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MEMORANDUM

April 24, 2013

From: Shawne E. Soper, PT, DPT, MBA, speaker of the HouseKristen Hecht, manager, National Governance and Leadership

RE: 2013 House of Delegates Packet I, Background Papers, and House of Delegates Handbook

Packet I, which contains all proposed main motions received by the March 25 deadline, is attached, along with subsequent appendices that contain information about additional materials, planning, and resources. Business of the House of Delegates (House) is conducted through the introduction of main motions; therefore, in order to be thoroughly prepared to represent your component, delegates must make the time to read and educate themselves about each motion and stay current on conversations occurring on the House of Delegates community discussion boards. Questions about anything contained within the motion may be asked via the House discussion boards or by directly contacting the maker of the motion or the Board of Directors (Board), staff, or Reference Committee contacts.

Within Packet I, delegates will find the Rules of the House of Delegates and the General Order of Business, both adopted by the House as the first and second orders of business, and Implications for Motion Language, developed by the Reference Committee to identify the implication of certain terms when used within House motions. Note: in the Rules of the House two new rules (18 and 19) have been added. Both of these rules are traditions of our House and their inclusion simply memorializes these traditions for future reference.

The Detailed Agenda, a subset of the General Order of Business which is adopted immediately prior to the start of new business, provides delegates with the logic used to guide the speaker of the House and Reference Committee in developing the order of the motions. It is important to note that this categorization is used only as a guide and that ultimately the order of motions is determined at the discretion of the speaker in order to facilitate the business of the House in the way she deems most efficient.

Downloading Packet I is accomplished by accessing the documents from the House community. From the APTA homepage (www.apta.org), at the top of the page in the teal horizontal tool bar, select “APTA Communities.” Once on the community homepage, select “House of Delegates” under “My Communities,” and under Documents, select “Packet I & House Handbook.” Please note that a downloadable file will be compiled by Friday, June 7, that contains all documents needed by delegates.

New this Year: As you read through Packet I you will notice some formatting differences as compared to prior years. Of

particular note is the use of conforming motions in several of the amendments to the bylaws and standing rules (RC’s 2-13, 4A-13, 4B-13, and 9-13 in particular) The concept of conforming motions is a new addition to Robert’s Rules of Order Newly Revised, 11th edition. A conforming motion is a single subsidiary motion that contains multiple amendments needed in order to achieve one end. Conforming motions are very helpful in situations in which a given change needs to be reflected in multiple places in a document. Using an example from Robert:

Suppose a lengthy resolution is pending relating to the creation of a new standing committee, called the “Ways and Means Committee,”…and this committee is referred to by name in a number of places scattered throughout the resolution. If it is desired to change the name of this committee from “Ways and Means Committee” to “Finance Committee,” it is both necessary and in order to move “to amend the pending resolution by striking out ‘Ways and Means Committee’ wherever it appears and inserting ‘Financing Committee’ in lieu thereof.” In such cases (where all of the individual amendments must be made, if any one of them is made, in

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order to leave a coherent resolution pending if the motion to amend is adopted), the proposed amendments are offered in a single motion and may not be divided.1

For more information on actions that can be made to this and other types of motions, please refer to the tables provided in Appendix D.

In this packet, conforming motions are presented with each amendment named as a separate part (Part A, Part B, etc). In the old world of bylaw amendments, each part (Part A, Part B, etc) would be presented as a separate motion. In this (brave) new world of Robert’s 11th edition, all of the necessary changes can be adopted in one motion, which of course makes our work much more efficient. There will be opportunity to amend the motion and we will move through each conforming motion seriatim, calling for debate and amendment on each part, and then ultimately take a vote on the entire document. Conforming motions will be reviewed at the Chief, Section, and Assembly (CSA) meeting, in motion discussion groups, and during the House prior to the consideration of an RC that is written as a series of conforming amendments.

Also new this year will be the use of online and social media tools to promote member-wide discussion of motions prior to debate in the House. Beginning with Packet I's posting, comment-enabled webpages on APTA's website will allow any member to post feedback on motions coming forward to this year’s House. Similarly, members may choose to discuss motions on Twitter using the hashtags that will be provided. While not considered substitutes for direct discussion with delegates, these tools will provide members additional opportunities to exchange thoughts on this year’s motions. Please note that the official discussion process for delegates hasn’t changed; the discussion forum remains in the House community for delegate interaction.

As you will recall from the “Message from the Speaker” sent via e-mail on April 18, there will be numerous pieces of information provided to you over the next 2 months. It is very important to thoroughly study each piece of this information in order to be fully prepared for the House activities and discussions. Given the number of items that will be coming your way, it will be necessary for you to set aside extra time for material review. Please pace yourself so that you are able to work through each piece of information well before arriving onsite at the House.

The House officers wish to thank the delegates for their preparation thus far and for their timely submission of motions. We are confident that the House can complete all the business to come before it this year if we work together efficiently and openly. Early and frequent networking with delegates and the APTA Board and staff will greatly improve our ability to resolve conflict and reach mutual understanding for the good of the association. Do not hesitate to contact us if you have questions, concerns, or suggestions for expediting the business of the House. We look forward to seeing you soon!

For information on preparation and planning for the House (Appendix A), accessing all of your important resources (Appendix B), specifics of the grab-and-go Downloadable File (Appendix C), and basic characteristics of motions (Appendix D) please see the corresponding appendix.

1 Robert III, H. M. et. al., Robert's Rules of Order, Newly Revised, (11th Edition), De Capo Press, Philadelphia, Pennsylvania; p.274

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APPENDIX APREPARATION AND PLANNING FOR THE HOUSE

The House of Delegates Handbook contains annual and special reports to the House. All reports published within the Handbook, with the exception of the House officers, Reference Committee, and Nominating Committee reports, have been written in response to charges from the House. Be sure to read these thoroughly; questions about anything contained within a report may be directed to the Board or staff contacts listed on each report, or asked on Tuesday, June 25, during the House when reports are taken up. The House of Delegates Handbook will be posted to the House Community on Friday, April 26, 2013.

Background Papers, which are written by APTA staff, are an invaluable resource to delegates in helping to understand the implications of motions published in Packet I. The Background Papers will be posted to the House Community on Friday, May 10, 2013.

Nominating Committee Candidate Video Interviews will be posted online on May 10, 2013. Please stay tuned for an announcement and link to the videos.

Reference Committee Appointments will be held Sunday, June 23, and Tuesday, June 25. For specific information regarding appointment times and guidance regarding what materials to bring to your appointment, please see the Reference Committee Appointment Schedule, which will be posted in a few weeks to the House Community under “Shared Documents.” Prior to arriving onsite, 2 more opportunities for virtual appointments are also available, on May 16 and June 13. Please refer to the House Community for more information.

“Month-Out Must Knows” webinar will be held on Thursday, May 23, 2013, 7:00 pm – 8:00 pm, ET. With the House just one month away, attend this webinar for a discussion of your important role as a delegate, resources to help you prepare for the House, and information you need to know once you arrive on site. This webinar will be useful even if you have served as a delegate in the past.

Pre-House Motions Discussion Groups will be held on Sunday, June 23, 2013, 6:00 pm - 7:45 pm. The agenda has been posted to the House Community under “Documents” “Packet I and House Handbook” “Motion Discussion Group Agendas.”

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APPENDIX BRESOURCE FOR DELEGATES: HOUSE COMMUNITY

The House of Delegates Community (House community) is the most important resource available to delegates. The House Community is your source for all of the important materials necessary to prepare for the House.

The House Community may be accessed from the APTA homepage (www.apta.org) by logging on and, at the very top of the page in the teal horizontal tool bar, selecting “APTA Communities.” Once on the main community page, select “House of Delegates” under “My Communities.”

The House Community is organized into 5 sections:

1. Announcements – this area is used solely by the House officers and APTA staff to communicate important information to delegates. *All delegates should subscribe for alerts to this area.

2. Web Resources – contains links to other web-based programs. Examples of links found in this area could include: Candidate Web page, Delegate Rosters, and the Nominations (NC-1) Form.

3. Discussion Boards – the sole purposes of these forums are to facilitate motion discussion prior to arrival onsite. *All delegates should subscribe for alerts to each one of the discussion boards listed on the House Community. Discussion boards are organized as follows:

Packet I - This forum is used for all delegates to provide opinion or to ask questions related to the motions that have been released in Packet I. Although the forum is open to all delegates, chief, section, and assembly delegates are the only individuals who may post the official opinion of a delegation, and should identify themselves within a post when providing official opinion.

Motion Cosponsors – This forum is used for official notification to the speaker of a component’s intent to cosponsor a motion.

Motion Concepts/Draft Motion – Now that Packet I is available this forum should be used only by delegations wishing to propose concepts for future meetings of the House.

4. Documents – contains materials in document formats (i.e. PDF, Word, PowerPoint, etc). Folders are organized as follows:

Packet I and HOD Handbook – after designated posted date, includes the current year’s Packet I, House Handbook, and Motion Discussion Group agendas

Onsite Packets – examples of documents in this folder could include Packet II, Packet III

Reference Materials – is organized into 6 separate folders

House Resources - examples of documents in this folder could include: House Schedule, Apportionment, Seating Chart

Motion Development - examples of documents in this folder could include: Motion Development Form, Main Motion Template, Bylaw Amendment Template, Implications for Motion Language

Nominations, Candidacy, and Elections – examples of documents in this folder could include: Slate of Candidates, Candidate Interview Groups/Schedule, Candidate Manual

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Orientations, Presentations, and Training – examples of documents in this folder could include: CSA meeting agendas, New Chief Delegate Orientation, Basics of Parliamentary Procedure

House Happenings – this folder includes PDF copies of the monthly House Happenings newsletter

Archive – this folder includes Packets, House Handbook, Post-House Survey data, and Summary of House Actions from past House of Delegates’ sessions

House of Delegates Online Manual – this document is posted as a stand-alone PDF file

5. How Do I – contains tutorials on how to navigate the various parts of the community

*Instructions for setting alerts - Alerts are very important because they inform delegates of when something new has been posted.

To set an alert, access the House Community and go to the area in which you’d like your alert set (ie, Announcements, Discussions).

Once in the desired area (i.e., Announcement, Discussions), locate on the blue tool bar the “Actions” button.

Click on “Items” in the teal navigation bar and click on the option “Alert me.” Click “Manage My Alerts.” If you have previously set an alert for the desired section it will be listed here and you may access your

settings in order to edit them. If no alert exists for the desired section, click on “Add Alert” From the right hand tool bar locate the section for which you would like to set the alert, click in the little

circle to the left of the title and at the bottom of the page click “Next.” For “Alert Title” it is recommended that you edit this title to identify the name of the Community for

which the alert is being set. This will help you to identify the particular community when the e-mail alert arrives in your in-box.

Under “Change Type,” click the circle next to “New items are added.” This will ensure you only get alerts about new items and not every single time an item is adjusted.

Second, under “When to Send Alerts,” decide how frequently you would like to receive an e-mail and click the circle next to the respective option.

Click okay and you have set up an alert for Announcements. You will receive an e-mail confirmation. Select the next area for which you want to set an alert and follow the instructions above (Note: in order

to be alerted to postings on all Discussion Boards you must set alerts for each individual discussion board).

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APPENDIX CHOUSE OF DELEGATES DOWNLOADABLE FILE

To assist with delegate preparation for the House a downloadable file that contains materials that each delegate is responsible for having in his/her possession during House proceedings, will be made available by Friday, June 7, 2013. The file will contain the following materials:

CORE DOCUMENTS AND BYLAWS APTA Bylaws APTA Standing Rules House of Delegates Positions, Standards, Guidelines, Policies, and Procedures Board of Directors Standards, Positions, Guidelines, Procedures: Professional and Societal (Section I) Code of Ethics for the Physical Therapist Guide for Professional Conduct Guide for Conduct of the Physical Therapist Assistant Standards of Ethical Conduct for the Physical Therapist Assistant

HOUSE REFERENCE MATERIALS House of Delegates Schedule Seating Chart and Microphone List House of Delegates Dates and Deadlines Apportionment House of Delegates Community Instructions Packet I Background Papers House of Delegates Handbook Pre-House Motions Discussion Group Agendas

REFERENCE COMMITTEE MATERIALS Reference Committee Roster and Liaison List House of Delegates Motion Development Form

ELECTIONS MATERIALS Nominating Committee Roster and Liaison List Slate of Candidates Candidate Statements and Bios Candidate Interview Schedule Candidate Responses to Regional Caucus Questions Link to Nominating Committee Candidate Interview Videos

To access and download the Downloadable File, access the House Community and in the Document area select “Reference Materials” and access the file titled “House Resources.” Once in House Resources select the “.exe” file version of the Downloadable File. Please refer to the instructions listed below which are organized by operating system.

The Downloadable File is comprised of self-extracting Zip files, which compress large documents for fast and easy downloading and enable the user to then “expand” the file in its native format – MS Word. Self-extracting zip files do not require the user to have a special computer program necessary for “unzipping.”

Windows: Click on the file link. When the security dialogue box pops up click "Run," and then click "run" again if a second

security dialogue box appears.

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When the Winzip Self Extractor dialogue box appears, click "Browse" and then select the folder on your computer where you would like the file saved. Click "OK." Then click "Unzip."

The files will be loaded, and an alert will appear when the files have been extracted onto your computer. Macs:It is recommended that you use either Unarchiver (current version 3.7) or Stuffit Expander (current version 15.0.7) – both are available from the Mac App Store.

Download the Packet 1 file to your Mac (it will most likely go to your downloads folder). If either Unarchiver or Stuffit Expander is your only extracting software, double click the .exe file. Tell Unarchiver/Stuffit Expander where you want the files to be extracted. If you have multiple zip extraction programs installed, right click on the .exe file and select “Open With.” Select the program you want to use or select “Other” and find the application you want to use. Follow the prompts to save the file to your preferred location and unzip.

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APPENDIX D

BASIC CHARACTERISTICS OF MOTIONS © From: The Complete Idiot’s Guide to Robert’s Rules

The Guerrilla’s Guide to Robert’s RulesNancy Sylvester, MA, PRP, CPP-T www.nancysylvester.com

Motion Purpose Interrupt speaker?

Second Needed? Debatable? Amendable

? Vote Needed

1 Fix the Time to Which to Adjourn Sets the time for a continued meeting No Yes No1 Yes Majority2 Adjourn Closes the meeting No Yes No No Majority3 Recess Establishes a brief break No Yes No2 Yes Majority

4 Raise a Question of Privilege Asks an urgent question regarding rights Yes No No No Ruled by chair

5 Call for Orders of the Day Requires that the meeting follow the agenda Yes No No No One member6 Lay on the Table Puts the motion aside for later consideration No Yes No No Majority7 Previous Question Ends debate and moves directly to the vote No Yes No No Two-thirds8 Limit or Extend Limits of Debate Changes the debate limits No Yes No Yes Two-thirds9 Postpone to a Certain Time Puts off the motion to a specific time No Yes Yes Yes Majority3

10 Commit or Refer Refers the motion to a committee No Yes Yes Yes Majority

11 Amend an amendment(Secondary Amendment)

Proposes a change to an amendment No Yes Yes4 No Majority

12 Amend a motion or resolution(Primary Amendment)

Proposes a change to a main motion No Yes Yes4 Yes Majority

13 Postpone Indefinitely Kills the motion No Yes Yes No Majority14 MAIN MOTION Brings business before the assembly No Yes Yes Yes Majority

1 Is debatable if the motion is made while no question is pending2 Unless no question is pending

3 Majority, unless it makes the question a special order4 If the motion it is being applied to is debatable

Note: Motions above are in the Order of Precedence of Motions. Based on Robert’s Rules of Order Newly Revised, 11th Edition

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BASIC CHARACTERISTICS OF MOTIONS © From: The Complete Idiot’s Guide to Robert’s Rules

The Guerrilla’s Guide to Robert’s RulesNancy Sylvester, MA, PRP, CPP-T www.nancysylvester.com

Motion Purpose Interrupt speaker?

Second Needed? Debatable? Amendable? Vote Needed

Point of Order Requests that the rules be followed Yes No No No Ruled by chair

Appeal from the Decision of the Chair Challenges a ruling of the chair Yes Yes Depends4 No Majority5

Suspend the Rules Allows the group to violate the rules No Yes No No Two-thirds(not bylaws)

Objection to Consideration Keeps the motion from being considered Yes6 No No No Two-thirds7

Division of the Question Separates consideration of the motion No Yes No Yes MajorityDivision of the Assembly Requires a standing vote Yes No No No One member

Parliamentary Inquiry or Allows a member to ask a question Yes No No No Responded to

Request for Information about the business at hand by chairWithdraw a Motion Removes a motion from Yes Depends8 No No Majority(after stated by the chair) considerationTake from the Table Resumes consideration of a motion No Yes No No Majority

that was laid on the tableReconsider Considers a motion again Yes9 Yes Depends10 No MajorityRescind or Amend Something Repeals a previously adopted motion No Yes Yes Yes Depends11

Previously Adopted or amends it after it has been adopted

4 If the motion it is being applied to is debatable5 Majority in negative required to reverse chair's decision6 Yes, until debate has begun or a subsidiary motion other than Lay on the Table has been stated by the chair7 Two- thirds against consideration sustains objection

8 Yes, if motion is made by the person requesting permission; no, if made by another member9 When another member has been assigned the floor, but not after he or she has begun to speak10 Only if the motion to be reconsidered is debatable11 Requires a) a majority with notice, b) two- thirds, OR c) majority of entire membership

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American Physical Therapy Association

2013 HOUSE OF DELEGATES

PACKET I

APRIL 24, 2013

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IMPLICATIONS FOR MOTION LANGUAGE

The following list, developed by the Reference Committee, identifies the implication of certain language that may be used in motions to be considered by the House. This standardized language helps to clarify the implication or direction of any position, standard, guideline, policy, or procedure, or charge adopted by the House. Delegates should refer to this standardized list to ensure that the words selected are consistent with the intent of the action or any outcome expected.

APPROPRIATE TO USE

Word Definition Association Interpretation

Fiscal Implication (monetary and

human resources)

Assoc Action Req’d (y/n)

Advocate To speak on favor of; recommend

Emphasize, raise awareness of. Not as strong as pursue, support, promote

Minimal to moderate

Y

Conduct To direct the course of: control; To guide or lead

Implies an action, but prefer the use of the words “Develop and Implement”

Usually significant Y

Develop To bring into being; make active

Requires action; generally requires an end product

Usually significant Y

Encourage To give support to; to foster; to stimulate

Non financial support; to foster member action

None Y

Endorse To give approval of or support to

General approval or support with minimal financial commitment

Minimal Y

Evaluate To determine or fix the value of; to examine carefully or appraise

Requires action; requires an end product

Minimal to significant

Y

Identify To find out the original nature or obligation

Requires action; requires an end product

Moderate to significant

Y

Implement To put into effect Put into effect; make happen Usually significant YMay To be allowed or

permittedAllowed or permitted, but does not obligate

None to significant Y/N

Oppose To be in disagreement with or resistant to

Affirmative statement of opposition

None to significant Y

Promote To raise to a more important or reasonable rank; to contribute to the progress or growth of; to urge adoption of (advocate)

Raise to a more important rank; Emphasize; Raise awareness; not as strong as “pursue” or “support”; stronger than advocate, endorse

Minimal to moderate

Y

Provide To furnish; supply; to make available

Requires action, generally requires an end product


Y

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human resources)


Pursue To strive to obtain or accomplish

Strongly implies goal directed activity with an identified end product

Moderate to significant

Y

Recognize To acknowledge, sanction Public acknowledgement None to minimal Y/NShall Used to express duty or

obligationObligates action and is preferred over “should” and stronger than “may”


Y

Should Used to express expectation

Use judiciously. Implies expectation, not action

N

Support To provide for, by supplying with money; to aid the cause of by approving, favoring or advocating

Implies action but not necessarily the attainment of an end product; not as strong as “pursue” but stronger than “endorse” and “promote”; Stronger than advocate


Y

INAPPROPRIATE TO USE



human resources)


Charge Inappropriate for use in motions (motion is a charge)

N

Consider To think about seriously Inappropriate for use in motions NOught Probability or likelihood;

duty or obligationInappropriate for use in motions; use shall or may

N

Recommend To counsel or advise (that something be done)

Inappropriate for use in motions (only a suggestion; does not imply action)

N

Will To decree; to resolve with a forceful will

Inappropriate for use in motions (implies expectation, not action; use “shall” or “may”)

N

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2013 PACKET I

TABLE OF CONTENTS

DOCUMENT TITLE PAGE

Rules of the House of Delegates 1

General Order of Business

RC # CAT SUBJECT CONTACT PAGE

1 1G RC 1-13: Amend: Bylaws of the American Physical Therapy Association, Article V. Components: Chapters, Sections, and Assemblies, Section 1: Chapters, D. Structure

MA 8

2 1G RC 2-13: Amend: Bylaws of the American Physical Therapy Association to Grant the Academic Council Component Status as the American Council of Academic Physical Therapy

BOD 10

3 1G RC 3-13: Amend: Bylaws of the American Physical Therapy Association, Article VIII. House of Delegates of the American Physical Therapy Association, Section 2: Composition, B. Consultants

BOD 19

4a 1G RC 4a-13: Amend: Bylaws of the American Physical Therapy Association and Standing Rules of the American Physical Therapy Association to Establish the Privilege of Section Delegates to Vote

BOD 21

4b 1G RC 4b-13: Amend: Bylaws of the American Physical Therapy Association and Standing Rules of the American Physical Therapy Association to Establish the Privilege of Section Delegates to Vote

FL 42

5 1G RC 5-13: Amend: Bylaws of the American Physical Therapy Association, Article IX. Board of Directors of the American Physical Therapy Association, Section 4: Tenure

BOD 56

6 1G RC 6-13: Amend: Bylaws of the American Physical Therapy Association, Article IX. Board of Directors of the American Physical

BOD 58

Therapy Association, Section 1: Composition

7 1G RC 7-13: Amend: Bylaws of the American Physical Therapy Association, Article VIII. House of Delegates of the American Physical Therapy Association, Section 1: General Powers

BOD 60

8 1G RC 8-13: Amend: Bylaws of the American Physical Therapy Association, Article IX. Board of Directors of the American Physical Therapy Association, Section 5: Duties

BOD 63

9 1G RC 9-13: Amend: Bylaws of the American Physical Therapy Association to Revise the Composition of the Reference Committee and its Role as House Consultant

BOD 66

10 2G RC 10-13: Amend: Standing Rules of the American Physical Therapy Association, 14. Reference Committee

BOD 75

11 2G RC 11-13: Amend: Standing Rules of the American Physical Therapy Association, Insert New Standing Rule Titled Main Motion Criteria

BOD 77

12 2G RC 12-13: Amend: Standing Rules of the American Physical Therapy Association, Insert New Standing Rule Entitled Background Paper Development

FL 79

13 2G RC 13-13: Amend: Standing Rules of the American Physical Therapy Association, 9. Component Delegates

BOD 81

14 3G RC 14-13: Amend: APTA Vision Sentence for Physical Therapy 2020 and APTA Vision Statement for Physical Therapy 2020 (HOD P06-00-24-35)

BOD 83

15 3G RC 15-13: Adopt: Guiding Principles to Achieve the Vision BOD 85

16 4A RC 16-13: Amend: Principles and Objectives for the United States Health Care System

MA 88

17 4E RC 17-13: Amend: Standards of Practice for Physical Therapy AZ 94

18 7E RC 18-13: Integration of Episode/Conclusion of Care Terminology AZ 99

19 6E RC 19-13: Adopt: Public Policy Efforts to Improve Consumer Access to Physical Therapists

BOD 100

20 4B RC 20-13: Rescind: Direct Access and Attainment of “Physician-Status” as Applied Under the Medicare Program (HOD P06-05-16-08)

BOD 103

21 6A RC 21-13: Adopt: Preferred Nomenclature For The Provision of Physical Therapy

MA 106

22 6E RC 22-13: Adopt: Physical Therapist’s Role in the Prevention and Management of Pediatric Overuse Injuries

CO/Orthopaedic

Section

108

23 7E RC 23-13: Plan to Achieve Physical Therapist’s Role in the Prevention and Management of Pediatric Overuse Injuries

CO/Orthopaedic

Section

110

24 6F RC 24-13: Adopt: Physical Therapy Documentation Reform AZ 111

25 6F RC 25-13: Adopt: The Role of Physical Therapy in Health Management for People with Chronic Disability

Neurology Section

114

26 7F RC 26-13: Physical Therapy Health Management Model for People with Chronic Disability

Neurology Section

117

27 6A RC 27-13: Adopt: Physical Therapists as Authorized Providers of Durable Medical Equipment

AZ 118

28 7A RC 28-13: Plan to Achieve Physical Therapists as Authorized Providers of Durable Medical Equipment

AZ 120

29 7D RC 29-13: Training Program for Physical Therapists to Perform Peer Review

PA 121

30 8G RC 30-13: Election To Honorary Membership In the American Physical Therapy Association: John Stackpole

BOD 124

12

RULES OF THE HOUSE OF DELEGATES

The following rules govern the conduct of business at the House of Delegates. Only Section III – Rules of the House of Delegates – Adopted for the Session: May be Suspended, are adopted by the House of Delegates.

I. RULES OF THE HOUSE OF DELEGATES REQUIRED BY APTA BYLAWS - MAY NOT BE SUSPENDED

Rules of the House as outlined within the Bylaws of the American Physical Therapy Association:

ARTICLE IV. MEMBERSHIP, Section 2: Rights and Privileges of Members

ARTICLE VIII. HOUSE OF DELEGATES OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION

ARTICLE IX. BOARD OF DIRECTORS OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION,

Section 2: Qualifications

ARTICLE X. COMMITTEES AND COUNCILS, Section 2: Committees of the House of Delegates

ARTICLE XIV. AMENDMENTS

II. RULES OF THE HOUSE OF DELEGATES - REQUIRED BY RELEVANT APTA STANDING RULES - MAY BE

SUSPENDED

Rules of the House as outlined with the Standing Rules of the American Physical Therapy Association:

12. ELECTIONS: TELLER’S REPORTS

A. The teller’s report to the House of Delegates shall include for each position to be filled:(1) The number eligible to vote.(2) The number of votes cast.(3) The number of votes necessary for election (for officers).(4) The number of votes cast for each eligible candidate.(5) The number of illegal votes, and the reason therefore.

13. VACANCIES -- OFFICERS AND DIRECTORS

A. If a vacancy occurs within the first year of a 3-year term, the Nominating Committee shall select a candidate(s) for election at the next annual session of the House of Delegates; the elected person shall serve for the remaining 2 years of the term.

B. If a vacancy occurs after the first year of a 3-year term, the vacancy shall be filled by appointment by the Board of Directors.

C. Not withstanding Standing Rule 13(B), if a vacancy occurs on the Board of Directors as a result of an election, a second election shall be required. The Nominating Committee shall prepare the slate for the second election and additional nominations from the floor shall be in order.

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All candidates who were slated for any position on the Board of Directors and were not elected in the first election will be slated in the second election unless they have indicated otherwise. Candidates who were not elected for the Nominating Committee shall not be automatically slated but may be nominated from the floor.

14. REFERENCE COMMITTEE

A. The committee shall receive and correlate motions and resolutions to be presented to the House of Delegates and shall identify motions which fall outside the object or functions of the Association. The committee shall provide advice and counsel regarding form, wording, and method of presentation of matters to be presented to the House.

B. All main motions and resolutions, except for procedural motions presented for action by the House of Delegates, shall be referred to the Reference Committee unless this rule is suspended in any particular case by a majority vote of the House of Delegates.

C. Members of the committee other than the Speaker of the House of Delegates shall be seated in the House of Delegates and shall reply to inquiries directed to the committee by the Speaker of the House.

15. DEADLINE FOR MAIN MOTIONS

All main motions to be considered by the House of Delegates shall be submitted in writing to APTA headquarters by a date set by the Speaker of the House of Delegates, which shall be at least 2 months and no more than 3 months prior to the date of the House of Delegates meeting. Any main motion which has not been so submitted shall require a majority vote, without debate, to be considered by the House.

18. CONSENT CALENDAR

A. The officers of the House of Delegates shall prepare a list of recommended motions that are routine, standard, non-controversial, or self-explanatory and where general approval is anticipated, for placement on a consent calendar.

B. The preliminary consent calendar will be distributed 3 weeks prior to the start of the first meeting of the House of Delegates.

C. Prior to the first meeting of the House of Delegates motions may be removed from the consent calendar by the officers of the House of Delegates or at the request of 5 chief delegates.

D. The revised consent calendar will be prepared by the officers of the House of Delegates for presentation to chief, section, and assembly delegates prior to the first meeting of the House of Delegates.

E. Following the opening of the House of Delegates motions may be removed from the consent calendar by an affirmative vote of one-third of the voting body of the House of Delegates.

F. If a motion is removed from the consent calendar, it shall be placed appropriately in the order of business previously assigned by the Speaker of the House and the chair of the Reference Committee.

G. The consent calendar shall be presented for adoption in a single motion.

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III. RULES OF THE HOUSE OF DELEGATES – ADOPTED FOR THE SESSION - MAY BE SUSPENDED

1. Only members of the American Physical Therapy Association, Association headquarters staff, component executive personnel, and nonmember guests approved by an officer of the House of Delegates may attend meetings of the House of Delegates. If the House of Delegates votes to go into executive session, the speaker, in consultation with the president and chief executive officer, may invite the following non-APTA members to remain in the House proper during the session: the parliamentarian, the House recorder, APTA staff, component executive personnel, and others.

2. An official delegate badge is required for admission of delegates to the meetings of the House. Admission cards, signed by an officer of the House, are required for the admission of nonmember guests to the House.

3. Delegates shall keep badges in evidence when attending the meetings of the House of Delegates.

4. All registered delegates (chapter, section, PTA Caucus delegates, and assembly delegates) and members of the Board of Directors, consultants to the House, and Nominating Committee shall be seated in designated areas within the House proper. PTA Caucus representatives, designated APTA staff, and Component Executives shall be seated in a designated area of the gallery.

5. All members of APTA may have the floor to speak, but registered delegates will be recognized first.

6. No delegate or member shall be entitled to the floor until recognized by the speaker of the House. Individuals recognized to speak shall provide their name, delegate affiliation if appropriate (e.g., name of chapter, section or assembly), and speak with the aid of a microphone.

7. Members of APTA headquarters staff and members of APTA appointed groups may be recognized for the purpose of giving information and participating in discussions.

8. The vice speaker shall be the official timekeeper at all meetings.9. When speaking to a motion, each speaker shall be limited to 3 minutes. The vice speaker

will indicate when 30 seconds remain in the allotted time.10. A speaker may not speak twice to the same motion until everyone wishing to speak has

done so.11. A delegate may not rise to debate and close by moving the previous question.12. A motion may not be seconded by a delegate from the same component as the delegate

making the motion.13. A motion made by a member of the Board of Directors may not be seconded by another

member of the Board of Directors.14. The delegate who moves the motion may not speak in opposition to the motion.15. Motions to amend must be in writing and four (4) copies handed to the secretary prior to

the opening of the meeting, if possible, or prior to the motion being made on the floor.16. The motion to suspend the requirement that all main motions and resolutions be referred to

the Reference Committee must identify the subject of the motion to be presented.17. Any motion to amend something previously adopted is a main motion and falls under the

standing rule of submitting main motions by the deadline date set by the speaker of the House. In addition, the vote required for such motions is a majority if notice is given. If notice is not given, a two-thirds vote or a vote of a majority of the entire voting membership of the House is required.

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18. Replacement motions for motions contained in Packet I may be offered by the motion maker and will be published in a subsequent packet. Replacement motions must be reviewed by the Reference Committee no later than Sunday, June 23 for Packet II and Tuesday, June 25 for Packet III.

19. Motions may be withdrawn by the motion maker after notice has been given via Packet I and only without objection by the delegates.

20. When voting during elections by use of an electronic keypad, a mechanism for indicating a “write-in” candidate will be provided.

21. If the number of anonymous write-in candidates is sufficient to preclude the election of a candidate or candidates, the floor will be opened for nominations and the election will proceed with the addition of those nominees to the ballot.

22. When a nomination comes from the floor of the House, the candidate will be provided the opportunity to present a statement in support of their candidacy that is no more than 5 minutes in length.

23. There must be an affirmative vote of one-fifth (1/5) of the voting body of the House of Delegates to order a roll call vote, except when ordered by the speaker of the House.

24. Electronic keypads may be used for counted votes at the discretion of the speaker of the House.

25. The secretary, in consultation with the speaker, shall: 1) Edit all House motions for grammar and punctuation; 2) Edit related items (positions, policies, guidelines) when newly adopted motions require editorial changes in previously adopted motions; and 3) Provide documentation of editorial changes to any delegate upon request.

26. No tape or other recordings may be made of the proceedings of the House of Delegates other than those made by the individuals approved by House officers.

27. Exhibitors are not to distribute promotional items in the House of Delegates, other than those approved by the House officers.

28. Delegates who are recognized to speak should consider those individuals who are hearing impaired and position themselves at the microphone so that their mouth and lips are not obscured from view.

29. Delegates who require a reasonable accommodation for a qualified disability should make their request known to the speaker of the House.

30. Service dogs are permitted in the House proper and gallery.

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2013 HOUSE OF DELEGATES

AMERICAN PHYSICAL THERAPY ASSOCIATION

GENERAL ORDER OF BUSINESS

MONDAY, JUNE 24

Call to Order

Opening Ceremonies

1. Pledge of Allegiance

2. Introductions

3. In Memoriam (2013 HOD Handbook)

Adoption of the Rules of House of Delegates (Packet I)

Adoption of General Order of Business (Packet I)(Adoption of Detailed Agenda deferred until Tuesday morning)

Report from the Nominating Committee

Introduction of Candidates

Appointments

1. Committee to Approve the Minutes

2. Elections Chair and Vice-Chair

Elections for National Office

Recognition of Catherine Worthingham Fellows

APTA President Address to the House of Delegates

Chief Executive Officer Address to the House of Delegates

Introduction of Student House Ushers

Report of Elections

Adjournment

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TUESDAY, JUNE 25

Adoption of Detailed Agenda: (Packet I)

Reports (Annual Report/2013 House Handbook)

1. President (Annual Report)

2. House Officers (Annual Report/2013 House Handbook)

3. Treasurer (Annual Report)

4. Nominating Committee (2013 House Handbook)

5. Reference Committee (2013 House Handbook)

6. Reports from Board of Directors to House of Delegates (2013 House Handbook)

*New Business: (Packet I)

Adjournment

* The Reference Committee has adopted the following categories as a guide for ordering the business of the House. Category:

1 Bylaws2 Standing Rules3 Adoption/Amendment of Mission/Vision/Goals4 Amending/Rescinding Previously Adopted Positions/Standards/Guidelines/Policies/Procedures5 Motions in Response to Previous House Referrals6 Association Positions/Standards/Guidelines/Policies/Procedures - New items7 New Business Related to Vision 20208 Other New Business

Categories 1-6 consist of motions that can only be handled by the House of Delegates.

Category 7 provides information about activities the House of Delegates would like to debate and potentially direct the Board of Directors to accomplish.

Within each category, the Committee attempts to group together similar motions or motions dealing with the same subject. The Reference Committee uses the six elements of APTA Vision Statement for Physical Therapy 2020 as subcategories, in the following order, to further prioritize: Autonomous Practice – A Direct Access – B Doctor of Physical Therapy – C Evidence-Based Practice – D Practitioner of Choice – E Professionalism – F Administration/Operational – G

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WEDNESDAY, JUNE 26

Continuation of New Business

Special Orders: 3:00 pm – 4:00 pm:

Recognition of Honorary Member

Installation of New Nominating Committee Members

Installation of New Officers and Directors

Recognition of Retiring Nominating Committee Members

Recognition of Retiring Members of the Board of Directors

Adjournment

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Required for Adoption: Previous Notice, 2/3 Vote to Consider, 2/3 to Vote to Adopt Category: 1G

Component Contact: George B. Coggeshall, Jr., PT, DPT, delegate, Massachusetts ChapterPhone: 617/997-2565 E-mail: [email protected]

Board Contact: Kathleen K. Mairella, PT, DPT, MAPhone: 973/972-5996 E-mail: [email protected]

RC Contact: Katherine S. Harris, PT, PhDPhone: 203/641-5229 E-mail: [email protected]

Staff Contact: Scharan M. Johnson, CAE, director, Membership DevelopmentPhone: 703/706-3110 E-mail: [email protected]

PROPOSED BY: MASSACHUSETTS CHAPTER

COSPONSORED BY:

RC 1-13 AMEND: BYLAWS OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION, ARTICLE V. COMPONENTS: CHAPTERS, SECTIONS, AND ASSEMBLIES, SECTION 1: CHAPTERS, D. STRUCTURE

That Bylaws of the American Physical Therapy Association, Article V. Components: Chapters, Sections, and Assemblies, Section 1: Chapters, D. Structure, be amended by adding a new (8) so that it would read:

(8) Chapters shall maintain a single corresponding student membership category in chapter bylaws for Student Physical Therapist and Student Physical Therapist Assistant members who are not assigned to that chapter. Dues for corresponding student members shall not exceed the chapter’s student physical therapist or student physical therapist assistant dues. Corresponding student members of a chapter shall have the following rights and privileges: Attend chapter meetings Speak and debate at chapter meetings Receive all chapter publications and correspondence and have access to chapter information

resources provided to chapter members

SS: Currently, if a student wants to be an APTA member of more than 1 chapter, the student pays the student rate for the first chapter but for additional chapters must pay the rate of other corresponding members, which is typically the full rate of a physical therapist or physical therapist assistant member. If, for example, a student wants to be a member of her or his home chapter, her or his DPT/PTA program’s chapter, and the chapter during a clinical affiliation or residency, the student would have to pay dues for 1 membership at the student rate plus 2 memberships at the physical therapist or physical therapist assistant rate, which is cost prohibitive in most cases. This bylaws change would make it financially feasible for students to be members of more than 1 chapter.

CURRENT BYLAW:Article V. Components: Chapters, Sections, and Assemblies

Section 1: Chapters

D. Structure

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(7) Chapters shall maintain a single corresponding membership category in chapter bylaws for Physical Therapist, Retired Physical Therapist, Life Physical Therapist, Physical Therapist Assistant, Retired Physical Therapist Assistant, and Life Physical Therapist Assistant members who are not assigned to that chapter. Dues for corresponding members shall not exceed the chapter’s physical therapist dues. Corresponding members of a chapter shall have the following rights and privileges:

Attend chapter meetings Speak and debate at chapter meetings Receive all chapter publications and correspondence and have access to chapter information

resources provided to chapter members

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Board Contact: Dianne V. Jewell, PT, DPT, PhD, CCSPhone: 804/955-7088 E-mail: [email protected]

RC Contact: Susan Griffin, PT, DPT, MS, GCSPhone: 414/530-4458 E-mail: [email protected]

Staff Contact: Janet R. Bezner, PT, PhD, vice president, Education and Governance & AdministrationPhone: 703/706-8516 E-mail: [email protected]

PROPOSED BY: BOARD OF DIRECTORS

COSPONSORED BY:

RC 2-13 AMEND: BYLAWS OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION TO GRANT THE ACADEMIC COUNCIL COMPONENT STATUS AS THE AMERICAN COUNCIL OF ACADEMIC PHYSICAL THERAPY

Note: Triple asterisks (* * *) indicate language that is not being amended and therefore has not been included in order to make the document more concise.

That Bylaws of the American Physical Therapy Association be amended as follows to grant the Academic Council Component status as the American Council of Academic Physical Therapy:

PART A

That Bylaws of the American Physical Therapy Association, Article V. Components: Chapters, Sections, and Assemblies, be retitled and amended by inserting a new Section 4 and reordering the remaining numbers accordingly:

ARTICLE V. COMPONENTS: CHAPTERS, SECTIONS, AND ASSEMBLIES, AND THE AMERICAN COUNCIL OF ACADEMIC PHYSICAL THERAPY

Section 1: Chapters* * *

Section 4: The American Council of Academic Physical Therapy

A. Formation and Purpose The American Council of Academic Physical Therapy (ACAPT) shall be a component, established by the Association’s Board of Directors, whose purpose shall be to take a leadership role in setting direction for physical therapist academic and clinical education.

B. Structure (1) ACAPT shall have articles of incorporation and bylaws that, in their original form and

as amended, shall not be inconsistent with the Association bylaws and shall be approved in writing by the Board of Directors.

(2) The members of ACAPT with authority to elect its Board of Directors shall be educational institutions that operate accredited physical therapist programs in the

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United States. If an institution operates 2 or more accredited programs or has 2 or more locations covered by the same accreditation, then it may be entitled to as many representatives as permitted by ACAPT. In addition to its institutional members, ACAPT may have members who are individuals and who are members of the Association. The individual members, if any, shall not have authority to elect ACAPT’s Board of Directors.

(3) The institutional members of ACAPT shall not be members of the Association and shall not be required to pay dues to the Association.

(4) Institutional members shall be represented by individuals, each of whom shall be the director of an accredited program operated by the institution or a person designated by such a director. R epresentatives must be members of a program’s core faculty, as defined by the accrediting body. Representatives must be members of the Association.

(5) ACAPT may establish dues, which may be for any amount.C. Obligations

ACAPT shall:(1) Further the object and the functions of the Association as set forth in the Association

bylaws and in policy statements made by the House of Delegates.(2) Make such policies concerning education as it deems advisable, subject to Section 5,

Limitations, of Article V.(3) Conduct its affairs in accordance with its bylaws. (4) Maintain complete and accurate financial records that shall be audited annually. (5) Submit to the Board of Directors annual reports of its activities and such other reports

as may be requested by the Board of Directors.(6) Hold an annual meeting of the general membership. (7) Be represented by a consultant in the House of Delegates at least every third year.

D. Trusteeship The Board of Directors may, at its discretion, conduct the affairs and assume custody of the records, funds, and management of ACAPT if it finds that ACAPT has failed to comply with its obligations. Such action shall be subject to ratification by the House of Delegates at its next session.

E. Dissolution (1) ACAPT may dissolve pursuant to the provisions of its bylaws and its articles of

incorporation.(2) The House of Delegates may, by a two-thirds vote, dissolve ACAPT if ACAPT has failed

to satisfy its obligations or has failed to observe the limitations on it as set forth in these bylaws. The House of Delegates shall have the power to do so only on the recommendation of a majority of the Board of Directors that is made after ACAPT has been given timely notice of charges against it and the opportunity to be heard in its own defense.

F. Property and Records If ACAPT is dissolved, all property and records of whatever nature in its possession shall, after payment of its bona fide debts, be conveyed to the Association. The Association shall not be obligated for any debts incurred by ACAPT unless ACAPT has been specifically authorized in writing by the Board of Directors to act on behalf of the Association.

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PART B

That Bylaws of the American Physical Therapy Association, Article V. Components: Chapters, Sections, Assemblies, and the American Council of Academic Physical Therapy, Section 5: Limitations, C., be amended by inserting the words “, except that this limitation shall not apply to ACAPT” after the word “bylaws” so that it would read:

Section 4 5: Limitations

Components are subject to the following limitations:A. The bylaws of the Association. If the component bylaws, rules, or resolutions are

inconsistent with the bylaws of the Association, the part or parts of the component bylaws, rules, or resolutions that are inconsistent are void and of no effect.

B. Policies adopted by the House of Delegates or by the Board of Directors.C. Membership categories and the rights and privileges for each category only as established

in Association bylaws, except that this limitation shall not apply to ACAPT. Chapter and section bylaws shall provide for all categories of members established in Association bylaws, except they need not provide for the Honorary and the Catherine Worthingham Fellow of APTA membership categories. Assembly bylaws shall provide for only the category or categories of members appropriate to the respective assembly. Chapters and sections retain the right to provide for the privilege of Physical Therapist Assistant, Retired Physical Therapist Assistant, and Life Physical Therapist Assistant members to hold office, with the exception of the office of president, president elect, vice president, and chief delegate, or any position that may succeed to the presidency.

D. No component shall profess or imply that it speaks for or represents the Association or members other than those currently holding membership in the component unless authorized to do so in writing by the Board of Directors.

Proviso: These amendments to the bylaws shall take effect at the close of business of the 2013 House of Delegates.

SS: The purpose of forming the American Council of Academic Physical Therapy (ACAPT), as defined in the proposed bylaw amendments, is to create a component within APTA that will provide leadership and direction for physical therapist academic and clinical education. Examples of the types of objectives that would fulfill the purpose include:

A) Providing mechanisms for collaboration among colleagues across institutions to develop, implement, and assess new and innovative models for curricula, clinical education, teaching/learning, scholarship/research, mentoring, and leadership.

B) Defining dimensions and metrics of quality and excellence within academic physical therapy to enhance academic programs/departments/schools.

C) Providing mechanisms for active and ongoing involvement of physical therapy educators and researchers to impel relevant decision-making at the institutional and national levels regarding academic policy and practice, accreditation, educational quality, professional licensure, and other similar issues.

D) Establishing and influencing policy and legislation related to academic physical therapy through collaboration with organizations and institutions that represent health professional education.

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E) Providing resources, mentorship, and leadership to those seeking change and improvement in academic programs/departments/schools.

While APTA can and does establish goals and priorities that impact education, APTA has no authority to implement the policies and practices required to realize these outcomes. Educational institutions possess the authority to make changes to educational policy and practices. Therefore, the ability to accomplish the purpose and objectives of ACAPT hinges on institutional membership. Establishing a component within APTA in which the voting member is the educational institution will enable governance of the component by the entities that have the responsibility and authority to fulfill the obligations of ACAPT on behalf of educational institutions. In other words, the voting members of ACAPT (academic institutions) will both determine and implement policies and practices related to education with input from and collaboration with APTA and other key stakeholders. The proposed bylaws establish that the individual representing the educational institution be a member of APTA, thus ensuring that the objectives and functions of the Association are being met. In addition, the individual representing the voting member of ACAPT must be a core faculty member of the physical therapist education program, thus ensuring that the individual can represent the program. Only institutions that operate accredited physical therapist educational programs may be members of ACAPT, thus ensuring that those programs meet standards set forth by CAPTE.

These bylaw amendments will clarify roles and responsibilities between APTA and the academic institutions and support appropriate use of resources by both with respect to physical therapist education.

CURRENT BYLAW:

PART ABYLAWS OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION, ARTICLE V. COMPONENTS: CHAPTERS, SECTIONS, AND ASSEMBLIES

Section 1: Chapters

A. DefinitionA chapter of the Association consists of a group of members of the Association in the United States or its possessions that is chartered by the Association as having territorial jurisdiction over a geographic area.

B. FormationThe Board of Directors may establish a chapter, as prescribed in the standing rules, by the issuance of a charter.

C. ChartersAll charters issued by the Association shall continue in force and effect until revoked (as provided for in the Association bylaws) or until notification is received from the chapter of its dissolution.

D. Structure (1) Every chapter shall enact bylaws that, in their original form and as amended, shall not be

inconsistent with the Association bylaws and shall be approved in writing by the Board of Directors.

(2) If a chapter is to be incorporated it shall submit its proposed certificate of incorporation, and any subsequently proposed amendments to this certificate, to the Board of Directors for prior written approval.

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(3) A chapter may create districts within its territorial jurisdiction. These districts shall:a. Operate under bylaws or rules of order that shall not be inconsistent with chapter or

Association bylaws and that shall be approved by the chapter.b. Not establish dues.

(4) A chapter may create a representative body for the transaction of chapter business provided that the basis for establishing and apportioning the membership of the representative body shall be included in the chapter bylaws. A chapter's method of apportioning representatives of Physical Therapist Assistant, Retired Physical Therapist Assistant, and Life Physical Therapist Assistant members of the representative body shall be proportional to one-half the number of Physical Therapist Assistant, Retired Physical Therapist Assistant, and Life Physical Therapist Assistant members in the chapter.

(5) A chapter may authorize the establishment of special interest groups within its territorial jurisdiction. These special interest groups shall be subject to rules and conditions set down by the chapter.

(6) Chapter dues for any category of membership shall not exceed Association dues for that membership category without specific approval of the Board of Directors. Such approval shall be granted when the chapter has complied with criteria established and published by the Board of Directors. Failure of the Board of Directors to grant approval under such circumstances shall be subject to appeal to the House of Delegates.

(7) Chapters shall maintain a single corresponding membership category in chapter bylaws for Physical Therapist, Retired Physical Therapist, Life Physical Therapist, Physical Therapist Assistant, Retired Physical Therapist Assistant, and Life Physical Therapist Assistant members who are not assigned to that chapter. Dues for corresponding members shall not exceed the chapter’s physical therapist dues. Corresponding members of a chapter shall have the following rights and privileges:

Attend chapter meetings Speak and debate at chapter meetings Receive all chapter publications and correspondence and have access to chapter

information resources provided to chapter members.E. Obligations

Each chapter shall do the following:(1) Further the object and the functions of the Association as set forth in the Association bylaws

and in policy statements made by the House of Delegates in the area of the chapter’s authority and within its territorial jurisdiction.

(2) Perform the duties and assume the responsibilities that Association bylaws place on chapters.

(3) Conduct its affairs in accordance with its bylaws. (4) Maintain complete and accurate financial records that shall be audited annually.(5) Submit to the Board of Directors annual reports of its activities and such other reports as

may be requested by the Board of Directors. (6) Hold an annual meeting of the general membership or representative body and, in chapters

in which no meetings are held at district level, hold at least one additional general membership meeting a year.

(7) Be represented in the House of Delegates at least every third year. (8) Investigate any complaints of violations of ethical principles or standards made against any

member in its jurisdiction in accordance with the Association’s Disciplinary Action Procedural Document.

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(9) Limit attendance at chapter business meetings to Association members and invited guests approved by the chapter officers.

F. TrusteeshipThe Board of Directors may, at its discretion, conduct the affairs and assume custody of the records, funds, and management of any chapter that it finds has failed to comply with its obligations. Such action shall be subject to ratification by the House of Delegates at its next session.

G. Dissolution (1) A chapter may dissolve pursuant to the provisions of its bylaws or pursuant to its articles of

incorporation. (2) The Board of Directors may revoke the charter of any chapter if the chapter has failed to

satisfy its obligations or to observe the limitations on chapters as set forth in the Association bylaws.

a. The chapter must be given timely notice of the charges against it and the opportunity to be heard in its own defense, and the judgment of revocation must be supported by at least two-thirds of the members of the Board of Directors.

b. A chapter whose charter has been revoked by the Board of Directors shall have the right to appeal to the House of Delegates at the next session of the House of Delegates following the decision of the Board of Directors. The decision of the House of Delegates in the matter shall be final. Pending the determination of the House of Delegates, the decision of the Board of Directors shall be given full force and effect.

H. Property and RecordsIf the charter of the chapter is revoked or if the chapter is dissolved or its existence otherwise terminated, all property and records of whatever nature in the possession of the chapter shall, after payment of its bona fide debts, be conveyed to the Association. The Association shall not be obligated for any debts incurred by a chapter unless the chapter has been specifically authorized in writing by the Board of Directors to act on behalf of the Association. In the case of 2 or more chapters merging, all property and records will be turned over to the continuing chapter without being returned through headquarters.

Section 2: Sections

A. PurposeSections may be organized to provide a means by which members having a common interest in special areas of physical therapy may meet, confer, and promote the interests of the respective sections.

B. FormationA section may be established as prescribed in the standing rules.

C. Structure (1) Each section shall operate under bylaws that in their original form and as amended shall not

be inconsistent with Association bylaws and shall be approved in writing by the Board of Directors.

(2) If a section is to be incorporated, it shall submit its proposed certificate of incorporation, and any subsequently proposed amendments to this certificate, to the Board of Directors for prior approval in writing.

(3) A section may be organized regionally.

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(4) A section may authorize the establishment of special interest groups within its area of authority. These special interest groups shall be subject to rules and conditions set down by the section.

(5) Section dues for any category of membership shall not exceed Association dues for that membership category without specific approval of the Board of Directors.

D. ObligationsEach section shall do the following: (1) Further the object and the functions of the Association as set forth in Association bylaws

and in policy statements made by the House of Delegates in the area of the section’s authority.

(2) Perform the duties and assume the responsibilities that Association bylaws place on sections.

(3) Conduct its affairs in accordance with its bylaws. (4) Maintain complete and accurate financial records that shall be audited annually. (5) Submit to the Association annual reports of its activities and such other reports as may be

requested by the Board of Directors. (6) Hold meetings in conformity with Association policy. (7) Be represented in the House of Delegates at least every third year. (8) Limit attendance at section business meetings to section members and invited guests

approved by the section officers. E. Trusteeship

The Board of Directors may, at its discretion, conduct the affairs and assume custody of the records, funds, and management of any section that it finds has failed to comply with its obligations. Such action shall be subject to ratification by the House of Delegates at its next session.

F. Dissolution (1) A section may dissolve pursuant to the provisions of its bylaws. (2) A section may be dissolved by a two-thirds vote of the Board of Directors if the membership

of the section remains fewer than 200 members during any consecutive 12-month period. (3) The House of Delegates may, by a two-thirds vote, dissolve a section if the section has failed

to satisfy its obligations or has failed to observe the limitations on sections as set forth in these bylaws. The House of Delegates shall have the power so to act only on the recommendation of a majority of the Board of Directors that is made after the section has been given timely notice of charges against it and the opportunity to be heard in its own defense.

G. Property and RecordsIf a section is dissolved, all property and records of whatever nature in the possession of the section shall, after payment of its bona fide debts, be conveyed to the Association. The Association shall not be obligated for any debts incurred by a section unless the section has been specifically authorized in writing by the Board of Directors to act on behalf of the Association. In the case of 2 or more sections merging, all property and records shall be turned over to the continuing section without being returned through headquarters.

Section 3: Assemblies

A. PurposeAssemblies may be organized to provide a means by which members of the same category, except Physical Therapist, Physical Therapist Assistant, and Honorary, having a common interest

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because of their membership category, may meet, confer, and promote the interests of the respective membership categories and assemblies. Exception: Student Physical Therapist and Student Physical Therapist Assistant categories may combine to form one assembly.

B. FormationAn assembly may be established in accordance with procedures prescribed by the Board of Directors, except that the decision to form shall not be effective unless made or approved by the House of Delegates.

C. Structure (1) Each assembly shall operate under bylaws that in their original form and as amended shall

not be inconsistent with Association bylaws and shall be approved in writing by the Board of Directors.

(2) An assembly shall not establish a representative body.(3) An assembly shall not be incorporated.(4) An assembly may be organized regionally.(5) An assembly may request that a chapter or section authorize the establishment of a chapter

or section special interest group within the chapter or section. The special interest group shall be subject to rules and conditions set down by the chapter or section.

(6) An assembly shall not charge dues.D. Obligations

Each assembly shall do the following: (1) Further the object and the functions of the Association as set forth in Association bylaws

and in policy statements made by the House of Delegates in the area of the assembly’s authority.

(2) Perform the duties and assume the responsibilities that Association bylaws place on assemblies.

(3) Conduct its affairs in accordance with its bylaws.(4) Hold meetings in conformity with Association policy.(5) Be represented in the House of Delegates at least every third year.

E. Dissolution An assembly may be dissolved in accordance with procedures prescribed by the Board of Directors, except that the decision to dissolve shall not be effective unless made or approved by the House of Delegates.

F. Property and RecordsIf an assembly is dissolved, all property and records of whatever nature in the possession of the assembly shall, after payment of its bona fide debts, be conveyed to the Association. The Association shall not be obligated for any debts incurred by an assembly unless the assembly has been specifically authorized in writing by the Board of Directors to act on behalf of the Association.

Section 4: Limitations

Components are subject to the following limitations: A. The bylaws of the Association. If the component bylaws, rules, or resolutions are inconsistent with

the bylaws of the Association, the part or parts of the component bylaws, rules, or resolutions that are inconsistent are void and of no effect.

B. Policies adopted by the House of Delegates or by the Board of Directors. C. Membership categories and the rights and privileges for each category only as established in

Association bylaws. Chapter and section bylaws shall provide for all categories of members

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established in Association bylaws, except they need not provide for the Honorary and the Catherine Worthingham Fellow of APTA membership categories. Assembly bylaws shall provide for only the category or categories of members appropriate to the respective assembly. Chapters and sections retain the right to provide for the privilege of Physical Therapist Assistant, Retired Physical Therapist Assistant, and Life Physical Therapist Assistant members to hold office, with the exception of the office of president, president elect, vice president and chief delegate, or any position that may succeed to the presidency.


PART BBYLAWS OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION, ARTICLE V. COMPONENTS: CHAPTERS, SECTIONS, ASSEMBLIES, AND THE AMERICAN COUNCIL OF ACADEMIC PHYSICAL THERAPY, SECTION 5: LIMITATIONS, C.

Components are subject to the following limitations:A. The bylaws of the Association. If the component bylaws, rules, or resolutions are

inconsistent with the bylaws of the Association, the part or parts of the component bylaws, rules, or resolutions that are inconsistent are void and of no effect.

B. Policies adopted by the House of Delegates or by the Board of Directors.C. Membership categories and the rights and privileges for each category only as established in

Association bylaws. Chapter and section bylaws shall provide for all categories of members established in Association bylaws, except they need not provide for the Honorary and the Catherine Worthingham Fellow of APTA membership categories. Assembly bylaws shall provide for only the category or categories of members appropriate to the respective assembly. Chapters and sections retain the right to provide for the privilege of Physical Therapist Assistant, Retired Physical Therapist Assistant, and Life Physical Therapist Assistant members to hold office, with the exception of the office of president, president elect, vice president and chief delegate, or any position that may succeed to the presidency.


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Board Contact: Dianne V. Jewell, PT, DPT, PhD, CCSPhone: 804/955-7088 E-mail: [email protected]

RC Contact: Susan R. Griffin, PT, DPT, MS, GCSPhone: 414/530-4458 E-mail: [email protected]



COSPONSORED BY:

RC 3-13 AMEND: BYLAWS OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION, ARTICLE VIII. HOUSE OF DELEGATES OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION, SECTION 2: COMPOSITION, B. CONSULTANTS


That Bylaws of the American Physical Therapy Association, Article VIII. House of Delegates of the American Physical Therapy Association, Section 2: Composition, B. Consultants, be amended by inserting the words “a representative designated by ACAPT” after the word “Specialties” so that it would read:

Section 2: Composition* * *

B. ConsultantsConsultants shall include all members of the Reference Committee, a member of the Ethics and Judicial Committee, a member of the American Board of Physical Therapy Specialties, a representative designated by ACAPT,* and Association staff designated by the Chief Executive Officer in consultation with the Board of Directors. All consultants shall be available in the House of Delegates to reply to inquiries as directed by the Speaker of the House of Delegates.

*Note, if RC 2-13 is not adopted, the language “a representative designated by ACAPT” will be revised to read “a representative designated by the Academic Council”.


SS: For a detailed description of the purpose of forming the American Council of Academic Physical Therapy (ACAPT), see the support statement of RC 2-13. Changes proposed to the House of Delegates (House) structure and processes include granting consultant status to a representative of ACAPT. This change will enable ACAPT to be seated in the House and respond to inquiries as necessary when directed by the Speaker of the House.

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mailto:[email protected]



CURRENT BYLAW:BYLAWS OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION, ARTICLE VIII. HOUSE OF DELEGATES OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION, SECTION 2: COMPOSITION, B. CONSULTANTS

Section 2: Composition

A. Registered DelegatesThe House of Delegates shall consist of all registered delegates. Registered delegates shall include: (1) All those who have filed delegate credentials approved by the Officers of the House of

Delegates.(2) Members of the Board of Directors.

B. ConsultantsConsultants shall include all members of the Reference Committee, a member of the Ethics and

Judicial Committee, a member of the American Board of Physical Therapy Specialties, and Association staff designated by the Chief Executive Officer in consultation with the Board of Directors. All consultants shall be available in the House of Delegates to reply to inquiries as directed by the Speaker of the House of Delegates.

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Board Contact: Roger A. Herr, PT, MPA, COS-CPhone: 206/890-0878 E-mail: [email protected]

RC Contact: Lynn N. Rudman, PTPhone: 443/604-1475 E-mail: [email protected]

Staff Contact: Dena Kilgore, CAE, director, Component Governance and LeadershipPhone: 703/706-3285 E-mail: [email protected]


COSPONSORED BY:

RC 4A-13 AMEND: BYLAWS OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION AND STANDING RULES OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION TO ESTABLISH THE PRIVILEGE OF SECTION DELEGATES TO VOTE


That Bylaws of the American Physical Therapy Association and Standing Rules of the American Physical Therapy Association be amended as follows to grant sections voting privileges in the House of Delegates:

PART A

That Bylaws of the American Physical Therapy Association, Article IV. Membership, Section 2: Rights and Privileges of Members, B., (2) To vote, a., be amended by inserting the words “and section delegates” after the word “delegates” so that it would read:

Section 2: Rights and Privileges of Members

* * *B. Only members in certain categories have the following privileges (subject to restriction as

otherwise provided in Association bylaws):* * *

(2) To vote.a. At House of Delegates meetings: Chapter delegates and section delegates, 1 vote.

PART B

That Bylaws of the American Physical Therapy Association, Article IV. Membership, Section 2: Rights and Privileges of Members, B., (4) To serve as a delegate to the House of Delegates, b., be amended by striking out the words “and Physical Therapist Assistant” so that it would read:



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(4) To serve as a delegate to the House of Delegates.a. As chapter delegate: Physical Therapist.b. As section delegate: Physical Therapist and Physical Therapist Assistant.c. As PTA Caucus delegate: Physical Therapist Assistant, subject to qualifications identified in

Article VIII., Section 4., of these bylaws.d. As assembly delegate: Assembly member, subject to additional eligibility requirements in

the assembly bylaws.

PART C

That Bylaws of the American Physical Therapy Association, Article VII. Meetings, Section 3: Notice of Sessions, A. Annual Session, be amended by striking out the word “chapter” after the words “to each” so that it would read:

Section 3: Notice of Sessions

A. Annual SessionThe time and place of the annual session shall be announced in the official journal of the Association, and notice shall be sent to each component president or chair and to each chapter chief delegate at least six weeks before the session is scheduled to convene. This notice may be made by mail or any telecommunications method including, but not limited to, fax and e-mail transmissions which must ensure the timely receipt of the notice and may ensure verifiable receipt of the notice by the intended recipients.

PART D

That Bylaws of the American Physical Therapy Association, Article VIII. House of Delegates of the American Physical Therapy Association, Section 3: Voting Delegates, be amended by substitution:

Section 3: Voting Delegates

The voting delegates of the House of Delegates shall be the chapter delegates and the section delegates.A. Qualifications of Voting Delegates

(1) Chapter delegates and section delegates: Only Physical Therapist members may serve as chapter delegates or section delegates. Only Physical Therapist members who have been Association members in good standing in any category of membership for no fewer than the 2 years immediately preceding the start of the House session may serve as chapter delegates or section delegates.

(2) Members of the Board of Directors may not serve as chapter delegates or section delegates.

(3) A delegate of any one component may not serve concurrently as a delegate of another component.

B. Number of Voting DelegatesThe number of chapter delegates shall be based on, but not limited to, 400, which shall be apportioned among the chapters on the basis of the number of Physical Therapist, Retired Physical Therapist, Life Physical Therapist, Physical Therapist

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Assistant, Retired Physical Therapist Assistant, and Life Physical Therapist Assistant members in each chapter according to membership records in the Association headquarters and as described in the standing rules. The number of each section’s delegates shall be based on its member count as determined according to the standing rules. The number of chapter delegates shall be based on, but not limited to, a target number equal to 420 minus the number of section delegates. The number of each chapter’s delegates shall be based on its member count as determined according to the standing rules. No chapter or section shall have fewer than 2 delegates.

C. Selection of Voting DelegatesEach chapter and section shall select the delegates who will represent it at the annual session. Each chapter and section shall designate 1 delegate as its chief delegate.

D. CredentialsCredentials shall be issued by the Association. Delegates shall register and file credentials before the first meeting of the House of Delegates and at such other times as designated by the Officers of the House of Delegates.

E. Voting BodyEach chapter voting delegate shall have 1 vote, except that if any of the delegates to which a chapter or section is entitled does not attend a meeting of the House of Delegates, the vote(s) may be transferred to the remaining member(s) of the delegation who are present.

PART E

That Bylaws of the American Physical Therapy Association, Article VIII. House of Delegates of the American Physical Therapy Association, Section 4: Nonvoting Delegates, be amended by substitution:

Section 4: Nonvoting Delegates

The nonvoting delegates of the House of Delegates shall be the section delegates, PTA Caucus delegates, Student Assembly delegates, and the members of the Board of Directors.A. Qualifications of Nonvoting Delegates

(1) Section delegates: Only Physical Therapist and Physical Therapist Assistant members may serve as section delegates. Only Physical Therapist and Physical Therapist Assistant members who have been Association members in good standing in any category of membership for no fewer than the 2 years immediately preceding the start of the House session may serve as section delegates.

(2 1) PTA Caucus delegates: Only Physical Therapist Assistant members who have been Association members in good standing for no fewer than 2 years immediately preceding the start of the House session may serve as PTA Caucus delegates.

(3 2) Student Assembly delegates: Only Student Physical Therapist and Student Physical Therapist Assistant members who have been Association members in good standing for the 4 months immediately preceding the start of the House session may serve as Student Assembly delegates.

(4 3) Members of the Board of Directors may not serve as section or assembly delegates.

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(5) A section delegate or Student Assembly delegate may not serve concurrently as a delegate of another component. A PTA Caucus delegate may not serve concurrently as a section delegate.

B. Number of Nonvoting Delegates(1) Section delegates: Each section shall be entitled to 1 delegate.(2 1) PTA Caucus delegates: The PTA Caucus shall be entitled to 5 delegates.(3 2) Student Assembly delegates: The Student Assembly shall be entitled to 2

delegates.C. Selection of Nonvoting Delegates

Each section, the Each of the PTA Caucus, and the Student Assembly shall select the delegate(s) who will represent it at the House session.


E. Rights and privileges of nonvoting delegatesSection delegates, PTA Caucus delegates, Student Assembly delegates, and members of the Board of Directors may speak, debate, and make and second motions.

PART F

That Bylaws of the American Physical Therapy Association, Article VIII. House of Delegates of the American Physical Therapy Association, Section 5: Conduct of Business, be amended by substitution:

Section 5: Conduct of Business

A. Officers of the House of Delegates(1) The officers shall be the Speaker of the House of Delegates, the Vice Speaker

of the House of Delegates, and the Secretary.(2) The officers shall be responsible for registering delegates, transferring voting

privileges, preparing rules of order and an agenda for the consideration of the House of Delegates, recording and reporting the proceedings, appointing the Committee to Approve the Minutes, making appointments to the Reference Committee, conducting elections, making editorial changes to the bylaws and standing rules, and performing other duties as determined by these bylaws or the standing rules.

B. QuorumDelegates representing one-third of the chapters and one-third of the sections and numbering one-third of the total number of chapter votes that could be cast if all voting delegates from all chapters were present shall constitute a quorum.

C. Voting(1) Voting on motions and resolutions in the House may be by voice, show of

hands, standing, roll call, or use of electronic equipment.(2) If a decision must be made during the interval between annual sessions, a

majority vote of the Board of Directors may determine that the voting chapter delegates be polled by mail. These delegates shall be those registered at the immediately preceding session of the House of Delegates. If the delegate is no longer a member of the chapter or section or holds membership in a category other than that held when the delegate registered at the immediately

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preceding session of the House of Delegates or for any other reason no longer meets the qualifications for delegate, an alternate delegate shall be named by that chapter or section. At least 50 percent of the ballots of the eligible delegates must be returned to validate the vote.

(3) Election of officers, directors, and members of the Nominating Committee shall be by ballot or use of electronic equipment. Officers shall be elected by a majority of the votes cast. Directors and members of the Nominating Committee shall be elected by a plurality of the votes cast. If the vote fails to determine election, reballoting shall be conducted under procedures determined by the Officers of the House of Delegates.

D. Memorials and ResolutionsOnly memorials or resolutions adopted by the House of Delegates can be issued validly in the name of the Association.

PART G

That Bylaws of the American Physical Therapy Association, Article XIV. Amendments, be amended by substitution:


These bylaws may be amended at the Annual Session of the House of Delegates in years ending in 0 and 5 by the affirmative vote of at least two-thirds of the chapter voting delegates present and voting, or at any special session of the House of Delegates or the Annual Session of the House of Delegates during years not ending in 0 or 5 by the consent to consider, without debate, of two-thirds of the chapter voting delegates present and voting and by the affirmative vote of at least two-thirds of the chapter voting delegates present and voting, providing the following:A. Any proposed amendment has been submitted in writing to the Association’s headquarters by a

date set by the Speaker of the House of Delegates, which shall be at least 4 months but no more than 5 months before the session of the House of Delegates.

B. Copies of all proposed amendments have been printed in an Association publication or distributed to all Association members at least 2 months before the session of the House of Delegates. This distribution may be made by mail or any telecommunications method including, but not limited to, fax and e-mail transmissions, which must ensure the timely receipt of the notice and may ensure verifiable receipt of the notice by the intended recipients.

Bylaw amendments pertaining to Article X: Finance, Section 3: Dues, may be amended at any Annual Session or special session of the House of Delegates by the affirmative vote of at least two-thirds of the chapter voting delegates present and voting, provided that the conditions of subparagraphs A and B above are satisfied.

PART H

That Standing Rules of the American Physical Therapy Association, 10. Delegate Credentials, be amended by substitution:

10. DELEGATE CREDENTIALS

Component Delegates: Chapter or section delegate credentials shall be signed by the chapter or section president or the chapter or section chief delegate. The designation of chief delegate shall be indicated

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on the appropriate chapter or section credential. Section or aAssembly delegate credentials shall be signed by the section or assembly president.

PART I

That Standing Rules of the American Physical Therapy Association, 11. Mail Ballot, be amended by substitution:

11. MAIL BALLOT

When the Board of Directors determines to conduct a mail ballot, according to Article VIII, Section 5., C., (2) of the bylaws, a ballot shall be prepared and distributed as follows:A. The question to be decided and appropriate supporting information shall be provided with the

ballot.B. Instructions for completing and returning the ballot shall be printed on the ballot.C. The deadline for receipt of ballots at the Association's headquarters shall be printed on the

ballot, and this deadline shall be no fewer than 30 days after the date mailed to the delegates to all voting delegates.

D. An addressed envelope (to the Association's headquarters) and a plain envelope shall be included in the mailing.

E. The ballots shall be mailed by first class mail to each chapter voting delegate.F. The voting delegate shall place the completed ballot in the plain envelope, place the plain

envelope in the envelope addressed to the Association's headquarters, sign the outside envelope, and mail it to Association headquarters.

G. The Officers of the House of Delegates shall be responsible for opening and counting the returned ballots and preparing a report of the results of the vote.

PART J

That Standing Rules of the American Physical Therapy Association, 17. Formula for Determining the Size of the House of Delegates, be retitled and amended by substitution:

17. FORMULA FOR DETERMINING THE SIZE OF THE THE NUMBER OF VOTING DELEGATES TO THE HOUSE OF DELEGATES

(1) Add the number of Physical Therapist, Retired Physical Therapist, and Life Physical Therapist members and one-half of the number of Physical Therapist Assistant, Retired Physical Therapist Assistant, and Life Physical Therapist Assistant members of the Association who are assigned to chapters as of June 30 of the year preceding the House of Delegates in which they will serve.

(2) Divide the total found in Step 1 by 400. This shall be the apportionment number.(3) Divide the total number of Physical Therapist, Retired Physical Therapist, and Life Physical

Therapist members and one-half of the number of Physical Therapist Assistant, Retired Physical Therapist Assistant, and Life Physical Therapist Assistant members for each chapter by the apportionment number.

(4) Chapters shall be allowed one delegate for each whole number and one additional delegate for any remainder equaling or exceeding 50 percent of the apportionment number.

(5) Any chapter that would be entitled to fewer than 2 delegates according to the above shall be allowed 2 delegates.

A. For each year the number of voting delegates in the House of Delegates shall be the sum of

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the section delegates and the chapter delegates, as determined in accordance with this Standing Rule.

B. For the purpose of determining the number of voting delegates to the House of Delegates for any year, the member count of each chapter and section shall be determined by adding the number of its Physical Therapist, Retired Physical Therapist, and Life Physical Therapist members and one-half of the number of its Physical Therapist Assistant, Retired Physical Therapist Assistant, and Life Physical Therapist Assistant members as of June 30 of the preceding year.

C. Each section shall be entitled to 2 or more delegates on the basis of its member count, as follows:

Member count 1-999.5 = 2 delegates Member count 1,000-1,999.5 = 3 delegates Member count 2,000-2,999.5 = 4 delegates Member count 3,000 or more = 5 delegates

D. The chapter delegate target shall be the difference between 420 and the number of section delegates.

E. The number of delegates to which each chapter is entitled shall be determined as follows: (1) Add the member counts of all chapters and divide the sum by the chapter delegate target.

This quotient shall be the chapter apportionment number.(2) For each chapter, divide its member count by the chapter apportionment number. The

chapter shall be allowed the number of delegates obtained by rounding this quotient to the nearest whole number, except that each chapter shall be allowed at least 2 delegates.

PART K

That Standing Rules of the American Physical Therapy Association, 18. Consent Calendar, D., be amended by striking out the word “section” after the word “chief,” so that it would read:









Proviso: These amendments to the bylaws and standing rules shall take effect at the close of business of the 2013 House of Delegates.

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SS: This motion contains 11 amendments (labeled as parts A-K) that propose changes to the structure of the House of Delegates.

These 11 amendments are being presented to the House via one RC as “conforming” motions, because all must be considered and adopted in order to avoid inconsistencies in APTA documents. If the House agrees with the concept that sections should be provided a vote or votes in the House, all of these motions must be considered and adopted in order to put this change into action.

These 11 amendments should be considered in the context of the overall proposal for House function that was part of the report of the Governance Proposal Board Work Group (GPBWG) to the November 2012 Board of Directors meeting.

The GPBWG was created in 2012 to focus on the portions of the governance review proposals that dealt with the House of Delegates structure and function. The GPBWG was composed of: Dave Pariser, chair; Cathy Ciolek (DE); Ira Gorman (CO); Jennifer Green-Wilson (NY); Laurie Hack (PA); Roger Herr (CA); Dianne Jewell (VA); Kathy Mairella (NJ); Kim Nixon-Cave (PA); Mary Sinnott (PA); Nicole Stout (MD); Cyndi Zadai (MA); and staff liaison Cheryl Robinson.

The work of the GPBWG began in June 2012 with a governance review dialogue session that enabled delegates to provide feedback on the proposals related to the House. During the session delegates submitted questions, concerns, and comments via index cards that the GPBWG used, along with oral comments and questions, as the basis for the 8 virtual town halls held throughout September and October. Approximately 150 individuals engaged in these town halls via conversation and typed chats, which were reviewed for consistent themes. Another avenue for feedback and dialogue was comment blogs made available to members. These efforts culminated in a survey forwarded to all members on October 15 and open through October 31, with 1,130 responses received.

To determine what would be proposed related to House structure and function, the GPBWG considered these data and the previous work of the Governance Review Task Force that included external benchmarking, wide-ranging data collection, work with expert consultants, and extensive member input. (See Governance Review Community).

Based on the premise that sections serve as the key resource for content knowledge and that chapters focus on jurisdictional scope of practice and payment issues, the GPBWG proposed that sections have a clearer voice in the deliberations of the House of Delegates by being provided the right to vote. As is explained below, after weighing all the information obtained from many sources, the best alternative was deemed to be a limited number of votes, rather than an allocation on par with the allocation to chapters. The proposed amendment is structured to provide delegates flexibility in determining the preferred number of section votes. Using this approach allows delegates to amend the number as they see fit between the current level and the proposed level, as is consistent with parliamentary procedure.

The following information, portions of which are extracted from the report of the GPBWG to the November 2012 Board of Directors meeting, provides context for how these motions support the overall concept related to House structure.

HOUSE CONSTITUENCY – WHO ARE THE PEOPLE IN THE ROOMOVERVIEWThe number of delegates that make up the voting members of the House of Delegates (House) will be based on, but not limited to, 420 (meaning that the total number of voting delegates could result

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in a number higher than 420 based on the apportionment formula, but could not fall below 420). Voting delegates will include chapters and sections. The Student Assembly will remain as is with 2 nonvoting delegates, and the PTA Caucus will remain as is with 5 nonvoting delegates.

The definition of assemblies will remain as is currently outlined within the APTA bylaws.

Parliamentary procedure dictates that the House may amend the delegate target number and section apportionment number down but may not amend it up. The proposed amendments are structured to make the highest number of options available to the House as it considers the section vote. Several examples have been appended to provide reference for how the chapter apportionment would change based on varying target numbers and different apportionment methods for sections.

Scenario A (Total delegate target 420; section delegates apportioned): Using the same membership numbers used to determine the 2013 apportionment, Scenario A illustrates how chapter apportionment would be impacted by subtracting from the target number of 420 the number of section voting delegates determined by the formula proposed via the amendments to Standing Rule 17. In this example, the number of section voting delegates is 66; the total number of chapter voting delegates is 356. In this scenario, each chapter will have a minimum of 2 delegates—some chapters will have no change, others will have a reduction of 1 delegate up to a maximum decrease of 4 delegates.

Scenario B (Total delegate target 400; section delegates apportioned):Using the same membership numbers used to determine the 2013 apportionment, Scenario B illustrates how chapter apportionment would be impacted by subtracting from the target number of 400 the number of section voting delegates determined by the formula proposed via the amendments to Standing Rule 17. In this example, the number of section voting delegates is 66; the total number chapter voting delegates is 338. In this scenario, each chapter will have a minimum of 2 delegates—some chapters will have no change, others will have a reduction of 1 delegate up to a maximum of 6 delegates.

Scenario C (Total delegate target 420; each section has 2 voting delegates):Using the same membership numbers used to determine the 2013 apportionment, Scenario C illustrates how chapter apportionment would be impacted by subtracting from the target number of 420 the number of section delegates determined by granting all sections 2 voting delegates. In this scenario, the number of section voting delegates is 36; the total number chapter voting delegates is 388. Each chapter will have a minimum of 2 delegates—some chapters will have no change, others will have a reduction of 1 delegate up to a maximum of 2 delegates.

Scenario D (Total delegate target 400; each section has 2 voting delegates):Using the same membership numbers used to determine the 2013 apportionment, Scenario D illustrates how chapter apportionment would be impacted by subtracting from the target number of 400 the number of section delegates determined by granting all sections 2 voting delegates. In this scenario, the number of section voting delegates is 36; the total number chapter voting delegates is 368. Each chapter will have a minimum of 2 delegates—some chapters will have no change, others will have a reduction of 1 delegate up to a maximum of 3 delegates.

Scenario E (Total delegate target 436; section delegates apportioned):

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Scenario E relates to RC 4B-13 proposed by the Florida Chapter. Although RC 4B-13 does not propose that section delegates be apportioned, this example is being provided to give delegates a broad understanding of the impact of all options. Using the same membership numbers used to determine the 2013 apportionment Scenario E illustrates how chapter apportionment would be impacted by subtracting from the target number of 436 the number of section voting delegates determined by the formula proposed via the amendments to Standing Rule 17. In this example, the number of section voting delegates is 66; the total number chapter voting delegates is 371. In this scenario, each chapter will have a minimum of 2 delegates—some chapters will have no change, others will have a reduction of 1 delegate up to a maximum of 3 delegates.

Scenario F (Total delegate target 436; each section has 2 voting delegtates):Scenario F relates to RC 4B-13 proposed by the Florida Chapter. Using the same membership numbers used to determine the 2013 apportionment, Scenario F subtracts from the target number of 436 the number of section delegates determined by granting all sections 2 voting delegates. In this scenario the total number of section voting delegates is 36; the total number of chapter voting delegates is 400. This scenario mirrors the current apportionment and therefore no table has been provided. The number of section voting delegates is 36; the total number chapter voting delegates is 400. Each chapter will have a minimum of 2 delegates.

BACKGROUNDThe original proposal for House constituency recommended a total of 350 voting delegates to include both chapter and section representation, and 50 nonvoting delegates to include permanent and rotating consultants. In an effort to balance regional representation and content expertise, the number of chapter voting delegates proposed was 250, and the number of section voting delegates was proposed at 100. Students and the PTA Caucus were to be added to the pool of permanent consultants, with both being represented by 2 nonvoting delegates. The group “caucus” was redefined and the PTA Caucus was to become an assembly. To align delegate terms with the House cycle, all terms would be 2 years in length and would start on January 1.

During the town halls, attendees explored the issue of granting a vote or votes to sections. The concerns expressed consistently centered on dual representation and the proportion of chapter voting delegates (250) to section voting delegates (100). Town hall conversation and results of the governance proposal survey reflect support for sections being granted a vote(s) in the House. When considering the number of section delegates that would be appropriate, the GPBWG heard the concerns raised and proposed sections having a vote in the House but at smaller numbers. The proposal offers flexibility to the House when deliberating on the final number.

Town hall attendees struggled with the concept of consultants—who those consultants would be, the number in attendance, and their role. There was little support for consultants from delegates that responded to the survey. Based on feedback received and due to the modified proposals being forwarded by the GPBWG relative to how the House does its work, the proposals related to consultants were not moved forward, and instead the current definition in the bylaws was left as is. [Note: The GPBWG was aware of, and in support of, an amendment being presented to add the American Council of Academic Physical Therapy to the consultant list. See RC 2-13]

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AFFE C T OF APPO R T I ONM E N T SCENARIO A ON C H A P T ERS Chapter 2013 Apportionment Apportionment

Total Voting Delegates: 420Voting Section Delegates: 66 (using formula) Voting Chapter Delegates: 356

Change toChapter(47 Total)

ALABAMA 3 3ALASKA 2 2ARIZONA 8 7 -1ARKANSAS 2 2CALIFORNIA 35 31 -4COLORADO 8 7 -1CONNECTICUT 6 5 -1DELAWARE 2 2DC 2 2FLORIDA 20 17 -3GEORGIA 8 7 -1HAWAII 2 2IDAHO 3 3ILLINOIS 19 17 -2INDIANA 7 6 -1IOWA 6 5 -1KANSAS 4 4KENTUCKY 6 5 -1LOUISIANA 5 5MAINE 3 2 -1MARYLAND 8 7 -1MASSACHUSETTS 10 9 -1MICHIGAN 13 12 -1MINNESOTA 9 8 -1MISSISSIPPI 3 3MISSOURI 8 7 -1MONTANA 3 3NEBRASKA 6 5 -1NEVADA 3 2 -1NEW HAMPSHIRE 3 2 -1NEW JERSEY 13 11 -2NEW MEXICO 2 2NEW YORK 27 23 -4NORTH CAROLINA 11 10 -1NORTH DAKOTA 2 2OHIO 13 11 -2OKLAHOMA 4 3 -1OREGON 7 6 -1PENNSYLVANIA 22 19 -3RHODE ISLAND 2 2SOUTH CAROLINA 5 4 -1SOUTH DAKOTA 2 2TENNESSEE 8 7 -1TEXAS 21 19 -2UTAH 4 4VERMONT 2 2VIRGINIA 12 10 -2WASHINGTON 14 13 -1WEST VIRGINIA 2 2WISCONSIN 11 10 -1WYOMING 2 2

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AFFE C T OF APPO R T I ONM E N T SCENARIO B ON C H A P T ERS Chapter 2013 Apportionment Apportionment

Total Voting Delegates: 400Voting Section Delegates: 66 (using formula) Voting Chapter Delegates: 338


ALABAMA 3 3ALASKA 2 2ARIZONA 8 7 -1ARKANSAS 2 2CALIFORNIA 35 29 -6COLORADO 8 7 -1CONNECTICUT 6 5 -1DELAWARE 2 2DC 2 2FLORIDA 20 16 -4GEORGIA 8 7 -1HAWAII 2 2IDAHO 3 3ILLINOIS 19 16 -3INDIANA 7 6 -1IOWA 6 5 -1KANSAS 4 4KENTUCKY 6 5 -1LOUISIANA 5 4 -1MAINE 3 2 -1MARYLAND 8 6 -2MASSACHUSETTS 10 9 -1MICHIGAN 13 11 -2MINNESOTA 9 7 -2MISSISSIPPI 3 2 -1MISSOURI 8 6 -2MONTANA 3 2 -1NEBRASKA 6 5 -1NEVADA 3 2 -1NEW HAMPSHIRE 3 2 -1NEW JERSEY 13 10 -3NEW MEXICO 2 2NEW YORK 27 22 -5NORTH CAROLINA 11 9 -2NORTH DAKOTA 2 2OHIO 13 11 -2OKLAHOMA 4 3 -1OREGON 7 6 -1PENNSYLVANIA 22 18 -4RHODE ISLAND 2 2SOUTH CAROLINA 5 4 -1SOUTH DAKOTA 2 2TENNESSEE 8 7 -1TEXAS 21 18 -3UTAH 4 4VERMONT 2 2VIRGINIA 12 10 -2WASHINGTON 14 12 -2WEST VIRGINIA 2 2WISCONSIN 11 9 -2WYOMING 2 2

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AFFE C T OF APPORTIONMENT SCENARIO C ON C H A P T ERS Chapter 2013 Apportionment Apportionment

Total Voting Delegates: 420Voting Section Delegates: 36 (2 per section) Voting Chapter Delegates: 388


ALABAMA 3 3ALASKA 2 2ARIZONA 8 8ARKANSAS 2 2CALIFORNIA 35 34 -1COLORADO 8 8CONNECTICUT 6 5 -1DELAWARE 2 2DC 2 2FLORIDA 20 19 -1GEORGIA 8 8HAWAII 2 2IDAHO 3 3ILLINOIS 19 18 -1INDIANA 7 7IOWA 6 5 -1KANSAS 4 4KENTUCKY 6 6LOUISIANA 5 5MAINE 3 3MARYLAND 8 7 -1MASSACHUSETTS 10 10MICHIGAN 13 13MINNESOTA 9 9MISSISSIPPI 3 3MISSOURI 8 7 -1MONTANA 3 3NEBRASKA 6 5 -1NEVADA 3 3NEW HAMPSHIRE 3 3NEW JERSEY 13 12 -1NEW MEXICO 2 2NEW YORK 27 25 -2NORTH CAROLINA 11 11NORTH DAKOTA 2 2OHIO 13 12 -1OKLAHOMA 4 4OREGON 7 7PENNSYLVANIA 22 21 -1RHODE ISLAND 2 2SOUTH CAROLINA 5 5SOUTH DAKOTA 2 2TENNESSEE 8 8TEXAS 21 20 -1UTAH 4 4VERMONT 2 2VIRGINIA 12 11 -1WASHINGTON 14 14WEST VIRGINIA 2 2WISCONSIN 11 11

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WYOMING 2 2AFFE C T OF APPO R T I ONM E N T SCENARIO D ON C H A P T ERS

Chapter 2013 Apportionment ApportionmentTotal Voting Delegates: 400Voting Section Delegates: 36 (2 per section) Voting Chapter Delegates: 368


ALABAMA 3 3ALASKA 2 2ARIZONA 8 7 -1ARKANSAS 2 2CALIFORNIA 35 32 -3COLORADO 8 8CONNECTICUT 6 5 -1DELAWARE 2 2DC 2 2FLORIDA 20 18 -2GEORGIA 8 8HAWAII 2 2IDAHO 3 3ILLINOIS 19 17 -2INDIANA 7 7IOWA 6 5 -1KANSAS 4 4KENTUCKY 6 5 -1LOUISIANA 5 5MAINE 3 2 -1MARYLAND 8 7 -1MASSACHUSETTS 10 9 -1MICHIGAN 13 12 -1MINNESOTA 9 8 -1MISSISSIPPI 3 3MISSOURI 8 7 -1MONTANA 3 3NEBRASKA 6 5 -1NEVADA 3 2 -1NEW HAMPSHIRE 3 2 -1NEW JERSEY 13 11 -2NEW MEXICO 2 2NEW YORK 27 24 -3NORTH CAROLINA 11 10 -1NORTH DAKOTA 2 2OHIO 13 12 -1OKLAHOMA 4 4OREGON 7 6 -1PENNSYLVANIA 22 20 -2RHODE ISLAND 2 2SOUTH CAROLINA 5 5SOUTH DAKOTA 2 2TENNESSEE 8 8TEXAS 21 19 -2UTAH 4 4VERMONT 2 2VIRGINIA 12 11 -1WASHINGTON 14 13 -1WEST VIRGINIA 2 2WISCONSIN 11 10 -1WYOMING 2 2

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AFFE C T OF APPO R T I ONM E N T SCENARIO E ON C H A P T ERS Chapter 2013 Apportionment Apportionment

Total Voting Delegates: 437Voting Section Delegates: 66 (using formula)Voting Chapter Delegates: 371

Loss to Chapter(32 Total)

ALABAMA 3 3ALASKA 2 2ARIZONA 8 7 -1ARKANSAS 2 2CALIFORNIA 35 32 -3COLORADO 8 8CONNECTICUT 6 5 -1DELAWARE 2 2DC 2 2FLORIDA 20 18 -2GEORGIA 8 8HAWAII 2 2IDAHO 3 3ILLINOIS 19 17 -2INDIANA 7 7IOWA 6 5 -1KANSAS 4 4KENTUCKY 6 5 -1LOUISIANA 5 5MAINE 3 2 -1MARYLAND 8 7 -1MASSACHUSETTS 10 10MICHIGAN 13 12 -1MINNESOTA 9 8 -1MISSISSIPPI 3 3MISSOURI 8 7 -1MONTANA 3 3NEBRASKA 6 5 -1NEVADA 3 2 -1NEW HAMPSHIRE 3 2 -1NEW JERSEY 13 12 -1NEW MEXICO 2 2NEW YORK 27 25 -2NORTH CAROLINA 11 10 -1NORTH DAKOTA 2 2OHIO 13 12 -1OKLAHOMA 4 4OREGON 7 6 -1PENNSYLVANIA 22 20 -2RHODE ISLAND 2 2SOUTH CAROLINA 5 5SOUTH DAKOTA 2 2TENNESSEE 8 8TEXAS 21 19 -2UTAH 4 4VERMONT 2 2VIRGINIA 12 11 -1WASHINGTON 14 13 -1WEST VIRGINIA 2 2WISCONSIN 11 10 -1WYOMING 2 2

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CURRENT BYLAW:

PART ABYLAWS OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION, ARTICLE IV. MEMBERSHIP, SECTION 2: RIGHTS AND PRIVILEGES OF MEMBERS, B., (2) TO VOTE, A.


* * *B. Only members in certain categories have the following privileges (subject to restriction as otherwise

provided in Association bylaws):* * *

(2) To vote.a. At House of Delegates meetings: Chapter delegates, 1 vote.

PART BBYLAWS OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION, ARTICLE IV. MEMBERSHIP, SECTION 2: RIGHTS AND PRIVILEGES OF MEMBERS, B., (4) TO SERVE AS A DELEGATE TO THE HOUSE OF DELEGATES, B.





Article VIII., Section 4., of these bylaws.d. As assembly delegate: Assembly member, subject to additional eligibility requirements in the

assembly bylaws.

PART CBYLAWS OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION, ARTICLE VII. MEETINGS, SECTION 3: NOTICE OF SESSIONS, A. ANNUAL SESSION



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PART DBYLAWS OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION, ARTICLE VIII. HOUSE OF DELEGATES OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION, SECTION 3: VOTING DELEGATES


The voting delegates of the House of Delegates shall be the chapter delegates.A. Qualifications of Voting Delegates

(1) Chapter delegates: Only Physical Therapist members may serve as chapter delegates. Only Physical Therapist members who have been Association members in good standing in any category of membership for no fewer than the 2 years immediately preceding the start of the House session may serve as chapter delegates.

(2) Members of the Board of Directors may not serve as chapter delegates.(3) A delegate of any one component may not serve concurrently as a delegate of

another component.B. Number of Voting Delegates

The number of chapter delegates shall be based on, but not limited to, 400, which shall be apportioned among the chapters on the basis of the number of Physical Therapist, Retired Physical Therapist, Life Physical Therapist, Physical Therapist Assistant, Retired Physical Therapist Assistant, and Life Physical Therapist Assistant members in each chapter according to membership records in the Association headquarters and as described in the standing rules. No chapter shall have fewer than 2 delegates.

C. Selection of Voting DelegatesEach chapter shall select the delegates who will represent it at the annual session. Each chapter shall designate 1 delegate as its chief delegate.


E. Voting BodyEach chapter delegate shall have 1 vote, except that if any of the delegates to which a chapter is entitled does not attend a meeting of the House of Delegates, the vote(s) may be transferred to the remaining member(s) of the delegation who are present.

PART EBYLAWS OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION, ARTICLE VIII. HOUSE OF DELEGATES OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION, SECTION 4: NONVOTING DELEGATES


The nonvoting delegates of the House of Delegates shall be the section delegates, PTA Caucus delegates, Student Assembly delegates, and the members of the Board of Directors.

A. Qualifications of Nonvoting Delegates(1) Section delegates: Only Physical Therapist and Physical Therapist Assistant members

may serve as section delegates. Only Physical Therapist and Physical Therapist Assistant members who have been Association members in good standing in any category of membership for no fewer than the 2 years immediately preceding the start of the House session may serve as section delegates.

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(2) PTA Caucus delegates: Only Physical Therapist Assistant members who have been Association members in good standing for no fewer than 2 years immediately preceding the start of the House session may serve as PTA Caucus delegates.

(3) Student Assembly delegates: Only Student Physical Therapist and Student Physical Therapist Assistant members who have been Association members in good standing for the 4 months immediately preceding the start of the House session may serve as Student Assembly delegates.

(4) Members of the Board of Directors may not serve as section or assembly delegates.(5) A section delegate or Student Assembly delegate may not serve concurrently as a

delegate of another component. A PTA Caucus delegate may not serve concurrently as a section delegate.

B. Number of Nonvoting Delegates(1) Section delegates: Each section shall be entitled to 1 delegate.(2) PTA Caucus delegates: The PTA Caucus shall be entitled to 5 delegates.(3) Student Assembly delegates: The Student Assembly shall be entitled to 2 delegates.

C. Selection of Nonvoting DelegatesEach section, the PTA Caucus, and the Student Assembly shall select the delegate(s) who will represent it at the House session.



PART FBYLAWS OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION, ARTICLE VIII. HOUSE OF DELEGATES OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION, SECTION 5: CONDUCT OF BUSINESS


A. Officers of the House of Delegates(1) The officers shall be the Speaker of the House of Delegates, the Vice Speaker of the

House of Delegates, and the Secretary.(2) The officers shall be responsible for registering delegates, transferring voting


B. QuorumDelegates representing one-third of the chapters and numbering one-third of the total number of chapter votes that could be cast if all delegates from all chapters were present shall constitute a quorum.

C. Voting(1) Voting on motions and resolutions in the House may be by voice, show of hands,

standing, roll call, or use of electronic equipment.(2) If a decision must be made during the interval between annual sessions, a majority

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vote of the Board of Directors may determine that the chapter delegates be polled by mail. These delegates shall be those registered at the immediately preceding session of the House of Delegates. If the delegate is no longer a member of the chapter or holds membership in a category other than that held when the delegate registered at the immediately preceding session of the House of Delegates or for any other reason no longer meets the qualifications for delegate, an alternate delegate shall be named by that chapter. At least 50 percent of the ballots of the eligible delegates must be returned to validate the vote.



PART GBYLAWS OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION, ARTICLE XIV. AMENDMENTS


These bylaws may be amended at the Annual Session of the House of Delegates in years ending in 0 and 5 by the affirmative vote of at least two-thirds of the chapter delegates present and voting, or at any special session of the House of Delegates or the Annual Session of the House of Delegates during years not ending in 0 or 5 by the consent to consider, without debate, of two-thirds of the chapter delegates present and voting and by the affirmative vote of at least two-thirds of the chapter delegates present and voting, providing the following:A. Any proposed amendment has been submitted in writing to the Association’s headquarters by a date set by

the Speaker of the House of Delegates, which shall be at least 4 months but no more than 5 months before the session of the House of Delegates.


Bylaw amendments pertaining to Article X: Finance, Section 3: Dues, may be amended at any Annual Session or special session of the House of Delegates by the affirmative vote of at least two-thirds of the chapter delegates present and voting, provided that the conditions of subparagraphs A and B above are satisfied.

PART HSTANDING RULES OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION, 10. DELEGATE CREDENTIALS


Component Delegates: Chapter delegate credentials shall be signed by the chapter president or the chapter chief delegate. The designation of chief delegate shall be indicated on the appropriate chapter credential. Section or assembly delegate credentials shall be signed by the section or assembly president.

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PART ISTANDING RULES OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION, 11. MAIL BALLOT

11. MAIL BALLOT

When the Board of Directors determines to conduct a mail ballot, according to Article VIII, Section 5., C., (2) of the bylaws, a ballot shall be prepared and distributed as follows:

A. The question to be decided and appropriate supporting information shall be provided with the ballot.

B. Instructions for completing and returning the ballot shall be printed on the ballot.C. The deadline for receipt of ballots at the Association's headquarters shall be printed on the

ballot, and this deadline shall be no fewer than 30 days after the date mailed to the delegates.


E. The ballots shall be mailed by first class mail to each chapter delegate.F. The delegate shall place the completed ballot in the plain envelope, place the plain envelope

in the envelope addressed to the Association's headquarters, sign the outside envelope, and mail it to Association headquarters.


PART JSTANDING RULES OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION, 17. FORMULA FOR DETERMINING THE SIZE OF THE HOUSE OF DELEGATES

17. FORMULA FOR DETERMINING THE SIZE OF THE HOUSE OF DELEGATES


(2) Divide the total found in Step 1 by 400. This shall be the apportionment number.(3) Divide the total number of Physical Therapist, Retired Physical Therapist, and Life Physical

Therapist members and one-half of the number of Physical Therapist Assistant, Retired Physical Therapist Assistant, and Life Physical Therapist Assistant members for each chapter by the apportionment number.



PART KSTANDING RULES OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION, 18. CONSENT CALENDAR, D.


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Component Contact: Gina M. Musolino, PT, MSEd, EdD, chief delegate, Florida ChapterPhone: 801/259-7007 E-mail: [email protected]



Staff Contact: Dena Kilgore, CAE, director, Component Governance and LeadershipPhone: 703/706-3285 E-mail: [email protected]

PROPOSED BY: FLORIDA CHAPTER

COSPONSORED BY:

RC 4B-13 AMEND: BYLAWS OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION AND STANDING RULES OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION TO ESTABLISH THE PRIVILEGE OF SECTION DELEGATES TO VOTE


Note: The differences between RC 4A-13 and RC 4B-13 are limited to Part D and Part J.

That Bylaws of the American Physical Therapy Association and Standing Rules of the American Physical Therapy Association be amended as follows to grant sections voting privileges in the House of Delegates:

PART A

That Bylaws of the American Physical Therapy Association, Article IV. Membership, Section 2: Rights and Privileges of Members, B., (2) To vote, a., be amended by inserting the words “and section delegates” after the word “delegates” so that it would read:




(2) To vote.a. At House of Delegates meetings: Chapter delegates and section delegates, 1 vote.

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PART B

That Bylaws of the American Physical Therapy Association, Article IV. Membership, Section 2: Rights and Privileges of Members, B., (4) To serve as a delegate to the House of Delegates, b., be amended by striking out the words “and Physical Therapist Assistant” so that it would read:





Article VIII., Section 4., of these bylaws.d. As assembly delegate: Assembly member, subject to additional eligibility requirements in

the assembly bylaws.

PART C

That Bylaws of the American Physical Therapy Association, Article VII. Meetings, Section 3: Notice of Sessions, A. Annual Session, be amended by striking out the word “chapter” after the words “to each” so that it would read:



PART D

That Bylaws of the American Physical Therapy Association, Article VIII. House of Delegates of the American Physical Therapy Association, Section 3: Voting Delegates, be amended by substitution:


The voting delegates of the House of Delegates shall be the chapter delegates and the section delegates.A. Qualifications of Voting Delegates

(1) Chapter delegates and section delegates: Only Physical Therapist members may serve as chapter delegates or section delegates. Only Physical Therapist members who have been Association members in good standing in any category of membership for no fewer than the 2 years immediately preceding

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the start of the House session may serve as chapter delegates or section delegates.

(2) Members of the Board of Directors may not serve as chapter delegates or section delegates.

(3) A delegate of any one component may not serve concurrently as a delegate of another component.

B. Number of Voting DelegatesThe number of chapter delegates shall be based on, but not limited to, 400, which shall be apportioned among the chapters on the basis of the number of Physical Therapist, Retired Physical Therapist, Life Physical Therapist, Physical Therapist Assistant, Retired Physical Therapist Assistant, and Life Physical Therapist Assistant members in each chapter according to membership records in the Association headquarters and as described in the standing rules. The number of each section’s delegates shall be based on its member count as determined according to the standing rules. The number of chapter delegates shall be based

on, but not limited to, a target number equal to 436 minus the number of section delegates. The number of each chapter’s delegates shall be based on its member count as determined according to the standing rules. No chapter or section shall have fewer than 2 delegates.

C. Selection of Voting DelegatesEach chapter and section shall select the delegates who will represent it at the annual session. Each chapter and section shall designate 1 delegate as its chief delegate.


E. Voting BodyEach chapter voting delegate shall have 1 vote, except that if any of the delegates to which a chapter or section is entitled does not attend a meeting of the House of Delegates, the vote(s) may be transferred to the remaining member(s) of the delegation who are present.

PART E

That Bylaws of the American Physical Therapy Association, Article VIII. House of Delegates of the American Physical Therapy Association, Section 4: Nonvoting Delegates, be amended by substitution:


The nonvoting delegates of the House of Delegates shall be the section delegates, PTA Caucus delegates, Student Assembly delegates, and the members of the Board of Directors.A. Qualifications of Nonvoting Delegates

(1) Section delegates: Only Physical Therapist and Physical Therapist Assistant members may serve as section delegates. Only Physical Therapist and Physical Therapist Assistant members who have been Association members in good standing in any category of membership for no fewer than the 2 years immediately preceding the start of the House session may serve as section delegates.

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(2 1) PTA Caucus delegates: Only Physical Therapist Assistant members who have been Association members in good standing for no fewer than 2 years immediately preceding the start of the House session may serve as PTA Caucus delegates.

(3 2) Student Assembly delegates: Only Student Physical Therapist and Student Physical Therapist Assistant members who have been Association members in good standing for the 4 months immediately preceding the start of the House session may serve as Student Assembly delegates.

(4 3) Members of the Board of Directors may not serve as section or assembly delegates.

(5) A section delegate or Student Assembly delegate may not serve concurrently as a delegate of another component. A PTA Caucus delegate may not serve concurrently as a section delegate.

B. Number of Nonvoting Delegates(1) Section delegates: Each section shall be entitled to 1 delegate.(2 1) PTA Caucus delegates: The PTA Caucus shall be entitled to 5 delegates.(3 2) Student Assembly delegates: The Student Assembly shall be entitled to 2

delegates.C. Selection of Nonvoting Delegates

Each section, the Each of the PTA Caucus, and the Student Assembly shall select the delegate(s) who will represent it at the House session.



PART F

That Bylaws of the American Physical Therapy Association, Article VIII. House of Delegates of the American Physical Therapy Association, Section 5: Conduct of Business, be amended by substitution:


A. Officers of the House of Delegates(1) The officers shall be the Speaker of the House of Delegates, the Vice Speaker

of the House of Delegates, and the Secretary.(2) The officers shall be responsible for registering delegates, transferring voting


B. QuorumDelegates representing one-third of the chapters and one-third of the sections and numbering one-third of the total number of chapter votes that could be cast if all

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voting delegates from all chapters were present shall constitute a quorum.C. Voting

(1) Voting on motions and resolutions in the House may be by voice, show of hands, standing, roll call, or use of electronic equipment.

(2) If a decision must be made during the interval between annual sessions, a majority vote of the Board of Directors may determine that the voting chapter delegates be polled by mail. These delegates shall be those registered at the immediately preceding session of the House of Delegates. If the delegate is no longer a member of the chapter or section or holds membership in a category other than that held when the delegate registered at the immediately preceding session of the House of Delegates or for any other reason no longer meets the qualifications for delegate, an alternate delegate shall be named by that chapter or section. At least 50 percent of the ballots of the eligible delegates must be returned to validate the vote.



PART G

That Bylaws of the American Physical Therapy Association, Article XIV. Amendments, be amended by substitution:


These bylaws may be amended at the Annual Session of the House of Delegates in years ending in 0 and 5 by the affirmative vote of at least two-thirds of the chaptervoting delegates present and voting, or at any special session of the House of Delegates or the Annual Session of the House of Delegates during years not ending in 0 or 5 by the consent to consider, without debate, of two-thirds of the chapter voting delegates present and voting and by the affirmative vote of at least two-thirds of the chapter voting delegates present and voting, providing the following:A. Any proposed amendment has been submitted in writing to the Association’s headquarters by a

date set by the Speaker of the House of Delegates, which shall be at least 4 months but no more than 5 months before the session of the House of Delegates.


Bylaw amendments pertaining to Article X: Finance, Section 3: Dues, may be amended at any Annual Session or special session of the House of Delegates by the affirmative vote of at least two-thirds of the chapter voting delegates present and voting, provided that the conditions of subparagraphs A and B above are satisfied.

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PART H

That Standing Rules of the American Physical Therapy Association, 10. Delegate Credentials, be amended by substitution:


Component Delegates: Chapter or section delegate credentials shall be signed by the chapter or section president or the chapter or section chief delegate. The designation of chief delegate shall be indicated on the appropriate chapter or section credential. Section or aAssembly delegate credentials shall be signed by the section or assembly president.

PART I

That Standing Rules of the American Physical Therapy Association, 11. Mail Ballot, be amended by substitution:

11. MAIL BALLOT

When the Board of Directors determines to conduct a mail ballot, according to Article VIII, Section 5., C., (2) of the bylaws, a ballot shall be prepared and distributed as follows:A. The question to be decided and appropriate supporting information shall be provided with the ballot.B. Instructions for completing and returning the ballot shall be printed on the ballot.C. The deadline for receipt of ballots at the Association's headquarters shall be printed on the ballot, and

this deadline shall be no fewer than 30 days after the date mailed to the delegates to all voting delegates.


E. The ballots shall be mailed by first class mail to each chapter voting delegate.F. The voting delegate shall place the completed ballot in the plain envelope, place the plain envelope in

the envelope addressed to the Association's headquarters, sign the outside envelope, and mail it to Association headquarters.


PART J

That Standing Rules of the American Physical Therapy Association, 17. Formula for Determining the Size of the House of Delegates, be retitled and amended by substitution:

17. FORMULA FOR DETERMINING THE SIZE OF THE THE NUMBER OF VOTING DELEGATES TO THE HOUSE OF DELEGATES


(2) Divide the total found in Step 1 by 400. This shall be the apportionment number.(3) Divide the total number of Physical Therapist, Retired Physical Therapist, and Life Physical Therapist

members and one-half of the number of Physical Therapist Assistant, Retired Physical Therapist Assistant, and Life Physical Therapist Assistant members for each chapter by the apportionment

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number.(4) Chapters shall be allowed one delegate for each whole number and one additional delegate for any

remainder equaling or exceeding 50 percent of the apportionment number.(5) Any chapter that would be entitled to fewer than 2 delegates according to the above shall be allowed

2 delegates.A. For each year the number of voting delegates in the House of Delegates shall be the sum of the

section delegates and the chapter delegates, as determined in accordance with this Standing Rule.B. For the purpose of determining the number of voting delegates to the House of Delegates for any

year, the member count of each chapter shall be determined by adding the number of its Physical Therapist, Retired Physical Therapist, and Life Physical Therapist members and one-half of the number of its Physical Therapist Assistant, Retired Physical Therapist Assistant, and Life Physical Therapist Assistant members as of June 30 of the preceding year.

C. Each section shall be entitled to 2 delegates. D. The chapter delegate target shall be the difference between 436 and the number of section

delegates.E. The number of delegates to which each chapter is entitled shall be determined as follows:

(1) Add the member counts of all chapters and divide the sum by the chapter delegate target. This quotient shall be the chapter apportionment number.

(2) For each chapter, divide its member count by the chapter apportionment number. The chapter shall be allowed the number of delegates obtained by rounding this quotient to the nearest whole number, except that each chapter shall be allowed at least 2 delegates.

PART K

That Standing Rules of the American Physical Therapy Association, 18. Consent Calendar, D., be amended by striking out the word “section” after the word “chief,” so that it would read:









Proviso: These amendments to the bylaws and standing rules shall take effect at the close of business of the 2013 House of Delegates.

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SS: Raising the target number for the House of Delegates to 436 provides each of the sections 2 voting delegates without Chapters losing any voting delegates of current apportionment. The Sections serve a different purpose than Chapters and therefore Sections should not have representation by apportionment, as this is already duplicative in the current House of Delegates Chapter apportionments. If a vote for each of the 18 special interest Sections is desired, equating to the least Chapter apportionment is most appropriate, two (2) maximum.

The APTA House of Delegates is a policy-making body of the association comprised of chapter voting delegates and section, assembly and PTA Caucus non-voting delegates and consultants. At present, the number of voting delegates is determined each year based on membership numbers within the 51 Chapters operating in the United States and its territories, as of June 30, annually. The 18 special interest Sections of the APTA have maintained a long standing and influential voice in the APTA House of Delegates, exercising all delegate rights, except for the opportunity to vote. The 18 special interest Sections include, Acute Care, Aquatic Physical Therapy, Cardiovascular and Pulmonary, Clinical Electrophysiology and Wound Management, Education, Federal Physical Therapy, Geriatrics, Hand Rehabilitation, Health Policy and Administration, Home Health, Neurology, Oncology, Orthopaedic, Pediatrics, Private Practice, Research, Sports Physical Therapy and Women’s Health.

Congruent with the APTA Strategic Plan, providing each Section with a vote is inclusive of all stakeholders, relative to the multi-faceted decision-making that occurs within the APTA House of Delegates. The Sections have indicated a ‘vote for the voice’ is of importance. Chapters have clearly indicated that the representative apportionment vote for the Chapters should not be altered in this member-driven association, and Chapters should not lose any representative voice. Altering the current apportionment may adversely impact Chapters in terms of membership. The Sections serve a different purpose than Chapters and therefore Sections should not have representation by apportionment, as this is already duplicative in the current House of Delegates Chapter apportionments. If a vote for each of the 18 special interest Sections is desired, equating to the least Chapter apportionment is most appropriate, two (2) maximum. An increase in the target number for the House of Delegates to 436 provides for 2 voting delegates for each of the 18 sections; while Chapters retain apportionment.

2013 APTA STRATEGIC PLAN ASSOCIATION PURPOSE The American Physical Therapy Association (Association) exists to improve the health and quality of life of individuals in society by advancing physical therapist practice. ASSOCIATION ORGANIZATIONAL VALUES Association members and staff working on behalf of the Association…

are committed to excellence in practice, education, research and advocacy; respect the dignity and differences of all individuals and commit to being a culturally competent and

socially responsible association; lead with professionalism, integrity, and honesty; and, make decisions that reflect visionary thinking, innovation, collaboration, and accountability

EFFECTIVENESS OF CARE Goal 1: APTA will better enable physical therapists to consistently use best practice to improve the quality of life of their patients and clients. Objectives:

a. Increase the number of peer-reviewed clinical practice guidelines (CPGs). b. Increase practitioner use of and adherence to best practice guidelines to reduce unwarranted variation in care and enhance patient and client outcomes. c. Develop and integrate available patient data registries, including quality measures. d. Explore alternative and innovative models of care delivery. e. Promote the use of valid measures.

PATIENT- AND CLIENT-CENTERED CARE ACROSS THE LIFESPAN

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Goal 2: APTA will be the recognized leader in supporting physical therapists in the delivery of patient- and client-centered care across the lifespan. Objectives:

a. Increase the prevalence of physical therapists providing prevention (primary, secondary, tertiary) and wellness services. b. Promote implementation of innovative models of practice that target patient- and client-centered care. c. Develop mechanisms to identify, prioritize, and address existing and emerging population-based health needs that will impact physical therapy. d. Identify and address physical therapy supply and demand work force needs. PROFESSIONAL GROWTH AND DEVELOPMENT

Goal 3: APTA will empower physical therapists to demonstrate and promote high standards of professional and intellectual excellence. Objectives:

a. Model and promote key values and behaviors that embrace professionalism. b. Explore and adopt innovative active learning opportunities that will enhance individual and collective abilities to provide optimal, collaborative patient- and client-centered care. c. Investigate the appropriate educational program(s) for the PTA. d. Demonstrate and promote interprofessional and intraprofessional collaboration.

VALUE AND ACCOUNTABILITY Goal 4: APTA will be the recognized leader in setting the standards for physical therapy service delivery and establishing and promoting the value of physical therapist practice to all stakeholders. Objectives:

a. Advocate for appropriate administrative, legislative, and regulatory policies that demonstrate value, ensure safe and effective delivery, enhance access, and protect the integrity of the health care system. b. Improve compliance with regulations, laws, and professional standards. c. Advance payment systems that recognize the severity of patient condition and the intensity of interventions required; reflect the clinical reasoning, judgment, and decision-making of the physical therapist; and appropriately pay for the value of the services. d. Define, advocate, and promote the role of the physical therapist in innovative and collaborative delivery models.

CURRENT BYLAW:

PART ABYLAWS OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION, ARTICLE IV. MEMBERSHIP, SECTION 2: RIGHTS AND PRIVILEGES OF MEMBERS, B., (2) TO VOTE, A.




(2) To vote.a. At House of Delegates meetings: Chapter delegates, 1 vote.

PART BBYLAWS OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION, ARTICLE IV. MEMBERSHIP, SECTION 2: RIGHTS

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AND PRIVILEGES OF MEMBERS, B., (4) TO SERVE AS A DELEGATE TO THE HOUSE OF DELEGATES, B.





Article VIII., Section 4., of these bylaws.d. As assembly delegate: Assembly member, subject to additional eligibility requirements in the

assembly bylaws.

PART CBYLAWS OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION, ARTICLE VII. MEETINGS, SECTION 3: NOTICE OF SESSIONS, A. ANNUAL SESSION



PART DBYLAWS OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION, ARTICLE VIII. HOUSE OF DELEGATES OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION, SECTION 3: VOTING DELEGATES


The voting delegates of the House of Delegates shall be the chapter delegates.A. Qualifications of Voting Delegates

(1) Chapter delegates: Only Physical Therapist members may serve as chapter delegates. Only Physical Therapist members who have been Association members in good standing in any category of membership for no fewer than the 2 years immediately preceding the start of the House session may serve as chapter delegates.

(2) Members of the Board of Directors may not serve as chapter delegates.(3) A delegate of any one component may not serve concurrently as a delegate of

another component.B. Number of Voting Delegates

The number of chapter delegates shall be based on, but not limited to, 400, which shall be apportioned among the chapters on the basis of the number of Physical Therapist, Retired Physical Therapist, Life Physical Therapist, Physical Therapist Assistant, Retired

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Physical Therapist Assistant, and Life Physical Therapist Assistant members in each chapter according to membership records in the Association headquarters and as described in the standing rules. No chapter shall have fewer than 2 delegates.

C. Selection of Voting DelegatesEach chapter shall select the delegates who will represent it at the annual session. Each chapter shall designate 1 delegate as its chief delegate.


E. Voting BodyEach chapter delegate shall have 1 vote, except that if any of the delegates to which a chapter is entitled does not attend a meeting of the House of Delegates, the vote(s) may be transferred to the remaining member(s) of the delegation who are present.

PART EBYLAWS OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION, ARTICLE VIII. HOUSE OF DELEGATES OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION, SECTION 4: NONVOTING DELEGATES


The nonvoting delegates of the House of Delegates shall be the section delegates, PTA Caucus delegates, Student Assembly delegates, and the members of the Board of Directors.

A. Qualifications of Nonvoting Delegates(1) Section delegates: Only Physical Therapist and Physical Therapist Assistant members

may serve as section delegates. Only Physical Therapist and Physical Therapist Assistant members who have been Association members in good standing in any category of membership for no fewer than the 2 years immediately preceding the start of the House session may serve as section delegates.

(2) PTA Caucus delegates: Only Physical Therapist Assistant members who have been Association members in good standing for no fewer than 2 years immediately preceding the start of the House session may serve as PTA Caucus delegates.

(3) Student Assembly delegates: Only Student Physical Therapist and Student Physical Therapist Assistant members who have been Association members in good standing for the 4 months immediately preceding the start of the House session may serve as Student Assembly delegates.

(4) Members of the Board of Directors may not serve as section or assembly delegates.(5) A section delegate or Student Assembly delegate may not serve concurrently as a

delegate of another component. A PTA Caucus delegate may not serve concurrently as a section delegate.

B. Number of Nonvoting Delegates(1) Section delegates: Each section shall be entitled to 1 delegate.(2) PTA Caucus delegates: The PTA Caucus shall be entitled to 5 delegates.(3) Student Assembly delegates: The Student Assembly shall be entitled to 2 delegates.

C. Selection of Nonvoting DelegatesEach section, the PTA Caucus, and the Student Assembly shall select the delegate(s) who will represent it at the House session.

D. CredentialsCredentials shall be issued by the Association. Delegates shall register and file

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credentials before the first meeting of the House of Delegates and at such other times as designated by the Officers of the House of Delegates.


PART FBYLAWS OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION, ARTICLE VIII. HOUSE OF DELEGATES OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION, SECTION 5: CONDUCT OF BUSINESS


A. Officers of the House of Delegates(1) The officers shall be the Speaker of the House of Delegates, the Vice Speaker of the

House of Delegates, and the Secretary.(2) The officers shall be responsible for registering delegates, transferring voting


B. QuorumDelegates representing one-third of the chapters and numbering one-third of the total number of chapter votes that could be cast if all delegates from all chapters were present shall constitute a quorum.

C. Voting(1) Voting on motions and resolutions in the House may be by voice, show of hands,

standing, roll call, or use of electronic equipment.(2) If a decision must be made during the interval between annual sessions, a majority

vote of the Board of Directors may determine that the chapter delegates be polled by mail. These delegates shall be those registered at the immediately preceding session of the House of Delegates. If the delegate is no longer a member of the chapter or holds membership in a category other than that held when the delegate registered at the immediately preceding session of the House of Delegates or for any other reason no longer meets the qualifications for delegate, an alternate delegate shall be named by that chapter. At least 50 percent of the ballots of the eligible delegates must be returned to validate the vote.



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PART GBYLAWS OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION, ARTICLE XIV. AMENDMENTS


These bylaws may be amended at the Annual Session of the House of Delegates in years ending in 0 and 5 by the affirmative vote of at least two-thirds of the chapter delegates present and voting, or at any special session of the House of Delegates or the Annual Session of the House of Delegates during years not ending in 0 or 5 by the consent to consider, without debate, of two-thirds of the chapter delegates present and voting and by the affirmative vote of at least two-thirds of the chapter delegates present and voting, providing the following:A. Any proposed amendment has been submitted in writing to the Association’s headquarters by a date set by

the Speaker of the House of Delegates, which shall be at least 4 months but no more than 5 months before the session of the House of Delegates.


Bylaw amendments pertaining to Article X: Finance, Section 3: Dues, may be amended at any Annual Session or special session of the House of Delegates by the affirmative vote of at least two-thirds of the chapter delegates present and voting, provided that the conditions of subparagraphs A and B above are satisfied.

PART HSTANDING RULES OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION, 10. DELEGATE CREDENTIALS


Component Delegates: Chapter delegate credentials shall be signed by the chapter president or the chapter chief delegate. The designation of chief delegate shall be indicated on the appropriate chapter credential. Section or assembly delegate credentials shall be signed by the section or assembly president.

PART ISTANDING RULES OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION, 11. MAIL BALLOT

11. MAIL BALLOT

When the Board of Directors determines to conduct a mail ballot, according to Article VIII, Section 5., C., (2) of the bylaws, a ballot shall be prepared and distributed as follows:

A. The question to be decided and appropriate supporting information shall be provided with the ballot.

B. Instructions for completing and returning the ballot shall be printed on the ballot.C. The deadline for receipt of ballots at the Association's headquarters shall be printed on the ballot,

and this deadline shall be no fewer than 30 days after the date mailed to the delegates.D. An addressed envelope (to the Association's headquarters) and a plain envelope shall be included in

the mailing.E. The ballots shall be mailed by first class mail to each chapter delegate.F. The delegate shall place the completed ballot in the plain envelope, place the plain envelope in the

envelope addressed to the Association's headquarters, sign the outside envelope, and mail it to Association headquarters.

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PART JSTANDING RULES OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION, 17. FORMULA FOR DETERMINING THE SIZE OF THE HOUSE OF DELEGATES

17. FORMULA FOR DETERMINING THE SIZE OF THE HOUSE OF DELEGATES


(2) Divide the total found in Step 1 by 400. This shall be the apportionment number.(3) Divide the total number of Physical Therapist, Retired Physical Therapist, and Life Physical Therapist

members and one-half of the number of Physical Therapist Assistant, Retired Physical Therapist Assistant, and Life Physical Therapist Assistant members for each chapter by the apportionment number.



PART KSTANDING RULES OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION, 18. CONSENT CALENDAR, D.









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Board Contact: Mary C. Sinnott, PT, DPT, MEdPhone: 610/304-5911 E-mail: [email protected]


Staff Contact: Cheryl Robinson, director, National Governance and LeadershipPhone: 703/706-3392 E-mail: [email protected]


COSPONSORED BY:

RC 5-13 AMEND: BYLAWS OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION, ARTICLE IX. BOARD OF DIRECTORS OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION, SECTION 4: TENURE

That Bylaws of the American Physical Therapy Association, Article IX. Board of Directors of the American Physical Therapy Association, Section 4: Tenure, be amended by inserting a new A., and re-lettering the remaining letters appropriately:

Section 4: Tenure

A. The members of the Board of Directors shall be divided into 3 classes, which shall be equal in size or as nearly equal as possible. Each class will include one-third or approximately one-third of the members who are not officers, plus two officers. The Secretary and the Vice Speaker of the House of Delegates shall belong to the first class, which shall be elected in years that are multiples of 3. The Treasurer and the Speaker of the House of Delegates shall belong to the second class, which shall be elected the year after the first class. The President and the Vice President shall belong to the third class, which shall be elected the year after the second class.

A B. Members of the Board of Directors shall assume office at the close of the annual session of the House of Delegates at which they were elected.

B C. The term of office of each member of the Board of Directors shall be 3 years or until their successors are elected.

C D. No member shall serve more than 3 complete consecutive terms on the Board of Directors or more than 2 complete consecutive terms in the same office.

D E. A complete term for a member of the Board of Directors shall be defined as 3 years.E F. Vacancies

In the event that a position on the Board of Directors becomes vacant, the vacancy shall be filled in the manner prescribed in the standing rules. (Exceptions: President and Speaker of the House of Delegates.)


SS: This motion, RC 5-13 Amend: Bylaws of the American Physical Therapy Association, Article IX. Board of Directors of the American Physical Therapy Association, Section 4: Tenure, relates specifically to the division of Board classes for each election cycle. APTA’s practice has been to stagger the terms of the Board of Directors, with 5 of the 15 members elected each year. The purpose of this new clause “A.” to

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Section 4 is to make explicit APTA’s longstanding practice; it does not change the current practice. This change in language is appropriate because the applicable Illinois corporation statute calls for directors to be elected annually unless the bylaws prescribe staggered terms. See 805 ILCS 105/108.10(c) and (e). Specifying that the classes must be equal in size or as nearly equal in size as possible, rather than inserting specific numbers, would accommodate the Board’s current size (15) as well as a different size. Changes proposed to the House of Delegates (House) structure and processes include increasing the APTA Board of Directors from 15 to 17. If the House were to increase the size of the Board to 17 members, the classes would have 6, 6, and 5 members rather than 5, 5, and 7 or some other less evenly distributed combination.

CURRENT BYLAW:BYLAWS OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION, ARTICLE IX. BOARD OF DIRECTORS OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION, SECTION 4: TENURE

Section 4: TenureA. Members of the Board of Directors shall assume office at the close of the annual session of the

House of Delegates at which they were elected.B. The term of office of each member of the Board of Directors shall be 3 years or until their

successors are elected.C. No member shall serve more than 3 complete consecutive terms on the Board of Directors or

more than 2 complete consecutive terms in the same office.D. A complete term for a member of the Board of Directors shall be defined as 3 years.E. Vacancies

In the event that a position on the Board of Directors becomes vacant, the vacancy shall be filled in the manner prescribed in the standing rules. (Exceptions: President and Speaker of the House of Delegates.)

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Board Contact: Mary C. Sinnott, PT, DPT, MEdPhone: 610/304-5911 E-mail: [email protected]




COSPONSORED BY:

RC 6-13 AMEND: BYLAWS OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION, ARTICLE IX. BOARD OF DIRECTORS OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION, SECTION 1: COMPOSITION

That Bylaws of the American Physical Therapy Association, Article IX. Board of Directors of the American Physical Therapy Association, Section 1: Composition, be amended by substitution:


A. Board of Directors of the American Physical Therapy AssociationThe 6 officers of the Association together with 9 11 directors shall constitute the Board of Directors.

B. Executive CommitteeThe Executive Committee shall consist of the President, Vice President, Secretary, Treasurer, and 1 of the 9 11 directors. This fifth member shall be elected to the Executive Committee annually by members of the Board of Directors who are not members of the Executive Committee.

Proviso: These amendments to the bylaws shall go into effect as follows: 1 additional director, for a total of 4, will be elected in 2014; 1 additional director, for a total of 4, will be elected in 2015.

SS: This motion relates specifically to increasing the number of directors on the APTA Board of Directors (Board) from the current 9 to 11. This change would increase the total number of Board members from 15 to 17. An increase in Board size was proposed by the subgroup of the Governance Review Task Force that was assigned to look specifically at the Board of Directors. The subgroup used many data sources, including surveys of former Board members , that demonstrated the workload of the Board has increased. In addition, the subgroup acknowledged that this increase is commensurate with the responsibility of oversight for a $40,000,000 organization. The Governance Proposals Board Work Group also supported an increase in Board size to help ensure that the workload of the Board would be more equitable and manageable.

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CURRENT BYLAW:BYLAWS OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION, ARTICLE IX. BOARD OF DIRECTORS OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION, SECTION 1: COMPOSITION


A. Board of Directors of the American Physical Therapy AssociationThe 6 officers of the Association together with 9 directors shall constitute the Board of Directors.

B. Executive CommitteeThe Executive Committee shall consist of the President, Vice President, Secretary, Treasurer, and 1 of the 9 directors. This fifth member shall be elected to the Executive Committee annually by members of the Board of Directors who are not members of the Executive Committee.

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Board Contact: Stephen M. Levine, PT, DPT, MSHAPhone: 954/745-7907 E-mail: [email protected]


Staff Contact: John J. Bennett, JD, sr. director/general counsel, Legal AffairsPhone: 703/706-3107 E-mail: [email protected]


COSPONSORED BY:

RC 7-13 AMEND: BYLAWS OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION, ARTICLE VIII. HOUSE OF DELEGATES OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION, SECTION 1: GENERAL POWERS

That Bylaws of the American Physical Therapy Association, Article VIII. House of Delegates of the American Physical Therapy Association, Section 1: General Powers, be retitled and amended by substitution:

ARTICLE VIII. HOUSE OF DELEGATES OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION

Section 1: General Powers

The House of Delegates of the American Physical Therapy Association has all legislative and elective powers and authority to determine policies elect the Board of Directors and the Association, including the power Nominating Committee; to:A. Amend amend and repeal these bylaws;B. Amend , and to amend , suspend, or rescind the standing rules;C. Adopt. The House of Delegates has authority, subject to the Board’s authority to manage the

affairs of the Association, to determine directives and policies of the Association, including the authority to adopt ethical principles and standards to govern the conduct of members of the Association in their roles as physical therapists or physical therapist assistants; and. The House of Delegates may modify or reverse a determination made by the Board of Directors subject to the Board’s authority to manage the affairs of the Association pursuant to its authority under these bylaws to determine directives and policies of the Association.

D. Modify or reverse a decision of the Board of Directors.

*Note: Due to the conversion of this language from a bulleted list to a paragraph format, the following is being provided to assist with readability:

The House of Delegates of the American Physical Therapy Association has all legislative and elective powers and authority to determine policies elect the Board of Directors and the Association, including the power Nominating Committee; to amend and repeal these bylaws; and to amend, suspend, or rescind the standing rules;. The House of Delegates has authority, subject to the Board’s authority to manage the affairs of the Association, to determine directives and policies of the Association, including the authority to adopt ethical principles and standards to govern the conduct of members of the Association in their roles as physical therapists or physical therapist assistants. The House of Delegates

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may modify or reverse a determination made by the Board of Directors subject to the Board’s authority to manage the affairs of the Association pursuant to its authority under these bylaws to determine directives and policies of the Association.D. Modify or reverse a decision of the Board of Directors.

SS: This motion would amend the statement of the authority of the House of Delegates in Article VIII of the bylaws. It is a companion to RC 8-13, which would amend the statement of the authority of the Board of Directors in Article IX of the bylaws. This support statement addresses both motions.

The Association is organized under the Illinois General Not For Profit Corporation Act of 1986 (the Act or GNPCA). The authority of the Board and the House depends on the interplay among the Act, APTA’s Articles of Incorporation, and APTA’s bylaws. The primary source of the Board’s authority is the Act. The Act does not address the House, which derives its authority from the bylaws. The Articles of Incorporation, as recently amended by the Board, provide that the Board “shall manage the Association in compliance with the provisions of the bylaws of the Association.” The 2 motions amend the bylaws in ways designed to clarify the roles played by the House and the Board.

With regard to the authority of the House, the motions are largely a restatement of the current bylaws, except as indicated below.

The current bylaws give the House “elective powers,” which refers to the authority to elect the Board of Directors and the Nominating Committee. The current bylaws also give the House “legislative” powers and the authority to determine “policies.” The bylaws explain that this legislative or policy-making authority includes the power to adopt and change the bylaws, the standing rules, and the ethical codes for physical therapists and physical therapist assistants. The grant of policy-making authority also includes the power to “modify or reverse a decision of the Board of Directors,” language that both (a) recognizes the Board’s policy-making role and (b) establishes the House’s primacy with respect to policy-making.

The motion amending Article VIII follows the current bylaws in giving the House (i) authority to elect the members of the Board and the Nominating Committee and (ii) control over the bylaws, the standing rules, and the ethical codes. In addition, the motion continues to give the House the authority to modify or reverse a policy decision made by the Board.

The principal difference between the current bylaws and the motion is that the motion gives the House the authority to determine “directives”1 of the Association in addition to “policies.” As explained below, the motion to amend Article IX provides that the Board “shall implement” House-adopted “directives.” The intent of granting the House authority to issue directives is to make explicit that the House may make decisions concerning APTA’s use of its human and financial resources, subject, of course, to the Board’s fiduciary duty of care.

1 The term “directive” is both undefined and new to the APTA bylaws. That is, it is not used elsewhere in the bylaws, so APTA has not had occasion over the years to give the term a practical interpretation. The Merriam-Webster online definition is: “something that serves to direct, guide, and usually impel toward an action or goal; especially: an authoritative instrument issued by a high-level body or official.” It give 2 examples of the use of the term:

• They received a written directive instructing them to develop new security measures.• <the company president regularly issues directives intended for all staff members>

See http://www.merriam-webster.com/dictionary/directive.

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With regard to the Board, the motions clarify that its authority depends on both the Act and the bylaws. The Act provides that, except as provided in the Articles of Incorporation, a corporation’s affairs “shall be managed by or under the direction of the Board of Directors.” 805 ILCS 105/108.05(a). The members of the Board owe a fiduciary duty to the Association to manage its affairs carefully, and they can be held personally liable for a failure to live up to this fiduciary duty of care.

The House in 2012 adopted RC 17-12, which called upon the Board to amend the Association’s Articles of Incorporation so that they “reflect the Board’s duty to manage APTA in compliance with the bylaws.” (HOD 06-12-14-11). The Board amended Paragraph 3 of the Articles of Incorporation to say:

The Board of Directors shall manage the Association in compliance with the provisions of the bylaws of the Association (BOD 01-13-19-04).

The motion follows the Act in specifying that the Board shall “manage or direct the management of the Association and the conduct of its affairs.” The motion also makes explicit that, in managing APTA’s affairs, the Board shall “implement the directives and policies” adopted by the House, unless it determines that doing so in a particular case would be “inadvisable.” The Board thus has a responsibility to carry out House-adopted directives and policies while at the same time retaining its fiduciary duty to manage the Association’s affairs with care.

The language added to Article IX elaborates on the Board’s responsibilities with regard to managing APTA’s affairs, making policy on matters the House has not addressed, establishing priorities for the utilization of the Association’s resources, and developing strategy.

The current bylaws contain a rather lengthy list of duties, many of which do not need to be stated in corporate bylaws. The motion’s elimination of these items is not intended to suggest that the Board lacks authority with respect to the matters involved, but rather that these responsibilities, and others that may not be listed, are typically not detailed in bylaws.

CURRENT BYLAW:BYLAWS OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION, ARTICLE VIII. HOUSE OF DELEGATES OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION, SECTION 1: GENERAL POWERS

Section 1: General PowersThe House of Delegates of the American Physical Therapy Association has all legislative and elective powers and authority to determine policies of the Association, including the power to:A. Amend and repeal these bylaws;B. Amend, suspend, or rescind the standing rules;C. Adopt ethical principles and standards to govern the conduct of members of the Association in

their roles as physical therapists or physical therapist assistants; andD. Modify or reverse a decision of the Board of Directors.

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Board Contact: Stephen M. Levine, PT, DPT, MSHAPhone: 954/745-7907 E-mail: [email protected]


Staff Contact: John J. Bennett, JD, sr. director/general counsel, Legal AffairsPhone: 703/706-3107 E-mail: [email protected]


COSPONSORED BY:

RC 8-13 AMEND: BYLAWS OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION, ARTICLE IX. BOARD OF DIRECTORS OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION, SECTION 5: DUTIES

That Bylaws of the American Physical Therapy Association, Article IX. Board of Directors of the American Physical Therapy Association, Section 5: Duties, be retitled and amended by substitution:

Section 5: Duties Responsibilities

The Board of Directors shall, in In addition to the duties otherwise responsibilities conferred or imposed upon the Board of Directors by law, including the authority to manage the affairs of the Association, and by other provisions of these bylaws and the standing rules:, the Board of Directors shall have the following responsibilities:

A. Carry out the mandates and policies of the Association as determined by the House of DelegatesThe Board shall manage or direct the management of the Association’s property and the conduct of its affairs, work, and activities. In doing so, the Board shall implement the directives and policies of the Association unless the Board determines that implementation of a specific directive or policy is inadvisable, in which case the Board shall report to the House of Delegates the reasons for its determination.

B. Between sessions of the House of Delegates , the Board of Directors may make and enforce such policy on behalf of the Association as is not inconsistent with the mandates and policies determined by the House of Delegates and in the absence of specifically applicable House policy, the Board shall determine the Association’s policy. In doing so, the Board shall take into account directives and policies previously passed by the House. The House thereafter may overturn, modify, or adopt the policy, or take no action, as it deems appropriate.

C. The Board shall act as the Association’s planning body. It shall exercise decision-making authority over developing the Association’s strategy and establishing priorities for the utilization of its resources. In exercising this authority the Board shall take into account the directives and policies passed by the House of Delegates.

D. The Board shall review all resolutions adopted by the House of Delegates to determine how best to carry out its responsibilities for managing or directing the management of the

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Association’s property and the conduct of its affairs, work, and activities, for developing the Association’s strategy, and for establishing priorities for the utilization of its resources.

E. The Board shall:

B 1. Direct all business and financial affairs for and on behalf of the Association, be responsible for all of its property and funds, and provide Provide for an annual audit by a certified public accountant.

C. Foster the growth and development of the Association.D. Provide for the maintenance of a headquarters of the Association and assume

responsibility for personnel policies.E 2. Appoint and employ a chief executive officer who shall be the administrator of the

headquarters and who shall be responsible to the Board of Directors.F. Provide for bonding of all persons handling money or other property of the

Association.G 3. Prescribe and publish with these bylaws the qualifications for each category of

individual membership and provide for appropriate action on all applications for membership.

H 4. Be responsible for filling Fill vacancies on the Board of Directors and on committees, except as otherwise provided in these bylaws and in the standing rules.

I 5. Be responsible for creation, appointment, purposes, and activities of Create and appoint such committees as it deems necessary and prescribe the purposes and activities of such committees.

J. Be responsible for the creation of and facilitation of activities of such councils as it deems necessary.

K. Be responsible for the program, time, and place of the annual conference of the Association.

L. Be responsible for publication of the official journal of the Association.M. Provide for development and maintenance of procedural documents related to these

bylaws.N 6. Approve the procedure by which reported violations of Adopt procedures for

processing charges that a member has violated the ethical principles and standards of the Association are to be processed.

O. Review and revise existing Association policies, except in these bylaws, for consistency of intent and language with such new policies as may be adopted from time to time by the House of Delegates.

SS: Please refer to the support statement for RC 7-13.

CURRENT BYLAW:BYLAWS OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION, ARTICLE IX. BOARD OF DIRECTORS OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION, SECTION 5: DUTIES

Section 5: DutiesThe Board of Directors shall, in addition to the duties otherwise imposed by these bylaws and the standing rules:A. Carry out the mandates and policies of the Association as determined by the House of

Delegates. Between sessions of the House of Delegates, the Board of Directors may make and

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enforce such policy on behalf of the Association as is not inconsistent with the mandates and policies determined by the House of Delegates.

B. Direct all business and financial affairs for and on behalf of the Association, be responsible for all of its property and funds, and provide for an annual audit by a certified public accountant.

C. Foster the growth and development of the Association.D. Provide for the maintenance of a headquarters of the Association and assume responsibility for

personnel policies.E. Appoint and employ a chief executive officer who shall be the administrator of the headquarters

and who shall be responsible to the Board of Directors.F. Provide for bonding of all persons handling money or other property of the Association.G. Prescribe and publish with these bylaws the qualifications for each category of individual

membership and provide for appropriate action on all applications for membership.H. Be responsible for filling vacancies on the Board of Directors and on committees, except as

otherwise provided in these bylaws and in the standing rules.I. Be responsible for creation, appointment, purposes, and activities of such committees as it

deems necessary.J. Be responsible for the creation of and facilitation of activities of such councils as it deems

necessary.K. Be responsible for the program, time, and place of the annual conference of the Association.L. Be responsible for publication of the official journal of the Association.M. Provide for development and maintenance of procedural documents related to these bylaws.N. Approve the procedure by which reported violations of the ethical principles and standards of

the Association are to be processed.O. Review and revise existing Association policies, except in these bylaws, for consistency of intent

and language with such new policies as may be adopted from time to time by the House of Delegates.

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RC Contact: Michael A. Pagliarulo, PT, MA, EdDPhone: 503/516-9592 E-mail: [email protected]



COSPONSORED BY:

RC 9-13 AMEND: BYLAWS OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION TO REVISE THE COMPOSITION OF THE REFERENCE COMMITTEE AND ITS ROLE AS HOUSE CONSULTANT


That Bylaws of the American Physical Therapy Association be amended as follows to revise the composition of the Reference Committee and its role as House consultant:

PART A

That Bylaws of the American Physical Therapy Association, Article X. Committees and Councils, Section 2: Committees of the House of Delegates, B. Reference Committee, be amended by substitution:

Section 2: Committees of the House of Delegates* * *

B. Reference Committee(1) This committee shall consist of the officers of the House of Delegates and at least 3

Physical Therapist members appointed by the officers of the House of Delegates. The Speaker of the House of Delegates shall serve as an ex officio member.

(2) Members The members appointed by the officers of the House of Delegates shall serve 3-year terms with at least one member being appointed each year.

PART B

That Bylaws of the American Physical Therapy Association, Article VIII. House of Delegates of the American Physical Therapy Association, Section 2: Composition, B. Consultants, be amended by inserting the words “appointed” after the word “all” so that it would read:

Section 2: Composition* * *

B. Consultants

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Consultants shall include all appointed members of the Reference Committee, a member of the Ethics and Judicial Committee, a member of the American Board of Physical Therapy Specialties, and Association staff designated by the Chief Executive Officer in consultation with the Board of Directors. All consultants shall be available in the House of Delegates to reply to inquiries as directed by the Speaker of the House of Delegates.

SS: Four motions (RC 9-13, RC 10-13, RC 11-13, RC 13-13) propose changes to the function of the House of Delegates. Together, these 4 motions support the overall concept related to House function and should be considered in the context of the overall proposal for House function that was part of the report of the Governance Proposal Board Work Group (GPBWG) to the November 2012 Board of Directors meeting (Report of the GPBWG). These proposed bylaw amendments: (1) clarify the composition of the Reference Committee to include all House officers and clarify its role as House consultant (RC 9-13); (2) add to the Reference Committee role the review of APTA bylaws (RC 10-13); (3) establish main motion criteria to guide the work of the Reference Committee (RC 11-13); and (4) align the delegate roster deadline with the House cycle (RC 13-13). While these elements require approval by the House, the remaining portions of the description provided in the Integrated Concept Support Statement overviews below can be implemented as part of the normal business of managing the House, and as such will be taken under consideration by the House officers as they continue their assigned work to develop best practices for the House. The Integrated Concept Support Statement is intended to inform all 4 motions and is referred to in the individual supports statements of those motions.

This motion, RC 9-13 Amend: Bylaws of the American Physical Therapy Association, Article X. Committees and Councils, Section 2: Committees of the House of Delegates, B. Reference Committee, relates specifically to the composition of the Reference Committee. This motion proposes that the 3 House officers serve as members of the committee, rather than the Secretary and Vice Speaker serving as consultants and the Speaker of the House serving as an ex-officio member. This more accurately reflects the evolving role of the Reference Committee and the current type of interaction between the Reference Committee and the House officers. Additionally, it clarifies the role of the House officers in the appointment of committee members, a clarification that is consistent with current procedure. There is no change proposed to the minimum number of members serving on the Reference Committee, allowing the House officers to continue to select the number of members needed to conduct the business of the House.

Integrated Concept Support Statement

The GPBWG was created in 2012 to focus on the portions of the governance review proposals that dealt with the House of Delegates structure and function. The GPBWG was composed of: Dave Pariser, chair; Cathy Ciolek (DE); Ira Gorman (CO); Jennifer Green-Wilson (NY); Laurie Hack (PA); Roger Herr (CA); Dianne Jewell (VA); Kathy Mairella (NJ); Kim Nixon-Cave (PA); Mary Sinnott (PA); Nicole Stout (MD); Cyndi Zadai (MA); and staff liaison Cheryl Robinson.

The work of the GPBWG began in June 2012 with a governance review dialogue session that enabled delegates to provide feedback on the proposals related to the House. During the session delegates submitted questions, concerns, and comments via index cards that the GPBWG used, along with oral comments and questions, as the basis for the 8 virtual town halls held throughout September and October. Approximately 150 individuals engaged in these town halls via conversation and typed chats, which were reviewed for consistent themes. Another avenue for feedback and dialogue was comment

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blogs made available to members. These efforts culminated in a survey forwarded to all members on October 15 and open through October 31, with 1,130 responses received.

To determine what would be proposed related to House structure and function, the GPBWG considered these data and the previous work of the Governance Review Task Force that included external benchmarking, wide-ranging data collection, work with expert consultants, and extensive member input. (See Governance Review Community).

The following information, portions of which are extracted from the report of the GPBWG to the November 2012 Board of Directors meeting, provides context for how RC 9-13, RC 10-13, RC 11-13, and RC 13-13 support the overall concept related to House function.

HOUSE PROCESS – WORK OF THE HOUSEOVERVIEWThe House of Delegates will continue to meet annually in person immediately prior to the start of the APTA Conference and Exposition. The concept of an additional virtual meeting of the House will continue to be explored with House delegates in an effort to better define the purpose and format for such a meeting.

In addition to the traditional main motions forwarded for House consideration, the Reference Committee will identify complex key issues from input provided by members at various forums held in the summer. To inform the discussion, a collaboration of delegates, additional content experts as needed, and APTA staff will write concept papers on these issues. The Reference Committee and House Officers will lead virtual town halls throughout the year. At any time throughout the year delegates will be encouraged to join a town hall and discuss motion concepts and motion language; however, the focus of the fall town halls likely will be discussion of the complex key issues. The concept papers for the key issues will be updated with additional information gleaned from town hall discussions and will be made available to members in January so that main motions may be developed on the topic in time to meet the main motion deadline for that year’s House. The House will continue to conduct business via the introduction of main motions. As is current procedure, all main motions forwarded to the House will require review by the Reference Committee. The number of committee members will increase from 5 total (4 members appointed by the House officers and the Speaker as ex-officio) to 9 total (6 APTA members serving 3-year terms appointed by the House officers using the APTA Volunteer Interest Pool, and, if adopted by the House, the 3 House officers as ex-officio members). A contracted parliamentarian will continue to serve as consultant. The increase is proposed to accommodate the addition of year-round virtual town halls, the role the Reference Committee will play in the review of APTA bylaws (if adopted), and the oversight role it will have in developing concept papers for complex key issues and developing background papers for all main motions, which are written collaboratively by APTA staff, the motion maker, and additional content experts as needed.

New main motion criteria (if adopted) will help guide the Reference Committee in its deliberations. The criteria will not be related to content but rather will outline the process motion makers should follow to have their motion placed on the House agenda. The criteria will ensure that each motion has been vetted appropriately and that motion makers have done due diligence in researching their concept and providing the background necessary to hold high-quality discussion on the floor of the House. Motions not meeting the criteria will be placed at the end of the agenda and require a vote of the House to

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consider whether it will hear the motion. (See Appendix A for the guidelines currently used by the Reference Committee.)

The proposed calendar of activities for a House cycle is as follows (see Appendix B for the detailed calendar):

Summer: During the summer, the Reference Committee receives information from a variety of forums (member forums, regional caucus meetings, delegate caucuses). The apportionment for the next House is shared with components, and delegate rosters are due August 30.

Fall: The Reference Committee reviews the information received from forums and identifies complex key issues facing the profession. The committee facilitates the development of concept papers for these issues, which are created collaboratively between delegates, additional content experts as necessary, and APTA staff. With the concept papers to inform the discussion, the committee leads virtual town halls that allow delegates to fully explore these issues. The virtual town halls also provide delegations the time to share other motion concepts in order to collect feedback and input from House colleagues.

Winter:Concept papers are revised with additional information gleaned from the virtual town halls and are made available to members so that motions may be developed in time to meet the main motion deadline. Additionally, draft motion language for all other topics discussed in the fall may be submitted for review by the Reference Committee. All main motions will be due by a date specified within the APTA standing rules.

Spring:Motion language is made available to all members. Virtual town halls continue throughout the spring to help delegations fully understand each motion concept and to help the motion makers refine motion language to be considered by the House.

June:The House of Delegates meets to deliberate all main motions and make decisions on the issues brought forward for consideration.

BACKGROUNDThe original House proposal indicated that the House would meet twice per year; once in person and once virtually. During its onsite meeting the House, which would be organized by House content teams, would hold high-level discussions on several topics predetermined by a Resolutions Committee. The topics would be explored onsite via roundtable discussion and reported out to all delegates. The Resolutions Committee would then correlate all information and, after the House had adjourned, develop main motions based on the data collected and conversation that occurred at the House. Delegates would then vote on motions electronically after the House.

Over the course of the town halls, it became clear that members did not support a House under which delegates organized into content teams to discuss issues at roundtable discussions voting electronically on motions after the House had adjourned. Members find high value in meeting in person to debate policy language and felt much would be lost by not being able to interact in this way. Concern was also expressed about a Resolutions Committee that had the authority to prevent a motion from being forwarded to the House. After examining the survey data and considering feedback from the town halls and comment blogs, it is recommended that the Reference Committee remain in place and, due to increased workload with the addition of year-round virtual meetings, be increased in size from 5 (4

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members appointed by the House officers and the Speaker serving as ex-officio) to 9 (6 members appointed by the House officers and the 3 House officers serving in ex-officio roles). Although the Reference Committee will be guided by House-adopted process-based criteria when reviewing motions to determine if and how they come forward to the House, it will not be within the purview of the committee to prevent a motion from being heard at the House based on content.

Town hall attendees and survey respondents indicated interest in holding a second virtual House each year; however, it was not clear that all were interpreting the virtual House the same way. Because of the interest expressed in this additional meeting, this element will continue to be explored with delegates to see what the format for such a meeting could be.

Support was expressed for the discussion of high-level complex issues facing the profession. Based on data received, a model that will enable House delegates to have virtual in-depth discussion on high-level topics before developing motions for House consideration is being proposed. The town halls, which will not be mandatory, will also allow time for components to discuss other motion concepts being considered in order to obtain feedback and insight from House colleagues.

Much conversation occurred about the development of background papers. The feedback received indicated that delegates find the papers written by staff to be valuable in their decision making but did not feel that the burden of creating the papers should fall solely on APTA staff. Members felt strongly that it should be a collaborative effort between the motion maker, additional content experts as appropriate, and APTA staff.

HOUSE PROCESS – COMPOSITION AND FUNCTION OF REFERENCE COMMITTEEOVERVIEWAs stated above, the number of Reference Committee members will increase to 9. The Reference Committee will continue to fulfill its role as is currently defined within the Standing Rules of the American Physical Therapy Association, 14. Reference Committee. In addition to what is currently outlined within the standing rules, the Reference Committee will receive, correlate, synthesize, and coordinate ideas from member forums, regional caucuses, delegate caucuses, members, and component leaders to identify key issues to be presented and discussed via virtual town halls in the fall. The committee will facilitate the development of concept papers for key issues as well as background papers for all main motions. Additionally, the committee will review the APTA bylaws and offer amendments for House consideration (if adopted).

To assist in its deliberations, the Reference Committee will be guided by the criteria for review of main motions (if adopted by the House as a standing rule) as described above. The criteria are not related to content but rather outline the process motion makers shall follow to have their motions placed on the initial House agenda for consideration.

BACKGROUNDThe GPBWG, as part of its exploration of the House proposals, gathered feedback related to the proposed Resolutions Committee, whose function would have been to gather input from various forums and members and funnel these issues to the appropriate group (House, Board, components). The Resolutions Committee would have had the authority to determine the 2-3 issues to be discussed by the House in any given year. To balance this authority, a reconsideration process for Resolutions Committee decisions was recommended. The composition of the Resolutions Committee was proposed to be 14 members total—8 selected by delegates from the House and House content teams and the remaining 6

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to be the 3 House officers and 3 non-officer members of the APTA Board of Directors. Following the roundtable discussions and reporting of those discussions by House delegates, the Resolutions Committee would have considered the data and draft motions to be voted on electronically by delegates after the House. Additionally, the committee would have been responsible for reviewing and offering amendments to the APTA bylaws.

Town hall attendees consistently expressed concern about the proposed Resolutions Committee. Members were particularly apprehensive about the authority of the committee, that too few people would control the flow of information, the proportion of members to APTA Board members on the committee, and the threshold for reconsideration of a topic that had not been forwarded to the House. Survey data supports that members feel that all motions within the object or function of the Association should come forward to the House. Survey data did not support the proposed composition for the Resolutions Committee but did support the committee regularly reviewing the APTA bylaws and forwarding proposed bylaw amendments to the House.

After consideration of all data and discussion about the House process, the proposal related to the Resolutions Committee did not move forward, but a proposed change to the role and function of the current Reference Committee is moving forward. Due to increased workload with the addition of year-round virtual meetings, oversight of background papers and concept papers, and review of the APTA bylaws, it is proposed that the Reference Committee be increased from 5 members to 9 members.

The concept of the development of criteria to guide the Reference Committee originated with motions to the House in 2007 that were withdrawn. The House officers received support from delegates that these criteria would be helpful, and since that time the Reference Committee has used the criteria to inform its work. The suggestion of House-adopted criteria surfaced again during town hall discussion and via the comment blog. The GPBWG finds value in this suggestion and is moving it forward as part of this proposal.

APPENDIX A: GUIDELINES FOR MOTION DEVELOPMENTBased on the request of Chief, Section, and Assembly delegates, the Reference Committee has used these guidelines since 2007 to assist delegates in the development of main motions. These guidelines were used as the building block to develop the main motion criteria proposed via RC 11-13.

HOUSE OF DELEGATES MOTION DEVELOPMENT FORM

In order to most effectively use the allocated time and resources prior to and during the House of Delegates (House) for efficient debate and decision making, motions that are brought to the House should be well thought out, researched, and of national scope and importance. This Motion Development Form has been created to provide a way for delegations to begin a dialogue about their concept with other delegations and the Reference Committee. Delegations are strongly encouraged to consider the format below in order to assist the House to most efficiently facilitate debate.

STEP 1: PROVIDE CONTACT INFORMATION

1. Provide the name of the component proposing this motion concept:

2. Provide the name of the individual who will be the contact for this motion concept; this person will be the decision maker:

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3. Provide contact information for the individual who will be the contact for this motion concept:Please provide a phone number and email address that may be used by the Reference Committee to contact you during its spring meeting and onsite during CSM and the House of Delegates; cell phone numbers are highly recommended for contact during the CSM and House of Delegates meeting.

STEP 2: DESCRIBE CONCEPT/OUTCOME/BUDGET

1. Please indicate the concept for this motion:

2. Please indicate what you would like to accomplish by forwarding this motion to the House:

3. Please provide the pros and cons should this motion be adopted; be as objective as possible:

4. BUDGET IMPLICATIONSTo the best of your knowledge, please indicate below what you think it will cost to implement this concept:

$0 - $9,999 $10,000 - $49,999 $50,000 - $999,999 $100,000 +

STEP 3: DEVELOP SUPPORT STATEMENT FOR MOTION

1. THERE SHOULD BE EVIDENCE THAT THE MOTION IS OF NATIONAL SCOPE OR IMPORTANCE: Have you identified the relevance of this concept to the profession? Have you indicated the relationship to APTA Vision Statement for Physical Therapy 2020

and/or Association goals? Have you discussed this concept with other components and if so, is there support from

three or more components as evidenced by sponsorship/co-sponsorship? Have you referenced other associations or agencies that have identified similar issues?

2. MOTIONS AND ACCOMPANYING SUPPORT STATEMENTS SHOULD DEMONSTRATE ADEQUATE BACKGROUND RESEARCH OF THE ISSUE, WHICH CAN BE ACHIEVED THROUGH THE FOLLOWING RESEARCH AND ACTIVITY:

Have you searched the APTA Web site to identify relevant APTA House of Delegates and/or Board of Directors positions, standards, guidelines, policies, procedures, core documents, and/or white papers?

Have you contacted relevant APTA *Staff or your component’s Board Liaison to identify current Association activities related to the concept?

Have you considered inclusion of the physical therapist assistant or other stakeholders when appropriate?

Have you identified previous relevant debate and discussion within Association or component forums?

Have you identified other relevant House of Delegates motions that were defeated or not heard?

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Have you identified any relevant Federal law/regulation? Have you identified all other relevant information on the topic?

*Please identify which APTA staff have been contacted and what expectations you have of the staff.

3. DETERMINE PROBABLE FISCAL IMPACT OF ADOPTING THE MOTION Have you identified budget implications, including amount and relevant description of

calculation methods? Have you provided a rationale for budget implications? Have you identified financial resources currently being allocated to related activities?

STEP 4: SHARE YOUR MOTION CONCEPT WITH OTHERS.

COMPONENTS SHOULD ENSURE ADEQUATE DISSEMINATION OF THE MOTION CONCEPT TO FACILITATE PROFESSIONAL COMMENT, WHICH CAN BE DEMONSTRATED BY: Have you enlisted the support of the majority of the sponsoring component’s delegation or

membership indicating that the issue be heard by the House? Has this concept been discussed at regional caucus meetings? Has this concept been published through an established Association mechanism (i.e. discussion

board)? Have you discussed this concept with other components?

STEP 5: COMPLETE THE MAIN MOTION or BYLAW TEMPLATE [ATTACHED]

APPENDIX B: CALENDAR OF HOUSE ACTIVITIESJune:

House of Delegates adjourns Open discussion begins on issues to come forward in next cycle and beyond Board of Directors holds member forums on issues for next cycle, plus other topics

June–July: Delegate and regional caucus meetings identify issues for next cycle Board of Directors holds virtual member forums on issues for next cycle, plus other topics

July: Apportionment for next House is made available

August: August 30 is deadline for submission of delegate rosters for next House

September: Issues forwarded to Reference Committee from many inputs (House discussion, member

forums, delegate and regional caucus meetings, Board)October:

Reference Committee identifies complex key issues for the House and begins development of concept papers with delegates, content experts as needed, and APTA staff

Reference Committee sends ideas from delegations and regional caucuses that are related to Association management to the Board of Directors

October–December:

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Reference Committee leads virtual town Halls led for in-depth discussion on the complex key issues and for delegations to discuss motion concepts

Board holds virtual member forums on issues being discussed in delegate meetings, issues for next cycle, plus other topics

January: Concept papers are updated with information from fall town halls and made available for the

generation of motions Draft motions or motion concepts are submitted

February: Board holds virtual member forums on issues for next cycle, plus other topics

January–May: Virtual town halls are held to refine motion language based on understanding of the issues Board holds virtual member forums on issues for next cycle, plus other topics

April: Final motions on major issues, as well as more focused issues, are submitted

June: House of Delegates meets to deliberate and decide

CURRENT BYLAW:

PART ABYLAWS OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION, ARTICLE X. COMMITTEES AND COUNCILS, SECTION 2: COMMITTEES OF THE HOUSE OF DELEGATES, B. REFERENCE COMMITTEE

Section 2: Committees of the House of Delegates* * *

B. Reference Committee(1) This committee shall consist of at least 3 Physical Therapist members appointed by the

officers of the House of Delegates. The Speaker of the House of Delegates shall serve as an ex officio member.

(2) Members shall serve 3-year terms with at least one member being appointed each year.

PART BBYLAWS OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION, ARTICLE VIII. HOUSE OF DELEGATES OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION, SECTION 2: COMPOSITION, B. CONSULTANTS

SECTION 2: COMPOSITION

B. ConsultantsConsultants shall include all members of the Reference Committee, a member of the Ethics and Judicial Committee, a member of the American Board of Physical Therapy Specialties, and Association staff designated by the Chief Executive Officer in consultation with the Board of Directors. All consultants shall be available in the House of Delegates to reply to inquiries as directed by the Speaker of the House of Delegates.

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Required for Adoption: Majority Vote Category: 2G





COSPONSORED BY:

RC 10-13 AMEND: STANDING RULES OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION, 14. REFERENCE COMMITTEE

That Standing Rules of the American Physical Therapy Association, 14. Reference Committee, be amended by substitution:




C. The committee will review main motions that are submitted by the established deadline and in the manner prescribed in the standing rule titled Main Motion Criteria.

CD. Members Appointed members of the committee other than the Speaker of the House of Delegates shall be seated in the House of Delegates and shall reply to inquiries directed to the committee by the Speaker of the House.

E. On a regular basis the committee will review the Association bylaws and standing rules and, as it deems appropriate, propose to the Board of Directors that it bring amendments to the House of Delegates for consideration.

SS: Four motions (RC 9-13, RC 10-13, RC 11-13, RC 13-13) propose changes to the function of the House of Delegates. Together, these 4 motions support the overall concept related to House function and should be considered in the context of the overall proposal for House function that was part of the report of the Governance Proposal Board Work Group (GPBWG) to the November 2012 Board of Directors meeting (Report of the GPBWG ). These proposed bylaw amendments: (1) clarify the composition of the Reference Committee to include all House officers and clarify its role as House consultant (RC 9-13); (2) add to the Reference Committee role the review of APTA bylaws (RC 10-13); (3) establish main motion criteria to guide the work of the Reference Committee (RC 11-13); and (4) align the delegate roster deadline with the House cycle (RC 13-13).

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This motion, RC 10-13 Amend: Standing Rules of the American Physical Therapy Association, Standing Rule 14. Reference Committee, relates specifically to role of the Reference Committee. This motion proposes that the Reference Committee use the main motion criteria, proposed via RC 11-13, to guide in its review of main motions. This formalizes processes already used by the Reference Committee in working with makers of motions. The motion also adds to the role of the committee regular review of APTA bylaws and standing rules, a role not defined formally elsewhere. (Please see the Integrated Concept Support Statement in RC 9-13 to read more about how this motion supports the overall concept related to House function.)

RELATIONSHIP TO APTA VISION 2020: Professionalism

CURRENT POSITION/STANDARD/GUIDELINE/POLICY/PROCEDURE:STANDING RULES OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION, 14. REFERENCE COMMITTEE




C. Members of the committee other than the Speaker of the House of Delegates shall be seated in the House of Delegates and shall reply to inquiries directed to the committee by the Speaker of the House.

RELATED POSITION/ STANDARD/GUIDELINE/POLICY/PROCEDURE : NONE

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COSPONSORED BY:

RC 11-13 AMEND: STANDING RULES OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION, INSERT NEW STANDING RULE TITLED MAIN MOTION CRITERIA

That Standing Rules of the American Physical Therapy Association be amended by inserting a new Standing Rule 15. and renumbering the remaining standing rules appropriately.

15. MAIN MOTION CRITERIA

All main motions submitted by the established deadline shall meet the following criteria.

It is the responsibility of the maker of the motion to:

(1) Provide a statement of the intended outcome of the motion.

(2) Demonstrate that the motion’s subject is national in scope or importance.

(3) Provide essential background information, including (a) a description of previous House, Board, or staff activity relating to the subject and (b) an identification of the stakeholders affected by the motion.

(4) Demonstrate that the motion concept has been disseminated to delegates of other delegations prior to the deadline for submission of main motions.

(5) Provide a description of the potential fiscal impact of adopting and implementing the motion.

Unless the Reference Committee determines all criteria have been met, the motion shall be placed at the end of the agenda of the House of Delegates and shall not be considered unless a majority of the delegates vote, without debate, to consider the motion. The Reference Committee shall develop and make available to the delegates guidance designed to help delegates satisfy the foregoing criteria.


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SS: Four motions (RC 9-13, RC 10-13, RC 11-13, RC 13-13) propose changes to the function of the House of Delegates. Together, these 4 motions support the overall concept related to House function and should be considered in the context of the overall proposal for House function that was part of the report of the Governance Proposal Board Work Group (GPBWG) to the November 2012 Board of Directors’ meeting (Report of the GPBWG). These proposed bylaw amendments: (1) clarify the composition of the Reference Committee to include all House officers and clarify its role as House consultant (RC 9-13); (2) add to the Reference Committee role the review of APTA bylaws (RC 10-13); (3) establish main motion criteria to guide the work of the Reference Committee (RC 11-13); and (4) align the delegate roster deadline with the House cycle (RC 13-13).

This motion, RC 11-13 Amend: Standing Rules of the American Physical Therapy Association, Insert New Standing Rule Titled Main Motion Criteria, proposes main motion criteria for consideration by the House of Delegates that will guide the work of the Reference Committee. The proposed criteria will affect the process for submitting a motion but not the specific motion content. Adoption of these criteria will ensure that each motion has been vetted appropriately and that motion makers have done due diligence in researching their concept and providing the background necessary to hold high-quality discussion during the House. Adoption of these criteria will support the Reference Committee in its work and allows the House to choose whether to consider motions that have not met the criteria. (Please see the Integrated Concept Support Statement in RC 9-13 to read more about how this motion supports the overall concept related to House function.)

RELATIONSHIP TO APTA VISION 2020:Professionalism

CURRENT POSITION/STANDARD/GUIDELINE/POLICY/PROCEDURE: NONE


OTHER RELEVANT INFORMATION:STANDING RULES OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION, 14. REFERENCE COMMITTEE

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Component Contact: Gina M. Musolino, PT, MSEd, EdD, chief delegate, Florida ChapterPhone: 801/259-7007 E-mail: [email protected]




PROPOSED BY: FLORIDA CHAPTER

RC 12-13 AMEND: STANDING RULES OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION, INSERT NEW STANDING RULE ENTITLED BACKGROUND PAPER DEVELOPMENT

That Standing Rules of the American Physical Therapy Association be amended by inserting a new Standing Rule after the standing rule titled “Deadline for Main Motions” and renumbering the remaining standing rules appropriately.

BACKGROUND PAPER DEVELOPMENT

A. The Reference Committee shall review proposed main motions submitted by the established deadline and make recommendations to the Board of Directors as to which motions require background papers to assist the delegates with their deliberations and decisions.

B. In response to proposed motions to the House of Delegates, Background Papers shall be written by staff when charged to do so by the Board of Directors, or when staff, in consultation with the Chief Executive Officer, determines that a Background Paper is warranted.

C. As Background Papers are developed, authors of the Background Papers shall consult the maker of the motion in order to gather necessary information to ensure a comprehensive approach to the Background Papers.

D. Background papers shall be released at least 1 month prior to the House of Delegates

SS: In 1999, Arizona and Georgia brought forward a motion Development of Briefing Papers to expand the then current board briefing papers that were essentially notes from staff on motions with background information that would assist the Board in making decisions on motions brought to the House. One of the key proposals of the 1999 motion was for briefing paper authors to contact the maker of the motion. The House voted to refer this motion to the Board, which passed it as a policy in June 1999 and revised it several times, most recently in 2009:BOD Y09-01-01-01Staff background papers in response to proposed motions to the HOD will be written when staff is charged to do so by the BOD, or when staff, in consultation with the CEO, determines that a staff briefing paper is warranted.

The current policy contains no reference to contacting the maker of the motion, which was a primary focus in the original motion presented by Arizona and Georgia. We believe this communication is important and that the maker of the motion should be able to provide input to the draft background papers prior to publication.

For the background papers to be most effective, they should be completed at least 1 month prior to the House, to best inform the delegates’ decision-making.

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CURRENT POSITION/STANDARD/GUIDELINE/POLICY/PROCEDURE: BACKGROUND PAPER DEVELOPMENT (BOD Y09-09-07-08)

Staff Background Papers in response to proposed motions to the House of Delegates will be written when staff is charged to do so by the Board of Directors, or when staff, in consultation with the Chief Executive Officer, determines that a staff background paper is warranted.


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COSPONSORED BY:

RC 13-13 AMEND: STANDING RULES OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION, 9. COMPONENT DELEGATES

That Standing Rules of the American Physical Therapy Association, 9. Component Delegates, be amended by substitution and retitled:

9. DELEGATE ROSTER

All components and the PTA Caucus shall provide Association headquarters with the names, postal addresses, telephone numbers, all addresses for electronic telecommunications, and terms of its delegates, chief delegate, and alternate delegates no later than January 1 August 30 of each year, with additions and changes sent within 2 weeks of their selection no later than 30 days prior to the start of the House of Delegates. Those components whose delegates have terms of office greater than 1 year shall confirm the information on file at Association headquarters no later than January 1 August 30 each year.

Proviso: These amendments to the standing rules shall take effect August 2014 in preparation for the 2015 House of Delegates.

SS: Four motions (RC 9-13, RC 10-13, RC 11-13, RC 13-13) propose changes to the function of the House of Delegates. Together, these 4 motions support the overall concept related to House function and should be considered in the context of the overall proposal for House function that was part of the report of the Governance Proposal Board Work Group (GPBWG) to the November 2012 Board of Directors meeting (Report of the GPBWG). These proposed bylaw amendments: (1) clarify the composition of the Reference Committee to include all House officers and clarify its role as House consultant (RC 9-13); (2) add to the Reference Committee role the review of APTA bylaws (RC 10-13); (3) establish main motion criteria to guide the work of the Reference Committee (RC 11-13); and (4) align the delegate roster deadline with the House cycle (RC 13-13).

This motion, RC 13-13 Amend: Standing Rules of the American Physical Therapy Association, Standing Rule 9. Component Delegates, relates specifically to the delegate roster deadline and is proposed to better align delegate terms with the House cycle.

The current delegate roster deadline of January 1 is based on the calendar year as opposed to the House of Delegates cycle. Motion discussions and dialogue regarding the next House typically begin in the fall. This inconsistency has been problematic in that many delegates miss important information provided prior to January. Furthermore, if virtual town halls on complex key issues are added to the House calendar, delegates not added to the roster until January would miss this rich discussion.

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This amendment does not mandate that components alter the length of their delegate terms. As is current practice, components and the PTA Caucus will continue to determine the length of delegate terms as they see fit; however, for association tracking purposes APTA will consider each delegate’s term to be September 1–August 30. Chapters who elect delegates after the roster deadline will continue to have the opportunity to change their roster, since in addition to the proposed change to the delegate roster deadline, this proposed amendment allows for delegate changes to be forwarded up to 30 days prior to the House. Delegates often need to be added to the roster throughout the spring, and the current rule, which prohibits changes after 2 weeks of the roster being received, is a disadvantage. (Please see the Integrated Concept Support Statement in RC 9-13 to read more about how this motion supports the overall concept related to House function.)

BACKGROUNDFeedback collected during a session held prior to the House of Delegates in June 2012 showed support for 2-year delegate terms that begin January 1 of each year; therefore, GPBWG neither focused on this issue during the town halls nor added it to the survey. During its deliberations in November in preparation for the development of proposals to the Board of Directors, the GPBWG realized 2 things: (1) the January 1 date did not accommodate the alignment of work, because the cycle for the next House begins in the summer; and (2) as long as delegates are documented each year within the APTA tracking system, the terms selected by the components and PTA Caucus do not affect the roster. As a result, a change was proposed to the deadline for delegate rosters (August 30) but no change was proposed to transition to 2-year terms. If this motion is approved it is recognized that elections for many delegations will likely take place prior to the date that the apportionment is published for the next House; however, during GPBWG discussions the point was raised that several chapters currently work in this model and have found ways to accommodate the potential for a change in their apportionment after their delegates have been elected.

CURRENT POSITION/STANDARD/GUIDELINE/POLICY/PROCEDURE:STANDING RULES OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION, 9. COMPONENT DELEGATES

9. COMPONENT DELEGATES

All components shall provide Association headquarters with the names, postal addresses, telephone numbers, all addresses for electronic telecommunications, and terms of its delegates, chief delegate, and alternate delegates no later than January 1 of each year, with additions and changes sent within 2 weeks of their selection. Those components whose delegates have terms of office greater than 1 year shall confirm the information on file at Association headquarters no later than January 1 each year.


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Board Contact: Lisa K. Saladin, PT, PhDPhone: 843/259-1177 E-mail: [email protected]




COSPONSORED BY:

RC 14-13 AMEND: APTA VISION SENTENCE FOR PHYSICAL THERAPY 2020 AND APTA VISION STATEMENT FOR PHYSICAL THERAPY 2020 (HOD P06-00-24-35)

That APTA Vision Sentence for Physical Therapy 2020 and APTA Vision Statement for Physical Therapy 2020 (HOD P06-00-24-35) be retitled and amended by substitution:

VISION STATEMENT

The physical therapy profession will transform society by optimizing movement for all people of all ages to improve the human experience.

SS: The proposed vision, developed by the Vision Task Force appointed by the Board of Directors over a 9-month period, involved extensive literature review, interviews and surveys, multiple meetings, and input/guidance from the Board of Directors. As such it addresses the charge from the House of Delegates to go beyond the internal focus of Vision 2020 and reflect the contribution of the physical therapy profession to the health of society. The style of the vision statement, while considerably different from the style of Vision 2020, reflects current best practice in vision writing and is consistent with the style of vision statements of other organizations with whom APTA interacts. Additional background information about the development of the proposed vision can be found at http://www.apta.org/BeyondVision2020/.

RELATIONSHIP TO APTA VISION 2020:Professionalism

CURRENT POSITION/STANDARD/GUIDELINE/POLICY/PROCEDURE:APTA VISION SENTENCE FOR PHYSICAL THERAPY 2020 AND APTA VISION STATEMENT FOR PHYSICAL

THERAPY 2020 (HOD P06-00-24-35)

APTA Vision Sentence for Physical Therapy 2020

By 2020, physical therapy will be provided by physical therapists who are doctors of physical therapy, recognized by consumers and other health care professionals as the practitioners of choice to whom consumers have direct access for the diagnosis of, interventions for, and prevention of impairments, activity limitations, participation restrictions, and environmental barriers related to movement, function, and health.

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APTA Vision Statement for Physical Therapy 2020

Physical therapy, by 2020, will be provided by physical therapists who are doctors of physical therapy and who may be board-certified specialists. Consumers will have direct access to physical therapists in all environments for patient/client management, prevention, and wellness services. Physical therapists will be practitioners of choice in patients’/clients’ health networks and will hold all privileges of autonomous practice. Physical therapists may be assisted by physical therapist assistants who are educated and licensed to provide physical therapist directed and supervised components of interventions.

Guided by integrity, life-long learning, and a commitment to comprehensive and accessible health programs for all people, physical therapists and physical therapist assistants will render evidence-based services throughout the continuum of care and improve quality of life for society. They will provide culturally sensitive care distinguished by trust, respect, and an appreciation for individual differences.

While fully availing themselves of new technologies, as well as basic and clinical research, physical therapists will continue to provide direct patient/client care. They will maintain active responsibility for the growth of the physical therapy profession and the health of the people it serves.

RELATED POSITION/STANDARD/GUIDELINE/POLICY/PROCEDURE:PROFESSIONALISM IN PHYSICAL THERAPY: CORE VALUES (BOD P05-04-02-03)STANDARDS OF PRACTICE FOR PHYSICAL THERAPY (HOD S06-10-09-07)

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Board Contact: Lisa K. Saladin, PT, PhDPhone: 843/259-1177 E-mail: [email protected]




COSPONSORED BY:

RC 15-13 ADOPT: GUIDING PRINCIPLES TO ACHIEVE THE VISION

That the following be adopted:

GUIDING PRINCIPLES TO ACHIEVE THE VISION

The physical therapy profession’s greatest calling is to maximize function and minimize disability for all people of all ages. In this context, movement is a key to optimal living and quality of life for all people of all ages that extends beyond health to every person’s ability to participate in and contribute to society. The complex needs of society, such as those resulting from a sedentary lifestyle, beckon for the physical therapy profession to engage with consumers to reduce preventable health care costs and overcome barriers to participation in society to ensure the successful existence of society far into the future.

While this is APTA’s vision for the physical therapy profession, it is meant also to inspire others throughout society to, together, create systems that optimize movement and function for all people of all ages. The following principles of Quality, Collaboration, Value, Innovation, Consumer-centricity, Access/Equity, and Advocacy demonstrate how the profession and society will look when this vision is achieved. The principles are described as follows:Quality. The physical therapy profession will commit to establishing and adopting best practice standards across the domains of practice, education, and research as the individuals in these domains strive to be flexible, prepared, and responsive in a dynamic and ever-changing world. As independent practitioners, physical therapists in clinical practice will embrace best practice standards in diagnosis/classification, measurement, and intervention. These physical therapists will generate, validate, and disseminate evidence and quality indicators, espousing payment for outcomes and patient satisfaction, striving to prevent adverse events related to patient care, and demonstrating continuing competence. Educators will seek to propagate the highest standards of teaching and learning, supporting collaboration and innovation throughout academia. Researchers will collaborate with clinicians to expand available evidence and translate it into practice, conduct comparative effectiveness research, standardize outcome measurement, and participate in interprofessional research teams.

Collaboration. The physical therapy profession will demonstrate the value of collaboration with other health care providers, consumers, community organizations, and other disciplines to solve the health-related challenges that society faces. In clinical practice, physical therapists, who collaborate across the continuum of care, will ensure that services are coordinated, of value, and consumer-centered by

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referring, co-managing, engaging consultants, and directing and supervising care. Education models will value and foster interprofessional approaches to best meet consumer and population needs and instill team values in physical therapists and physical therapist assistants. Interprofessional research approaches will ensure that evidence translates to practice and is consumer-centered.

Value. Value has been defined as “the health outcomes achieved per dollar spent.”1 To ensure the best value, services that the physical therapy profession will provide will be safe, effective, patient-centered, timely, efficient, and equitable.2 Outcomes will be both meaningful to patients and cost-effective. Value will be demonstrated and achieved in all settings in which physical therapist services are delivered. Accountability will be a core characteristic of the profession and will be essential to demonstrating value.

Innovation. The physical therapy profession will stimulate creative and proactive solutions to enhance health services delivery and to increase the value of physical therapy to society. Innovation will occur in many settings and dimensions, including practice patterns, education, research, and the development of patient-centered procedures and devices and new technology applications. In clinical practice, collaboration with developers, engineers, and social entrepreneurs will capitalize on the technological savvy of the consumer and extend the reach of the physical therapist beyond traditional patient–therapist settings. Innovation in education will enhance interprofessional learning, address workforce needs, respond to declining higher education funding, and, anticipating the changing way adults learn, foster new educational models and delivery methods. In research, innovation will advance knowledge about the profession, apply new knowledge in such areas as genetics and engineering, and lead to new possibilities related to movement and function. New models of research and enhanced approaches to the translation of evidence will more expediently put these discoveries and other new information into the hands and minds of clinicians and educators.

Consumer-centricity. Patient/client/consumer values and goals will be central to all efforts in which the physical therapy profession will engage. Ever mindful to ensure that patient/client/consumer values guide all decisions, the physical therapy profession will respect and respond to individual and cultural considerations, needs, and values.2

Access/Equity. The physical therapy profession will recognize health inequities and disparities and work to ameliorate them through innovative models of service delivery, advocacy, attention to the influence of the social determinants of health on the consumer, collaboration with community entities to expand the benefit provided by physical therapy, serving as a point of entry to the health care system, and direct outreach to consumers to educate and increase awareness.

Advocacy. The physical therapy profession will advocate for patients/clients/consumers both as individuals and as a population, in practice, education, and research settings to manage and promote change, adopt best practice standards and approaches, and ensure that systems are built to be consumer-centered.

1. Porter ME, Teisberg EO. Redefining health care: creating value-based competition on results. Boston: Harvard Business School Press, 2006.

2. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: Institute of Medicine of the National Academies, 2001.

SS: The vision principles were written by the Vision Task Force to further explain the vision and to be used to communicate to the delegates and members the ways in which the vision will be realized as the profession engages in bringing the vision to reality. Similar to the elements identified in APTA Vision Sentence for Physical Therapy 2020 and APTA Vision Statement for Physical Therapy 2020 (HOD P06-00-24-35) (DPT, evidence-based practice, direct access, autonomous practice, professionalism, practitioner of choice), the

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House of Delegates might consider using the principles to guide policy development to ensure the profession and association are poised to achieve the new vision. Additional background information about the development of the proposed vision can be found at http://www.apta.org/BeyondVision2020/.

RELATIONSHIP TO APTA VISION 2020:Direct Access; Evidence Based Practice; Professionalism


RELATED POSITION/STANDARD/GUIDELINE/POLICY/PROCEDURE:PRINCIPLES AND OBJECTIVES FOR THE UNITED STATES HEALTH CARE SYSTEM AND THE DELIVERY OF

PHYSICAL THERAPY SERVICES (HOD P06-04-17-16)ENTRY POINT INTO HEALTH CARE (HOD P06-02-23-45)EVIDENCE-BASED PRACTICE (HOD P06-06-12-08)CRITERIA FOR STANDARDS OF PRACTICE FOR PHYSICAL THERAPY (BOD S03-06-16-38)PROFESSIONALISM IN PHYSICAL THERAPY: CORE VALUES (BOD P05-04-02-03)

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Required for Adoption: Majority Vote Category: 4A

Component Contact: Douglas M. White, DPT, OCS, delegate, Massachusetts ChapterPhone: 617/696-1974 E-mail: [email protected]

Board Contact: Sharon L. Dunn, PT, PhD, OCSPhone: 318/813-2941 E-mail: [email protected]


Staff Contact: Roshunda Drummond-Dye, JD, director, Regulatory AffairsPhone: 703/706-8547 E-mail: [email protected]


COSPONSORED BY:

RC 16-13 AMEND: PRINCIPLES AND OBJECTIVES FOR THE UNITED STATES HEALTH CARE SYSTEM

Note: In the course of reviewing this policy for publication in Packet I, editorial changes were incorporated to remain consistent with APTA’s current style guide and have not been shown with underlines and strikethroughs.

That Principles and Objectives for the United States Health Care System and the Delivery of Physical Therapy Services (HOD P06-04-17-16) be retitled and amended by substitution.

PRINCIPLES AND OBJECTIVES FOR THE UNITED STATES HEALTH CARE SYSTEM AND THE DELIVERY OF PHYSICAL THERAPY SERVICES

The American Physical Therapy Association (APTA) supports a health care system that provides all individuals within the United States with access to high-quality health care.

This system should provide comprehensive, cost-effective, and appropriate physical therapy therapist services provided by, or under the direction and supervision of, a licensed physical therapist. or by a qualified physical therapist assistant under the direction and supervision of a physical therapist.

Physical therapists participate in and make unique contributions as individuals or members of primary care teams to the provision of primary care. In primary care, physical therapists should be recognized as health care professionals who can and should play have a major responsibility role in achieving clinically effective outcomes and cost efficiencies that are essential to comprehensive health care.

APTA endorses the following principles and objectives for the United States a health care system: in which physical therapy is acknowledged as an essential component of health care:

PRINCIPLE I: ACCESS TO CARE The health care system should provide access to care for all individuals and should:

Respect Enable patient/client autonomy to select among providers, including physical therapists, who are qualified and authorized by state and other jurisdictional law to provide professional health care services.

Enable health care providers to provide the full scope of their practice as supported by their education, training, and professional standards.

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Encourage health care service delivery models that facilitate efficient patient-centered care. These health care service delivery models may necessitate changes in law, regulation, payment policy, and institutional bylaws to optimize patient-centered care efficiently and cost-effectively.

Permit direct patient/client access to physical therapists with no requirement of a referral from another any other practitioner.

Encourage employers to offer a choice of high-quality, affordable health care coverage to employees and their dependents.

Enable patients/clients to select and participate in plans that allow the development of financial reserves to cover individual health care expenses, including those incurred for physical therapy and any catastrophic coverage.

Include mechanisms to allow patients/clients to pay their provider of choice directly for health care services.

Prohibit denials of coverage due to preexisting and/or congenital health conditions. Provide affordable fee-for-service options payment methodologies that will and other mechanisms to

assure that patients/clients are able to choose their health care providers. Provide financial support for the education and training of sufficient numbers and types of health care

professionals providers to ensure appropriate access to care for all individuals. Include a rRequirement that all public and private health plans provide examination, evaluation,

diagnostic, prognostic services provided by a physical therapist, and intervention services provided by a physical therapist or physical therapist assistant under the direction and supervision of a physical therapist coverage for the full scope of physical therapist practice in any setting.

Provide coverage for programs and incentives that prevent injury, impairment, and illness; promote wellness and aid in maintenance of functional independence; and provide coverage for preventive, maintenance, and restorative care programs to reduce the incidence and long-term impact of disease, disability, and injury.

Include a rRequirement that all public and private health plans provide coverage for adequate assistive technology, including but not limited to durable medical equipment.

PRINCIPLE II: TEAM-BASED CAREThe health care system should foster team-based care.

Team-based health care is the provision of health services to individuals, families, and/or their communities by at least 2 health care providers who work collaboratively with patients and their caregivers—to the extent preferred by each patient—to accomplish shared goals within and across settings to achieve coordinated, high-quality care. 1

The patient is the center of the health care team. The health care team does not belong to a single provider, system, or discipline. The health care team is dynamic, with the needs of the patient directing who best can lead the team at any given point of time. 2

PRINCIPLE III: QUALITY OF CARE The plan of care for a patient/client should ensure that intervention is based on achieving appropriate outcomes specific to the patient’s/client’s needs. Although APTA endorses adherence to standards of practice and efficiency of care, the Association opposes any policy that places arbitrary limits on physical therapy services. To ensure quality of care and protection of the patient/client’s public’s best interests:

Professional practitionersHealth care providers should be involved in the development of practice parameters and guidelines specific to their scope of practice.

Physical therapists should use clinical experience, literature-based evidence, and patient/client preferences and apply APTA’s Code of Ethics for the Physical Therapist and Standards of Practice for

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Physical Therapy Guide to Physical Therapist Practice as the foundation of such parameters and guidelines.

Decisions regarding the initiation, continuation, or discharge of a patient’s/client’s physical therapy should be determined by the physical therapist responsible for that patient’s/client’s management.

Physical therapists should hold themselves accountable to the public and to third-party payers through peer review and are the only should be recognized as the appropriate professionals to review the delivery and utilization of physical therapy therapist services.

PRINCIPLE IV III: COST CONTAINMENT AND PAYMENT Payment rates for health care services should be reasonable and equitable, and mechanisms to control costs in the health care system should not incent encourage providers to withhold, restrict, or deny essential patient/client services. Insurers should be required by law to disclose to patients/clients the services and types of care covered, including the extent of coverage of physical therapy therapist services. To ensure appropriate payment and cost containment:

Health care professionals should be involved in the development of standards, establishment of payment methodologies, rates, and review of claims and utilization for their specific disciplines.

A referral from a physician or any other practitioner should not be required for payment for physical therapy therapist services.

No arbitrary criteria should be used to determine payment for physical therapy therapist services. Practitioner self-referral arrangements, including physician ownership of physical therapy therapist

services, should be prohibited by law. The use of billing codes should be restricted to professionals who are licensed to perform those

services, and payment for physical therapy therapist services should be made only when the services have been provided by or under the direction of a physical therapist. or by a physical therapist assistant under the direction and supervision of a physical therapist.

Administration of health care benefits, coverage, and payment should be simplified, and patients/clients and providers should have access to a fair and expedited appeals process for denied claims.

Payment for physical therapy therapist services should occur only when adequate documentation exists, consistent with APTA guidelines, to support the need for physical therapy therapist services.

Payment for physical therapy therapist services should be determined fairly in all settings, and guidelines should be consistent regardless of the setting in which the services are provided.

Payment should cover all elements of the patient/client management model, including the education of the patient/client, family, and caregiver as a component of the physical therapist’s plan of care.

Health care professionals should seek optimal treatment effectiveness in consideration of cost efficiencies.

PRINCIPLE V IV: STATE LICENSURE The responsibility for licensure and regulation should remain exclusively within the purview of the state or other jurisdiction and should not be preempted by any federal or regional agency or process. There should be no credentialing of institutions that would override or eliminate the requirements of individual practitioner licensure laws.

Mitchell P, Wynia M, Golden R, McNellis B, et al. Core principles and values of effective team-based health care. Discussion Paper. Washington, DC: Institute of Medicine; 2012. www.iom.edu/tbc. Accessed March 11, 2013.2Nurse Practitioners and Team Based Care. Webpage. American Academy of Nurse Practitioners. http://www.aanp.org/images/documents/publications/nurse%20practitioners%20and%20team%20based%20care.pdf.Accessed March 11, 2013.

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SS: This motion accomplishes several important purposes.

It strengthens the focus on the health care system and deemphasizes self-serving language specific to physical therapy, while maintaining the intent and message of the original language. Thus the document will be viewed as the profession’s statement on what is best for the health of society and not what is best for the profession.

It moves to terminology that reflects physical therapy as rendered by physical therapists or under the direction of physical therapists, which includes physical therapists assistants and others as may be permitted by law, regulation, and APTA positions. This conveys that physical therapy is not a generic term or health care service; physical therapy is the professional services of a physical therapist. This is in keeping with House of Delegates actions in 2012. APTA already uses the nomenclature “physical therapist services” in policy arenas to differentiate the services provided by physical therapists from other professions. This language strengthens the role and responsibility of physical therapists in primary care.

It places greater focus on patient-centered care and patient autonomy. This strengthens the societal focus of the position and the right of self-determination.

It conveys that health care providers, including physical therapists, should be able to practice, and be paid for, their full scope of practice.

It adds language recognizing the provision of care for the maintenance of health. This important principle is essential for the health of society and was recently reaffirmed with a significant legal settlement by CMS.

It adds a principle on team-based care. Team-based care has always been important to high-quality health care delivery, but recent changes in health policy, laws, regulations, and payment have placed renewed emphasis on team-based care. There has been significant debate in policy arenas on who (what discipline) leads health care teams. This revised position supports flexibility in the leadership of health care teams based on the needs of the patient.

In updating this position the profession outlines the important principles of the health care system and positions the physical therapist as integral to the system for the benefit of the patient and society.

RELATIONSHIP TO APTA VISION 2020: Practitioner of Choice

CURRENT POSITION/STANDARD/GUIDELINE/POLICY/PROCEDURE:PRINCIPLES AND OBJECTIVES FOR THE UNITED STATES HEALTH CARE SYSTEM AND THE DELIVERY OF PHYSICAL

THERAPY SERVICES (HOD P06-04-17-16)

The American Physical Therapy Association (APTA) supports a health care system that provides all individuals within the United States with access to quality health care.

This system should provide comprehensive, cost-effective, and appropriate physical therapy services provided by a licensed physical therapist or by a qualified physical therapist assistant under the direction and supervision of a physical therapist. In primary care, physical therapists should be recognized as health care professionals who can and should play a major role in achieving clinically effective outcomes and cost efficiencies that are essential to comprehensive health care.

APTA endorses the following principles and objectives for a health care system in which physical therapy is acknowledged as an essential component of health care:

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PRINCIPLE I: ACCESS TO CARE

The health care system should provide access for all individuals, and should:

• Enable patients/clients to select among providers, including physical therapists, who are qualified and authorized by state and other jurisdiction law to provide professional health care services.

• Permit patient/client direct access to physical therapists with no requirement of a referral from any other practitioner.

• Encourage employers to offer a choice of quality, affordable health care coverage to employees and their dependents.

• Enable patients/clients to select and participate in plans that allow the development of financial reserves to cover individual health care expenses, including those incurred for physical therapy and any catastrophic coverage.

• Include mechanisms to allow patients/clients to pay their provider of choice directly for health care services.

• Prohibit denials of coverage due to preexisting and/or congenital health conditions. • Provide affordable fee-for-service options and other mechanisms to assure that patients/clients are able

to choose their health care providers. • Provide financial support for the education and training of sufficient numbers and types of health care

professionals to assure appropriate access to care for all individuals. • Include a requirement that all public and private health plans provide examination, evaluation,

diagnostic, prognostic services provided by a physical therapist, and intervention services provided by a physical therapist or physical therapist assistant under the direction and supervision of a physical therapist in any setting.

• Provide coverage for programs and incentives that prevent injury, impairment, and illness, promote wellness and aid in maintenance of functional independence, and provide coverage for preventive and restorative care programs to reduce the incidence and long-term impact of disease, disability, and injury.

• Include a requirement that all public and private health plans provide adequate assistive technology, including but not limited to durable medical equipment.

PRINCIPLE II: QUALITY OF CARE The plan of care for a patient/client should ensure that intervention is based on achieving appropriate outcomes specific to the patient’s/client’s needs. Although APTA endorses adherence to standards of practice and efficiency of care, the Association opposes any policy that places arbitrary limits on physical therapy services. To ensure quality of care and protection of the public’s best interests:

• Professional practitioners should be involved in the development of practice parameters and guidelines specific to their scope of practice.

• Physical therapists should use clinical experience, literature-based evidence, and patient/client preferences and apply APTA’s Guide to Physical Therapist Practice as the foundation of such parameters and guidelines.

• Decisions regarding the initiation, continuation, or discharge of a patient’s/client’s physical therapy should be determined by the physical therapist responsible for that patient’s/client’s management.

• Physical therapists should hold themselves accountable to the public and to third party payers through peer review, and should be recognized as the appropriate professionals to review the delivery and utilization of physical therapy services.

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PRINCIPLE III: COST CONTAINMENT AND PAYMENT

Payment rates for health care services should be reasonable and equitable, and mechanisms to control costs in the health care system should not encourage providers to withhold, restrict, or deny essential patient/client services. Insurers should be required by law to disclose to patients/clients the services and types of care covered, including the extent of coverage of physical therapy services. To ensure appropriate payment and cost containment:

• Health care professionals should be involved in the development of standards, establishment of payment rates, and review of claims and utilization for their specific discipline.

• A referral from a physician or any other practitioner should not be required for payment for physical therapy services.

• No arbitrary criteria should be utilized to determine payment for physical therapy services. • Practitioner self-referral arrangements, including physician ownership of physical therapy services,

should be prohibited by law. • The use of billing codes should be restricted to those professionals who are licensed to perform those

services and payment for physical therapy services should be made only when the services have been provided by a physical therapist or by a physical therapist assistant under the direction and supervision of a physical therapist.

• Administration of health care benefits, coverage, and payment should be simplified, and patients/clients and providers should have access to a fair and expedited appeals process for denied claims.

• Payment for physical therapy services should occur only when adequate documentation exists, consistent with APTA guidelines, to support the need for physical therapy services.

• Payment for physical therapy services should be determined fairly in all settings, and guidelines should be consistent regardless of the setting in which the services are provided.

• Payment should cover all elements of the patient/client management model, including the education of the patient/client, family, and caregiver as a component of the physical therapist’s plan of care.

• Health care professionals should seek optimal treatment effectiveness in consideration of cost efficiencies.

PRINCIPLE IV: STATE LICENSURE

The responsibility for licensure and regulation should remain exclusively within the purview of the state or other jurisdiction and should not be preempted by any federal or regional agency or process. There should be no credentialing of institutions that would override or eliminate the requirements of individual practitioner license laws.


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Required for Adoption: Majority Vote Category: 4E

Component Contact: John D. Heick, PT, DPT, OCS, chief delegate, Arizona ChapterPhone: 480/440-9272 E-mail: [email protected]

Board Contact: Jeanine M. Gunn, PT, DPTPhone: 513/543-8671 E-mail: [email protected]


Staff Contact: Lisa L. Culver, PT, DPT, MBA, sr. clinical practice specialist, Clinical PracticePhone: 703/706-3172 E-mail: [email protected]

PROPOSED BY: ARIZONA CHAPTER

COSPONSORED BY:

RC 17-13 AMEND: STANDARDS OF PRACTICE FOR PHYSICAL THERAPY

That Standards of Practice for Physical Therapy (HOD S06-10-09-07), Section III. Patient/Client Management, be amended by substitution:

III. Patient/Client Management

A. Physical Therapist of Record

The physical therapist of record is the therapist who assumes responsibility for patient/client management and is accountable for the coordination, continuation, and progression of the plan of care.

B. Patient/Client Collaboration Within the patient/client management process, the physical therapist and the patient/client establish and maintain an ongoing collaborative process of decision making that exists throughout the provision of services.

C. Initial Examination/Evaluation/Diagnosis/Prognosis

The physical therapist performs an initial examination and evaluation to establish a diagnosis and prognosis prior to intervention. Wellness and prevention visits/encounters may occur without the presence of disease or illness.

D. Plan of Care

The physical therapist establishes a plan of care and manages the needs of the patient/client based on the examination, evaluation, diagnosis, prognosis, goals, and outcomes of the planned interventions for identified impairments, activity limitations, and participation restrictions.

The physical therapists therapist involves the patient/client and appropriate others in the planning, anticipated goals and expected outcomes, proposed frequency and duration, and implementation, and assessment of the plan of care.

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The physical therapist, in consultation with appropriate disciplines, plans for discharge of the patient/client taking into consideration achievement of anticipated goals and expected outcomes, and provides for appropriate follow-up or referral.

E. Intervention The physical therapist provides or directs and supervises the physical therapy intervention

consistent with the results of the examination, evaluation, diagnosis, prognosis, and plan of care. The physical therapy intervention may be provided in an episode of care, or in a single visit/encounter such as for a wellness and prevention visit/encounter or a specialty consultation or for a follow-up visit/encounter after episodes of care, or may be provided intermittently over longer periods of time in cases of managing chronic conditions.

An episode of care is the managed care provided for a specific problem or condition during a set time period, and can be given either for a short period or on a continuous basis or it may consist of a series of intervals marked by 1 or more brief separations from care.

F. Reexamination The physical therapist reexamines the patient/client as necessary during an episode of care, during follow-up visits/encounters after an episode of care, or periodically in the case of chronic care management, to evaluate progress or change in patient/client status and modifies the plan of care accordingly or discontinues concludes physical therapy services.

G. Discharge/Discontinuation of Intervention Conclusion of Episode of CareThe physical therapist discharges the patient/client from physical therapy services concludes an episode of care when the anticipated goals or expected outcomes for the patient/client have been achieved. The physical therapist discontinues intervention, when the patient/client is unable to continue to progress toward goals, or when the physical therapist determines that the patient/client will no longer benefit from physical therapy.

H. Communication/Coordination/Documentation The physical therapist communicates, coordinates, and documents all aspects of patient/client management including the results of the initial examination and evaluation, diagnosis, prognosis, plan of care, interventions, responses to interventions, changes in patient/client status relative to the interventions, reexamination, and discharge/discontinuation of intervention and other patient/client management activities episode of care summary. The physical therapist of record is responsible for “hand off” communication.

An episode of care summary shall i ncl u de the cur r ent phys i cal/fu n c tional status and recommendations and plans related to the patient’s/client's continuing care that may include home p r o gr am, r eferra l s for additio n al s e rvices, r e com m en d ations for fol l ow-up ph y sical therapy care, family and caregiv e r train i ng, and equipm e nt provided. In the case of long-term management of chronic conditions this information shall be documented at least annually. The physical therapist of record is responsible for “hand off” communication that facilitates the services or care of others involved.

SS: This motion makes important changes in the Standards of Practice for Physical Therapy, sections III. C, D, E, F, G, and H, that will potentially change how physical therapists and their patients relate to each other in the future. Changes from the current standards are as follows:

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1. Defines, in paragraph E, the phrase “episode of care” that is currently included but undefined in paragraph F of the standards. This new definition also allows for:

a. single visits/encounters, such as for wellness and prevention visits without the presence of disease or illness, or for specialty consultations between physical therapists

b. follow-up visits after a previous episode of care c. long-term intermittent care for management of chronic conditions

2. Eliminates the words “discharge” and “discharge summary” from the standards, replacing them with “concludes an episode of care” and “episode of care summary” in paragraphs D, G and H

3. Further defines “episode of care summary” in paragraph H by using language from the Board of Directors Guidelines: Physical Therapy Documentation of Patient/Client Management (BOD G03-05-16-41) that suggests, among other things, the possible need for referral to others, or follow-up physical therapy care after an episode of care is concluded

At the center of this change is the elimination of the term and concept of “patient discharge” from our professional lexicon and from practice. In an evolving profession direct access is becoming the norm, and doctors of physical therapy are developing long-term professional relationships with their patients that may stretch over many years and episodic consults or treatment series. It is time that our practice standards reflect these changes.

“Discharge” has its origin in, and may still be appropriate when, referring to discharge from an institution, such as a hospital or extended care facility. However, concluding physical therapy with an episode of care summary, even in these practice settings, is still a more accurate description of what is occurring than is concluding physical therapy with a “discharge.” Additionally, “discharge” may also be linked to another referring practitioner controlling prescriptive care and making a decision independent of the physical therapist (and even the patient) to “discharge” the patient from physical therapy services.

This change may be considered a widespread cultural shift, but it will promote the idea and practice of patients/clients having their own physical therapist over time and making their own decisions as the need for episodic care may emerge, as they would with their own physician or their own dentist. Rather than “discharging” a patient, the physical therapist is concluding one and only one episode of care, with the possibility of future physical therapy and the continuation of a professional-patient/client relationship being fostered. In pediatrics, wellness and prevention, private practice, chronic care management, and other settings, delivery of services other than episodically is becoming common. As the motion addresses and will now add to the Standards of Practice for Physical Therapy, this includes but is not limited to the following areas of physical therapist-patient/client interaction:

wellness and prevention visits/interactions without the presence of disease or illness single visit follow-ups after an episode of physical therapy to ensure long-term patient adherence and

progress single visit or brief series for specialty consultations for which physical therapists are referring to other

physical therapists, perhaps to board-certified physical therapists, and are providing services outside the historical pattern of a physician referral that usually includes a series of visits/encounters and a discharge from service

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physical therapists managing the long-term care of patients/clients with chronic conditionsThis motion, and these changes in the Standards of Practice for Physical Therapy, both accommodate and foresee such changes in the profession.

RELATIONSHIP TO APTA VISION 2020: Autonomous Practice; Direct Access; Practitioner of Choice; Doctor of Physical Therapy; Evidence Based Practice;Professionalism

CURRENT POSITION/STANDARD/GUIDELINE/POLICY/PROCEDURE:STANDARDS OF PRACTICE FOR PHYSICAL THERAPY (HOD S06-10-09-07) SECTION III. PATIENT/CLIENT MANAGEMENT

III. Patient/Client ManagementA. Physical Therapist of Record

The physical therapist of record is the therapist who assumes responsibility for patient/client management and is accountable for the coordination, continuation, and progression of the plan of care.

B. Patient/Client CollaborationWithin the patient/client management process, the physical therapist and the patient/client establish and maintain an ongoing collaborative process of decision making that exists throughout the provision of services.

C. Initial Examination/Evaluation/Diagnosis/PrognosisThe physical therapist performs an initial examination and evaluation to establish a diagnosis and prognosis prior to intervention.

D. Plan of CareThe physical therapist establishes a plan of care and manages the needs of the patient/client based on the examination, evaluation, diagnosis, prognosis, goals, and outcomes of the planned interventions for identified impairments, activity limitations, and participation restrictions.

The physical therapists involve the patient/client and appropriate others in the planning, implementation, and assessment of the plan of care.

The physical therapist, in consultation with appropriate disciplines, plans for discharge of the patient/client taking into consideration achievement of anticipated goals and expected outcomes, and provides for appropriate followup or referral.

E. InterventionThe physical therapist provides or directs and supervises the physical therapy interventionconsistent with the results of the examination, evaluation, diagnosis, prognosis, and plan of care.

F. ReexaminationThe physical therapist reexamines the patient/client as necessary during an episode of care to evaluate progress or change in patient/client status and modifies the plan of care accordingly or discontinues physical therapy services.

G. Discharge/Discontinuation of Intervention

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The physical therapist discharges the patient/client from physical therapy services when the anticipated goals or expected outcomes for the patient/client have been achieved.

The physical therapist discontinues intervention when the patient/client is unable to continue to progress toward goals or when the physical therapist determines that the patient/client will no longer benefit from physical therapy.

H. Communication/Coordination/DocumentationThe physical therapist communicates, coordinates, and documents all aspects of patient/client management including the results of the initial examination and evaluation, diagnosis, prognosis, plan of care, interventions, response to interventions, changes in patient/client status relative to the interventions, reexamination, and discharge/discontinuation of intervention and other patient/client management activities. The physical therapist of record is responsible for “hand off” communication.

RELATED POSITION/STANDARD/GUIDELINE/POLICY/PROCEDURE:GUIDELINES: PHYSICAL THERAPY DOCUMENTATION OF PATIENT/CLIENT MANAGEMENT (BOD G03-05-16-41) CRITERIA FOR STANDARDS OF PRACTICE FOR PHYSICAL THERAPY (BOD S03-06-16-38)

OTHER RELEVANT INFORMATION:DEFENSIBLE DOCUMENTATION FOR PATIENT/CLIENT MANAGEMENT

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Board Contact: Jeanine M. Gunn, PT, DPTPhone: 513/543-8671 E-mail: [email protected]




COSPONSORED BY:

RC 18-13 INTEGRATION OF E PISODE/CONCLUSION OF CARE TERMINOLOGY

That language to reflect the intent of RC 17-13 Amend: Standards of Practice for Physical Therapy shall be incorporated into all relevant APTA publications, documents, and communications through existing planned review and revision cycles.

Further, wherever possible and not limited to the following actions, APTA shall inform its membership of such changes and encourage changes in payer policy criteria, in practice act language, in professional education, and in electronic health record language, to effect widespread adoption of language and practice consistent with this amended standard.

SS: See support statement for RC 17-13. While the adoption of RC 17-13 changes a standard for the physical therapy profession, many documents, activities, initiatives, practices, policies, and procedures, some outside of APTA jurisdiction, will benefit by a concerted APTA campaign to educate membership and others to effect changes consistent with RC 17-13.

RELATIONSHIP TO APTA VISION 2020: Autonomous Practice; Direct Access; Practitioner of Choice; Doctor of Physical Therapy; Evidence Based Practice; Professionalism

CURRENT POSITION/STANDARD/GUIDELINE/POLICY/PROCEDURE:STANDARDS OF PRACTICE FOR PHYSICAL THERAPY (HOD S06-10-09-07)

RELATED POSITION/STANDARD/GUIDELINE/POLICY/PROCEDURE:GUIDELINES: PHYSICAL THERAPY DOCUMENTATION OF PATIENT/CLIENT MANAGEMENT (BOD G03-05-

16-41)CRITERIA FOR STANDARDS OF PRACTICE FOR PHYSICAL THERAPY (BOD S03-06-16-38)

OTHER RELEVANT INFORMATION:DEFENSIBLE DOCUMENTATION FOR PATIENT/CLIENT MANAGEMENTThere are several other potentially related Association documents that may require review and revision.

Search for “discharge” in APTA Standards, Policies, Positions, and Guidelines

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Staff Contact: Justin D. Moore, PT, DPT, vice president, Public Policy, Practice and Professional AffairsPhone: 703/706-3162 E-mail: [email protected]


COSPONSORED BY:

RC 19-13 ADOPT: PUBLIC POLICY EFFORTS TO IMPROVE CONSUMER ACCESS TO PHYSICAL THERAPISTS


PUBLIC POLICY EFFORTS TO IMPROVE CONSUMER ACCESS TO PHYSICAL THERAPISTS

Whereas, The health care delivery system in the United states is in the process of significant change due to the passage of the Patient Protection and Affordable Care Act (PL 111-148) and consolidation and integration of past delivery models;

Whereas, Opportunities to improve, simplify, and reduce barriers (statutory and regulatory) to consumer access to physical therapists are evident and fluid; and,

Whereas, Pursuing selective changes in specific provisions in statute and regulations on the federal and state levels may be timely and achievable;

Resolved, The public policy and payment efforts of APTA shall continue to focus on opportunities to demonstrate to society the value of physical therapists’ participation in the health care system and in improving individuals’ health and functional performance; and,

Resolved, These efforts shall be focused on consumers achieving access to medically necessary physical therapist services and recognition of the entire professional scope of practice.

SS: Note: as this motion is a companion to RC 20-13, this support statement is identical except for the final paragraph.

Health policy has significantly evolved since the passage of Direct Access and Attainment of “Physician-Status” as Applied Under the Medicare Program (HOD P06-05-16-08), from the implementation of the Patient Protection and Affordable Care Act, PL 111-148 (ACA) to reforms of entitlement programs such as Medicare. As these sweeping changes to the US health services delivery system are implemented, there are unique opportunities for APTA to demonstrate the value of physical therapists’ contributions to the delivery system and societal needs. These opportunities present legislative and regulatory changes with far-reaching impact on individuals’ ability to access physical therapists’ services and warrant APTA’s focused energy and resources. As we navigate our course in this evolving public policy environment, we are best served to focus on our potential to impact society (improving health and functional performance), while continuing to advocate for the recognition and inclusion of the entire professional scope of practice in policies emerging from the implementation of ACA.

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Since the House of Delegates adopted HOD P06-05-16-08, APTA’s federal advocacy efforts have included several bills before Congress and key policy initiatives in unsuccessful attempts to achieve “physician status” in the Medicare program. Within the context of the rapidly evolving health care system, the Association commissioned Health Policy Alternatives Inc, a Washington, DC-based firm specializing in health policy analytics and legislative strategy, to assist in determining the feasibility and advisability of continuing to pursue the tenets of HOD P06-05-16-08, particularly achieving “physician status.” The firm’s report to APTA’s Public Policy and Advocacy Committee (PPAC) and the Board of Directors in May 2012 (Physical Therapists Under Medicare: Opportunities for Improving the Profession’s Status and Recognition) examined the feasibility and impact of the required regulatory and legislative changes as well as potential advantages, disadvantages, and policy ramifications. The report recommended that APTA pursue legislative and regulatory changes that would ultimately reduce impediments to beneficiary access to the full value of physical therapist services, while minimizing the risks of unsustainable resource demands and unintended consequences for the profession. Following is a brief excerpt of a few of the summary comments:

“Of the legislative options, Health Policy Alternatives Inc believes that two of them (amending discrete provisions of the Medicare statute to remedy selected problems and eliminating physician plan of care certification requirements, which could be combined into a single, multi-faceted legislative proposal) offer the most promise, even though they would still be challenging to pursue.

“There are potential down-sides to pursuing/obtaining “physician status”: the definition of physician would likely be accompanied by limitations such as those seen in the case of podiatrists, optometrists, and chiropractors (that is, even within section 1861(r), not all “physicians” are equal); some policy-makers may entertain the idea of including only doctors of physical therapy into the definition of physician; Congress and CMS apply some policies only to certain “physicians” when drafting legislation or policy (ACO legislation is limited only to medical doctors and osteopaths); and Congress could use the opportunity to define physical therapists as a “practitioners,” as physician assistants, nurse practitioners, and others are defined, and reduce the fee schedule payment by some percentage.

“In addition, obtaining “physician status” under Medicare would require significant legislative action and, given the current environment, would meet significant opposition from various and numerous opponents.”

The Board of Directors and the PPAC have carefully reviewed this report and assessed the implications of continuing to pursue “physician status,” balanced against the opportunities to enhance consumer access to physical therapists’ services in the currently fluid regulatory environment. We are therefore bringing 2 motions before the House for discussion and consideration: 1 to direct APTA’s public policy and payment efforts toward improving consumer access to physical therapists and the entire professional scope of practice (RC-19-13), and the other to rescind Direct Access and Attainment of “Physician-Status” as Applied Under the Medicare Program (HOD P06-05-16-08) (RC 20-13).

In summary, the public policy environment is fluid, and APTA policies and positions that direct broad action provide the Association with the flexibility to respond accordingly. This position allows the Association to pursue multiple strategies in improving access to physical therapist services while focusing energy and resources toward aggressively pursuing options with the best opportunities for success.

RELATIONSHIP TO APTA VISION 2020:Autonomous Practice; Direct Access; Practitioner of Choice; Doctor of Physical Therapy; Evidence Based Practice; Professionalism


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RELATED POSITION/ STANDARD/GUIDELINE/POLICY/PROCEDURE : DIRECT ACCESS AND ATTAINMENT OF “PHYSICIAN-STATUS” AS APPLIED UNDER THE MEDICARE PROGRAM (HOD

P06-05-16-08)

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Required for Adoption: Majority Vote Category: 4B



Staff Contact: Justin D. Moore, PT, DPT, vice president, Public Policy, Practice and Professional AffairsPhone: 703/706-3162 E-mail: [email protected]


COSPONSORED BY:

RC 20-13 RESCIND: DIRECT ACCESS AND ATTAINMENT OF “PHYSICIAN-STATUS” AS APPLIED UNDER THE MEDICARE PROGRAM (HOD P06-05-16-08)

That Direct Access and Attainment of “Physician-Status” as Applied Under the Medicare Program (HOD P06-05-16-08) be rescinded.

SS: Note: as this motion is a companion to RC 19-13, this support statement is identical except for the final 2 paragraphs.

Health policy has significantly evolved since the passage of Direct Access and Attainment of “Physician-Status” as Applied Under the Medicare Program (HOD P06-05-16-08), from the implementation of the Patient Protection and Affordable Care Act, PL 111-148 (PPACA) to reforms of entitlement programs such as Medicare. As these sweeping changes to the US health services delivery system are implemented, there are unique opportunities for APTA to demonstrate the value of physical therapists’ contributions to the delivery system and societal needs. These opportunities present legislative and regulatory changes with far-reaching impact on individuals’ ability to access physical therapists’ services and warrant APTA’s focused energy and resources. As we navigate our course in this evolving public policy environment, we are best served to focus on our potential to impact society (improving health and functional performance), while continuing to advocate for the recognition and inclusion of the entire professional scope of practice in policies emerging from the implementation of PPACA.

Health policy has significantly evolved since the passage of Direct Access and Attainment of “Physician-Status” as Applied Under the Medicare Program (HOD P06-05-16-08), from the implementation of the Patient Protection and Affordable Care Act, PL 111-148 (ACA) to reforms of entitlement programs such as Medicare. As these sweeping changes to the US health services delivery system are implemented, there are unique opportunities for APTA to demonstrate the value of physical therapists’ contributions to the delivery system and societal needs. These opportunities present legislative and regulatory changes with far-reaching impact on individuals’ ability to access physical therapists’ services and warrant APTA’s focused energy and resources. As we navigate our course in this evolving public policy environment, we are best served to focus on our potential to impact society (improving health and functional performance), while continuing to advocate for the recognition and inclusion of the entire professional scope of practice in policies emerging from the implementation of ACA.

Since the House of Delegates adopted HOD P06-05-16-08, APTA’s federal advocacy efforts have included several bills before Congress and key policy initiatives in unsuccessful attempts to achieve “physician status” in the Medicare program. Within the context of the rapidly evolving health care system, the Association commissioned Health Policy Alternatives Inc, a Washington, DC-based firm specializing in health policy analytics and legislative strategy, to assist in determining the feasibility and advisability of continuing to pursue the tenets of HOD P06-05-16-08, particularly achieving “physician status.” The firm’s report to APTA’s Public Policy and Advocacy

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Committee (PPAC) and the Board of Directors in May 2012 (Physical Therapists Under Medicare: Opportunities for Improving the Profession’s Status and Recognition) examined the feasibility and impact of the required regulatory and legislative changes as well as potential advantages, disadvantages, and policy ramifications. The report recommended that APTA pursue legislative and regulatory changes that would ultimately reduce impediments to beneficiary access to the full value of physical therapist services, while minimizing the risks of unsustainable resource demands and unintended consequences for the profession. Following is a brief excerpt of a few of the summary comments:

“Of the legislative options, Health Policy Alternatives Inc believes that two of them (amending discrete provisions of the Medicare statute to remedy selected problems and eliminating physician plan of care certification requirements, which could be combined into a single, multi-faceted legislative proposal) offer the most promise, even though they would still be challenging to pursue.

“There are potential down-sides to pursuing/obtaining “physician status”: the definition of physician would likely be accompanied by limitations such as those seen in the case of podiatrists, optometrists, and chiropractors (that is, even within section 1861(r), not all “physicians” are equal); some policy-makers may entertain the idea of including only doctors of physical therapy into the definition of physician; Congress and CMS apply some policies only to certain “physicians” when drafting legislation or policy (ACO legislation is limited only to medical doctors and osteopaths); and Congress could use the opportunity to define physical therapists as a “practitioners,” as physician assistants, nurse practitioners, and others are defined, and reduce the fee schedule payment by some percentage.

“In addition, obtaining “physician status” under Medicare would require significant legislative action and, given the current environment, would meet significant opposition from various and numerous opponents.”

The Board of Directors and the PPAC have carefully reviewed this report and assessed the implications of continuing to pursue “physician status,” balanced against the opportunities to enhance consumer access to physical therapists’ services in the currently fluid regulatory environment. We are therefore bringing 2 motions before the House for discussion and consideration: 1 to direct APTA’s public policy and payment efforts toward improving consumer access to physical therapists and the entire professional scope of practice (RC-19-13), and the other to rescind Direct Access and Attainment of “Physician-Status” as Applied Under the Medicare Program (HOD P06-05-16-08) (RC 20-13).

Rescinding this position would eliminate the high priority assigned to achieving “physician status under Medicare” and allow the Association to pursue multiple strategies to improve access to physical therapist services. However, rescinding this position does not preclude the Association from taking any statutory opportunities that present in the current and evolving environment. Examples of these opportunities include amending discrete provisions in the Medicare statute such as opt-out and locum tenens options to include physical therapists or amending to eliminate or reduce the plan of care certification requirements.

In summary, the public policy environment is fluid, and APTA policies and positions that direct broad action provide the Association with the flexibility to respond accordingly. Rescinding this position will allow the Association to focus energy and resources toward aggressively pursuing options with the best opportunities for success for our patients and our profession, while reducing the risks of unintended consequences.

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RELATIONSHIP TO APTA VISION 2020: Autonomous Practice; Direct Access; Practitioner of Choice; Doctor of Physical Therapy; Evidence Based Practice;Professionalism

CURRENT POSITION/STANDARD/GUIDELINE/POLICY/PROCEDURE:DIRECT ACCESS AND ATTAINMENT OF "PHYSICIAN-STATUS"AS APPLIED UNDER THE

MEDICARE PROGRAM HOD (P06-05-16-08)

Whereas, Section 1861(r) of the Social Security Act currently recognizes certain health careprofessionals who do not have medical degrees, such as dentists, podiatrists, and optometrists,as having status equivalent to physicians under the Medicare program;

Whereas, Physical therapists have attained education and clinical preparation within their scopeof practice at least equivalent to many of these professionals; and,

Whereas, Attainment of beneficiary’s direct access to physical therapists and recognition by theMedicare program of physical therapists’ advanced education, clinical preparation, and expertiseare consistent with the achievement of American Physical Therapy Association Vision Statementfor Physical Therapy 2020 and the goals and objectives of the American Physical TherapyAssociation;

Resolved, That the American Physical Therapy Association shall assign high priority in its federalgovernment affairs activities to achieving the enactment of legislation and promulgation ofregulations that shall result in beneficiary’s direct access to physical therapists and the attainmentof “physician status” as recognized under the Medicare program.


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Component Contact: Douglas M. White, DPT, OCS, delegate, Massachusetts ChapterPhone: 617/696-1974 E-mail: [email protected]

Board Contact: Nicole L. Stout, PT, MPT, CLT-LANAPhone: 215/668-4161 E-mail: [email protected]


Staff Contact: Lois Douthitt, director, Publishing and Member CommunicationsPhone: 703/706-3192 E-mail: [email protected]


COSPONSORED BY:

RC 21 -13 ADOPT: PREFERRED NOMENCLATURE FOR THE PROVISION OF PHYSICAL THERAPY


PREFERRED NOMENCLATURE FOR THE PROVISION OF PHYSICAL THERAPY

“Physical therapist services” or “physical therapist practice” shall be the preferred nomenclature when referring to the provision of physical therapy.

Proviso: The American Physical Therapy Association shall incorporate this preferred nomenclature into all relevant documents, publications and communications in a manner that is efficient.

SS: The nomenclature “physical therapy services” has been used by the profession and externally for decades. The terminology reflects on physical therapy as a generic commodity that does not indicate the involvement of a physical therapist. The misuse of “physical therapy” and “physical therapy services” by others has been problematic for many years and in many situations. APTA already uses the term “physical therapist services” in policy areas to differentiate services provided by or under the direction of a physical therapist from “physical therapy” provided by other practitioners. Adoption of this language will standardize nomenclature throughout the profession. Using the nomenclature of “physical therapist services” conveys the involvement of a physical therapist in the provision of physical therapy and reflects the provision of physical therapy as a knowledge-based profession. Adoption of this language allows for, but does not mandate, the provision of physical therapy under the direction of a physical therapist by a physical therapist assistant and by others as law, regulation, and APTA policy shall allow.

A search of the APTA website for the terms “physical therapy services” returned 707 items. Each of these items should be reviewed in an efficient manner, and changes to the terminology to reflect “physical therapist services” should be made as determined appropriate by the Secretary and APTA staff.

Style manuals in APTA publications and communications should be updated as is efficient to reflect the intent of this motion.

As opportunities present, APTA should encourage the use of “physical therapist services” or physical therapist practice” in documents, communications, and publications by external entities.

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RELATIONSHIP TO APTA VISION 2020: Autonomous PracticeCURRENT POSITION/STANDARD/GUIDELINE/POLICY/PROCEDURE: None

RELATED POSITION/ STANDARD/GUIDELINE/POLICY/PROCEDURE : REFERRAL TO PHYSICAL THERAPY (HOD P06-00-24-06)REIMBURSEMENT FOR PHYSICAL THERAPY SERVICES (HOD P06-01-12-15)REIMBURSEMENT POLICIES (FEDERAL AND STATE) AFFECTING PHYSICAL THERAPY SERVICES (HOD P06-00-31-09) PHYSICAL THERAPY AS A MANDATED SERVICE UNDER MEDICAID HOD (P06-03-21-17)STUDENT PHYSICAL THERAPIST PROVISION OF SERVICES HOD (P06-00-18-30) STANDARDS OF PRACTICE FOR PHYSICAL THERAPY (HOD S06-10-09-07)CRITERIA FOR STANDARDS OF PRACTICE FOR PHYSICAL THERAPY (BOD S03-06-16-38) INSURANCE BENEFITS FOR PHYSICAL THERAPY SERVICES HOD (P06-02-25-05)DOCUMENTATION AUTHORITY FOR PHYSICAL THERAPY SERVICES HOD (P05-07-09-03)DISTINCTION BETWEEN THE PHYSICAL THERAPIST AND THE PHYSICAL THERAPIST ASSISTANT IN PHYSICAL

THERAPY (HOD P06-01-18-19)REFERRAL TO PHYSICAL THERAPY (HOD P06-00-24-06)MEDICALLY NECESSARY PHYSICAL THERAPY SERVICES (BOD P08-11-03-04)REFORMING PAYMENT FOR OUTPATIENT PHYSICAL THERAPY SERVICES (BOD P03-11-04-09)PLAN OF ACTION REGARDING PAYOR REIMBURSEMENT FOR PHYSICAL THERAPY SERVICES DELIVERED WITHOUT

REFERRAL (BOD 11-03-17-55)

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Component Contact: Cameron W. MacDonald, PT, DPT, GCS, OCS, chief delegate, Colorado ChapterPhone: 719/200-3474 E-mail: [email protected] Joseph M. Donnelly, PT, DHS, OCS, section delegate, Orthopaedic SectionPhone: 678/547-6220 E-mail: [email protected]

Board Contact: Jennifer E. Green-Wilson, PT, MBA, EdDPhone: 585/747-9622 E-mail: [email protected]


Staff Contact: Matthew W. Elrod, PT, DPT, MEd, NCS, sr. clinical practice specialist, Clinical PracticePhone: 703/706-8596 E-mail: [email protected]

PROPOSED BY: COLORADO CHAPTER AND ORTHOPAEDIC SECTION

COSPONSORED BY:

RC 22 -13 ADOPT: THE PHYSICAL THERAPIST’S ROLE IN THE PREVENTION AND MANAGEMENT OF PEDIATRIC OVERUSE INJURIES


THE PHYSICAL THERAPIST’S ROLE IN THE PREVENTION AND MANAGEMENT OF PEDIATRIC OVERUSE INJURIES

Whereas, The rate of overuse injuries in children and youth athletes of all abilities appears to be increasing1;

Whereas, Several health organizations, such as the World Health Organization, the National Athletic Trainers’ Association, the American Academy of Pediatrics, and the International Olympic Committee, have published positions and recommendations regarding the prevention of overuse injuries in children and youth athletes2-5;

Whereas, Overuse injuries comprise a list of impairments that can be effectively diagnosed and treated with interventions administered by physical therapists6; and,

Whereas, The National Athletic Trainers’ Association has included physical therapists in the list of medical professionals who should be members of the athletic health care team that ensures that medical care is provided to school-aged athletes7;

Resolved, That the American Physical Therapy Association promote the following concepts:

• Education of physical therapists in the recognition, treatment, and diagnosis of overuse injuries in children and youth athletes of all abilities

• Inclusion of physical therapists in the athletic health care team responsible for the medical care of children and youth athletes of all abilities

• Inclusion of physical therapists in preparticipation screening for sports and organized activities to reduce the rate, risk, and likelihood of overuse injuries in children and youth athletes of all abilities

REFERENCES1. NCYS. Market Research Report NCYS Membership Survey - 2008 Edition. Stuart FL: National Council of Youth Sports; 2008.2. Brenner JS, American Academy of Pediatrics Council on Sports M, Fitness. Overuse injuries, overtraining, and burnout in child and adolescent

athletes. Pediatrics. Jun 2007; 119(6):1242-1245.3. Mountjoy M, Armstrong N, Bizzini L, et al. IOC consensus statement on training the elite child athlete. Clinical journal of sport medicine: official

journal of the Canadian Academy of Sport Medicine. Mar 2008; 18(2):122-123.

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4. Valovich McLeod TC, Decoster LC, Loud KJ, et al. National Athletic Trainers' Association position statement: prevention of pediatric overuse injuries. Journal of athletic training. Mar-Apr 2011; 46(2):206-220.

5. WHO Ad Hoc Committee on Sports and Children. Sports and children: consensus statement on organized sports for children. FIMS/WHO ad Hoc Committee on Sports and Children. Bulletin of the World Health Organization. 1998; 76(5):445-447.

6. American Physical Therapy Association (1921- ). Guide to physical therapist practice, revised. 2nd ed. Alexandria, Va.: American Physical Therapy Association; 2003.

7. Almquist J, Valovich McLeod TC, Cavanna A, et al. Summary statement: appropriate medical care for the secondary school-aged athlete. Journal of athletic training. Jul-Aug 2008; 43(4):416-427.

SS: Between 1997 and 2008, participation in youth sports increased from 45 million participants to 63 million.1 As the rate of participation increased, an apparent increase in the rate of overuse injuries has also occurred. 8,9 In response to this seeming epidemic, several health and sports organizations have taken a firm position on limiting overuse injuries in youth sports. These include the World Health Organization, the International Olympic Committee, the American Academy of Pediatrics, and the National Athletic Trainers’ Association.2-5 Multifactorial preventive strategies are necessary to reduce the incidence of overuse injuries. These strategies include parent, coach, and athlete education, preparticipation examinations, identification and treatment of overuse injuries, and development of injury surveillance systems to detect injury trends. Physical therapists have been identified as key members of the athletic health care teams for school-aged athletes.7

REFERENCES1. NCYS. Market Research Report NCYS Membership Survey - 2008 Edition. Stuart, FL: National Council of Youth Sports; 2008.2. Brenner JS, American Academy of Pediatrics Council on Sports M, Fitness. Overuse injuries, overtraining, and burnout in child and adolescent

athletes. Pediatrics. Jun 2007;119(6):1242-1245.3. Mountjoy M, Armstrong N, Bizzini L, et al. IOC consensus statement on training the elite child athlete. Clin J Sport Med: official journal of the

Canadian Academy of Sport Medicine. Mar 2008;18(2):122-123.4. Valovich McLeod TC, Decoster LC, Loud KJ, et al. National Athletic Trainers' Association position statement: prevention of pediatric overuse injuries. J

Athletic Training. Mar-Apr 2011; 46(2):206-220.5. FIMS/WHO Ad Hoc Committee on Sports and Children. Sports and children: consensus statement on organized sports for children. Bulletin of the

World Health Organization. 1998;76(5):445-447.6. Guide to Physical Therapist Practice. Rev 2nd ed. Alexandria, VA: American Physical Therapy Association; 2003.7. Almquist J, Valovich McLeod TC, Cavanna A, et al. Summary statement: appropriate medical care for the secondary school-aged athlete. J Athletic

Training. Jul-Aug 2008;43(4):416-427.8. DiFiori JP. Evaluation of overuse injuries in children and adolescents. Current Sports Medicine Reports. Nov-Dec 2010 9(6):372-378.9. Watkins J, Peabody P. Sports injuries in children and adolescents treated at a sports injury clinic. J Sports Med Phys Fit. Mar 1996;36(1):43-48.

RELATIONSHIP TO APTA VISION 2020:Practitioner of Choice


RELATED POSITION/STANDARD/GUIDELINE/POLICY/PROCEDURE:HEALTH PROMOTION AND WELLNESS BY PHYSICAL THERAPISTS AND PHYSICAL THERAPIST ASSISTANTS (HOD

P06-93-25-50)PHYSICAL EDUCATION, PHYSICAL CONDITIONING, AND WELLNESS ADVOCACY (HOD P06-04-22-18)PHYSICAL THERAPISTS AND PHYSICAL THERAPIST ASSISTANTS AS PROMOTERS AND ADVOCATES FOR PHYSICAL

ACTIVITY/EXERCISE (HOD P06-08-07-08)PHYSICAL THERAPISTS AS EXPERT PROVIDERS OF EXERCISE AND PHYSICAL ACTIVITY PRESCRIPTION (HOD P06-12-

20-07)

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Component Contact: Cameron W. MacDonald, PT, DPT, GCS, OCS, chief delegate, Colorado ChapterPhone: 719/200-3474 E-mail: [email protected] Joseph M. Donnelly, PT, DHS, OCS, section delegate, Orthopaedic SectionPhone: 678/547-6220 E-mail: [email protected]



Staff Contact: Matthew W. Elrod, PT, DPT, MEd, NCS, sr. clinical practice specialist, Clinical PracticePhone: 703/706-8596 E-mail: [email protected]

PROPOSED BY: COLORADO CHAPTER AND ORTHOPAEDIC SECTION

COSPONSORED BY:

RC 23-13 PLAN TO ACHIEVE THE PHYSICAL THERAPIST’S ROLE IN THE PREVENTION AND MANAGEMENT OF PEDIATRIC OVERUSE INJURIES

That the American Physical Therapy Association develop a plan to implement the concepts outlined in RC 22-13 The Physical Therapist’s Role in the Prevention and Management of Pediatric Overuse Injuries, with an interim report to the 2014 House of Delegates and a final report to the 2015 House of Delegates.

SS: See support statement for RC 23-13.

RELATIONSHIP TO APTA VISION 2020:Practitioner of Choice


RELATED POSITION/STANDARD/GUIDELINE/POLICY/PROCEDURE:HEALTH PROMOTION AND WELLNESS BY PHYSICAL THERAPISTS AND PHYSICAL THERAPIST ASSISTANTS (HOD

P06-93-25-50)PHYSICAL EDUCATION, PHYSICAL CONDITIONING, AND WELLNESS ADVOCACY (HOD P06-04-22-18)PHYSICAL THERAPISTS AND PHYSICAL THERAPIST ASSISTANTS AS PROMOTERS AND ADVOCATES FOR PHYSICAL

ACTIVITY/EXERCISE (HOD P06-08-07-08)PHYSICAL THERAPISTS AS EXPERT PROVIDERS OF EXERCISE AND PHYSICAL ACTIVITY PRESCRIPTION (HOD P06-12-

20-07)

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Required for Adoption: Majority Vote Category: 6F


Board Contact: Elmer R. Platz, PTPhone: 973/764-6136 E-mail: [email protected]


Staff Contact: Anita Bemis-Dougherty, PT, DPT, MAS, director, Clinical PracticePhone: 703/706-8513 E-mail: [email protected]


COSPONSORED BY:

RC 24-13 ADOPT: PHYSICAL THERAPY DOCUMENTATION REFORM


PHYSICAL THERAPY DOCUMENTATION REFORM

As new payment systems and models for reimbursement evolve, the American Physical Therapy Association shall pursue concurrent reform of documentation requirements for physical therapy services. New documentation standards shall focus on clinical decision making that promotes efficiency, effectiveness, quality, and value to patient/clients.

SS: As the American Physical Therapy Association (APTA) actively engages CMS and other payers in exploring and developing new payment models for physical therapy services there must also be a parallel track that includes our commitment to fundamentally change the documentation required in physical therapy practice. These 2 activities should go forward together.

Documentation is an essential element of good patient/client care for the very reasons confirmed in the proposed position. However, there is an increasing perception among physical therapists and most health care professionals that the increased load of documentation of services is becoming burdensome to the point where it is not adding to but may be detracting from the quality of services being provided. This problem is complex in its origins and will not have simple solutions. Regulatory, payer, legal, and our own intrinsic professional standards all have contributed over time to documentation standards and to current practices that are adding to professional workload but may not be adding to the quality of care being provided. And to be fair, there have been issues of below-standard care and documentation that have contributed to more documentation requirements.

Perhaps much of this has come as a result of continuing to define ourselves, and to be defined and perceived by others for what we do as physical therapists, and even how we do what we do, rather than why we exist as a profession. The “why,” which should be first and foremost, is our unique knowledge and skill set that helps individuals of all ages overcome physical limitations to movement and functional mobility. We are the experts at this. “How” we do this is as clinicians, researchers, and educators, and in acute care, outpatient care, preventive and wellness services, and in various settings either unilaterally or in collaboration with other health care professionals. And “what” we do is defined in the patient/client management model with its various elements including the components of intervention, the “tools” of the profession.

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But we are not the tools. We have the ennobling mission to help society overcome physical impairments to movement and live full lives. However, we are now required to document which tools we use, for how long we use them, and in what setting we do them. Our colleague, Carl DeRosa, PT, PhD, FAPTA, has repeatedly pointed out that we have been defined by what we do from the neck down (a compendium of skill sets), rather than from the neck up (the thought process and decision making).

The current state of health care documentation may be characterized as defensive. Indeed, in physical therapy we have the document “Defensible Documentation of Patient/Client Management.” We may be documenting to avoid (a) not being paid for our services, (b) being brought before our licensing board and disciplined, (c) being investigated by Medicare and fined or worse, (d) being in violation of our professional organization’s standards, (e) being sued, or (f) all of the above. How much more positive would this key aspect of practice be if documentation was focused on our knowledge and how we use that to help get people moving again?

We may find allies in a concerted effort to effect change with physician and other health care provider organizations. A 2012 nationwide study of US physicians found significant dissatisfaction in individual physician practice and in the direction of medicine as a whole among the 13,575 respondents to the survey.1

The results indicated that physician productivity has decreased by 16.6% and that documentation now requires greater than 20% of a clinical encounter. Over 80% of physician respondents mostly or somewhat agreed that the medical profession is in decline. The highest reason identified for this (79.2%) was “too much regulation/paperwork.”

Even payers may be supportive of such change if greater effectiveness and value can be demonstrated in the service for which they are paying. APTA should try to establish and strengthen dialogue and working relations with all payers and with other health care profession associations in an effort to address a challenge that is not unique to physical therapy and may, in fact, require a multidisciplinary approach to bring about real change.

Whether or not we achieve a groundswell of effort with other professions, there is much we can do ourselves. While not directing what APTA, its leadership, or components would specifically do in response to adoption of this position, the motion anticipates that these entities would do at least the following:

Determine current APTA documentation standards and requirements that should be eliminated due to their lack of value and that are unnecessary, and revise or propose new and necessary documentation standards consistent with the intent of this motion

Collaborate between APTA chapters and national and jurisdictional regulatory associations and agencies to effect changes in practice act and rule language to reform documentation requirements to include necessary standards that will improve public protection by ensuring higher-quality care provision

Encourage physical therapy software vendors to reduce and simplify the elements of electronic health record documentation while maintaining quality of care

Work with federal and private payers to modernize, reduce, and simplify documentation requirements for physical therapy services consistent with new and developing payment models and ensuring that such payment models include fair and reasonable reimbursement for physical therapy services

Reach out to other health care professional organizations to organize a united effort to reform, reduce, and simplify health services documentation in a way that allows providers to spend more time, rather than less, with their patients

REFERENCES1. http://www.physiciansfoundation.org/uploads/default/Physicians_Foundation_2012_Biennial_Survey.pdf.

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RELATIONSHIP TO APTA VISION 2020:Autonomous Practice; Direct Access; Practitioner of Choice; Doctor of Physical Therapy; Evidence Based Practice; Professionalism

CURRENT POSITION/STANDARD/GUIDELINE/POLICY/PROCEDURE: None

RELATED POSITION/STANDARD/GUIDELINE/POLICY/PROCEDURE: None

OTHER RELEVANT INFORMATION:DEFENSIBLE DOCUMENTATION FOR PATIENT/CLIENT MANAGEMENT

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Component Contacts: Deborah S. Larsen, PT, section delegate, Neurology SectionPhone: 614/247-4217 E-mail: [email protected]




PROPOSED BY: NEUROLOGY SECTION

COSPONSORED BY:

RC 25-13 ADOPT: THE ROLE OF PHYSICAL THERAPY IN HEALTH MANAGEMENT FOR PEOPLE WITH CHRONIC DISABILITY


THE ROLE OF PHYSICAL THERAPY IN HEALTH MANAGEMENT FOR PEOPLE WITH CHRONIC DISABILITY

Whereas, The number of people across the lifespan living with chronic disability is increasing, and they have heath care needs that are not adequately being met or covered by the current system of management and reimbursement1;

Whereas, Those individuals have health care needs that, because of personal income limitations, require reimbursement by both Medicare and Medicaid, and commonly are referred to in the literature as being “dual eligible”2;

Whereas, Those who are identified under dual eligible criteria have a wide range of conditions; often have multiple chronic health care problems, overall poor health, and multiple disabilities, the care for which is described as being high-need or high-cost; and require extensive support across multiple episodes of care2;

Whereas, The current model of management involving episodic care is not adequate to meet the needs of those living with chronic disability and relying on both Medicare and Medicaid for the reimbursement of physical therapy services;

Whereas, Governmental agencies are the insurers of last resort for the majority of those with chronic or degenerative disability and who are classified as being dual eligible;

Whereas, The Medicare-Medicaid Coordination Office and the Center for Medicare and Medicaid Innovation, created under the Patient Protection and Affordable Care Act, are working with states to develop new approaches to improve care for beneficiaries who are dual eligible2;

Whereas, Finding a means to ensure coordinated and efficient care is necessary in the current climate of reimbursement by Medicare and Medicaid; and,

Whereas, The American Physical Therapy Association Code of Ethics for the Physical Therapist (Code) and Standards of Ethical Conduct for the Physical Therapist Assistant state that physical therapists and physical therapist assistants, respectively, shall act “in the patients’s/client’s best interest in all practice settings,”3,4

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and the Code states that physical therapists “shall advocate for the reduction of disparity in health care” and “improved access to health care services”3 for all individuals;

Resolved, That the American Physical Therapy Association support and advocate for timely and regular access to physical therapy services, rehabilitation equipment, and assistive/adaptive devices for children and adults with severe chronic physical disability, with particular attention to the health needs of the population who are disabled and are dual eligible under Medicare and Medicaid, so that all people with chronic disability will experience better health and improved life participation.

REFERENCES1. Murray CJL, Vos T, Lozano R, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic

analysis for the Global Burden of Disease Study 2010. The Lancet. 2012;380(9859):2197-2223.2. Jacobson G, Neuman T, Damico A. Medicare’s role for dual eligible beneficiaries. Washington, DC: Kaiser Family Foundation. 2012.3. Code of Ethics for the Physical Therapist. APTA. HOD S06-09-07-12 [Amended HOD S06-00-12-23; HOD 06-91-05-05;HOD 06-87-11-17; HOD 06-81-

06-18; HOD 06-78-06-08; HOD 06-78-06-07; HOD 06-77-18-30; HOD 06-77-17-27; Initial HOD 06-73-13-24] [Standard]. Accessed at: http://www.apta.org

4. Standard of Ethical Conduct for the Physical Therapist Assistant. APTA. HOD S06-09-20-18 [Amended HOD S06-00-13-24; HOD 06-91-06-07; Initial HOD 06-82-04-08] [Standard].

SS: According to the 2010 Global Burden of Disease report, the greatest change impacting health care systems is the shift from the health management of communicable diseases to noncommunicable diseases and from premature death to years lived with disability.1 The rising burden from mental and behavioral disorders, musculoskeletal and neuromuscular disorders, and diabetes and other chronic health conditions are imposing new challenges on national health systems. In the United States, advances in medical management and technology have resulted in a population that lives longer but ages into disability or survives serious disease or injury to live with premature disability. Thus, there is a growing need for health care systems to shift from a medical model of episodic health care toward a health management model that focuses on healthy life expectancy across the life span for those who are typically developing and aging or who live with chronic severe disability.5

Based on 2010 US Census data, approximately 56.7 million people (18.7%) live with disability. Approximately 38 million children and adults have severe disability as defined by the Centers for Disease Control and Prevention as needing assistance with one or more activities of daily living or instrumental activities of daily living.6 About 9 million people in the United States are covered by both Medicare and Medicaid, including low-income seniors and younger people with disabilities. These dual eligible beneficiaries, due to their physical and cognitive impairments, have complex and often costly health care needs. Nationally, the dual eligible beneficiaries comprise 21% of the Medicare population but 31% of total Medicare costs, and 15% of the Medicaid population but 39% of total Medicaid costs.2

One of the highest priorities of the Center for Medicare and Medicaid Innovation is to support initiatives to improve the coordination of care for people with severe disability aimed at both raising the quality of their care and reducing its costs. Policymakers are interested in finding ways to improve the delivery of care and reduce spending for beneficiaries with chronic disability, because these beneficiaries are among the sickest, frailest, and highest cost segments of the Medicare and Medicaid programs. It is anticipated that the cost to taxpayers will be substantial if the population with chronic disability continues to grow without a more efficient and effective approach to health services delivered to the most severely disabled beneficiaries of the dual eligible program.2

The physical therapy profession, with its history and unique scope of practice that includes the medical rehabilitation management of children or adults with severe physical disability, is an essential health service needed to ensure the healthy life expectancy of people with disability. APTA can participate in addressing the health needs of people with disability by developing a physical therapy chronic health management and payment model that specifies the physical therapy services and care plans needed to ensure health and optimal life participation in this special-needs population.

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REFERENCES

1. Murray CJL, Vos T, Lozano R, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. The Lancet. 2012;380(9859):2197-2223.

2. Jacobson G, Neuman T, Damico A. Medicare’s role for dual eligible beneficiaries. Washington, DC: Kaiser Family Foundation. 2012.3. Code of Ethics for the Physical Therapist. American Physical Therapy Association House of Delegates. HOD S06-09-07-12..

http://www.apta.org/Ethics.4. Standard of Ethical Conduct for the Physical Therapist Assistant. American Physical Therapy Association House of Delegates. HOD S06-09-20-18.

http://www.apta.org/Ethics.5. Salomon JA. Healthy life expectancy for 187 countries, 1990-2010: a systematic analysis for the Global Burden Disease Study 2010. The Lancet (British

edition). 2013;380(9859):2144-2162.6. Brault MW. Americans with Disabilities: 2010. In: Administration EaS, ed. Washington, DC: U.S. Census Bureau; 2012:P70-131.

RELATIONSHIP TO APTA VISION 2020: Direct Access; Professionalism


RELATED POSITION/STANDARD/GUIDELINE/POLICY/PROCEDURE: STANDARDS OF PRACTICE FOR PHYSICAL THERAPY (HOD S06-10-09-07)APTA VISION SENTENCE FOR PHYSICAL THERAPY 2020 AND APTA VISION STATEMENT FOR PHYSICAL THERAPY

2020 (HOD P06-00-24-35)PROFESSIONALISM IN PHYSICAL THERAPY: CORE VALUES (BOD P05-04-02-03)PRINCIPLES AND OBJECTIVES FOR THE UNITED STATES HEALTH CARE SYSTEM AND THE DELIVERY OF PHYSICAL


OTHER RELEVANT INFORMATION:2013 APTA STRATEGIC PLAN APTA Proposed Vision Statement Beyond 2020

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Component Contacts: Deborah S. Larsen, PT, section delegate, Neurology SectionPhone: 614/247-4217 E-mail: [email protected]




PROPOSED BY: NEUROLOGY SECTION

COSPONSORED BY:

RC 26-13 PHYSICAL THERAPY HEALTH MANAGEMENT MODEL FOR PEOPLE WITH CHRONIC DISABILITY That the American Physical Therapy Association develop a plan to meet the intent of the resolution clause of RC 25-13 The Role of Physical Therapy in Health Management for People With Chronic Disability with an interim report to the 2014 House of Delegates and a final report no later than the 2015 House of Delegates.

This shall be accomplished with appropriate input from key stakeholders.

SS: Refer to RC 25-13 for support statement.

RELATIONSHIP TO APTA VISION 2020: Direct Access; Professionalism


RELATED POSITION/STANDARD/GUIDELINE/POLICY/PROCEDURE: STANDARDS OF PRACTICE FOR PHYSICAL THERAPY (HOD S06-10-09-07)APTA VISION SENTENCE FOR PHYSICAL THERAPY 2020 AND APTA VISION STATEMENT FOR PHYSICAL THERAPY

2020 (HOD P06-00-24-35)PROFESSIONALISM IN PHYSICAL THERAPY: CORE VALUES (BOD P05-04-02-03)PRINCIPLES AND OBJECTIVES FOR THE UNITED STATES HEALTH CARE SYSTEM AND THE DELIVERY OF PHYSICAL


OTHER RELEVANT INFORMATION:2013 APTA STRATEGIC PLAN APTA Proposed Vision Statement Beyond 2020

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Staff Contact: Deborah Crandall, JD, sr. regulatory affairs specialist, Regulatory AffairsPhone: 703/706-3177 E-mail: [email protected]


COSPONSORED BY:

RC 27-13 ADOPT: PHYSICAL THERAPISTS AS AUTHORIZED PROVIDERS OF DURABLE MEDICAL EQUIPMENT


PHYSICAL THERAPISTS AS AUTHORIZED PROVIDERS OF DURABLE MEDICAL EQUIPMENT

Whereas, The physical therapist’s goal is to improve the patient’s/client's ability to move, reduce pain, restore function, and prevent disability, (Principles and Objectives for the United States Health Care System and the Delivery of Physical Therapy Services HOD P06-04-17-16);

Whereas, Goals That Represent the Priorities of the American Physical Therapy Association (HOD 06-05-15-24) include recognition of physical therapists as the practitioners of choice for persons with conditions that affect movement and function; and,

Whereas, There are frequently delays in prescribing durable medical equipment by providers authorized to do so even after an evaluation by a physical therapist reveals this necessity; Resolved, That the American Physical Therapy Association supports physical therapists as providers authorized to prescribe durable medical equipment.

SS: Our profession’s commitment to our patients/clients demands that we advocate for ease of access to durable medical equipment (DME.) Under the current reimbursement system, patients/clients may suffer long waits with immobility or the burden of reduced functioning and safety before they are able to procure this DME, because CMS only recognizes physicians, nurse practitioners, physician’s assistants and clinical nurse specialists as providers who can prescribe DME.

The 2004 conference “Clinical Education in a Doctoring Profession” achieved consensus on minimum skills for graduates of physical therapist professional programs. Included in the minimum skill set was the ability to examine and reexamine the need for assistive devices and to intervene and direct when training is required in the use of assistive and adaptive equipment.

Physical therapists are recognized as experts in providing services to people with impairments,

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functional limitations, disabilities, and/or changes in physical function. We have a unique ability to assess the need for DME for patients/clients with reduced function. The physical therapist working with a person with reduced function evaluates the need for and determines the specific DME for the patient/client. However, because of CMS’ lack of recognition of physical therapists as providers of DME, the patient/client is often unable to obtain this DME in a timely manner or at all.

Current policy leads to hardship for many patients/clients with mobility issues. Patients in the hospital setting who have been evaluated by physical therapists and found to need particular DME must often wait to receive it until the professionals who are permitted to and available can sign the prescription. This delay leads to increased time in the inpatient setting and potential safety issues. In the outpatient setting or home health settings, there may not be a physician, nurse practitioner, physician’s assistant or clinical nurse specialist available to sign a prescription in a reasonable time frame, which leads to potential safety issues and/or limited mobility for the patient/client. Additionally, this requirement leads to additional costs to the patient and the health care system without any added value. Recognizing physical therapists for their expertise in evaluating for, training in, and prescribing DME will lead to better outcomes and satisfaction in the populations we serve.

RELATIONSHIP TO APTA VISION 2020: Autonomous Practice; Direct Access; Evidence Based Practice; Professionalism


RELATED POSITION/ STANDARD/GUIDELINE/POLICY/PROCEDURES: PRINCIPLES AND OBJECTIVES FOR THE UNITED STATES HEALTH CARE SYSTEM AND THE DELIVERY OF

PHYSICAL THERAPY SERVICES (HOD P06-04-17-16)DIRECT ACCESS AND ATTAINMENT OF "PHYSICIAN-STATUS"AS APPLIED UNDER THE MEDICARE

PROGRAM HOD (P06-05-16-08)REFERRAL RELATIONSHIPS (HOD P06-90-15-28)REFORMING PAYMENT FOR OUTPATIENT PHYSICAL THERAPY SERVICES (BOD P03-11-04-09)

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Staff Contact: Deborah Crandall, JD, sr. regulatory affairs specialist, Regulatory AffairsPhone: 703/706-3177 E-mail: [email protected]


COSPONSORED BY:

RC 28-13 PLAN TO ACHIEVE PHYSICAL THERAPISTS AS AUTHORIZED PROVIDERS OF DURABLE MEDICAL EQUIPMENT

That the American Physical Therapy Association pursue the enactment of legislation and regulations resulting in physical therapists being included as providers authorized to prescribe durable medical equipment.

SS: See support statement for RC 27-13.

RELATIONSHIP TO APTA VISION 2020: Autonomous Practice; Direct Access; Evidence Based Practice; Professionalism


RELATED POSITION/ STANDARD/GUIDELINE/POLICY/PROCEDURES PRINCIPLES AND OBJECTIVES FOR THE UNITED STATES HEALTH CARE SYSTEM AND THE DELIVERY OF

PHYSICAL THERAPY SERVICES (HOD P06-04-17-16)DIRECT ACCESS AND ATTAINMENT OF "PHYSICIAN-STATUS"AS APPLIED UNDER THE MEDICARE

PROGRAM (HOD P06-05-16-08)REFERRAL RELATIONSHIPS (HOD P06-90-15-28)REFORMING PAYMENT FOR OUTPATIENT PHYSICAL THERAPY SERVICES (BOD P03-11-04-09)

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Required for Adoption: Majority Vote Category: 7D

Component Contact: Susan L. Whitney, PT, PhD, NCS, ATC, FAPTA, delegate, Pennsylvania ChapterPhone: 412/383-6642 E-mail: [email protected]



Staff Contact: Anita Bemis-Dougherty, PT, DPT, MAS, director, Clinical PracticePhone: 703/706-8513 E-mail: [email protected]

PROPOSED BY: PENNSYLVANIA CHAPTER

COSPONSORED BY:

RC 29-13 TRAINING PROGRAM FOR PHYSICAL THERAPISTS TO PERFORM PEER REVIEW

That the American Physical Therapy Association develop, promote, and provide a process for training and recognition of physical therapists to perform peer review of physical therapy services. A report, including an outline of the process and timeline for completion, will be presented to the 2014 House of Delegates, with plans for implementation of the program no later than January 1, 2015.

SS: Anecdotal reports from colleagues indicate there is wide variation in the quality of peer review performed by physical therapists. To foster consistent, high-quality peer review, APTA should develop training for physical therapists who perform this important function for society. A recognition process will enable APTA, and those who complete the training, to demonstrate a standard of quality. APTA can then advocate for this recognition as the minimum standard for physical therapists performing peer review, with the anticipated outcome of more consistent and higher quality review of physical therapist services.

Currently, educational opportunities for physical therapists interested in performing peer review are minimal and self-directed. Peer review including disability determination and independent medical examinations serve important functions in health care and in medical-legal environments. The APTA position that only physical therapists should review physical therapy services has not been realized to a large extent. One of the reasons for this is a lack of trained and qualified reviewers and the opportunity to receive training.

The APTA Minnesota Chapter has a model process that has been in place since 1984. This process arose out of a need for quality peer review of physical therapy services, and it requires training and mentorship by an experienced physical therapist peer reviewer. When it first began, the chapter was processing approximately 20 reviews weekly by some 20 trained peer reviewers. As insurance companies have turned to internal reviews, they have seen a decrease in requests for reviews but still process approximately 10 per month with approximately 10 trained physical therapist peer reviewers. In addition to receiving requests from third-party payers, this chapter also receives requests from practice owners wishing to gain an independent review of the care they provide and from the Minnesota State Board of Physical Therapy in its efforts to assess physical therapists wishing to bring their professional license into good standing.While Minnesota’s program could serve as a model for APTA as it develops a national recognition process, it also provides evidence that insurance companies have been less likely to seek true independent peer review of physical therapy services. This should not be seen as evidence that such a program is not needed but rather a call to action. The Position Statement (Peer Review of Physical Therapy Services (HOD P06-04-16-15))and Guidelines (Guidelines: Peer Review Training (BOD G03-05-15-40)) previously adopted by APTA were good first steps in achieving the goal of having peer review of physical therapy services provided only by physical

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therapists. The guidelines discuss “training” extensively, but there is no standard, recognized training process for physical therapists to turn to. This motion is an attempt to move that ideal forward.As noted in the guidelines, an optimal training program could include, but not be limited to, the following components:

Understanding and complying with all relevant APTA documents Understanding and working within all appropriate laws and regulations Competence in disability determination including rating Competence in performing independent examinations typically referred to as independent medical

examinations (IME) Understanding and complying with relevant payer policies Understanding the appropriate fiduciary duties in peer review Understanding the ethical implications of peer review Maintenance of independent professional judgment with a duty to “do what is best” for the

patient/clientAPTA may choose to develop modules of training such as workers compensation peer review or performing independent medical examinations. Physical therapists could then tailor the training to the type of peer review they perform. This initiative would help provide physical therapists in local communities with the resources and knowledge to build relationships with local payers. It is also hoped that by increasing knowledge of the peer review process, that there would be greater and faster dissemination of information that could decrease the fraud and abuse claims against physical therapists nationwide.

A recent question to a seasoned peer reviewer by a physical therapist out of school 6 months was “How do I learn to do what you do?” The reviewer explained that to provide high-quality reviews, a reviewer needs to have a broad breath of experience. When asked how the reviewer learned about performing peer review and independent medical examinations, the reviewer explained that there were no resources at the time and it would have been helpful to have materials to read early on.

As there are constant changes in laws, rules, regulations, and health care provider policy, the knowledge of a peer reviewer is constantly growing. This motion would assist physical therapists in learning the basics, after which it would be up to them to continue to grow as professionals in this area of expertise.

The goal of this RC is to be revenue neutral. People would most likely pay to attend workshops or webinars to increase their knowledge. The development costs could be built into the price of the course.

Neither ASHA nor AOTA has a training program, but when asked they were interested in the concept of having a formalized training process.

As a cadre of physical therapists becomes trained and recognized as peer reviewers, society will benefit from more consistent and independent determination of appropriate use of limited health care resources. The profession will gain greater recognition as having a body of knowledge, which requires the knowledge of a physical therapist to make determinations as to appropriate physical therapy care. It is hoped that these efforts will train the next generation of physical therapists to provide thoughtful reviews of physical therapy care.



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RELATED POSITION/ STANDARD/GUIDELINE/POLICY/PROCEDURE : PEER REVIEW OF PHYSICAL THERAPY SERVICES (HOD P06-04-16-15)PEER REVIEW TRAINING (BOD G03-05-15-40)

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Required for Adoption: 2/3 Vote to Adopt Category: 8G

Board Contact: Paul A. Rockar Jr, PT, DPT, MSPhone: 412/673-6660, ext. 215 E-mail: [email protected]


Staff Contact: Agatha D. Johnson, MA, CAE director, Member ServicesPhone: 703/706-3233 E-mail: [email protected]


COSPONSORED BY: ARIZONA, ARKANSAS, FLORIDA, GEORGIA, HAWAII, IDAHO, ILLINOIS, IOWA, KANSAS, MAINE, MASSACHUSETTS, MICHIGAN, MINNESOTA, MONTANA, NEW MEXICO, NEW YORK, NORTH DAKOTA, OHIO, OREGON, PENNSYLVANIA, SOUTH CAROLINA, TENNESSEE, TEXAS, WASHINGTON AND WISCONSIN CHAPTERS AND EDUCATION, HEALTH POLICY AND ADMINISTRATION, ORTHOPAEDIC, PEDIATRICS, PRIVATE PRACTICE AND WOMEN'S HEALTH SECTIONS

RC 30-13 ELECTION TO HONORARY MEMBERSHIP IN THE AMERICAN PHYSICAL THERAPY ASSOCIATION: JOHN STACKPOLE

Whereas, The American Physical Therapy Association’s House of Delegates (House) uses parliamentary process to guide its debate and decision making to set policies to move forward the profession of physical therapy;

Whereas, John Stackpole, PhD, PRP, CPP, possesses great knowledge and skill in the use of parliamentary process, which he has shared generously with all participants in the House;

Whereas, John Stackpole has used his knowledge of the parliamentary process and APTA to assist delegates in developing motions that more clearly reflect their intent and allow informed debate;

Whereas, John Stackpole has used wisdom and humor in his diligence in helping delegates participate in debate to achieve decisions that represent the will of the majority, while respecting the voice of the minority;

Whereas, John Stackpole has provided countless positive suggestions to components to assist them in developing their own bylaws; and,

Whereas, John Stackpole has served the profession of physical therapy in his role as consultant to the House since 1994, working with 4 Speakers of the House, numerous Reference Committees, and countless chief delegates and delegates;

Resolved, that John Stackpole, PhD, PRP, CPP, be elected as an Honorary Member of the American Physical Therapy Association.

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