Intro to PT Chapter 5 Flashcards
Law
a body of rules of action or conduct
prescribed by the controlling authority and
having binding legal force
Statutes are laws
created by legislatures
Common law
includes decrees handed down by
courts
Regulations
are created by government agencies
The Americans with Disabilities Act
(ADA)
* Prohibits discrimination against persons with disabilities
The Individuals with Disabilities Education Act
(IDEA)
* Requires physical therapy (and other related services) be
provided to students when needed
Social Security Amendments of 1965
- Created Medicare and Medicaid
- Health insurance for the elderly primarily (Medicare) and the
poor (Medicaid)
The Health Insurance Portability and Accountability Act
(HIPAA)
Protects privacy of patient information
The Patient Protection and Affordable Care Act of 2010
Reduces the number of uninsured and underinsured Americans
Many other provisions
State statutes that affect PT
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
Common Characteristics of a Physical
Therapy State Practice Act
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
Model Practice Act for Physical Therapy
Federation of State Boards of Physical Therapy
Regulations More detail
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.
Centers for Medicare and Medicaid Services (CMS)
Have regulations that if they are not followed no reimbursement for PT PTA services.
State Physical Therapy Board
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
State Disciplinary Agency
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
At the federal level, proposed and final regulations
are published daily
in the Federal Register. www.gpoaccess.gov/fr/index.html.
The Court System
Functions
Clarify and interpret statutes and regulations
Source of common law
* Created by court decisions
Malpractice and negligence were developed primarily
through common law.
To prove negligence, the patient would have to prove:
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.
Public Policy
The ways in which governmental bodies act to address issues in society. Include statutes, regulations and executive orders. Sum of all the “law”
Executive orders
Issued by governor or president.
Health Insurance Marketplace
where small employers and individuals can shop for insurance under ACA
Essential Health benefits
minimum requirements for ACA health marketplace plans.
federal false claims act
can impose fines three times the value of the fraud.
Model Practice Act for Physical Therapy (MPA)
Developed by the Federation of State Boards of Physical Therapy - used as the model for state practice acts.
Exception for CMS Medicare part b reimbursement for PT
permanent passage in 2018
Professional Misconduct
involves actions by licensed professionals that demonstrate an inability to meet professional standards or to perform the duties of a licensed professional competently.
When a provider or PT signs onto a Managed Care organization to become a recognized provider
They have to sign an agreement that may include lower reimbursements.
CEC
Chapter ethics committee, in charge of ethics complaints to the APTA
Criminal Law and PT
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
Malpractice
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.
Vicarious Liability
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.
Supervisory Liability
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?
Private Policies
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
