RULES AND REGULATIONS
Title 49—PROFESSIONAL AND VOCATIONAL STANDARDS
STATE BOARD OF MEDICINE
[ 49 PA. CODE CHS. 16 AND 18 ]
[43 Pa.B. 2142]
[Saturday, April 20, 2013]
The State Board of Medicine (Board) amends §§ 16.11, 16.13 and 18.501—18.511 to read as set forth in Annex A.
This final-form rulemaking will be effective upon publication in the Pennsylvania Bulletin.
The final-omitted rulemaking is required to implement the act of December 22, 2011 (P. L. 572, No. 124) (Act 124). Section 51.1(d) of the Medical Practice Act of 1985 (act) (63 P. S. § 422.51a(d)) authorizes the Board and the State Board of Osteopathic Medicine to jointly promulgate regulations regarding athletic trainers. Additionally, section 8 of the act (63 P. S. § 422.8) authorizes the Board to adopt regulations reasonably necessary to carry out the purposes of the act.
Omission of Proposed Rulemaking
Under section 204 of the act of July 31, 1968 (P. L. 769, No. 240) (45 P. S. § 1204), known as the Commonwealth Documents Law (CDL), the Board is authorized to omit the procedures for proposed rulemaking in sections 201 and 202 of the CDL (45 P. S. §§ 1201 and 1202) if the Board finds that the specified procedures are impracticable, unnecessary or contrary to the public interest.
In this instance, the procedures for proposed rulemaking are unnecessary. The final-omitted rulemaking tracks the amendments in Act 124, changing ''certified'' to ''licensed'' athletic trainers and defines the term ''licensed athletic trainer'' as defined in Act 124. Furthermore, section 4 of Act 124 provides that references in the current regulations referring to certification or certified athletic trainers are deemed to be references to licensure or licensed athletic trainers. Because the final-omitted rulemaking does not change or interpret the statutory language in any way, notice of proposed rulemaking is unnecessary. The Board is updating the regulations to be consistent with the act.
Background and Need for Amendment
Act 124 amended the act by replacing references to ''certified'' athletic trainers with references to ''licensed'' athletic trainers. The Board is amending its regulations to conform to the act.
Description of Amendments
''Athletic trainer license'' and ''biennial registration of athletic trainer license'' are added to the list of licenses the Board issues under § 16.11(b) and (c) (relating to licenses, certificates and registrations).
The Board is adding ''license'' to § 16.13(h) (relating to licensure, certification, examination and registration fees) and amends the reference to ''application for certification'' to ''application'' to conform subsection (h) to the format of this section.
The remaining changes are to Chapter 18, Subchapter H (relating to athletic trainers). The Board is changing ''certification'' to ''licensure,'' ''certified'' to ''licensed'' and ''certificate'' to ''license'' throughout the subchapter.
Section 18.502 (relating to definitions) is amended to replace the definition of ''certified athletic trainer'' with a definition of ''licensed athletic trainer.'' In § 18.503 (relating to licensure requirement), the abbreviations used by certified athletic trainers, ''A.T.C'' and ''C.A.T.,'' are replaced with those used by licensed athletic trainers, ''A.T.L.'' and ''L.A.T.'' In addition, § 18.503(c) is deleted because Act 124 deleted section 51.1(b) of the act, which provided a transitional rule for athletic trainers formerly licensed under the Physical Therapy Practice Act (63 P. S. §§ 1301—1313).
In §§ 18.506 and 18.507 (relating to examination requirement; and temporary licensure), the Board is deleting ''certification'' to refer simply to the Board of Certification, Inc. examination, which is the examination required for licensure.
When the regulations refer to athletic trainers in other states, ''certified'' and ''licensed'' are used because some states still use the term ''certified'' to refer to athletic trainers. Therefore, both terms appear in § 18.503(b)(1) because athletic trainers from other states may be in this Commonwealth on a visiting basis. Likewise, in § 18.509(a) and (b) (relating to practice standards for athletic trainers), athletic trainers from other states may be in this Commonwealth working with an out-of-State team.
This final-omitted rulemaking will not have fiscal impact on the Commonwealth, the general public or political subdivisions.
This final-omitted rulemaking does not create additional paperwork for the Board, the Board's licensees or the general public.
The Board continuously monitors its regulations. Therefore, a sunset date has not been assigned.
Under section 5.1(c) of the Regulatory Review Act (71 P. S. § 745.5a(c)), on March 4, 2013, the Board submitted a copy of the final-omitted rulemaking and a copy of a Regulatory Analysis Form to the Independent Regulatory Review Commission (IRRC) and to the Chairpersons of the Senate Consumer Protection and Professional Licensure Committee (SCP/PLC) and the House Professional Licensure Committee (HPLC). On the same date, the regulations were submitted to the Office of Attorney General for review and approval under the Commonwealth Attorneys Act (71 P. S. §§ 732-101—732-506).
Under section 5.1(j.2) of the Regulatory Review Act, on April 3, 2013, the final-omitted rulemaking was deemed approved by the HPLC and the SCP/PLC. Under section 5.1(e) of the Regulatory Review Act, IRRC met on April 4, 2013, and approved the final-omitted rulemaking.
For additional information about the final-omitted rulemaking, contact Teresa Lazo, Board Counsel, State Board of Medicine, P. O. Box 2649, Harrisburg, PA 17105-2649, (717) 783-7200, firstname.lastname@example.org. When requesting additional information, reference No. 16A-4936 (athletic trainers).
The Board finds that:
(1) Notice of the Board's intention to amend its regulations under the procedures in sections 201 and 202 of the CDL has been omitted under the authority of section 204 of the CDL because public comment is unnecessary due to the fact that this final-omitted rulemaking is limited to implementing statutory requirements and it does not interpret the act or make other changes not authorized under the act.
(2) The amendment of the Board's regulations in the manner provided in this order is necessary and appropriate for the administration of the act.
The Board, acting under its authorizing statute, orders that:
(a) The regulations of the Board, 49 Pa. Code Chapters 16 and 18, are amended by amending §§ 16.11, 16.13 and 18.501—18.511 to read as set forth in Annex A, with ellipses referring to the existing text of the regulations.
(b) The Board shall submit this order and Annex A to the Office of General Counsel and the Office of Attorney General for approval as to form and legality as required by law.
(c) The Board shall certify this order and Annex A and deposit them with the Legislative Reference Bureau as required by law.
(d) This order shall take effect upon publication in the Pennsylvania Bulletin.
JAMES W. FREEMAN, M.D.,
(Editor's Note: For the text of the order of the Independent Regulatory Review Commission relating to this document, see 43 Pa.B. 2242 (April 20, 2012).)
Fiscal Note: 16A-4936. No fiscal impact; (8) recommends adoption.
TITLE 49. PROFESSIONAL AND VOCATIONAL STANDARDS
PART I. DEPARTMENT OF STATE
Subpart A. PROFESSIONAL AND OCCUPATIONAL AFFAIRS
CHAPTER 16. STATE BOARD OF MEDICINE—GENERAL PROVISIONS
Subchapter B. GENERAL LICENSE, CERTIFICATION AND REGISTRATION PROVISIONS
§ 16.11. Licenses, certificates and registrations.
(a) The following medical doctor licenses are issued by the Board:
(1) License without restriction.
(2) Institutional license.
(3) Extraterritorial license.
(4) Graduate license.
(5) Temporary license.
(6) Interim limited license.
(b) The following nonmedical doctor licenses and certificates are issued by the Board:
(1) Nurse-midwife license.
(2) Nurse-midwife certificate of prescriptive authority.
(3) Physician assistant license.
(4) Acupuncturist license.
(5) Practitioner of Oriental medicine license.
(6) Behavior specialist license.
(7) Athletic trainer license.
(c) The following registrations are issued by the Board:
(1) Registration as a supervising physician of a physician assistant.
(2) Biennial registration of a license without restriction.
(3) Biennial registration of an extraterritorial license.
(4) Biennial registration of a midwife license.
(5) Biennial registration of a physician assistant license.
(6) Biennial registration of a drugless therapist license.
(7) Biennial registration of a limited license-permanent.
(8) Biennial registration of an acupuncturist license.
(9) Biennial registration of a practitioner of Oriental medicine license.
(10) Biennial registration of a behavior specialist license.
(11) Biennial registration of athletic trainer license.
§ 16.13. Licensure, certification, examination and registration fees
* * * * *
(h) Athletic Trainer License:
(i) Behavior Specialist License:
* * * * *
CHAPTER 18. STATE BOARD OF MEDICINE—PRACTITIONERS OTHER THAN MEDICAL DOCTORS
Subchapter H. ATHLETIC TRAINERS
§ 18.501. Purpose.
This subchapter implements section 51.1 of the act (63 P. S. § 422.51a) to provide for the licensure and practice standards of athletic trainers.
§ 18.502. Definitions.
The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise:
Approved athletic training education programs—An athletic training education program that is accredited by a Board-approved Nationally recognized accrediting agency.
Athletic training services—The management and provision of care of injuries to a physically active person, with the direction of a licensed physician.
(i) The term includes the rendering of emergency care, development of injury prevention programs and providing appropriate preventative and supportive devices for the physically active person.
(ii) The term also includes the assessment, management, treatment, rehabilitation and reconditioning of the physically active person whose conditions are within the professional preparation and education of a licensed athletic trainer.
(iii) The term also includes the use of modalities such as: mechanical stimulation, heat, cold, light, air, water, electricity, sound, massage and the use of therapeutic exercise, reconditioning exercise and fitness programs.
(iv) The term does not include surgery, invasive procedures or prescription of any medication or controlled substance.
BOC—The Board of Certification, Inc., a National credentialing organization for athletic trainers.
Direction—Supervision over the actions of a licensed athletic trainer by means of referral by prescription to treat conditions for a physically active person from a licensed physician, dentist or podiatrist or written protocol approved by a supervising physician, except that the physical presence of the supervising physician, dentist or podiatrist is not required if the supervising physician, dentist or podiatrist is readily available for consultation by direct communication, radio, telephone, facsimile, telecommunications or by other electronic means.
Licensed athletic trainer—A person who is licensed to perform athletic training services by the Board or the State Board of Osteopathic Medicine.
Physically active person—An individual who participates in organized, individual or team sports, athletic games or recreational sports activities.
Referral—An order from a licensed physician, dentist or podiatrist to a licensed athletic trainer for athletic training services. An order may be written or oral, except that an oral order must be reduced to writing within 72 hours of issuance.
Standing written prescription—A portion of the written protocol or a separate document from a supervising physician, which includes an order to treat approved individuals in accordance with the protocol.
Written protocol—A written agreement or other document developed in conjunction with one or more supervising physicians, which identifies and is signed by the supervising physician and the licensed athletic trainer, and describes the manner and frequency in which the licensed athletic trainer regularly communicates with the supervising physician and includes standard operating procedures, developed in agreement with the supervising physician and licensed athletic trainer, that the licensed athletic trainer follows when not directly supervised onsite by the supervising physician.
§ 18.503. Licensure requirement.
(a) A person may not use the title ''athletic trainer'' or ''licensed athletic trainer'' or use any abbreviation including ''A.T.,'' ''A.T.L.'' or ''L.A.T.'' or any similar designation to indicate that the person is an athletic trainer unless that person has been licensed by the Board.
(b) Except as otherwise provided in this subsection, a person may not perform the duties of an athletic trainer unless that person is licensed by the Board. This provision is not intended to prevent the following:
(1) A person trained and licensed or certified under any other law from engaging in the licensed or certified practice in which the person is trained.
(2) An athletic trainer from another state, province, territory or the District of Columbia, who is employed by an athletic team or organization that is competing in this Commonwealth only on a visiting basis, from providing athletic training services, provided the practice of the athletic trainer is limited to the members of the team or organization.
(3) An athletic training student practicing athletic training that is coincidental to required clinical education and is within the scope of the student's education and training.
(c) Athletic trainers licensed by the State Board of Osteopathic Medicine are deemed licensed by the Board.
§ 18.504. Application for licensure.
(a) The applicant shall submit the following on forms supplied by the Board:
(1) A completed application and the fee set forth in § 16.13 (relating to licensure, certification, examination and registration fees).
(2) Verification of professional education in athletic training in accordance with § 18.505 (relating to educational requirements).
(3) Documentation of passage of the National examination in accordance with § 18.506 (relating to examination requirement).
(4) Documentation of practice as an athletic trainer, if licensed or certified in another jurisdiction, and verification as to whether there has been disciplinary action taken in that jurisdiction.
(b) To qualify for licensure, an applicant shall be at least 20 years of age and may not be addicted to alcohol or hallucinogenic, narcotic or other drugs which tend to impair judgment or coordination.
§ 18.505. Educational requirements.
An applicant for licensure shall comply with one of the following:
(1) Be a graduate of an approved athletic training education program.
(2) Hold and maintain current credentialing as a certified athletic trainer (ATC) from the BOC or another credentialing body approved by the Board.
§ 18.506. Examination requirement.
An applicant for a license to practice as a licensed athletic trainer shall submit to the Board written evidence that the applicant has passed the BOC examination for athletic trainers, or its equivalent as determined by the Board.
§ 18.507. Temporary licensure.
An applicant who is a graduate of an approved athletic training education program and who has applied to take the examination may be granted a temporary license to practice athletic training under the onsite direct supervision of a licensed athletic trainer. The temporary license expires 1 year from issuance or upon licensure as an athletic trainer by the Board, whichever comes first, and may not be renewed.
§ 18.508. Renewal of license.
(a) A license issued under this subchapter expires on December 31 of every even-numbered year unless renewed for the next biennium.
(b) Biennial renewal forms and other forms and literature to be distributed by the Board will be forwarded to the last mailing address given to the Board.
(c) To retain the right to engage in practice, the licensee shall renew licensure in the manner prescribed by the Board and pay the required fee prior to the expiration of the next biennium.
(d) When a license is renewed after December 31 of an even-numbered year, a penalty fee of $5 for each month or part of a month of practice beyond the renewal date will be charged in addition to the renewal fee as set forth in section 225 of the Bureau of Professional and Occupational Affairs Fee Act (63 P. S. § 1401-225).
(e) As a condition of renewal, a licensee shall comply with the continuing education requirements in § 18.511 (relating to continuing education).
§ 18.509. Practice standards for athletic trainers.
(a) Athletic trainers licensed by the Board or certified or licensed by the proper licensing authority of another state, province, territory or the District of Columbia shall comply with the following:
(1) Ensure that the physically active person has secured a written referral or prescription from a licensed physician, dentist or podiatrist or is subject to a written protocol for treatment by a licensed or certified athletic trainer from a licensed physician.
(2) Comply strictly with conditions or restrictions that may be placed on the course of athletic training services by the referring physician, dentist or podiatrist.
(3) Ensure that the physically active person has undergone a medical diagnostic examination or has had the results of a recently performed medical diagnostic examination reviewed by the referring physician, dentist or podiatrist.
(4) Keep a copy of the referral or prescription and the results of the medical diagnostic examination in the physically active person's file.
(5) Consult promptly with the referring physician, dentist or podiatrist regarding a new ailment or condition or a worsened ailment or condition of the physically active person.
(6) Consult with the referring physician, dentist or podiatrist upon request of either the referring physician, dentist or podiatrist or the physically active person.
(7) Refer a physically active person with conditions outside the scope of athletic training services to a licensed physician, dentist or podiatrist.
(b) Athletic trainers licensed by the Board or certified or licensed by the proper licensing authority of another state, province, territory or the District of Columbia who are working in a team setting, treating injuries which arise in the course of practices or team sports events, may treat the participant at the events under the conditions of the referral, or the standing written prescription or written protocol.
(c) An athletic trainer shall obtain the standing written prescription or protocol annually from the supervising physician and review it at least annually. The standing written prescription or written protocol shall be retained at or near the treatment location or facility. An individual referral or prescription from a referring physician, dentist or podiatrist is required in the absence of a standing written prescription or written protocol.
§ 18.510. Refusal, suspension or revocation of license.
(a) The Board may refuse to issue a license, and after notice and hearing, may suspend or revoke the license of a person who is subject to disciplinary action under section 41 of the act (63 P. S. § 422.41) as set forth in § 16.61 (relating to unprofessional and immoral conduct).
(b) Actions taken by the Board regarding the refusal, suspension or revocation of a license are taken subject to the right of notice, hearing and adjudication and appeal under 2 Pa.C.S. §§ 501—508 and 701—704 (relating to Administrative Agency Law).
§ 18.511. Continuing education.
(a) Beginning with the biennial period commencing on the next biennial renewal period following July 14, 2007, athletic trainers shall complete the continuing education requirements prescribed by the BOC.
(b) Applicants for renewal of a license shall provide a signed statement verifying that the continuing education requirement has been met.
(c) Proof of completion of the required continuing education shall be retained for at least 2 years after completion.
[Pa.B. Doc. No. 13-704. Filed for public inspection April 19, 2013, 9:00 a.m.]
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