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Practice News:
 

SB 582 is now: Act No. 62 Public Acts of 2018 - PT Addition to Disability Placard Authorization Effective June 12, 2018

posted: July 12, 2019

As the result of legislation introduced by MPTA, Physical Therapists are now able to authorize the need for a disability plackard.  

Physical Therapist’s Role in Issuing Disability Parking Permits in Michigan

 

Public Act 62 of 2018 amended the Motor Vehicle Code to add physical therapists to the list of individuals who are able to authorize/approve the need for disability parking placards. Public Act 62 of 2018 helps to meet the need of Michigan residents with mobility limitations to have more efficient access to health care providers who can determine qualifying conditions by adding physical therapists to those already identified in statute.

 

Eligibility Standards

  • The Michigan Vehicle Code (MCL 257.19a) states that persons with a qualifying disability, as determined by a licensed physician, physician’s assistant, chiropractor, nurse practitioner, optometrist or physical therapist, may apply for a disability license plate or placard. To qualify a person must have one or more of the following characteristics which affect a patient’s ability to walk:
  • Blindness as determined by an optometrist, physician, or physician assistant.
  • Inability to walk more than 200 feet without having to stop and rest.
  • Requires a wheelchair, crutch, brace, or other ambulatory aid to walk.
  • A lung disease from which a person’s FEV1, when measured by spirometry, is less than 1 liter, or from which to persons arterial oxygen tension is less than 60 mm/hg of room air at rest.
  • Patient has a cardiovascular condition which measure between 3 and 4 on the New York Heart Classification Scale (http://www.heartonline.org.au/media/DRL/New_York_Heart_Association_(NYHA)_classification.pdf )     
  • An arthritic, neurological, or orthopedic condition that severely limits ability to walk.
  • Persistent reliance upon an oxygen source other than ordinary air.

 

Directions

  • Applicants complete Part 1 of the Disability Parking Placard Application from the Michigan Department of State.
  • A licensed Physical Therapist must complete Part 2 (Medical Eligibility Standards) of the Disability Parking Placard Application, including the certification section to determine permanent (>6 months) vs. temporary (<6 months) disability.
    • This determination is based on your clinical judgment as there are no specific criteria nor is there space to justify this determination on the form.  Your judgment should, however, be able to be clearly articulated if there were to be further inquiry by the Secretary of State.
    • Note that the online version of the form does not list the physical therapist as being able to complete Part 2.  This is an omission that is being corrected by the Secretary of State, who will accept the current form even with this omission.
  • If the applicant also qualifies for free parking (criteria listed on form), a Physical Therapist must complete Part 3.
  • Completed application may be presented at any Secretary of State branch office or mailed to the address on the reverse side of the application.
  • The Secretary of State plans to deplete existing paper applications before replacing them with the physical therapist added, but will still accept these old versions when completed by the physical therapist.
  • Although we do not expect the Michigan Board of Physical therapy to promulgate rules related to physical therapist determination of need for disability parking placards, it would be prudent to document all patient/client encounters as required by state law and professional practice standards.

 

 

Public Health Code Amended to Allow Nurse Practitioners to Prescribe Physical Therapy - Effective April 9, 2017

posted: April 24, 2017

The Physical Therapy Section of the Public Health Code has been amended to allow Advanced Practice Registered Nurses to prescribe physical therapy:

 

PUBLIC HEALTH CODE (EXCERPT)
Act 368 of 1978

***** 333.17820.amended THIS AMENDED SECTION IS EFFECTIVE APRIL 9, 2017 *****



333.17820.amended Practice of physical therapy or physical therapist assistant; license or authorization required; engaging in treatment with or without prescription of certain license holders; use of words, titles, or letters.

Sec. 17820.

(1) An individual shall not engage in the practice of physical therapy or practice as a physical therapist assistant unless licensed or otherwise authorized under this part. Except as otherwise provided in this subsection, a physical therapist or physical therapist assistant shall engage in the treatment of a patient if that treatment is prescribed by a health care professional who is an advanced practice registered nurse as that term is defined in section 17201, or who holds a license issued under part 166, 170, 175, or 180, or an equivalent license issued by another state. A physical therapist or a physical therapist assistant may engage in the treatment of a patient without the prescription of a health care professional who is an advanced practice registered nurse as that term is defined in section 17201, or who holds a license issued under part 166, 170, 175, or 180, or an equivalent license issued by another state, under either of the following circumstances:

(a) For 21 days or 10 treatments, whichever first occurs. However, a physical therapist shall determine that the patient's condition requires physical therapy before delegating physical therapy interventions to a physical therapist assistant.

(b) The patient is seeking physical therapy services for the purpose of preventing injury or promoting fitness.

 

 

(2) The following words, titles, or letters or a combination of words, titles, or letters, with or without qualifying words or phrases, are restricted in use only to those persons authorized under this part to use the terms and in a way prescribed in this part: "physical therapy", "physical therapist", "doctor of physiotherapy", "doctor of physical therapy", "physiotherapist", "physiotherapy", "registered physical therapist", "licensed physical therapist", "physical therapy technician", "physical therapist assistant", "physical therapy assistant", "physiotherapist assistant", "physiotherapy assistant", "p.t. assistant", "p.t.", "r.p.t.", "l.p.t.", "c.p.t.", "d.p.t.", "m.p.t.", "p.t.a.", "registered p.t.a.", "licensed p.t.a.", "certified p.t.a.", "c.p.t.a.", "l.p.t.a.", "r.p.t.a.", and "p.t.t.".

Section 17201:

Sec. 17201. (1) As used in this part:

(a) “Advanced practice registered nurse” or “a.p.r.n.” means a registered professional nurse who has been granted

a specialty certification under section 17210 in 1 of the following health profession specialty fields:

(i) Nurse midwifery.

(ii) Nurse practitioner.

(iii) Clinical nurse specialist.

PUBLIC HEALTH CODE (EXCERPT)
Act 368 of 1978

***** 333.17820.amended THIS AMENDED SECTION IS EFFECTIVE APRIL 9, 2017 *****

 


333.17820.amended Practice of physical therapy or physical therapist assistant; license or authorization required; engaging in treatment with or without prescription of certain license holders; use of words, titles, or letters.

 

Sec. 17820.

(1) An individual shall not engage in the practice of physical therapy or practice as a physical therapist assistant unless licensed or otherwise authorized under this part. Except as otherwise provided in this subsection, a physical therapist or physical therapist assistant shall engage in the treatment of a patient if that treatment is prescribed by a health care professional who is an advanced practice registered nurse as that term is defined in section 17201, or who holds a license issued under part 166, 170, 175, or 180, or an equivalent license issued by another state. A physical therapist or a physical therapist assistant may engage in the treatment of a patient without the prescription of a health care professional who is an advanced practice registered nurse as that term is defined in section 17201, or who holds a license issued under part 166, 170, 175, or 180, or an equivalent license issued by another state, under either of the following circumstances:

(a) For 21 days or 10 treatments, whichever first occurs. However, a physical therapist shall determine that the patient's condition requires physical therapy before delegating physical therapy interventions to a physical therapist assistant.

(b) The patient is seeking physical therapy services for the purpose of preventing injury or promoting fitness.

(2) The following words, titles, or letters or a combination of words, titles, or letters, with or without qualifying words or phrases, are restricted in use only to those persons authorized under this part to use the terms and in a way prescribed in this part: "physical therapy", "physical therapist", "doctor of physiotherapy", "doctor of physical therapy", "physiotherapist", "physiotherapy", "registered physical therapist", "licensed physical therapist", "physical therapy technician", "physical therapist assistant", "physical therapy assistant", "physiotherapist assistant", "physiotherapy assistant", "p.t. assistant", "p.t.", "r.p.t.", "l.p.t.", "c.p.t.", "d.p.t.", "m.p.t.", "p.t.a.", "registered p.t.a.", "licensed p.t.a.", "certified p.t.a.", "c.p.t.a.", "l.p.t.a.", "r.p.t.a.", and "p.t.t.".

 

 


Practice Resources

The practice of physical therapy is governed by various sets of laws, regulations, policies, and guidelines. It is important for physical therapists and physical therapist assistants to be familiar with them and to understand when each is applicable to a given practice setting and/or specific patient. They include:

State Law. The practice of physical therapy is legally regulated at the state level. In Michigan, the Public Health Code is state law. The Administrative Rules written by the Michigan Board of Physical Therapy provide details and interpretation of legislative intent, and are as binding as state law. Compliance with both is required for all settings and patients at all times. Violations of state law can result in sanctions against your license.

Michigan Public Health Code General Provisions:
http://www.legislature.mi.gov/(S(mythcqvglmcecop44qzzz3vd))/mileg.aspx?page=getObject&objectName=mcl-368-1978-15-161

Michigan Public Health Code Part 178, Physical Therapy: http://www.legislature.mi.gov/(S(s1hvtjgnvvp2pive3db5cuzd))/mileg.aspx?page=getObject&objectName=mcl-368-1978-15-178

Michigan Board of Physical Therapy Administrative Rules: http://dmbinternet.state.mi.us/DMB/ORRDocs/AdminCode/1597_2015-088LR_AdminCode.pdf

Information on filing a complaint against another licensee:
http://www.michigan.gov/lara/0,4601,7-154-35299_63294_27647---,00.html

Third Party Payer Regulations/Contracts. Billing a third party payer for care provided to one of its beneficiaries explicitly attests to your compliance with all of the third party payer's regulations. The penalty for inappropriately billing for services is insurance fraud. Some consider this the most challenging aspect of practice given the wide variety of payer regulations and contracts. Below are links to key regulations for Medicare and Medicaid. Be sure to be familiar with all private payer contracts to whom you bill for services.

Medicare Benefit Policy Manual (See especially Chapter 15, Sections 220 and 230, as well as other Chapters relevant to your specific setting)
http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS012673.html

Michigan Medicaid Provider Manual (see especially Outpatient Therapy Section 5.2 as well as therapy sections for other settings)
http://www.mdch.state.mi.us/dch-medicaid/manuals/medicaidprovidermanual.pdf

Reporting Medicare Fraud and Abuse:
http://www.medicare.gov/forms-help-and-resources/report-fraud-and-abuse/report-fraud/reporting-fraud.html

Reporting Michigan Medicaid Fraud and Abuse:
http://www.michigan.gov/ag/0,4534,7-164-18156_18152-47192--,00.html

Professional Practice Standards. The American Physical Therapy Association (APTA) is the exclusive professional association that supports the profession of physical therapy. It sets forth policies and positions regarding best practice and helps establish the prevailing practice standards. Although adherence to all APTA policies and positions is not required, it is strongly advised. In the event of a complaint or lawsuit filed against you, APTA policies and positions will be used to judge your actions by the Michigan Board of Physical Therapy and in a court of law through expert witness testimony.

American Physical Therapy Association Polices and Positions:
http://www.apta.org/Policies/
*See especially those related to "Practice" (http://www.apta.org/Policies/Practice/)

Facility Policies. Each practice setting/facility has policies and procedures for the provision of care to patients. As with professional practice standards, facility polices are not legally binding. However, if there is a malpractice claim against you, your deviation from any established policies or procedures will be used to judge your actions.

Your Personal Scope of Competence. Although this is addressed in the General Provisions of the Michigan Public Health Code and is therefore a legal requirement, it bears repeating: No matter what your license allows you as a PT/PTA to perform legally, you should not perform any aspect of physical therapy practice that you personally are not trained or competent to perform.

     

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