Intro to PT Chapter 5

Question 1

Law

Answer 1

a body of rules of action or conduct
prescribed by the controlling authority and
having binding legal force

Question 2

Statutes are laws

Answer 2

created by legislatures

Question 3

Common law

Answer 3

includes decrees handed down by
courts

Question 4

Regulations

Answer 4

are created by government agencies

Question 5

The Americans with Disabilities Act

Answer 5

(ADA)
* Prohibits discrimination against persons with disabilities

Question 6

The Individuals with Disabilities Education Act

Answer 6

(IDEA)
* Requires physical therapy (and other related services) be
provided to students when needed

Question 7

Social Security Amendments of 1965

Answer 7

• Created Medicare and Medicaid
• Health insurance for the elderly primarily (Medicare) and the
  poor (Medicaid)

Question 8

The Health Insurance Portability and Accountability Act

Answer 8

(HIPAA)
 Protects privacy of patient information

Question 9

The Patient Protection and Affordable Care Act of 2010

Answer 9

 Reduces the number of uninsured and underinsured Americans
 Many other provisions

Question 10

State statutes that affect PT

Answer 10

 Regulation of the insurance industry
 Availability of state health care funding for the poor
 State health department requirements
 Most important—the state physical therapy practice
act
* Legal foundation for the scope and protection of physical
therapy practice

Question 11

Common Characteristics of a Physical
Therapy State Practice Act

Answer 11

 Definition of physical therapy practice
 Identifies legal providers
 Identifies tasks that can be delegated
 Identifies supervisory requirements
 Identifies consequences for violating the practice act - Example:
In New York, unlicensed practice is a criminal offense

Question 12

Model Practice Act for Physical Therapy

Answer 12

Federation of State Boards of Physical Therapy

Question 13

Regulations More detail

Answer 13

Rules that governs the operation of a particular
government program or regulate industries.

 The practice act may require PTAs to be supervised—
the legislature may delegate to the state’s physical
therapy board or education department the
responsibility for defining supervision.

Question 14

Centers for Medicare and Medicaid Services (CMS)

Answer 14

Have regulations that if they are not followed no reimbursement for PT PTA services.

Question 15

State Physical Therapy Board

Answer 15

 Composition and function of board are determined by
legislature through statutes
 May advise/clarify scope of practice to government
bodies
 Advise state practitioners regarding practice issues
 Assist in state licensing procedures
 Assist in professional misconduct cases

Question 16

State Disciplinary Agency

Answer 16

 Regulates professional conduct
 Consequences for professional misconduct
* Reprimand
* Fine
* Requirement to obtain remedial professional education
* Probation
* Suspension or revocation of license
* Combination of the above
* Final disciplinary actions are often published on state agency
websites

Question 17

At the federal level, proposed and final regulations
are published daily

Answer 17

in the Federal Register. www.gpoaccess.gov/fr/index.html.

Question 18

The Court System
 Functions

Answer 18

 Clarify and interpret statutes and regulations
 Source of common law
* Created by court decisions
 Malpractice and negligence were developed primarily
through common law.

Question 19

To prove negligence, the patient would have to prove:

Answer 19

 A patient–therapist relationship existed at time of injury.
 The therapist failed to provide the appropriate standard of care at
the time of injury.
 The patient sustained injuries or damages: physical injuries,
financial losses, and so on.
 The patient’s injuries were directly caused by the therapist’s
failure to provide the appropriate standard of care.

Question 20

Public Policy

Answer 20

The ways in which governmental bodies act to address issues in society. Include statutes, regulations and executive orders. Sum of all the “law”

Question 21

Executive orders

Answer 21

Issued by governor or president.

Question 22

Health Insurance Marketplace

Answer 22

where small employers and individuals can shop for insurance under ACA

Question 23

Essential Health benefits

Answer 23

minimum requirements for ACA health marketplace plans.

Question 24

federal false claims act

Answer 24

can impose fines three times the value of the fraud.

Question 25

Model Practice Act for Physical Therapy (MPA)

Answer 25

Developed by the Federation of State Boards of Physical Therapy - used as the model for state practice acts.

Question 26

Exception for CMS Medicare part b reimbursement for PT

Answer 26

permanent passage in 2018

Question 27

Professional Misconduct

Answer 27

involves actions by licensed professionals that demonstrate an inability to meet professional standards or to perform the duties of a licensed professional competently.

Question 28

When a provider or PT signs onto a Managed Care organization to become a recognized provider

Answer 28

They have to sign an agreement that may include lower reimbursements.

Question 29

CEC

Answer 29

Chapter ethics committee, in charge of ethics complaints to the APTA

Question 30

Criminal Law and PT

Answer 30

 Criminal prosecution can not affect your license; however, you may be referred to a state professional disciplinary agency.  Students, therapists, and assistants must be aware that criminal activity has criminal liability. It may also complicate the process of obtaining a license or certificate or result in revocation of a license or certificate.  Example: DUI or DWI

Question 31

Malpractice

Answer 31

 Professional negligence  Failure to do (or failure to avoid doing) something that a member in good standing of a profession would have done (or avoided doing), which causes subsequent injury to the patient  Failure to meet the professional standard of care  Example: A therapist excessively mobilizes a joint to the point of injury.

Question 32

Vicarious Liability

Answer 32

 Employer is responsible for acts of employees performing job duties  Is considered to control the workplace  In physical therapy, the ultimate responsibility for patient care always remains with the PT.  But, the PT owner may be held liable for a patient’s injury even though he or she was not directly providing care.

Question 33

Supervisory Liability

Answer 33

 Again, the ultimate responsibility for patient care always remains with the PT.  Duty to properly supervise when delegating parts of patient program to PTA/student  For example: A patient is injured by a PTA under the supervision of the PT.  Did the PT negligently supervise the PTA?

Question 34

Private Policies

Answer 34

 Rules within organizations  Unlike laws, cannot be legally enforced  In the APTA, a policy is defined as “association directives defining operational or administrative activities.”  APTA policies drive scope of practice, reimbursement, ethical conduct, and professionalism. * Examples:  Payer reimbursement policies  Employer policies  APTA core documents