modalities which are specifically excluded from the practice of physical therapy. These include: "diagnosis of physical disabilities," "use of roentgenic rays or radium," "use of electricity for cauterization or surgery," and "occupation of a masseur who massages only the superficial soft tissues of the body ... " See, NRS 640.024(2)(a), (b), (c) and (d). From this specific recitation of those items which fall outside the practice of physical therapy, it is reasonable to infer that other items were not prohibited from falling within it. On this point, in the case of Galloway v. Trusedell, 83 Nev. 13 (1967), the Nevada Supreme Court stated, as follows: The maxim 'expressio unius est exclusio alterius,' the expression of one thing is the exclusion of another, has been repeatedly confirmed in this State [citations omitted].. . The affirmation of a distinct policy upon any specific point in a state [statute] implies the negation of any power in the legislature to establish a different policy. Id., 83 Nev. at 27 (emphasis added.) Simply put, because the Nevada Legislature has seen fit to set forth those treatment modalities which are expressly excluded from the practice of physical therapy in Nevada, the Galloway decision teaches that it is fair to conclude that other modalities not specified in the statute are not prohibited from use. Because none of the stated exceptions apply to the DN scenario, there is nothing within NRS 640.024 to suggest that DN is specifically excluded from the scope of physical therapy practice in Nevada. This fact, coupled with the relatively broad phrases used to describe acceptable techniques (i.e., "tests and measurements as an aid to evaluation or treatment" and "mechanical devices" (NRS 640.024(1)(a) and (c), respectively) provide great definitional flexibility as to those items which are part of the scope of Nevada physical therapy practice. For these reasons, the Board will now deem the practice of DN, as described herein, to constitute the practice of physical therapy. One important implication of this opinion is as follows: If you are a licensed physical therapist in the State of Nevada and use DN as part of your practice, the Board now considers itself to have jurisdiction over that action since DN now constitutes the practice of physical therapy in this State. However, this opinion has no impact upon the requirements or actions of other Nevada licensing boards. V. Conclusion For the reasons set forth herein, this Board will now consider the practice of DN (as defined above) to fall within the scope of practice of physical therapy in the State of Nevada. Adopted 6/25/2012 35 Current as of April 2014 24. NPTE Testing Prior to Graduation At a recent meeting of the State of Nevada Board of Physical Therapy Examiners (hereinafter, the “BOARD”), the issue of granting authorization to take the National Physical Therapy Examination prior to graduation was discussed. It is the official policy of the Board that applicants for licensure by examination may take the NPTE prior to graduation, upon receipt of a completed application, including an official transcript from the physical therapy school that reflects the applicant is in the last semester of school. A letter from the school will not be accepted in lieu of the official transcript. Reference: NAC 640.040, NAC 640.020. Adopted March 20, 2014 36 Current as of April 2014
