TITLE 22. EXAMINING BOARDS

PART 16. TEXAS BOARD OF PHYSICAL THERAPY EXAMINERS

CHAPTER 322. PRACTICE

The Texas Board of Physical Therapy Examiners (board) proposes amending 22 TAC §322.1(a)(2)(D)-(G) relating to exceptions to referral requirement.

The following amendment is necessary to implement changes to Texas Occupations Code §453.301(a)(3)(B) and (b) pursuant Tex. H.B. 4099, 89th R.S. (2025). Specifically, the amendment changes the number of days a physical therapist (PT) who possesses a doctoral degree in physical therapy or has completed at least 30 CCUs in the area of differential diagnosis may treat a patient without a referral from "for not more than 10 consecutive business days" to "for not more than 30 consecutive calendar days."

Additionally, the requirement for a PT to possess a doctoral degree and either has completed a physical therapy residency or fellowship or is certified by an entity approved by the board to treat a patient without a referral for not more than 15 consecutive business days has been eliminated.

Fiscal Note

Ralph A. Harper, Executive Director of the Executive Council of Physical Therapy & Occupational Therapy Examiners, has determined that for the first five-year period the amendment is in effect there would be no loss of revenue, and there would be no fiscal implication to units of local government as a result of enforcing or administering the rules.

Public Benefits and Costs

Mr. Harper has determined that for the first five-year period the amendment is in effect, the public benefit will be greater accessibility to physical therapy services to prevent delay of care and worsened outcomes, higher costs, and greater strain on the health care system. Additionally, there will be no cost to the public with implementation of this amendment.

Local Employment Economic Impact Statement

The amendment is not anticipated to impact a local economy, so a local employment economic impact statement is not required.

Small and Micro-Businesses and Rural Communities Impact

Mr. Harper has determined that there will be no costs or adverse economic effects to small or micro-businesses or rural communities as the result of the amendment; therefore, an economic impact statement or regulatory flexibility analysis is not required.

Government Growth Impact Statement

During the first five-year period the amendment is in effect, the impact on government growth is as follows:

(1) The proposed rule amendment will neither create nor eliminate a government program.

(2) The proposed rule amendment will neither create new employee positions nor eliminate existing employee positions.

(3) The proposed rule amendment will neither increase nor decrease future legislative appropriations to the agency.

(4) The proposed rule amendment will require neither an increase nor a decrease in fees paid to the agency.

(5) The proposed rule amendment does not create a new regulation.

(6) The proposed rule amendment will repeal the requirement for a PT to possess a doctoral degree and either has completed a physical therapy residency or fellowship or is certified by an entity approved by the board to treat a patient without a referral for not more than 15 consecutive business days.

(7) The proposed rule amendment will not increase individuals subject to the rule's applicability.

(8) The proposed rule amendment will neither positively nor adversely affect this state's economy.

Takings Impact Assessment

The proposed rule amendment will not impact private real property as defined by Tex. Gov't Code §2007.003, so a takings impact assessment under Tex. Gov't Code §2001.043 is not required.

Requirement for Rule Increasing Costs to Regulated Persons

Tex. Gov't Code §2001.0045, Requirement for Rule Increasing Costs to Regulated Persons, does not apply to this because the proposed rule amendment will not increase costs to regulated persons.

Public Comment

Comments on the proposed amendment and repeal may be submitted to Karen Gordon, PT Coordinator, Texas Board of Physical Therapy Examiners, 1801 Congress Ave, Suite 10.900, Austin, Texas 78701; email: karen@ptot.texas.gov. Comments must be received no later than 30 days from the date this proposed amendment is published in the Texas Register.

Statutory Authority

The amendment is proposed under Texas Occupation Code §453.102, which authorizes the board to adopt rules necessary to implement chapter 453.

Cross-reference to Statute

The proposed amendment implements provisions in Chapter 453, Subchapter G, Occupations Code, specifically §453.301(a)(3)(B) and (b) that pertain to treatment without a referral. No other statutes, articles, or codes are affected by the proposed amendment.

§322.1. Provision of Services.

(a) Initiation of physical therapy services.

(1) (No change.)

(2) Exceptions to referral requirements

(A) - (C) (No change.)

(D) A PT may treat a patient for an injury or condition without a referral for not more than 30 [10] consecutive calendar [~~business~~] days if the PT:

(i) has been licensed to practice physical therapy for at least one year;

(ii) is covered by professional liability insurance in the minimum amount of $100,000 per claim and $300,000 aggregate per year; and

(iii) either:

(I) possesses a doctoral degree in physical therapy from:

(-a-) a program that is accredited by the Commission on Accreditation in Physical Therapy Education; or

(-b-) an institution that is accredited by an agency or association recognized by the United States secretary of education; or

(II) has completed at least 30 CCUs in the area of differential diagnosis.

[(E) A PT may treat a patient for an injury or condition without a referral for not more than 15 consecutive business days if the PT possesses a doctoral degree as described in subparagraph (D)(iii)(I)(-a-) or (-b-) of this paragraph and has satisfied the conditions set forth in subparagraph (D)(i) and (ii) of this paragraph, and either:]

[(i) has completed a physical therapy residency or fellowship, or]

[(ii) is certified by an entity approved by the board. The board will maintain a list of approved entities on its website.]

(E) [ ~~(F)~~ ] A PT must obtain a referral from a qualified healthcare practitioner before continuation of treatment that exceeds that which is authorized in subparagraph (D) [ ~~or (E)~~ ] of this paragraph.

(F) [~~(G)~~] A PT who treats a patient without a referral under subparagraph (D) [~~or (E)~~] of this paragraph must obtain a signed disclosure on a form prescribed by the board prior to the initiation of treatment. The disclosure form will be made available on the board's website.

(3) (No change.)

(b) - (e) (No change.)

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on August 8, 2025.

TRD-202502828

Ralph Harper

Executive Director

Texas Board of Physical Therapy Examiners

Earliest possible date of adoption: September 21, 2025

For further information, please call: (512) 305-6900

22 TAC §322.5

The Texas Board of Physical Therapy Examiners (Board) proposes amending 22 TAC §322.5(e) relating to standardize formats for and retention of records related to a patient's consent to treatment, data collection, and data sharing when providing physical therapy services via telehealth.

The following amendment is necessary to implement changes to Texas Occupations Code §111.004 pursuant to Tex. H.B. 1700, 89th R.S. (2025) which requires each agency with regulatory authority over a health professional providing telehealth service to adopt rules necessary to standardize formats for and retention of records related to a patient's consent to treatment, data collection, and data sharing.

Fiscal Note

Public Benefits and Costs

Mr. Harper has determined that for the first five-year period the amendment is in effect, the public benefit will be to enable the patient or the patient's authorized representative to make decisions regarding the provision of physical therapy via telehealth with knowledge of the benefits and/or risks, data collection and sharing, and retention of the documentation. Additionally, there will be no cost to the public with the implementation of this amendment.

Local Employment Economic Impact Statement

The amendment is not anticipated to impact a local economy, so a local employment economic impact statement is not required.

Small and Micro-Businesses and Rural Communities Impact

Government Growth Impact Statement

During the first five-year period the amendment is in effect, the impact on government growth is as follows:

(1) The proposed rule amendment will neither create nor eliminate a government program.

(2) The proposed rule amendment will neither create new employee positions nor eliminate existing employee positions.

(3) The proposed rule amendment will neither increase nor decrease future legislative appropriations to the agency.

(4) The proposed rule amendment will require neither an increase nor a decrease in fees paid to the agency.

(5) The proposed rule amendment does not create a new regulation.

(6) The proposed rule amendment will neither repeal nor limit an existing regulation.

(7) The proposed rule amendment will not increase individuals subject to the rule's applicability.

(8) The proposed rule amendment will neither positively nor adversely affect this state's economy.

Takings Impact Assessment

The proposed rule amendment will not impact private real property as defined by Tex. Gov't Code §2007.003, so a takings impact assessment under Tex. Gov't Code §2001.043 is not required.

Requirement for Rule Increasing Costs to Regulated Persons

Tex. Gov't Code §2001.0045, Requirement for Rule Increasing Costs to Regulated Persons, does not apply to this because the proposed rule amendment will not increase costs to regulated persons.

Public Comment

Comments on the proposed amendment may be submitted to Karen Gordon, PT Coordinator, Texas Board of Physical Therapy Examiners, 1801 Congress Ave, Suite 10.900, Austin, Texas 78701; email: karen@ptot.texas.gov. Comments must be received no later than 30 days from the date this proposed amendment is published in the Texas Register.

Statutory Authority

The Board proposes the amendment to §322.5, Telehealth, pursuant to Tex. H.B. 1700, 89th R.S. (2025), which requires each agency with regulatory authority over a health professional providing telehealth service to adopt rules necessary to standardize formats for and retention of records related to a patient's consent to treatment, data collection, and data sharing. The Board also proposes the amendment to §322.5 pursuant to Texas Occupations Code § 453.102, which authorizes the Board to adopt rules necessary to implement chapter 453, Occupations Code.

Cross-reference to Statute

The Board proposes the amendment to §322.5 under Texas Occupations Code § 111.102, Informed Consent, which sets out the telehealth requirements for informed consent that apply to health professionals generally. No other statutes, articles, or codes are affected by the proposed amendment.

§322.5. Telehealth.

(a) - (d) (No change.)

(e) Informed Consent. A physical therapist that provides telehealth services must obtain and maintain the informed consent of the patient, or of another individual authorized to make health care treatment decisions for the patient, prior to the provision of telehealth services.

(1) The informed consent must include the patient's consent to:

(A) treatment;

(B) data collection; and

(2) Consent documentation is acceptable either in written format or verbally.

(A) Informed consent obtained verbally must be documented in the patient's medical record and must include the date that the verbal consent is given.

(B) If the informed consent is provided by a responsible party of the patient, the name and relationship to the patient must be included.

(3) The informed consent must be retained as part of the patient's medical record.

(f) - (i) (No change.)

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on August 8, 2025.

TRD-202502829

Ralph Harper

Executive Director

Texas Board of Physical Therapy Examiners

Earliest possible date of adoption: September 21, 2025

For further information, please call: (512) 305-6900

CHAPTER 329. LICENSING PROCEDURE

22 TAC §329.1, §329.7

The Texas Board of Physical Therapy Examiners (Board) proposes amending 22 TAC §329.1(a)(2) relating to the exemption of the non-refundable application fee for active U.S. military service members, military spouses, or military veterans. Additionally, the Board proposes amending 22 TAC §329.7(b)(5) and (c) relating to exemptions from licensure for active military service members and military spouses and relating to a license in good standing with another state's licensing authority.

Specifically, the amendment to §329.1(a)(2) corrects an omission of military spouses from exemption of the non-refundable application fee, and the amendment to §329.7(b)(5) and (c) align with the changes to Texas Occupations Code §55.0041 effective September 1, 2025 and to the provisions in 50 USC 4025a: Portability of professional licenses of servicemembers and their spouses.

The following amendments are necessary to implement changes to Texas Occupations Code §55.004 and §55.0041 pursuant to Tex. H.B. 5629, 89th R.S. (2025) relating to the occupational licensing of military service members, military veterans, and military spouses.

Fiscal Note

Ralph A. Harper, Executive Director of the Executive Council of Physical Therapy & Occupational Therapy Examiners, has determined that for the first five-year period these amendments are in effect there would be no loss of revenue, and there would be no fiscal implication to units of local government as a result of enforcing or administering the rules.

Public Benefits and Costs

Mr. Harper has determined that for the first five-year period these amendments are in effect, the public benefit will be greater access to physical therapy services by providing military service members and military spouses licensure through recognition of their out-of-state license. Additionally, there will be no cost to the public with the implementation of these amendments.

Local Employment Economic Impact Statement

The amendments are not anticipated to impact a local economy, so a local employment economic impact statement is not required.

Small and Micro-Businesses and Rural Communities Impact

Mr. Harper has determined that there will be no costs or adverse economic effects to small or micro-businesses or rural communities as the result of these amendments; therefore, an economic impact statement or regulatory flexibility analysis is not required.

Government Growth Impact Statement

During the first five-year period these amendments are in effect, the impact on government growth is as follows:

(1) The proposed rule amendments will neither create nor eliminate a government program.

(2) The proposed rule amendments will neither create new employee positions nor eliminate existing employee positions.

(3) The proposed rule amendments will neither increase nor decrease future legislative appropriations to the agency.

(4) The proposed rule amendments will require neither an increase nor a decrease in fees paid to the agency.

(5) The proposed rule amendments do not create a new regulation.

(6) The proposed rule amendments will neither repeal nor limit an existing regulation.

(7) The proposed rule amendments will not increase individuals subject to the rule's applicability.

(8) The proposed rule amendments will neither positively nor adversely affect this state's economy.

Takings Impact Assessment

The proposed rule amendments will not impact private real property as defined by Tex. Gov't Code §2007.003, so a takings impact assessment under Tex. Gov't Code §2001.043 is not required.

Requirement for Rule Increasing Costs to Regulated Persons

Tex. Gov't Code §2001.0045, Requirement for Rule Increasing Costs to Regulated Persons, does not apply to this because the proposed rule amendments will not increase costs to regulated persons.

Public Comment

Comments on the proposed amendments may be submitted to Karen Gordon, PT Coordinator, Texas Board of Physical Therapy Examiners, 1801 Congress Ave, Suite 10.900, Austin, Texas 78701; email: karen@ptot.texas.gov. Comments must be received no later than 30 days from the date these proposed amendments are published in the Texas Register.

Statutory Authority

The Board proposes amendments to §329.1. General Licensure Requirements and Procedures and §329.7. Exemptions from Licensure pursuant to Tex. H.B. 5629, 89th R.S. (2025) relating to the occupational licensing of military service members, military veterans, and military spouses. The Board also proposes these amendments pursuant to Texas Occupations Code § 453.102, which authorizes the Board to adopt rules necessary to implement chapter 453, Occupations Code.

Cross-reference to Statute

The Board proposes the amendments to §329.1 and §329.7 under Texas Occupations Code §55.004 and §55.0041 pertaining to alternative licensing for military service members, military veterans, and military spouses and to the recognition of out-of-state license of military service members and military spouses. No other statutes, articles, or codes are affected by the proposed amendments.

§329.1. General Licensure Requirements and Procedures.

(a) Requirements. All applications for licensure shall include:

(1) a completed board application form with a recent color photograph of the applicant;

(2) the non-refundable application fee as set by the executive council; the application fee of applicants who are active U.S. military service members, military spouses, or military veterans will be waived upon submission of official documentation of the active duty, military spouse, or veteran status of the applicant.

(3) - (5) (No change.)

(b) - (i) (No change.)

§329.7. Exemptions from Licensure.

(a) (No change.)

(b) The following categories of individuals practicing physical therapy in the state are exempt from licensure by the board and must notify the board of their intent to practice in the state.

(1) - (4) (No change.)

(5) A physical therapist or physical therapist assistant licensed in good standing in another jurisdiction of the U.S. who is a military service member or military spouse for the period during which the military service member to whom the military spouse is married is stationed at a military installation in Texas.

(A) The military service member or military spouse must submit an application [~~written notification~~] including the following:

(i) [~~proof of the military service member or military spouse's residency in this state including~~] a copy of the member's military orders showing relocation to this state [~~permanent change of station order for the military service member to whom the spouse is married~~];

(ii) a copy of the [~~military service member or~~] military spouse's marriage license if the applicant is a military spouse [~~military identification card~~]; and

(iii) a notarized affidavit affirming under penalty of perjury that: [~~a list of the jurisdictions in which the military service member or military spouse has held or currently holds a license.~~]

(I) the applicant is the person described and identified in the application;

(II) all statements in the application are true, correct, and complete;

(III) the applicant understands the scope of practice for the physical therapy or physical therapist assistant license in this state and will not perform outside of that scope of practice; and

(IV) the applicant is in good standing in each state in which the applicant holds or has held an applicable license.

(B) Not later than the 10th business day after the date the board receives an application, the board will notify the applicant that: [~~The board will issue a written confirmation stating that:~~]

(i) the board recognizes the applicant's out-of-state license; [~~licensure in other jurisdictions has been verified;~~]

(ii) the application is incomplete; or [~~the military service member or military spouse is authorized to practice physical therapy in the state; and~~]

(iii) the board is unable to recognize the applicant's out-of-state license because the board does not issue a license similar in scope of practice to the applicant's license. [~~authorization does not exceed three years from the date the confirmation is received.~~]

(C) This exemption establishes requirements and procedures authorized or required by Texas Occupations Code, Chapter 55, and does not modify or alter rights that might be provided under federal law.

(1) any jurisdiction of the U.S. that licenses physical therapists and physical therapist assistants is deemed to have substantially equivalent requirements for licensure;

(2) verification of licensure in other jurisdictions may be through online primary source verification; [~~and~~]

(3) the individual must comply with all of the laws and regulations applicable to the provision of physical therapy in Texas; and [.]

(4) a person is in good standing with another state's licensing authority if the person:

(A) holds a license that is current, has not been suspended or revoked, and has not been voluntarily surrendered during an investigation for unprofessional conduct;

(B) has not been disciplined by the licensing authority with respect to the license or person's practice of the occupation for which the license is issued; and

(C) is not currently under investigation by the licensing authority for unprofessional conduct related to the person's license or profession.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on August 8, 2025.

TRD-202502830

Ralph Harper

Executive Director

Texas Board of Physical Therapy Examiners

Earliest possible date of adoption: September 21, 2025

For further information, please call: (512) 305-6900

CHAPTER 341. LICENSE RENEWAL

22 TAC §341.2

The Texas Board of Physical Therapy Examiners (Board) proposes amending 22 TAC §341.2(h) relating to the development and maintenance of an online repository for storing and tracking of continuing competence activities as part of any Request for Approval (RFP) for the continuing competence approval program.

The following amendment is in response to the provision in Tex. S.B. 912, 89th R.S. (2025) that allows a licensing entity that has an agreement in place with a continuing education tracking system provider that is able to implement the requirements of Subchapter C, Chapter 112, Occupations Code may maintain that agreement and any costs associated with implementation of the agreement.

The Board has a Memorandum of Understanding (MOU) with the Texas Physical Therapy Association (TPTA) as the result of an RFP in 2018 and 2022 to develop, administer, and maintain a continuing competence approval system including an online repository for storing and tracking of continuing competence completion documents by licensees of Texas.

Fiscal Note

Public Benefits and Costs

Mr. Harper has determined that for the first five-year period the amendment is in effect, the public benefit will be assurance that the continuing competence activities of licensees can be tracked for compliance with the renewal requirement. Additionally, there will be no cost to the public with the implementation of the amendment.