18VAC112-20 Regulations Governing the Practice of Physical Therapy

REGULATIONS

Vol. 30 Iss. 10 - January 13, 2014

TITLE 18. PROFESSIONAL AND OCCUPATIONAL LICENSING

BOARD OF PHYSICAL THERAPY

Chapter 20

Fast-Track Regulation

Title of Regulation: 18VAC112-20. Regulations Governing the Practice of Physical Therapy (amending 18VAC112-20-10, 18VAC112-20-60, 18VAC112-20-65, 18VAC112-20-90, 18VAC112-20-120, 18VAC112-20-135, 18VAC112-20-136, 18VAC112-20-140; adding 18VAC112-20-27; repealing 18VAC112-20-150).

Statutory Authority: §§ 54.1-2400 and 54.1-3474 of the Code of Virginia.

Public Hearing Information: No public hearings are scheduled.

Public Comment Deadline: February 12, 2014.

Effective Date: February 27, 2014.

Agency Contact: Lisa R. Hahn, Executive Director, Board of Physical Therapy, 9960 Mayland Drive, Suite 300, Richmond, VA 23233, telephone [phone], FAX [phone], or email [e-mail].

Basis: Regulations are promulgated under the general authority of Chapter 24 (§ 54.1-2400 et seq.) of Title 54.1 of the Code of Virginia. Section 54.1-2400 provides the Board of Physical Therapy the authority to promulgate regulations to administer the regulatory system.

Specific authority for regulation of physical therapy is found in § 54.1-3474 of the Code of Virginia, which requires the board to promulgate regulations establishing requirements to ensure continuing competency of physical therapists and physical therapist assistants, which may include continuing education, testing, or such other requirements as the board may determine to be necessary.

Purpose: The purpose of the amended regulation is to address some inconsistencies in the clinical practice requirements for applicants by reactivation, reinstatement, or licensure by endorsement and to make the traineeship less burdensome. The amendments will not reduce the responsibility of supervisors for trainees and will continue to protect the health and safety of the public. Additionally, changes to the evaluation responsibilities of physical therapists will not affect public safety because the language is more clarifying and consistent with current practice.

Rationale for Using Fast-Track Process: The action is less restrictive regulation for applicants and practitioners. It will resolve some issues relating to evaluation of patients by physical therapists and be more consistent with current practices. It will not be controversial.

Substance: The amendments (i) eliminate specific remedial requirements for persons who fail the licensure examination three times; (ii) reduce the traineeship hours required for applicants by endorsement, reactivation, or reinstatement; (iii) clarify that a reevaluation of patients is required at certain intervals of care; and (iv) eliminate the requirement that traineeships be served in facilities approved as clinical sites for students enrolled in an accredited education program.

Issues: There are no advantages or disadvantages to the public. The public continues to be protected by assurances that applicants will have clinical competency evidenced by hours of active practice in another jurisdiction or hours under supervision in a traineeship.

There are no advantages or disadvantages to the agency or the Commonwealth.

Department of Planning and Budget's Economic Impact Analysis:

Summary of the Proposed Amendments to Regulation. The Board of Physical Therapy (Board) proposes to: 1) eliminate specific remedial requirements for persons who fail the licensure examination three times, 2) reduce the traineeship hours required for applicants by endorsement, reactivation or reinstatement, 3) no longer require that applicants for licensure by endorsement have active, clinical practice with a current, unrestricted license for at least five years prior to applying for licensure in Virginia if the applicant did not take the same examination, 4) eliminate the requirement that traineeships be served in facilities approved as clinical sites for students enrolled in an accredited education program, 5) amend the requirement for evaluation of those patients who have been receiving care for the same condition or injury for six months or longer to require evaluation at least every 90 days from the last evaluation, 6) establish that if a patient is discharged from a health care facility without the opportunity for the physical therapist to evaluate the patient, the final note in the patient record may document patient status, and 7) amend language for clarification.

Result of Analysis. The benefits likely exceed the costs for all proposed changes.

Estimated Economic Impact. Under the current regulations, an applicant for licensure who has failed the national examination three times must:

1. Provide the board with a copy of the deficiency report from the examination;

2. Review areas of deficiency with the applicant's physical therapy educational program and develop a plan, which may include additional clinical training or coursework, to address deficiency areas; and

3. Take an examination review course and the practice examination.

The Board proposes to repeal these requirements. According to the Department of Health Professions (Department), The requirement to review areas of deficiency with the applicant's physical therapy educational program and develop a plan, which may include additional clinical training or coursework, to address deficiency areas was very problematic for applicants and programs, which are not organized to assume that responsibility. The Board determined that remedial steps following failure of an examination should be left to the individual. The first exam review course listed by the American Physical Therapy Association is from TherapyEd (http://www.therapyed.com/ptmain.htm#ptreg). TherapyEd charges $265 for their review course. Thus, if the applicant determined that taking the review course was not his/her best course of action, then the proposed repeal would save approximately $265 in fees. Since the applicant will still not become licensed without passing the exam, there is no reduction in required knowledge to become a licensed physical therapist. Therefore the proposed repeal of these requirements should produce a net benefit.

The current regulations require applicants by endorsement, reactivation or reinstatement to have completed a 480 hour internship/traineeship if they do not have at least 320 hours of active practice in another jurisdiction. The board proposes to amend the internship/traineeship requirement to 320 hours for consistency with the active practice requirement and to enable the applicant to become fully licensed more quickly. If the applicant completes the Practice Review Tool (PRT) offered by the Federation of State Boards of Physical Therapy (FSBPT), he can reduce the internship hours to 160 (amended from the current requirement of 320 hours). This significantly reduces the burden to obtain licensure for these individuals who previously were licensed in Virginia.

For individuals applying for licensure by endorsement, the existing regulations require active, clinical practice with a current, unrestricted license for at least five years prior to applying for licensure in Virginia if the applicant did not take the same examination Virginia required at the time of initial licensure in another state. The Board believes passage of the examination required for licensure in the other state is adequate evidence of competency. Additionally, all states have required the FSBPT examination for many years; so the likelihood of receiving an application from a person who passed only a state examination is decreasing. This proposed change eliminates a burden without in practice making any significant change in qualification; thus this proposed change should also provide net benefit.

Presently, traineeship must be held in a facility that serves as a clinical education facility for students enrolled in an accredited program educating physical therapists in Virginia. The Board has determined that that requirement is too limiting and burdensome and substantially reduces the physical therapy settings in which an applicant or graduate may serve a traineeship. Thus the Board proposes to eliminate that provision in the requirements but retain the requirement that the traineeship be under direction and supervision of a licensed physical therapist to assure patient safety.

For patients in settings other than in-patient, the current regulations require that the physical therapist evaluate the patient not less than once out of 12 visits made to the patient during a 30-day period, or once every 30 days from the last evaluation, whichever occur first. The Board believes that the requirement for evaluation every 30 days is burdensome for patients who have been receiving physical therapy care for the same condition or injury over an extended period of time. For example, children with physical disabilities who are receiving physical therapy in school settings may not need evaluation every 30 days. There will not be enough significant progress within that time frame to warrant an evaluation by the physical therapist. Therefore, the Board proposes to amend the requirement for evaluation of those patients who have been receiving care for the same condition or injury for six months or longer to require evaluation at least every 90 days from the last evaluation. This proposed amendment should produce net benefits in that it will eliminate the nonproductive use of time by both physical therapists and their patients.

The regulations require physical therapists to document the status of the patient at the time of discharge, including the response to therapeutic intervention. The Department notes that the patient often is discharged from a health care facility without the opportunity for the physical therapist to evaluate the patient. So the Board proposes to amend the regulations to allow the final note in the patient record to document patient status.

Businesses and Entities Affected. The proposed amendments potentially affect the 6,580 licensed physical therapists and 2,692 physical therapist assistants currently licensed in the Commonwealth, as well as future licensure applicants.

Localities Particularly Affected. The proposed amendments do not disproportionately affect particular localities.

Projected Impact on Employment. The proposed amendments reduce some burdens in obtaining licensure, and may therefore moderately increase the number of licensed physical therapists in the Commonwealth.

Effects on the Use and Value of Private Property. The proposed amendments reduce some burdens in obtaining licensure and allow physical therapy practices additional discretion in how often to see patients.

Small Businesses: Costs and Other Effects. The proposed amendments will not increase costs for small businesses.

Small Businesses: Alternative Method that Minimizes Adverse Impact. The proposed amendments do not adversely impact small businesses.

Real Estate Development Costs. The proposed amendments will not affect real estate development costs.

Legal Mandate. The Department of Planning and Budget (DPB) has analyzed the economic impact of this proposed regulation in accordance with § 2.2-4007.04 of the Administrative Process Act and Executive Order Number 14 (10). Section 2.2-4007.04 requires that such economic impact analyses include, but need not be limited to, a determination of the public benefit, the projected number of businesses or other entities to whom the regulation would apply, the identity of any localities and types of businesses or other entities particularly affected, the projected number of persons and employment positions to be affected, the projected costs to affected businesses or entities to implement or comply with the regulation, and the impact on the use and value of private property. Further, if the proposed regulation has an adverse effect on small businesses, § 2.2-4007.04 requires that such economic impact analyses include (i) an identification and estimate of the number of small businesses subject to the regulation; (ii) the projected reporting, recordkeeping, and other administrative costs required for small businesses to comply with the regulation, including the type of professional skills necessary for preparing required reports and other documents; (iii) a statement of the probable effect of the regulation on affected small businesses; and (iv) a description of any less intrusive or less costly alternative methods of achieving the purpose of the regulation. The analysis presented above represents DPB's best estimate of these economic impacts.

Agency's Response to Economic Impact Analysis: The Board of Physical Therapy concurs with the analysis of the Department of Planning and Budget for amendments to 18VAC112-20, Regulations Governing the Practice of Physical Therapy, relating to regulatory reform.

Summary:

The amendments (i) eliminate specific remedial requirements for persons who fail the licensure examination three times; (ii) reduce the traineeship hours required for applicants by endorsement, reactivation, or reinstatement; (iii) eliminate the requirement that applicants for licensure by endorsement have active, clinical practice with a current, unrestricted license for at least five years prior to applying for licensure in Virginia; (iv) eliminate the requirement that traineeships be served in facilities approved as clinical sites for students enrolled in an accredited education program; (v) amend the requirement for evaluation of those patients who have been receiving care for the same condition or injury for six months or longer to require evaluation at least every 90 days from the last evaluation; and (vi) establish that the final note in the patient record may document patient status if a patient is discharged from a health care facility without the opportunity for the physical therapist to evaluate the patient.

Part I
General Provisions

18VAC112-20-10. Definitions.

In addition to the words and terms defined in § 54.1-3473 of the Code of Virginia, the following words and terms when used in this chapter shall have the following meanings unless the context clearly indicates otherwise:

"Active practice" means a minimum of 160 hours of professional practice as a physical therapist or physical therapist assistant within the 24-month period immediately preceding renewal. Active practice may include supervisory, administrative, educational or consultative activities or responsibilities for the delivery of such services.

"Approved program" means an educational program accredited by the Commission on Accreditation in Physical Therapy Education of the American Physical Therapy Association.

"CLEP" means the College Level Examination Program.

"Contact hour" means 60 minutes of time spent in continuing learning activity exclusive of breaks, meals or vendor exhibits.

"Direct supervision" means a physical therapist or a physical therapist assistant is physically present and immediately available and is fully responsible for the physical therapy tasks or activities being performed.

"Discharge" means the discontinuation of interventions in an episode of care that have been provided in an unbroken sequence in a single practice setting and related to the physical therapy interventions for a given condition or problem.

"Evaluation" means a process in which the physical therapist makes clinical judgments based on data gathered during an examination or screening in order to plan and implement a treatment intervention, provide preventive care, reduce risks of injury and impairment, or provide for consultation.

"FCCPT" means the Foreign Credentialing Commission on Physical Therapy.

"FSBPT" means the Federation of State Boards of Physical Therapy.

"General supervision" means a physical therapist shall be available for consultation.

"National examination" means the examinations developed and administered by the Federation of State Boards of Physical Therapy and approved by the board for licensure as a physical therapist or physical therapist assistant.

"PRT" means the Practice Review Tool for competency assessment developed and administered by FSBPT.

"Reevaluation" means a process in which the physical therapist makes clinical judgments based on data gathered during an examination or screening in order to determine a patient's response to the treatment plan and care provided.

"Support personnel" means a person who is performing designated routine tasks related to physical therapy under the direction and supervision of a physical therapist or physical therapist assistant within the scope of this chapter.

"TOEFL" means the Test of English as a Foreign Language.

"Trainee" means a person seeking licensure as a physical therapist or physical therapist assistant who is undergoing a traineeship.

"Traineeship" means a period of active clinical practice during which an applicant for licensure as a physical therapist or physical therapist assistant works under the direct supervision of a physical therapist approved by the board.

"TSE" means the Test of Spoken English.

"Type 1" means continuing learning activities offered by an approved organization as specified in 18VAC112-20-131.

"Type 2" means continuing learning activities which may or may not be offered by an approved organization but shall be activities considered by the learner to be beneficial to practice or to continuing learning.

18VAC112-20-27. Fees.

A. Unless otherwise provided, fees listed in this section shall not be refundable.

B. Licensure by examination.

1. The application fee shall be $140 for a physical therapist and $100 for a physical therapist assistant.

2. The fees for taking all required examinations shall be paid directly to the examination services.

C. Licensure by endorsement. The fee for licensure by endorsement shall be $140 for a physical therapist and $100 for a physical therapist assistant.

D. Licensure renewal and reinstatement.

1. The fee for active license renewal for a physical therapist shall be $135 and for a physical therapist assistant shall be $70 and shall be due by December 31 in each even-numbered year.

2. The fee for an inactive license renewal for a physical therapist shall be $70 and for a physical therapist assistant shall be $35 and shall be due by December 31 in each even-numbered year.

3. A fee of $50 for a physical therapist and $25 for a physical therapist assistant for processing a late renewal within one renewal cycle shall be paid in addition to the renewal fee.

4. The fee for reinstatement of a license that has expired for two or more years shall be $180 for a physical therapist and $120 for a physical therapist assistant and shall be submitted with an application for licensure reinstatement.

E. Other fees.

1. The fee for an application for reinstatement of a license that has been revoked shall be $1,000; the fee for an application for reinstatement of a license that has been suspended shall be $500.

2. The fee for a duplicate license shall be $5, and the fee for a duplicate wall certificate shall be $15.

3. The fee for a returned check shall be $35.

4. The fee for a letter of good standing/verification to another jurisdiction shall be $10.

F. Direct access certification fees.

1. The application fee shall be $75 for a physical therapist to obtain certification to provide services without a referral.

2. The fee for renewal on a direct access certification shall be $35 and shall be due by December 31 in each even-numbered year.

3. A fee of $15 for processing a late renewal of certification within one renewal cycle shall be paid in addition to the renewal fee.

18VAC112-20-60. Requirements for licensure by examination.

A. Every applicant for initial licensure by examination shall submit:

1. Documentation of having met the educational requirements specified in 18VAC112-20-40 or 18VAC112-20-50;

2. The required application, fees and credentials to the board; and

3. Documentation of passage of the national examination as prescribed by the board.

B. If an applicant fails the national examination three times, he shall apply for approval to sit for any subsequent examination by submission of evidence satisfactory to the board of having successfully completed the following requirements:

1. Provide the board with a copy of the deficiency report from the examination;

2. Review areas of deficiency with the applicant's physical therapy educational program and develop a plan, which may include additional clinical training or coursework, to address deficiency areas; and

3. Take an examination review course and the practice examination.

18VAC112-20-65. Requirements for licensure by endorsement.

A. A physical therapist or physical therapist assistant who holds a current, unrestricted license in the United States, its territories, the District of Columbia, or Canada may be licensed in Virginia by endorsement.

B. An applicant for licensure by endorsement shall submit:

1. Documentation of having met the educational requirements prescribed in 18VAC112-20-40 or 18VAC112-20-50. In lieu of meeting such requirements, an applicant may provide evidence of clinical practice consisting of at least 2,500 hours of patient care during the five years immediately preceding application for licensure in Virginia with a current, unrestricted license issued by another U.S. jurisdiction;

2. The required application, fees, and credentials to the board;

3. A current report from the Healthcare Integrity and Protection Data Bank (HIPDB) and a current report from the National Practitioner Data Bank (NPDB);

4. Evidence of completion of 15 hours of continuing education for each year in which the applicant held a license in another U.S. jurisdiction, or 60 hours obtained within the past four years; and

5. Documentation of passage of an examination equivalent to the Virginia examination at the time of initial licensure or documentation of passage of an examination required by another state at the time of initial licensure in that state and active, clinical practice with a current, unrestricted license for at least five years prior to applying for licensure in Virginia.; and

For the purpose of this subsection, active, clinical practice shall mean at least 2,500 hours of patient care over a five-year period.

C. A physical therapist seeking licensure by endorsement who has not actively practiced 6. Documentation of active practice in physical therapy in another U.S. jurisdiction for at least 320 hours within the four years immediately preceding his application for licensure. A physical therapist who does not meet the active practice requirement shall:

1. a. Successfully complete 480 320 hours in a traineeship in accordance with requirements in 18VAC112-20-140; or

2. b. Document that he meets the standard of the PRT within the two years preceding application for licensure in Virginia and successfully complete 320 160 hours in a traineeship in accordance with the requirements in 18VAC112-20-140.

D. C. A physical therapist assistant seeking licensure by endorsement who has not actively practiced physical therapy for at least 320 hours within the four years immediately preceding his application for licensure shall successfully complete 320 hours in a traineeship in accordance with the requirements in 18VAC112-20-140.

18VAC112-20-90. General responsibilities.

A. The physical therapist shall be responsible for managing all aspects of the physical therapy care of each patient and shall provide:

1. The initial evaluation for each patient and its documentation in the patient record; and

2. Periodic evaluations reevaluation, including documentation of the patient's response to therapeutic intervention.; and

3. The documented status of the patient at the time of discharge, including the response to therapeutic intervention. If a patient is discharged from a health care facility without the opportunity for the physical therapist to reevaluate the patient, the final note in the patient record may document patient status.

B. The physical therapist shall communicate the overall plan of care to the patient or his legally authorized representative and shall also communicate with a referring doctor of medicine, osteopathy, chiropractic, podiatry, or dental surgery, nurse practitioner or physician assistant to the extent required by § 54.1-3482 of the Code of Virginia.

C. A physical therapist assistant may assist the physical therapist in performing selected components of physical therapy intervention to include treatment, measurement and data collection, but not to include the performance of an evaluation as defined in 18VAC112-20-10.

D. A physical therapist assistant's visits to a patient may be made under general supervision.

E. A physical therapist providing services with a direct access certification as specified in § 54.1-3482 of the Code of Virginia shall utilize the Direct Access Patient Attestation and Medical Release Form prescribed by the board or otherwise include in the patient record the information, attestation and written consent required by subsection B of § 54.1-3482 of the Code of Virginia.

18VAC112-20-120. Responsibilities to patients.

A. The initial patient visit shall be made by the physical therapist for evaluation of the patient and establishment of a plan of care.

B. The physical therapist assistant's first visit with the patient shall only be made after verbal or written communication with the physical therapist regarding patient status and plan of care. Documentation of such communication shall be made in the patient's record.

C. Documentation of physical therapy interventions shall be recorded on a patient's record by the physical therapist or physical therapist assistant providing the care.

D. The physical therapist shall reevaluate the patient as needed, but not less than according to the following schedules:

1. For inpatients in hospitals as defined in § 32.1-123 of the Code of Virginia, it shall be not less than once every seven consecutive days.

2. For patients in other settings, it shall be not less than one of 12 visits made to the patient during a 30-day period, or once every 30 days from the last evaluation reevaluation, whichever occurs first.

3. For patients who have been receiving physical therapy care for the same condition or injury for six months or longer, it shall be at least every 90 days from the last reevaluation.

Failure to abide by this subsection due to the absence of the physical therapist in case of illness, vacation, or professional meeting, for a period not to exceed five consecutive days, will not constitute a violation of these provisions.

E. The physical therapist shall be responsible for ongoing involvement in the care of the patient to include regular communication with a physical therapist assistant regarding the patient's plan of treatment.

18VAC112-20-135. Inactive license.

A. A physical therapist or physical therapist assistant who holds a current, unrestricted license in Virginia shall, upon a request on the renewal application and submission of the required renewal fee of $70 for a physical therapist and $35 for a physical therapist assistant, be issued an inactive license. The fee for the renewal of an inactive license due December 31, 2010, shall be $60 for a physical therapist and $30 for a physical therapist assistant.

1. The holder of an inactive license shall not be required to meet active practice requirements.

2. An inactive licensee shall not be entitled to perform any act requiring a license to practice physical therapy in Virginia.

B. A physical therapist or physical therapist assistant who holds an inactive license may reactivate his license by:

1. Paying the difference between the renewal fee for an inactive license and that of an active license for the biennium in which the license is being reactivated;

2. Providing proof of 320 active practice hours in another jurisdiction equal to those required for renewal of an active license in Virginia for the period in which the license has been inactive within the four years immediately preceding application for reactivation.

a. If the inactive physical therapist licensee does not meet the requirement for active practice, the license may be reactivated by completing 480 320 hours in a traineeship that meets the requirements prescribed in 18VAC112-20-140 or documenting that he has met the standard of the PRT within the two years preceding application for reactivation of licensure in Virginia and successfully completing 320 160 hours in a traineeship in accordance with requirements in 18VAC112-20-140.

b. If the inactive physical therapist assistant licensee does not meet the requirement for active practice, the license may be reactivated by completing 320 hours in a traineeship that meets the requirements prescribed in 18VAC112-20-140; and

3. Completing the number of continuing competency hours required for the period in which the license has been inactive, not to exceed four years.

18VAC112-20-136. Reinstatement requirements.

A. A physical therapist or physical therapist assistant whose Virginia license is lapsed for two years or less may reinstate his license by payment of the renewal and late fees as set forth in 18VAC112-20-150 and completion of continued competency requirements as set forth in 18VAC112-20-131.

B. A physical therapist or physical therapist assistant whose Virginia license is lapsed for more than two years and who is seeking reinstatement shall:

1. Apply for reinstatement and pay the fee specified in 18VAC112-20-150;

2. Complete the number of continuing competency hours required for the period in which the license has been lapsed, not to exceed four years; and

3. Have actively practiced physical therapy in another jurisdiction for at least 320 hours within the four years immediately preceding applying for reinstatement.

a. If a physical therapist licensee does not meet the requirement for active practice, the license may be reinstated by completing 480 320 hours in a traineeship that meets the requirements prescribed in 18VAC112-20-140 or documenting that he has met the standard of the PRT within the two years preceding application for licensure in Virginia and successfully completing 320 160 hours in a traineeship in accordance with requirements in 18VAC112-20-140.

b. If a physical therapist assistant licensee does not meet the requirement for active practice, the license may be reinstated by completing 320 hours in a traineeship that meets the requirements prescribed in 18VAC112-20-140.

18VAC112-20-140. Traineeship requirements.

A. The traineeship shall be (i) in a facility that serves as a clinical education facility for students enrolled in an accredited program educating physical therapists in Virginia, (ii) approved by the board, and (iii) under the direction and supervision of a licensed physical therapist.

B. Supervision and identification of trainees:

1. There shall be a limit of two physical therapists assigned to provide supervision for each trainee.

2. The supervising physical therapist shall countersign patient documentation (i.e., notes, records, charts) for services provided by a trainee.

3. The trainee shall wear identification designating them as a "physical therapist trainee" or a "physical therapist assistant trainee."

C. Completion of traineeship.

1. The physical therapist supervising the trainee shall submit a report to the board at the end of the required number of hours on forms supplied by the board.

2. If the traineeship is not successfully completed at the end of the required hours, as determined by the supervising physical therapist, the president of the board or his designee shall determine if a new traineeship shall commence. If the president of the board determines that a new traineeship shall not commence, then the application for licensure shall be denied.

3. The second traineeship may be served under a different supervising physical therapist and may be served in a different organization than the initial traineeship. If the second traineeship is not successfully completed, as determined by the supervising physical therapist, then the application for licensure shall be denied.

18VAC112-20-150. Fees. (Repealed.)

A. Unless otherwise provided, fees listed in this section shall not be refundable.

B. Licensure by examination.

1. The application fee shall be $140 for a physical therapist and $100 for a physical therapist assistant.

2. The fees for taking all required examinations shall be paid directly to the examination services.

C. Licensure by endorsement. The fee for licensure by endorsement shall be $140 for a physical therapist and $100 for a physical therapist assistant.

D. Licensure renewal and reinstatement.

1. The fee for active license renewal for a physical therapist shall be $135 and for a physical therapist assistant shall be $70 and shall be due by December 31 in each even-numbered year. The fee for renewal of an active license due December 31, 2010, shall be $100 for a physical therapist and $60 for a physical therapist assistant.

2. A fee of $25 for a physical therapist assistant and $50 for a physical therapist for processing a late renewal within one renewal cycle shall be paid in addition to the renewal fee.

3. The fee for reinstatement of a license that has expired for two or more years shall be $180 for a physical therapist and $120 for a physical therapist assistant and shall be submitted with an application for licensure reinstatement.

E. Other fees.

1. The fee for an application for reinstatement of a license that has been revoked shall be $1,000; the fee for an application for reinstatement of a license that has been suspended shall be $500.

2. The fee for a duplicate license shall be $5, and the fee for a duplicate wall certificate shall be $15.

3. The fee for a returned check shall be $35.

4. The fee for a letter of good standing/verification to another jurisdiction shall be $10.

F. Direct access certification fees.

1. The application fee shall be $75 for a physical therapist to obtain certification to provide services without a referral.

2. The fee for renewal on a direct access certification shall be $35 and shall be due by December 31 in each even-numbered year. The fee for direct access certification due December 31, 2010, shall be $30.

3. A fee of $15 for processing a late renewal of certification within one renewal cycle shall be paid in addition to the renewal fee.

VA.R. Doc. No. R14-3816; Filed December 18, 2013, 9:14 a.m.