1. Direction and Supervision of Physical Therapy Personnel as per APTA Guidelines, State Regulations, and Third-party Payers. Know your laws, guidelines, and requirements so you stay legal and get paid!

2. Direction versus Supervision PTAs, aides, and PT and PTA students require varying levels of direction and supervision in the clinical setting. Direction = assigning portions of the intervention or other tasks Supervision = ensuring that the duties assigned are properly performed

3. Three Parties With Requirements to Consider The APTA State Regulations Third-Party Payers

4. Supervision Definitions by APTA General Supervision Direct Supervision Direct Personal Supervision

5. Supervision Definitions by APTA General Supervision -The supervising PT must be accessible immediately through telecommunications. -Least restrictive -level recommended when supervising PTAs Direct Supervision -requires the PT to be on-site while the PTA delivers interventions and requires daily interaction between the supervising PT and the patient being seen by the PTA -APTA-recommended level of supervision for PT and PTA students. Direct Personal Supervision -requires the PT or the PTA (when allowed by state law) to be physically present and the supervisor must continually direct and supervise the person performing the tasks. -APTA recommended level for supervision of PT aides

6. Supervision definitions by Utah State Physical Therapy Practice Act General Supervision On-site Supervision

7. Supervision definitions by Utah State Physical Therapy Practice Act General Supervision -the supervising PT is available immediately in person, by telephone, or by electronic communication On-site Supervision -supervision of a person by a licensed PT or PTA who is continually present, immediately available, and regularly involved in the services being provided

8. Supervision Comparisons APTA General Supervision – For PTAs Direct Supervision – For PT and PTA students Direct Personal Supervision – For PT Aides State of Utah General Supervision – For PTAs On-Site Supervision – For Aides. PTAs are allowed to supervise Aides. Supervision of Students not addressed Supervisory Limits – PT can supervise 3 full-time supportive personnel – PT must visit patient every 10 treatments or 30 days

9. Third-Party Payer Regulation of Supervision There are third-party payer requirements which will affect the ability of PT practices to receive payment and avoid charges of fraud. Medicare is a large third-party payer involved in the reimbursement of physical therapy services.

10. Medicare Supervisory Requirements direct supervision of PTAs within an office suite In other settings, general supervision of PTAs and supervisory visits at least every 30 days Supervisory regulations for students More information available to APTA members on the APTA website

11. Supervision Comparisons Medicare Direct Supervision of PTA in an Office Suite In other settings, general supervision and supervisory visits at least every 30 days Students supervision requirements are addressed and depend on Part A or Part B State of Utah General Supervision of PTA in an Office Suite In other settings, general supervision and supervisory visits at least every 30 days Students supervision requirements are not addressed in the State Practice Act

12. Summary Supervisory requirements differ among APTA guidelines, state regulations, and third-party payers. When looking for direction as to what supervision is required, a PTA should first consult his/her state’s Practice Act to make sure of legal compliance and then look to the APTA as a guide for topics not covered by the state. Third-party regulations must also be considered to ensure lawful payment for services provided.