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Open Book

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Overcoming Roadblocks to PT Compact Implementation—The State Perspective

There are multiple advantages to joining the PT Compact, but there are some challenges to getting there. However, FSBPT and the PT Compact staff and members are here to help. This article is based on a presentation by T.J. Cantwell, Kathy Arney, Claire Covert-ByBee, Scott Majors, and Charlotte Martin at the 2019 FSBPT Annual Meeting.

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The Physical Therapy Compact is an agreement between member states to improve access to physical therapy services for the public by increasing the mobility of eligible physical therapy providers to work in multiple states.

So far, sixteen states are actively issuing and accepting compact privileges, ten states have enacted legislation but are not yet actively participating, and three states have introduced legislation.

Once a jurisdiction passes PT Compact legislation, there are a few steps before becoming an active member. The time it takes, from enacting legislation to issuing Compact Privileges can vary. Currently, it ranges from about eight to twelve months, but the PT Compact staff is trying to get that down to six months.

FBI Criminal Background Checks

Jurisdictions must have criminal background checks when joining the compact, which can sometimes be a challenge to implement.

For example, Kentucky passed the PT Compact legislation and the board and staff thought that the FBI background check was included in that legislation. However, they learned about six months after they filed the application that the FBI had denied them. Furthermore, they learned that they had been denied only a week after the regulations that indicated that they had to be issuing and accepting compact privileges within three months went into effect. As that would likely not be enough time to get FBI approval, they filed an emergency regulation to undo the regulations and basically start over.

Unfortunately, the Kentucky board and staff were not getting any communication directly from the FBI. So, they went through the State Police. Through that channel, they were told the FBI was not going to respond or give them any clarification on what the new language must include. The staff filed an amended bill and fortunately that worked.

Overall, the process required patience and flexibility. Fortunately, the PT Compact staff has better information from the FBI now on what type of language is needed in the bill and they can help jurisdictions with that process.

In North Carolina, the board and staff had better luck with the FBI. They established a point person at the FBI in order to get more information from them and that helped to some extent, but the process still had its challenges. Like Kentucky, they also had some issues getting background checks even though they thought everything within the legislation was set up. In the end, once they surmounted the legislative hurdles, they’ve continued to have some issues. For example, they still get delayed criminal background check reports, even via a system called Live Scan that is supposed to turn around records within a few days.

Louisiana was already performing background checks, so the board and staff assumed that aspect of joining the PT Compact would be a non-issue. However, the Louisiana State Police interpreted the statue to read that the board couldn’t perform background checks for the specific use of the PT Compact, even though they were already performing them for state licenses. Therefore, that took a little working out. Even if your jurisdiction is already performing background checks, it’s important to work with the PT Compact staff and your state contacts to ensure there isn’t an additional legislative action needed.

Nebraska already had statutory language that covered all health care professionals and outlined individuals who would be required to have a criminal background check. The Nebraska board simply inserted physical therapists and physical therapist assistants into that. They also already had a standard Memorandum of Understanding with the Nebraska State Patrol.

However, four compacts were passed the same year the PT Compact legislation was passed. The Nebraska State Patrol voiced concern relating to the manpower that they were going to need to build to run all of these checks and they emphasized that there would be delays. To address this, the Nebraska board and staff advise their applicants that the process takes four-to-six weeks.

Data Sharing

Jurisdictions that are part of the PT Compact must share their licensee data on a weekly basis with the PTCC to ensure that only eligible PTs and PTAs can obtain and keep compact privileges.

This process can also involve a few different hurtles depending on state statutes.

For example, in Louisiana, social security numbers are not considered part of the public record and, therefore, the Louisiana board is not able to share that information. Therefore, in order to get up and running and become an active member state in the PT Compact, they had to submit a special request to the Compact to not share the social security numbers. In order to be fair to all of the states and ensure quality data, the PT Compact developed criteria Louisiana had to meet before they could go through an alternative method of connecting social security numbers. This process required Louisiana to complete a significant amount of additional research and data verification.

Kentucky, doesn’t even track all the data the PT Compact wants in its own database. Therefore, they were not required to provide that, but they also had to take a few additional steps to address that lack of data.

A few states also had to address technical and administrative issues to meet the data sharing requirement. The Licensing Information Software system Nebraska used was an arduous and outdated system. From a technical perspective, it was difficult to map the connection between their state system and the PT Compact’s system. Addressing that took some IT expertise and work.

Kentucky, Louisiana, and North Carolina had one of their staff members manually upload the data monthly before it was required. Working with both PT Compact and FSBPT staff, they smoothed out kinks ahead of time and were ready to go with weekly updates when they began issuing privileges.

Jurisprudence Exam

Jurisprudence exam requirements also vary by state and can impact PT Compact considerations.

For example, in North Carolina, the board wanted anyone seeking Compact Privileges to first take the jurisprudence exam. However, from an IT perspective, they were only set up to allow individuals applying for regular licenses to take the jurisprudence exam. Therefore, it took an extensive amount of work and effort to change the system to allow anyone who has an FSBPT ID to take the exercise. They created a wizard to allow PT Compact applicants to take the exam and then be re-directed back to the PT Compact site. The system also allows the public to confirm if the person is a licensee or if they have compact privileges on the North Carolina website. That’s just one of the many benefits of the new, integrated system.

In Louisiana, they also had to create a separate system for their jurisprudence exam. While PT Compact applicants use the same jurisprudence exam licensees take, the system doesn’t register them as licensees in the state of Louisiana.

In Nebraska, the jurisprudence exam was also tied to the license application. Therefore, they instituted an approval process requiring individuals to submit a form requesting access to the jurisprudence exam.

In Kentucky, they thought they were good to go with compact privilege applicants attesting on the compact website that they’d taken the Kentucky jurisprudence exam. However, one of the very first applicants said they took the exam when they hadn’t. Other applicants thought that if their home state’s jurisprudence exam was run by FSBPT then it would just carry over. Therefore, the board and staff worked on the website language to clarify the need for the Kentucky Jurisprudence Exam.

PT Compact Benefits

Since Nebraska had some agencies that were working with travelling physical therapists, having the Compact really helped bring in younger practitioners. It also helped military families and other people who may have spouses in more transient professions. They are still in a transitional stage where some people with a Nebraska license are just now realizing they can allow that license to expire and get a Compact Privilege instead (assuming they still have a license in a home state that is part of the PT Compact).

Initially, Kentucky’s board opposed joining the PT Compact. However, they started to rethink it after learning more from FSBPT and the PT Compact. One of the biggest tipping points was when they looked at their state’s data. The Kentucky board originally didn’t think there were enough people coming in and out of the state to warrant belonging to the PT Compact, but they wanted to make an evidence-based decision. FSBPT helped them get the data, which showed that almost a third of all physical therapists and physical therapist assistants in Kentucky held multiple licenses. Kentucky asked FSBPT to look at historical data, and they saw that 78 percent of physical therapists had at one point held multiple licenses. With that information in hand, the board voted unanimously in favor of it.

States can also see a financial benefit. Each state gets to set their fee for a Compact Privilege and can waive it in certain circumstances. For example, in Nebraska, the support for military families was a more important than any financial gain, so Nebraska has decided to waive fees for active duty military and military spouses starting January 1, 2020.

Conclusion

While there may be some hurdles to joining the PT Compact, many jurisdictions have gone through the process successfully. They’ve learned lessons and have tips and guidance to help new states come on board. Additionally, the FSBPT and PT Compact staff can help with a range tasks, from examining data and creating fiscal impact statements to drafting legislative language and guiding technical processes. Ultimately, joining the PT Compact helps improve public protection by expanding services and ensuring data sharing.

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T.J. Cantwell

Compact Administrator, Physical Therapy Compact Commission

T.J Cantwell became the first Compact Administrator for the Physical Therapy Compact Commission in July 2017. T.J. works with PT Compact member states on the Compact implementation process, manages day-to-day activities, advises state boards interested in joining the PT Compact, and communicates with the public regarding the operations and value of the PT Compact. T.J. has more than twenty years of national nonprofit and association management experience. T.J. holds a Bachelor of Arts in History and Government from the University of Virginia and a Master of Public Policy from American University.

 

Kathy Arney, PT, MA

Executive Director, North Carolina Board of Physical Therapy Examiners

Kathy Arney, PT, is the current Executive Director of the North Carolina Board of Physical Therapy Examiners. She also serves as the Board’s delegate to the Physical Therapy Compact Commission, where she serves as Vice Chair of the Executive Board. Kathy has worked in regulation for over a decade, holding a variety of positions, including developing and implementing programs related to continuing competence requirements, rulemaking, investigations and disiciplinary actions, and scope of practice issues. She has also served on FSBPT committees and task forces including the continuing competence, minimum data set, and board assessment.

 

Claire Covert-ByBee

Program Manager II, Nebraska Department of Health and Human Services, Licensure Unit

In her role as a Program Manager for the Nebraska Department of Health and Human Services, Claire has served as the administrator for the Nebraska Physical Therapy Board since 2015. Claire is currently serving as Nebraska’s Delegate to the Physical Therapy Compact Commission.

 

 

Scott Majors

Executive Director, Kentucky Board of Physical Therapy

Scott has served as Executive Director for the Kentucky Board of Physical Therapy since 2012. He currently serves as Kentucky’s Delegate to the Physical Therapy Licensure Compact Commission and was elected as a member of the Commission’s Executive Board in 2018. He also currently serves as the Vice-Chair of the Council of Board Administrators for FSBPT. Scott earned degrees in both Psychology and Law from the University of Kentucky. He has over thirty years of experience working in state government with administrative boards, agencies and commissions, with a focus placed on licensing and regulation, disciplinary procedures, administrative adjudication, and professional ethics.

 

Charlotte Martin, MPA

Executive Director, Lousiana Physical Therapy Board

Charlotte has served as the Executive Director of the Louisiana Physical Therapy Board since 2014. She is the current Chair of the FSBPT Council of Board Administrators (CBA) and Board Assessment Task Force and the former Chair of the FSBPT Foreign EducatedStandards Committee. Charlotte is a National Certified Investigator and Inspector through the Council on Licensure, Enforcement & Regulation (CLEAR). Charlotte received a baccalaureate degree from the Louisiana State University (LSU) College of Humanities & Social Sciences in 2004 and a Master’s degree in Public Administration from the LSU E.J. Ourso College of Business in 2008.

 

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