691433 To establish requirements for licensed physical therapists to perform intramuscular manual therapy, also knownas dry needling, in the District.

DEPARTMENT OF HEALTH

 

NOTICE OF FINAL RULEMAKING

 

The Director of the Department of Health, pursuant to the authority set forth in section 302(14) of the District of Columbia Health Occupations Revision Act of 1985, effective March 25, 1986 (D.C. Law 6-99; D.C. Official Code § 3-1203.02 (14)), and Mayor’s Order 98-140, dated August 20, 1998, hereby gives notice of the adoption of the following amendments to Chapter 67, “Physical Therapy,” of Title 17, “Businesses, Occupations, and Professions,” of the District of Columbia Municipal Regulations (DCMR).   The purpose of these amendments is to clarify the scope of practice for physical therapists licensed in the District of Columbia and to establish requirements for licensed physical therapists to perform intramuscular manual therapy, also known as dry needling, in the District.

 

These rules were previously published in the D.C. Register as a proposed rulemaking on November 12, 2010, at 57 DCR 10616.  No written comments were received from the public in connection with this publication during the 30-day comment period and no changes have been made to the rulemaking.  These final rules will be effective upon publication of this notice in the D.C. Register.

 

Chapter 67, PHYSICAL THERAPY, of Title 17, BUSINESSES, OCCUPATIONS, AND PROFESSIONS, of the DCMR is amended as follows:

 

Section 6715, SCOPE OF PRACTICE, is amended by adding a new subsection 6715.2 to read as follows:

 

6715.2             A physical therapist may also perform intramuscular manual therapy, which is also known as dry needling, if performed in conformance with the requirements of section 6716.

 

A new section 6716 is added to read as follows:

 

6716                REQUIREMENTS FOR PHYSICAL THERAPISTS TO PERFORM INTRAMUSCULAR MANUAL THERAPY

 

6716.1                          Intramuscular manual therapy may be performed by a licensed physical therapist who meets the requirements of this section.

 

6716.2                          Intramuscular manual therapy shall be performed directly by the licensed physical therapist and shall not be delegated.

 

6716.3                          Intramuscular manual therapy shall be performed in a manner that is consistent with generally accepted standards of practice, including clean needle techniques, and other applicable standards of the Centers for Disease Control and Prevention.

 

6716.4                          Intramuscular manual therapy is an advanced procedure that requires specialized training.  A physical therapist shall not perform intramuscular manual therapy in the District of Columbia unless he or she has documented proof of completing:

 

(a)                A Board-approved professional training program on intramuscular manual therapy.  The training program shall require each trainee to demonstrate cognitive and psychomotor knowledge and skills.  The training program shall be attended in person by the physical therapist,  shall not be attended online or through any other means of distance learning, and shall not be a self-study program

 

(b)               A professional training program on intramuscular manual therapy accredited by the Commission on Accreditation in Physical Therapy Education (CAPTE).  The training program shall require each trainee to demonstrate cognitive and psychomotor knowledge and skills.  The training program shall be attended in person by the physical therapist,  shall not be attended online or through any other means of distance learning, and shall not be a self-study program; or

 

(c)                Graduate or higher-level coursework in a CAPTE-approved educational program that included intramuscular manual therapy in the curriculum.

 

6716.5                          A physical therapist shall only perform intramuscular manual therapy following an

                        examination and diagnosis, and for the purpose of treating specific anatomic

                        entities selected according to physical signs.

 

6716.6                          A physical therapist who performs intramuscular manual therapy shall obtain written informed consent from each patient who will receive intramuscular manual therapy before the physical therapist performs intramuscular manual therapy on the patient.

 

6716.7                          The informed consent form shall include, at a minimum, the following:

 

(a)                The patient’s signature;

 

(b)               The risks and benefits of intramuscular manual therapy;

 

(c)                The physical therapist’s level of education and training in intramuscular manual therapy; and

 

(d)               A clearly and conspicuously written statement that the patient is not receiving acupuncture.

 

6716.8                          A physical therapist who performs intramuscular manual therapy shall maintain a separate procedure note in the patient’s chart for each intramuscular manual therapy.  The note shall indicate how the patient tolerated the intervention as well as the outcome after the intramuscular manual therapy.

 

6716.9                          A physical therapist who performs intramuscular manual therapy shall be required to produce documentation of meeting the requirements of this section immediately upon request by the Board or an agent of the Board.

 

6716.10                      Failure by a physical therapist to provide written documentation of meeting the training requirements of this section shall be deemed prima facie evidence that the physical therapist is not competent and not permitted to perform intramuscular manual therapy.

 

Section 6799.1 is amended by adding the following definition after the definition of “Direct supervision”:

 

Intramuscular manual therapy - a technique used to treat myofascial pain that uses a dry needle, without medication, that is inserted into a trigger point with the goal of releasing or inactivating the trigger points and relieving pain.