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NEW JERSEY REGISTER
VOLUME 43, ISSUE 01
Issue Date: JANUARY 3, 2011
RULE PROPOSALS
Law and Public Safety
Division of Consumer Affairs
STATE BOARD OF MEDICAL EXAMINERS
ATHLETIC TRAINING ADVISORY COMMITTEE

Proposed Amendments: N.J.A.C. 13:35-10.2, 10.3 and 10
Proposed New Rules: N.J.A.C. 13:35-10.5 through 10.17
Proposed Repeal: N.J.A.C. 13:35-10.5

Definitions; Application for Licensure; Licensure; Biennial License Renewal; License Suspension; Reinstatement of Suspended License; Inactive Status; Return from Inactive Status; Plan of Care Guidelines; Practice Outside of Schools and Professional Teams; Scope of Practice; Records; Use of Personal or Other Computer to Prepare Records; Release of Records; Advertising and Solicitation Practices; Advertising Free or Discounted Services; Required Disclosures; Testimonial Advertising; Minimum Content; Advertising by a Business Entity Offering Athletic Training; Advertising Record Retention; Use of Professional Credentials and Certifications

Authorized By: State Board of Medical Examiners, William Roeder, Executive Director.
Authority: N.J.S.A. 45:9-37.38 and P.L. 2007, c. 323.

Calendar Reference: See Summary below for explanation of exception to calendar requirement.
Proposal Number: PRN 2011-006.

Submit comments by March 4, 2011 to:

  William Roeder, Executive Director
  State Board of Medical Examiners
  P.O. Box 183
    Trenton, NJ 08625

The agency proposal follows:

Summary

Prior to April 12, 2008, N.J.S.A. 45:9-37.35 et seq., the Athletic Training Licensure Act (Act), limited licensed athletic trainers to working with athletes who participated in interscholastic, intercollegiate, intramural or professional athletic activities. Licensed athletic trainers were required to be employees of a school, college, university or professional team.

P.L. 2007, c. 323 amended N.J.S.A. 45:9-37.35 et seq. to permit athletic trainers, under the supervision of a physician, to provide athletic training to any individual who participates in strenuous physical exercise, physical conditioning or a sport. The amendments also deleted the requirement that a licensed athletic trainer only be employed at a school, college, university or by a professional team. Pursuant to its rulemaking powers found at N.J.S.A. 45:9-37.38, the State Board of Medical Examiners (the Board), upon consultation with the Athletic Training Advisory Committee, proposes to amend N.J.A.C. 13:35-10 to implement P.L. 2007, c. 323 and to introduce new recordkeeping and advertising requirements. The Board anticipates that the proposed amendments and new rules will be welcomed by licensed athletic trainers who will now be permitted to work outside of the school or professional team setting.

Throughout the rules, the terms "licensee" and "athletic trainer" have been changed to "licensed athletic trainer" for clarity. The Board proposes to amend N.J.A.C. 13:35-10.2 to incorporate the new statutory definition for "athlete." The term is no longer restricted to individuals who participate in athletic activities conducted by educational institutions or professional teams. An "athlete" is now defined as any individual who engages in strenuous physical exercise, physical conditioning or a sport. The definition of "athletic trainer" currently refers to employment status at an educational institution or with a professional team. The Board proposes to delete this definition and proposes a new definition of "licensed athletic trainer," which focuses on the licensure status of the licensed athletic trainer and incorporates the statutory amendment. The definition of "athletic training" is proposed for amendment to incorporate the statutory requirement that physical modalities be applied under a plan of care designed and overseen by a physician.

The Board proposes a new definition for the term "bracing," which is taken from N.J.S.A. 45:12B-3 and recognizes items that may be purchased over-the-counter and are excluded from the definition of "orthotic appliance" by the Orthotics and Prosthetics Board of Examiners. These items can be provided by individuals who are not licensed orthotists. The Board is proposing to delete the definition of "direction of a licensed physician" as this term has been superseded by the statutory term "supervision." The Board proposes to delete the definition of "non-injured athlete" and "professional athletic team" as these terms are no longer used in the rules. The Board also proposes definitions for "physician," "plan of care," "supervision" and "supervising physician."

The Board proposes to amend N.J.A.C. 13:35-10.3 to reflect recodifications in N.J.A.C. 13:35-10. The existing rule refers to the National Athletic Trainers' Association Board of Certification, Inc. as the entity that approves athletic training education programs. This is not the entity that accredits education programs and the Board proposes to amend the rule to recognize that the Commission on Accreditation of Athletic Training Education is the entity that accredits athletic training education programs.

The Board proposes to amend N.J.A.C. 13:35-10.4 to reflect recodifications in N.J.A.C. 13:35-10 and to incorporate a statutory amendment in P.L. 2007, c. 323 that requires submission of proof of current certification by the National Athletic Trainers Association Board of Certification, as well as compliance with initial licensure requirements, for licensed athletic trainers seeking reinstatement after a period of suspension of more than three years, but less than five years (subsection (f)). There are no such requirements applicable to licensees who hold inactive licenses for more than three, but less than five, years.

Consistent with N.J.S.A. 45:1-7.1, an athletic trainer whose license has been suspended for more than five years under N.J.A.C. 13:35-10.4(e) and recodified subsection (g) must pay a reinstatement fee and all past delinquent renewal fees, submit an affidavit of employment and reapply for licensure and may be subject to an examination if he or she cannot demonstrate that he or she has maintained proficiency. Proof of certification would demonstrate proficiency. A licensee who seeks reinstatement after having elected inactive status for more than five years under recodified N.J.A.C. 13:35-10.4(i) and (j) must pay a reinstatement fee, submit an affidavit of employment and reapply for licensure and, if he or she cannot demonstrate that he or she maintained proficiency, may be subject to an examination. Proof of certification would demonstrate proficiency. The reinstatement requirements after five years for a suspended license and an inactive license differ only because there is currently no fee for an inactive license, thus there would be no delinquent renewal fees. The Board proposes to remove a mistaken reference in recodified N.J.A.C. 13:35-10.4(j) to the "practice of medicine" and to replace it with "practice of athletic training."

The Board proposes to repeal N.J.A.C. 13:35-10.5, which sets forth the activities in which a licensed athletic trainer may engage. The majority of the provisions in this rule are incorporated into proposed new N.J.A.C. 13:35-10.6. The Board has not incorporated N.J.A.C. 13:35-10.5(h) into proposed new N.J.A.C. 13:35-10.6. This subsection states that the provision of certain preventative measures, such as taping and wrapping, to non-injured athletes by unlicensed individuals does not violate N.J.A.C. 13:35-10.5. The Board believes that providing such measures to non-injured athletes prevents injuries to athletes and is included in the definition of "athletic training" in N.J.S.A. 45:9-37.36. But under N.J.S.A 45:9-37.40b, certain unlicensed individuals may still perform these acts of athletic training, including candidates for licensure as part of their mandated supervised clinical experience and students enrolled in a school or education program of athletic training approved by [page=27] the Board under the direction of a licensed athletic trainer when incidental to the course of study.

The Board proposes new N.J.A.C. 13:35-10.5, which sets forth requirements for a plan of care between licensed athletic trainers and supervising physicians. The proposed new rule requires every licensed athletic trainer practicing outside the traditional interscholastic, intercollegiate, intramural or professional athletic settings to enter into a written plan of care with a supervising physician setting forth the practices in which the licensed athletic trainer may engage while providing any athletic training services, including physical treatment modalities outside of traditional practice settings. The Board proposes this new rule based on the definition of "athletic training" in N.J.S.A. 45:9-37.36 and 37.37, which requires that licensed athletic trainers only provide athletic training outside the school or professional team setting when they are under the supervision of a physician. The definition of "athletic training" in N.J.S.A. 45:9-37.36d also dictates that physical treatment modalities be provided only under a plan of care. Accordingly, the proposed new rule also requires licensed athletic trainers practicing in the traditional institutional or professional settings to enter into a plan of care setting forth the practices the licensed athletic trainer may engage while providing physical treatment modalities. The plans of care must be signed by the licensed athletic trainer and the supervising physician and the two must meet at least once a year to review the plan of care. A supervising physician must be available either in person or through voice communication whenever an athletic trainer is practicing. A plan of care must be submitted to the Board upon request. The proposed new rule requires that the plan of care be signed, that the licensed athletic trainer and the supervising physician meet at least once a year to review the plan, that the supervising physician be available when the licensed athletic trainer is practicing and that the plan be made available to the Board upon request. The Board believes that a plan of care is the best way to ensure the provision of supervision required when licensed athletic trainers are working outside of the school or professional team.

New N.J.A.C. 13:35-10.6 addresses practice requirements when a licensed athletic trainer is working outside of an educational institution or professional team setting. A licensed athletic trainer may provide athletic training services in such settings only when a physician, who may be licensed in another state in this instance, has referred an athlete for athletic training services after a physical examination and when the athletic trainer is under the supervision of a physician. The rule requires that, when a licensed athletic trainer is working outside of a school or professional team setting, the plan of care include a provision that requires physician supervision during all aspects of athletic training. The Board proposes to require referral from a physician to an athletic trainer in order to ensure that the athletes receiving athletic training services outside of the school or professional team setting are evaluated by a physician prior to the provision of these services. In the school and professional team setting, there is a team physician who can provide this evaluation, but outside of these settings, there is no guarantee that an athlete has seen a physician who can establish that athletic training services are appropriate.

Proposed new N.J.A.C. 13:35-10.7 sets forth the scope of practice applicable to all licensed athletic trainers. The rule permits licensed athletic trainers to provide conditioning programs, testing and first aid. These are services that licensed athletic trainers are permitted to provide under existing N.J.A.C. 13:35-10.5. A licensed athletic trainer may also provide physical treatment modalities, as long as they are part of the licensed athletic trainer's plan of care and are designed and overseen by a licensed physician. Licensed athletic trainers are permitted to provide these services under existing N.J.A.C. 13:35-10.5. A licensed athletic trainer is prohibited from conducting electromyographic testing and nerve conduction velocity studies and from diagnosing injury or illness. These prohibitions are imposed under existing N.J.A.C. 13:35-10.5. A licensed athletic trainer is required to refer athletes to a health care professional if athletic training is contraindicated. This provision is taken from N.J.S.A. 45:9-37.37.

As the amended Act no longer requires licensed athletic trainers to be employed by a school, college, university or professional team, licensed athletic trainers may begin practicing outside of such employment relationships. Most of the other professionals regulated by the Board have rules governing such independent business practices to ensure that these professionals do not engage in misleading or fraudulent practices. The Board believes that licensed athletic trainers should be required to follow similar rules regarding business practices as the other professionals regulated by the Board. Proposed new rules N.J.A.C. 13:35-10.8 through 10.17 deal with recordkeeping and advertising practices and are the same as the rules that physicians and acupuncturists, among others licensed by the Board, are required to follow.

New N.J.A.C. 13:35-10.8 deals with recordkeeping. Under existing N.J.A.C. 13:35-10.5, licensed athletic trainers were required to maintain a written record regarding treatment. The proposed new rule does not affect when a written record must be made, but the Board believes that standards for written records should be clearly established in the rule, so that licensed athletic trainers are clear as to what these records must contain and how they should be maintained to ensure confidentiality. This is particularly relevant now that licensed athletic trainers will no longer be limited to working in an educational institution or for a professional team. The proposed new rule requires licensed athletic trainers to prepare a record for each athlete they evaluate and treat and sets forth what the record must contain. The rule prohibits the falsification of records and sets forth the minimum information that must be contained in records. Records must be maintained for at least seven years and a plan of care must be kept as part of a licensed athletic trainer's records. The rule permits students in approved athletic training programs to enter information into records. A licensed athletic trainer supervising the student must co-sign these records.

Proposed new rule N.J.A.C. 13:35-10.9 sets forth requirements for records that are kept solely on a computer. These standards are imposed by the Board on other professions it regulates in order to ensure that computerized records are kept confidential and cannot be fraudulently altered. A licensed athletic trainer who keeps records solely on computer shall use a program that contains internal permanently activated date and time recordation of entries, automatically prepares a back-up copy and prevents an entry from being changed after it has been finalized. Records must include two forms of identification for a licensed athletic trainer. The rule requires a licensed athletic trainer to finalize entries into computer records. Licensed athletic trainers must provide paper copies of computer records upon request.

Proposed new rule N.J.A.C. 13:35-10.10 requires licensed athletic trainers to release records to athletes, designated representatives and legal guardians. Licensed athletic trainers may charge a fee of $ 1.00 per page or $ 100.00 total, whichever is less, for requested records. If a record is less than 10 pages, licensed athletic trainers are permitted to charge up to $ 10.00 for providing the record. If records are unreadable because they are illegible or in a language other than English, licensed athletic trainers will be required to provide a transcript of the records. When an athlete requests the release of a record to another, licensed athletic trainers are required to secure written authorization for the release, signed by the athlete or his or her representative in order to help preserve the confidentiality of records and to prevent the inappropriate release of records. A licensed athletic trainer is prohibited from withholding records because an athlete did not pay for services rendered. The proposed new rule ensures that athletes are able to obtain records when they need them and that athletic trainers will not charge a fee for providing these records that is more than the reasonable cost they will bear in reproducing the records.

Proposed new rules N.J.A.C. 13:35-10.11 through 10.16 set forth requirements for advertising by licensed athletic trainers. While these rules apply to all licensed athletic trainers who advertise, it is likely that only those licensed athletic trainers who work outside of the school or professional team setting will engage in advertising.

Proposed new rule N.J.A.C. 13:35-10.11 permits a licensed athletic trainer to advertise, but prohibits inaccurate or misleading statements in advertisements. The Board may request that a licensed athletic trainer substantiate any statement made in an advertisement. The rule prohibits a licensed athletic trainer from soliciting patients to his or her athletic training practice and sets forth standards for advertising of fees and specialty certifications. The proposed new rule ensures that licensed athletic trainers are advertising in a truthful manner.

[page=28] Proposed new rule N.J.A.C. 13:35-10.12 deals with advertising discounted fees. An advertisement that offers a reduced fee must state the usual fee and the reduced fee. If an athletic trainer offers free services in an advertisement, he or she cannot charge for any service for 72 hours from the time a free service is rendered, unless a service was specifically exempted in the advertisement from free services. The proposed new rule ensures that fees that are advertised as discounted are actually discounted from the usual fee charged for those services.

Proposed new N.J.A.C. 13:35-10.13 imposes requirements on licensed athletic trainers who use testimonials in advertisements. Testimonials must truthfully reflect the experience of the athlete making the testimonial. Licensed athletic trainers will be required to be able to substantiate any statement of fact in a testimonial and, when compensation is made for a testimonial, the advertisement must reflect this. The proposed new rule ensures that testimonials used in advertisements are not misleading.

Pursuant to proposed new rule N.J.A.C. 13:35-10.14, every advertisement must contain a licensed athletic trainer's name and license number and the address and telephone number of the practice. This allows consumers to easily identify the licensed athletic trainer who is advertising services and facilitates the Board's ability to identify a licensed athletic trainer who has engaged in inappropriate advertising.

Pursuant to proposed new N.J.A.C. 13:35-10.15, a licensed athletic trainer who is a principal, partner or officer of a firm that offers athletic training will be jointly and severally liable for any advertisement from that entity. The proposed new rule ensures that those athletic trainers who have control of an athletic training business will be responsible for the advertisements made by that business.

According to proposed new N.J.A.C. 13:35-10.16, licensed athletic trainers must retain copies of advertisements and documents on testimonials for three years from the date of publication of the advertisement. This ensures that advertisements will be available to the Board when issues arise as to whether the advertisements were appropriate.

Proposed new rule N.J.A.C. 13:35-10.17 requires licensed athletic trainers to accurately represent his or her competence, education, training and experience. The rule also requires licensed athletic trainers to use the phrase "athletic trainer" or "licensed athletic trainer," or the initials "AT" or "LAT" when identifying him- or herself as a licensed athletic trainer. Any advertisement that refers to a professional credential must also contain any academic degrees earned from accredited academic institutions. The proposed new rule ensures that licensed athletic trainers are not misrepresenting their education or training and will allow consumers to easily identify those individuals who are legitimately licensed by the Board as athletic trainers.

The Board has determined that the comment period for this notice of proposal shall be 60 days; therefore, pursuant to N.J.A.C. 1:30-3.3(a)5, this notice is excepted from the rulemaking calendar requirement.

Social Impact

The Board believes that the proposed new rules, repeal and amendments will benefit athletes and licensed athletic trainers. The proposed new rules, repeal and amendments effectuate P.L. 2007, c. 323, which permits licensed athletic trainers to provide athletic training services outside educational institution and professional team settings. This increases the opportunities for athletes to receive services from licensed athletic trainers, which often are the difference between an athlete continuing to engage in athletic activities and having to give them up. Licensed athletic trainers will benefit by having a larger population who may avail themselves of the services. Requiring a physician referral prior to the provision of services in these new practice settings will ensure that athletes are receiving appropriate services and that they are not suffering from undiagnosed conditions that contraindicate athletic training services.

Proposed new rules governing the business practices of licensed athletic trainers will benefit the public by ensuring that licensed athletic trainers are not engaging in misleading or fraudulent business practices.

Economic Impact

The proposed new rules, repeal and amendments will impose costs on athletic trainers who seek reinstatement after being suspended for more than three years. These individuals will be required to obtain and submit proof that they are currently certified by the National Athletic Trainers Association Board of Certification. They will bear the cost of obtaining this certification and submitting it to the Board.

The proposed new rules dealing with recordkeeping requirements will impose costs on licensed athletic trainers. Licensed athletic trainers who advertise athletic training services will incur costs to comply with Board rules that impose standards for advertising.

Federal Standards Statement

A Federal standards analysis is not required because the proposed amendments, repeal and new rules do not involve any Federal standards or requirements.

Jobs Impact

The Board does not believe that the proposed amendments, repeal and new rules will have an impact on jobs in New Jersey.

Agriculture Industry Impact

The Board does not believe that the proposed amendments, repeal and new rules will have any impact on the agriculture industry of this State.

Regulatory Flexibility Analysis

Since licensed athletic trainers are individually licensed by the Board, they may be considered "small businesses" under the Regulatory Flexibility Act (the Act), N.J.S.A. 52:14B-16 et seq.

Costs that small businesses may incur are the same all licensed athletic trainers incur as summarized in the Economic Impact above. The Board does not believe that licensed athletic trainers will need to employ any professional services in order to comply with the proposed amendments or new rules. The proposed amendments and new rules impose compliance, recordkeeping and reporting requirements as detailed in the Summary above.

As the proposed amendments and new rules protect the health, safety and welfare of athletes who receive athletic training services, the Board believes that the amendments and new rules must be uniformly applied to all licensed athletic trainers and no exemptions are provided based on the size of the licensed athletic trainer's business.

Smart Growth Impact

The Board does not anticipate that the proposed amendments, repeal and new rules will have any impact on the achievement of smart growth and implementation of the State Development and Redevelopment Plan, otherwise known as the State Plan.

Housing Affordability Impact

The proposed amendments, repeal and new rules will have an insignificant impact on affordable housing in New Jersey and there is an extreme unlikelihood that the rules would evoke a change in the average costs associated with housing because the proposed amendments, repeal and new rules concern the practice of licensed athletic trainers.

Smart Growth Development Impact

The proposed amendments, repeal and new rules will have an insignificant impact on smart growth and there is an extreme unlikelihood that the rules would evoke a change in housing production in Planning Areas 1 or 2 or within designated centers under the State Development and Redevelopment Plan in New Jersey because the proposed amendments, repeal and new rules concern the practice of licensed athletic trainers.

Full text of the proposal follows (additions indicated in boldface thus; deletions indicated in brackets [thus]):

SUBCHAPTER 10.     ATHLETIC TRAINERS

13:35-10.2   Definitions

The following words and terms, as used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise.

. . .

"Athlete" means an individual who participates in [an inter-scholastic, intercollegiate or intramural athletic activity being conducted by an educational institution licensed in the State of New Jersey or a [page=29] professional athletic activity] strenuous physical exercise, physical conditioning or a sport.

["Athletic trainer" means a person who practices athletic training as an employee of a school, college, university or professional athletic team.]

"Athletic training" means the practice of physical conditioning and reconditioning of athletes[,] and the prevention of injuries incurred by athletes. [and at the direction of a physician licensed in the State of New Jersey,] "Athletic training" also includes the application of physical treatment modalities to athletes under a plan of care designed and overseen by a supervising physician licensed in New Jersey, as recommended by the Advisory Committee and defined in N.J.A.C. 13:35-[10.4(c)]10.7(b).

. . .

["Direction of a licensed physician" means the designing and overseeing of a plan of care for the athlete by a physician licensed in the State of New Jersey (M.D., D.O., D.C., D.P.M.) within his or her permitted scope of practice as specified by N.J.S.A. 45:9-5.1, N.J.S.A. 45:9-14.5, N.J.S.A. 45:9- 41.27, N.J.S.A. 45:5-7.

"Non-injured athlete" means an athlete who has not sustained an injury or who has received medical clearance from a physician licensed in the State of New Jersey for full participation after injury/illness.

"Professional athletic team" means any team, group or individual athlete paid to perform at athletic events and activities.]

"Bracing" means the provision of fabric and elastic supports, corsets, arch supports, trusses, elastic hose, canes, crutches, cervical collars, dental appliances or other similar devices carried in stock and sold by drug stores, department stores, corset shops or surgical supply facilities.

"Licensed athletic trainer" means an individual who is licensed by the Board to practice athletic training.

"Physician" means a physician and surgeon licensed pursuant to N.J.S.A. 45:9-1 et seq.

"Plan of care" means a documented arrangement between a licensed athletic trainer and a physician, which sets forth:

1. The physical treatment modalities a licensed athletic trainer will utilize while providing services to athletes in an interscholastic, intercollegiate, intramural or professional athletic setting; and

2. Any athletic training services, including physical treatment modalities, the athletic trainer will provide when he or she is working with an athlete outside of an interscholastic, intercollegiate, intramural or professional athletic setting.

"Supervising physician" means a physician with whom an athletic trainer has a plan of care.

"Supervision" means that a physician licensed in this State is accessible to a licensed athletic trainer, either on-site or through voice communication, during athletic training.

13:35-10.3   Application for licensure

(a) An applicant for athletic trainer licensure shall submit to the Board:

1. (No change.)

2. Proof that the applicant has completed a program of education, training and experience, which is approved by the [National Athletic Trainers' Association Board of Certification, Inc.] Commission on Accreditation of Athletic Training Education, or its successor;

3. (No change.)

4. The application fee pursuant to N.J.A.C. 13:35-[10.6]10.19.

13:35-10.4   Licensure; biennial license renewal; license suspension; reinstatement of suspended license; inactive status; return from inactive status

(a) All licenses issued by the Board shall be issued for a two-year [biennial] licensure period. A [licensee] licensed athletic trainer who seeks renewal of the license shall submit a completed renewal application and the renewal fee as set forth in N.J.A.C. 13:35-[10.7]10.19 prior to the expiration date of the license.

(b) (No change.)

(c) If a [licensee] licensed athletic trainer does not renew the license prior to its expiration date, the [licensee] licensed athletic trainer may renew the license within 30 days of its expiration by submitting a renewal application, a renewal fee and a late fee, as set forth in N.J.A.C. 13:35-[10.7]10.19. During this 30-day period, the license shall be valid, and the [licensee] licensed athletic trainer shall not be deemed to be practicing without a license.

(d) (No change.)

(e) A [licensee] licensed athletic trainer whose license has been automatically suspended for five years or less for failure to renew pursuant to (d) above may be reinstated by the Board upon completion of the following:

1. Payment of the reinstatement fee and all past delinquent biennial renewal fees pursuant to N.J.A.C. 13:35-[10.7]10.19; and

2. (No change.)

(f) In addition to fulfilling the requirements set forth in (e) above, a licensed athletic trainer whose license has been automatically suspended for more than three years who wishes to return to practice shall submit proof that he or she is currently certified by the National Athletic Trainers Association Board of Certification, or its successor.

[(f)] (g) In addition to [the] fulfilling the requirements set forth in (e) and (f) above, a [licensee] licensed athletic trainer whose license has been automatically suspended for more than five years who wishes to return to practice shall reapply for licensure and shall demonstrate that he or she has maintained proficiency. An applicant who fails to demonstrate to the satisfaction of the Board that he or she has maintained proficiency while suspended may be subject to an examination or other requirements as determined by the Board prior to reinstatement of his or her license.

[(g)] (h) Renewal applications shall provide the [licensee] licensed athletic trainer with the option of either active or inactive status. A [licensee] licensed athletic trainer electing inactive status shall pay the inactive license fee set forth in N.J.A.C. 13:35-[10.7]10.19 and shall not engage in practice.

[(h)] (i) (No change in text.)

[(i)] (j) In addition to [the] fulfilling the requirements set forth in [(h)] (i) above, a [licensee] licensed athletic trainer who has been on inactive status for more than five years who wishes to return to the practice of [medicine] athletic training shall reapply for licensure and shall demonstrate that he or she has maintained proficiency. An applicant who fails to demonstrate to the satisfaction of the Board that he or she has maintained proficiency while on inactive status may be subject to an examination or other requirements as determined by the Board prior to reinstatement of his or her license.

[13:35-10.5  Approved activities

(a) A licensed athletic trainer may provide the full spectrum of pre-season, in-season and post-season conditioning programs. These programs include maintenance and reconditioning programs, as well as bandaging, wrapping, taping, padding, and splinting procedures for the prevention and management of injuries.

(b) Nothing in this subchapter shall be interpreted to prohibit licensed athletic trainers from providing first-aid.

(c) A licensed athletic trainer may, at the direction of a licensed physician, administer the following physical treatment modalities:

1. Cold;

2. Heat;

3. Light;

4. Sound;

5. Electricity;

6. Electromagnetic waves;

7. Water; and

8. Traditional mobilization techniques, rehabilitative exercise programs, traction, and massage.

(d) A licensed athletic trainer may, at the direction of a licensed physician, provide testing or neuromotor and musculoskeletal functional capability for the purposes of conditioning, reconditioning or otherwise evaluating the athlete's performance capability. However, nothing in this subchapter shall be interpreted to permit a licensed athletic trainer to conduct electromyographic testing or nerve conduction velocity studies.

(e) The licensed athletic trainer shall not diagnose an injury or illness. However, prior to implementing or while maintaining the plan of care, the licensed athletic trainer shall exercise professional judgment to determine whether any intervening circumstances have adversely affected the athlete's ability to participate in or continue to participate in the plan of care.

[page=30] (f) A written record regarding the treatment of an athletic injury shall be created by the licensed athletic trainer and maintained for a period of seven years from the date of the last entry.

(g) Nothing in this subchapter shall be interpreted to prohibit licensed athletic trainers from being employed or performing activities which do not require licensure or registration provided they do not hold themselves out as athletic trainers during that employment or performance.

(h) Nothing in this section shall be interpreted to prohibit unlicensed individuals from applying bandaging, wrapping, taping, padding or splinting techniques to non-injured athletes.]

13:35-10.5   Plan of care guidelines

(a) Every licensed athletic trainer shall enter into a written plan of care with a supervising physician, which sets forth the practices in which a licensed athletic trainer shall engage in while providing physical treatment modalities to athletes in an interscholastic, intercollegiate, intramural or professional athletic setting and all athletic training services, including physical treatment modalities, provided outside of these settings. The plan of care shall be signed and dated by both the licensed athletic trainer and the supervising physician.

(b) A licensed athletic trainer and his or her supervising physician shall meet at least once a year to review the plan of care and revise it as necessary.

(c) A supervising physician shall be available, either in person or through voice communication, whenever a licensed athletic trainer is practicing athletic training.

(d) A licensed athletic trainer shall make a plan of care available to the Board upon request.

13:35-10.6   Practice outside of schools and professional teams

(a) If a licensed athletic trainer is working outside of an interscholastic, intercollegiate, intramural or professional athletic setting, the licensed athletic trainer shall provide athletic training services only when a physician (who may, in this instance, be licensed in another state) has referred the athlete for athletic training after physically examining the athlete.

(b) When a licensed athletic trainer is working outside of an interscholastic, intercollegiate, intramural or professional athletic setting with an athlete, the licensed athletic trainer's plan of care shall include provisions for supervision from a supervising physician during all aspects of athletic training, not just during the provision of physical modalities.

13:35-10.7   Scope of practice

(a) A licensed athletic trainer in an interscholastic, intercollegiate, intramural or professional athletic setting, or any other setting pursuant to a referral from a physician, may provide to an athlete:

1. Conditioning programs for the prevention and management of injuries including:

i. Maintenance programs;

ii. Reconditioning programs;

iii. Exercise programs; and

iv. Bandaging, wrapping, taping, padding, bracing and splinting procedures;

2. Testing of neuromotor and musculoskeletal functional capability for the purposes of conditioning, reconditioning or otherwise evaluating the athlete's performance capability; and

3. First-aid.

(b) If they are included in the licensed athletic trainer's plan of care with a supervising physician, a licensed athletic trainer may administer physical treatment modalities, such as:

1. Cold;

2. Heat;

3. Light;

4. Sound;

5. Electricity;

6. Electromagnetic waves;

7. Water; and

8. Traditional mobilization techniques, rehabilitative exercise programs, traction and massage.

(c) A licensed athletic trainer shall not conduct electromyographic testing or nerve conduction velocity studies.

(d) A licensed athletic trainer shall not diagnose an injury or illness. Prior to implementing or continuing athletic training services, the licensed athletic trainer shall exercise professional judgment to determine whether any intervening circumstances have adversely affected the athlete's ability to participate in or continue to participate in athletic training.

(e) A licensed athletic trainer shall immediately refer an athlete to a health care professional licensed in this State if the licensed athletic trainer has cause to believe that athletic training is contraindicated or symptoms or conditions are present that require services outside the scope of a licensed athletic trainer's practice.

13:35-10.8   Records

(a) A licensed athletic trainer shall prepare and maintain for each athlete a contemporaneous, permanent record that accurately reflects the evaluation and treatment of the athlete's illness or injury by the licensed athletic trainer.

(b) A licensed athletic trainer shall not falsify a record.

(c) A record shall include, in addition to personal identifying information, consents and disclosures, at least the following information:

1. The full name, as it appears on the license, and license number of the licensed athletic trainer who rendered care. This information shall be legible and shall appear at least once on each page of the record;

2. Dates of all athletic training services;

3. The findings of the evaluation including test results;

4. Documentation of health care practitioner referrals, if any;

5. Established measurable goals of the athletic training with stated time frames, the type of athletic training and the frequency and expected duration of athletic training;

6. A contemporaneous note that accurately represents the services rendered during the athletic training sessions including the components of athletic training, the athlete's response to activities and current status;

7. Progress notes in accordance with stated goals at a frequency consistent with the evaluated findings and changes in the athlete's conditions;

8. Communication with other health care professionals relative to the athlete's care;

9. A discharge or return to activity summary, which includes the reason for discharge from and outcome of athletic training relative to established goals at the time of discharge; and

10. Pertinent legal document(s).

(d) Records shall be maintained for at least seven years from the date of the last entry.

(e) A student in a Commission on Accreditation of Athletic Training Education approved athletic training education program may enter information in an athlete's record, as long as the licensed athletic trainer supervising the student co-signs his or her full name and license number next to the student's entry.

(f) A licensed athletic trainer shall maintain his or her plan of care as part of his or her records.

13:35-10.9   Use of personal or other computer to prepare records

(a) A licensed athletic trainer who prepares a record maintained solely on a personal or other computer shall use a write-protected program that:

1. Contains an internal permanently activated date and time recordation for all entries;

2. Automatically prepares a back-up copy of the file; and

3. Is designed in such manner that, after the licensed athletic trainer "signs" by means of a confidential personal code (CPC), the entry cannot be changed in any manner.

(b) The licensed athletic trainer shall include in the record at least two forms of identification; for example, name and record number of the athlete or any other specific identifying information.

(c) The licensed athletic trainer shall finalize or "sign" the entry by means of a CPC. Where more than one individual is authorized to [page=31] make entries into the computer file of any record, the licensed athletic trainer responsible for the facility at which the licensed athletic trainers work shall assure that each such person obtains a CPC and uses the program in the same manner.

(d) The licensed athletic trainer shall generate a hard copy of the complete record upon request.

13:35-10.10   Release of records

(a) A licensed athletic trainer shall provide a copy of the athlete's record within 30 days of a written request by the athlete or any person whom the athlete has designated to receive that record, or, if the athlete is a minor, the athlete's legal guardian.

(b) Licensed athletic trainers may require a record request to be in writing and may charge a fee for the reproduction of records, which shall be no greater than $ 1.00 per page or $ 100.00 for the entire record, whichever is less. (If the record requested is less than 10 pages, the licensed athletic trainer may charge up to $ 10.00 to cover postage and the miscellaneous costs associated with retrieval of the record.) If the athlete requests a summary in lieu of the actual record, the charge for the summary shall not exceed the cost that would be charged for the actual record.

(c) If the athlete or a subsequent treating health care professional is unable to read the treatment record, either because it is illegible or prepared in a language other than English, the licensed athletic trainer shall provide a transcription at no cost to the athlete or the person requesting the record.

(d) Where the athlete has requested the release of all or part of a professional treatment record to a specified individual or entity, in order to protect the confidentiality of the records, the licensed athletic trainer shall:

1. Secure and maintain a current written authorization, bearing the signature of the athlete or an authorized representative;

2. Assure that the scope of the release is consistent with the request; and

3. Forward the records to the attention of the specific individual or entity identified and mark the material "Confidential."

(e) A licensed athletic trainer shall not withhold or delay providing a record because the athlete or any other payor failed to pay for services rendered.

13:35-10.11   Advertising and solicitation practices

(a) The following words and terms, when used in this section shall have the following meanings unless the context clearly indicates otherwise.

1. "Advertisement" shall mean any attempt directly or indirectly by publication, dissemination or circulation in print or electronic media to induce directly or indirectly any person or entity to purchase or enter into an agreement to purchase services, treatment or goods related thereto from a licensed athletic trainer.

2. "Electronic media" shall include radio, television, telephone, facsimile machine or computer.

3. "Fee schedule" refers to the fees charged for services or goods offered by a licensed athletic trainer.

4. "Graphic representation" shall mean the use of drawings, animations, clinical photographs, dramatizations, music or lyrics.

5. "Print media" shall refer to newspapers, magazines, periodicals, professional journals, telephone directories, circulars, handbills, fliers or other publications, the content of which is disseminated by means of the printed word.

6. "Routine professional service" refers to a service that a licensed athletic trainer or professional association routinely performs.

(b) Subject to the limitation of (c) and (e) through (i) below, a licensed athletic trainer may provide information to the public by advertising in print or electronic media.

(c) A licensed athletic trainer who engages in the use of advertising that contains any of the following shall be deemed to have engaged in professional misconduct:

1. Any statement, claim or format including a graphic representation that is false, fraudulent, misleading or deceptive;

2. Any misrepresentation of a material fact;

3. The suppression, omission or concealment of any material fact under circumstances that the licensed athletic trainer knows or should have known is improper or prevents an athlete from making a full and informed judgment on the basis of the information set forth in the advertisement;

4. Any claim that the service performed or the materials used are superior to those ordinarily performed or used in the profession;

5. Any promotion of professional service that the licensed athletic trainer knows or should know is beyond the licensed athletic trainer's ability to perform;

6. A technique or communication that appears to intimidate, exert undue pressure or to unduly influence an athlete;

7. Any personal testimonial attesting to the quality or competence of service or treatment by a licensed athletic trainer involving medical or technical assessments that are beyond the athlete's competency to assess, or any testimonial not in compliance with N.J.A.C. 13:35-10.13;

8. The communication of any fact, data or information that may personally identify an athlete without the athlete's signed written permission obtained in advance;

9. An offer to pay, give or accept a fee or other consideration to or from a third party for the referral of an athlete;

10. Any print, language or format that directly or indirectly obscures a material fact; or

11. Any guarantee of results from any procedure.

(d) The Board may require a licensed athletic trainer to substantiate the truthfulness of any assertion or representation set forth in an advertisement.

(e) Any violations of (f) through (i) below shall be deemed professional misconduct.

(f) A licensed athletic trainer shall not engage, either directly or through the use of any agent, employee or representative, in solicitation of an athlete. This subsection shall not prohibit a licensed athletic trainer from offering services through materials provided to a community service organization that makes known the availability of all professional services listed; nor shall it prohibit the offering of services by a licensed athletic trainer to any bona fide representative of an athlete including, employers, labor union representatives or insurance carriers.

(g) Advertising making reference to or setting forth fees shall be limited to a stated fee for specifically described routine professional services or goods offered by licensed athletic trainers.

1. A licensed athletic trainer who advertises a fee shall disclose all relevant and material variables and considerations that are ordinarily included in such a service, so that the fee will be clearly understood by athletes.

2. In the absence of such disclosure referred to in (g)1 above, the stated fees shall be presumed to include everything ordinarily required for such a service. No additional charges shall be made for an advertised service unless the advertisement specifically delineates the additional services contemplated and the fee to be charged.

(h) The time period during which an advertised fee will remain in effect shall be set forth on the face of the advertisement. In the absence of such disclosure, the effective period shall be deemed to be 30 days from the date of the advertisement's final publication.

(i) Any licensed athletic trainer advertising a specialty certification shall have been certified by a certifying entity and shall maintain documentary proof of certification from the entity as part of his or her records. A licensed athletic trainer who advertises a specialty certification shall include the full name of the certification and the certifying entity in any advertisements and shall not use initials or acronyms for the certification or certifying entity. For example, a licensed athletic trainer may indicate in advertisements that he or she is a Certified Strength and Conditioning Specialist certified by the National Strength and Conditioning Association but shall not indicate that he or she is a CSCS certified by the NSCA.

[page=32] 13:35-10.12    Advertising free or discounted services; required disclosures

(a) An advertisement offering a fee reduction shall state the reduced fee and the licensed athletic trainer's usual fee for each service for which a reduction is advertised. The usual fee shall be the fee charged for the advertised service for a period of not less than 90 days prior to the publication of the advertised reduction.

(b) If the discount or free service does not apply to all services to be rendered, the advertisement shall specify any associated or reasonably anticipated services that are not included and a statement of the specific charges for all associated or reasonably anticipated services that are not included.

(c) Except for those services specifically excluded in the advertisement offering free services, the licensed athletic trainer shall not charge for any service whatsoever rendered during a period of 72 hours from the time the free service was rendered.

13:35-10.13   Testimonial advertising

(a) All testimonials involving a specific or identifiable procedure shall truthfully reflect the actual experience of the athlete.

(b) The licensed athletic trainer shall be able to substantiate any objective, verifiable statement of fact appearing in a testimonial. The failure to do so, if required by the Board, may be deemed professional misconduct.

(c) Where a licensed athletic trainer directly or indirectly provides compensation to a testimonial giver, the fact of such compensation shall be conspicuously disclosed in a clear, legible and readable manner in any advertisement as follows: "COMPENSATION HAS BEEN PROVIDED FOR THIS TESTIMONIAL."

13:35-10.14   Minimum content

(a) A licensed athletic trainer shall include the following in all advertisements and professional representations (other than an office entry sign), including advertisements in a classified directory, business cards and professional stationery:

1. The name and license number of at least one licensed athletic trainer working at the advertised practice location; and

2. The street address and telephone number of the practice.

13:35-10.15   Advertising by a business entity offering athletic training

The responsibility for the form and content of any advertisement offering services or goods by a licensed athletic trainer shall be jointly and severally that of each licensed athletic trainer who is a principal, partner, officer or employee of the firm or entity identified in the advertisement.

13:35-10.16   Advertising record retention

(a) A licensed athletic trainer shall retain, for a period of three years from the date of initial publication or dissemination, a copy of every advertisement for his or her services appearing in print media, as well as a video or audio tape of every advertisement communicated by electronic media. A licensed athletic trainer shall indicate on all advertisements in his or her possession the date and place of publication.

(b) Documentation relating to the use of testimonials shall be retained for a period of three years from the date of last use of the testimonial. Documentation shall include the name, address and telephone number of the testimonial giver and the type and amount or value of compensation, if any.

13:35-10.17   Use of professional credentials and certifications

(a) A licensed athletic trainer shall accurately and objectively represent his or her competence, education, training and experience.

(b) A licensed athletic trainer shall use the designation "athletic trainer" or "licensed athletic trainer" or the abbreviation "AT" or "LAT" in conjunction with the use of his or her name and license number. Academic degree designations may be placed after the name and the title.

(c) An advertisement that includes information on professional credentials shall contain the academic degrees attained related to the practice of athletic training and shall refer only to degrees obtained from accredited academic institutions.

Recodify existing 13:35-10.6, 10.7 and 10.8 as 13:35-10.18, 10.19 and 10.20 (No change in text.

   
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