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  • Statehouse Roundup: Licensure Compact Progress; Chapters Press for Changes to Direct Access, Pain Management Policy, Payment, and More

    Providing all goes as hoped during current state legislative sessions, the Physical Therapy Licensure Compact could pass the halfway mark in its progress toward adoption in every state, with a potential for 28 states to be participating in the system that allows physical therapists (PTs) and physical therapist assistants (PTAs) licensed in 1 compact state to obtain practice privileges in others.

    "Thanks to the hard work of APTA state chapters and state licensing boards, we've been able to keep up the momentum around the compact," said Angela Shuman, APTA's director of state affairs. "As more states join, it will make the case even stronger for the remaining non-compact states to sign on."

    Compact bills are now being considered in Georgia, Maryland, Massachusetts, Michigan, Nevada, and Pennsylvania. If the legislation is successful, those states will join 23 others already in the system: Arizona, Arkansas, Colorado, Iowa, Kentucky, Louisiana, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, North Carolina, North Dakota, Oklahoma, Oregon, South Carolina, Tennessee, Texas, Utah, Virginia, Washington, and West Virginia.

    But that's not all that's been going on at the state level during an extremely active legislative season. Here's a roundup of other activity:

    Practice

    • Direct access. Efforts to expand direct access to physical therapist (PT) services and remove restrictions on existing laws continue, with Wyoming becoming the 19th state to adopt unrestricted direct access—"a very, very big win," according to Shuman. Other states that are considering positive direct access changes include Alabama, Indiana, Missouri, North Carolina, South Carolina, and Texas.
    • Dry needling. Legislation is being considered in Hawaii, New Jersey, and Washington that would lift prohibitions on dry needling by qualified PTs, while advocates in Indiana are seeking to include the treatment as part of a sweeping revision of the physical therapy practice act. Meanwhile, PTs and supporters in Nevada are fighting an attempt to make dry needling the exclusive practice of oriental medicine practitioners.
    • Telehealth. "There's a lot going on right now related to telehealth," Shuman said. "State legislatures are considering everything from changing practice standards that would increase telehealth options for all health providers to legislation that would require insurers to cover remotely delivered services in the same manner they cover in-person visits." States that are considering other changes include Florida and South Dakota, which are debating the adoption of statewide telehealth standards; and North Dakota, where the legislature is asking the governor sign a bill that adds a definition of telehealth to the physical therapy practice act.
    • Concussions. Bills to add PTs as providers authorized to remove student athletes from activity due to a concussion, as well as make return-to-activity decisions, are being considered in Colorado, Massachusetts, and Texas. A similar change in West Virginia already has been signed into law.
    • Disability determinations. PTs in Florida and Texas soon may be permitted to make disability determinations for license plates and placards; the provision is now law in Minnesota.
    • PTA Issues. Montana is considering a law that would allow PTAs to be supervised through telecommunications, while New York is looking to change the status of PTAs from "certified" to a licensed profession. In North Dakota, a bill that changes supervision requirements for assistive personnel has been sent to the governor to be signed into law.
    • Mandatory reporting. Legislators in Michigan are considering including PTs and PTAs as mandatory reporters of suspected child abuse.

    Payment and referral

    • Copays and patient cost-sharing. Four states—Georgia, Rhode Island, New Mexico, and New York—are moving on legislation that would set limits on out-of-pocket patient costs, with New Mexico's bill already on the governor's desk.
    • Utilization management and other insurance issues. Lawmakers in California, Michigan, Washington, and Oregon are considering changes that would decrease unnecessary delays in care caused by prior authorization and other utilization management practices by insurance companies. The California legislation focuses on workers' compensation.
    • Medicaid. PTs and supporters in Iowa are fighting a proposal to implement multiple procedure payment reduction (MPPR) in Medicaid, while legislators in Maine are looking at improving provider reimbursement for physical therapy.
    • Tax breaks for PTs. It isn’t payment per se, but a move that would keep more money in the pockets of PTs and PTAs: New Mexico may adopt a law that would provide state tax credits for PTs and PTAs working in rural areas.
    • Referral sources. Oklahoma is considering a change that would allow nurse practitioners to make referrals to physical therapy; North Dakota and South Carolina are discussing similar legislation that would apply to physician assistants.

    The Opioid Crisis

    • Nonpharmacological approaches to pain management. "There's so much going on in this space at so many levels," Shuman said, "but the trend is definitely toward changes that increase patient access to nonopioid and nondrug options for pain."

      Several APTA chapters have been directly involved in policy discussions, including in Connecticut, which is establishing guidelines for nonpharmacological pain treatments that include physical therapy; and Minnesota, which is considering a bill that would direct a new Health Services Policy Committee to seek consultation with PTs as it develops recommendations on pain management. In Tennessee, changes are being considered that would add physical therapy as an "alternative treatment" that prescribers may discuss with patients before prescribing opioids, while in Indiana, lawmakers are considering requiring certain health insurers to include physical therapy as a medically necessary (and thus covered) service in the treatment of chronic pain.

    Practice acts, licensing boards, and the National Physical Therapy Exam (NPTE)

    • Improving terms and protecting titles. Terms such as "PT," "DPT," "physiotherapy," and "doctor of physical therapy" could be reserved for the exclusive use of PTs in Alaska and Indiana if legislation moves ahead in those states. North Dakota has sent a similar bill to its governor to be signed into law.
    • Licensing boards. PTs could be getting better representation and autonomy in the state regulatory arena. Indiana is looking at moving away from its current regulatory system based on a physical therapy committee under the state's medical board and toward a freestanding board of physical therapy. Connecticut and North Dakota are making changes to the composition of their physical therapy boards, with Connecticut possibly eliminating rules that require a physician to be a member of the board and North Dakota reducing physician board members from 2 to 1—and adding a PTA member. The North Dakota bill is now on the governor's desk.
    • The NPTE. Indiana, South Carolina, and North Dakota are discussing imposing a lifetime limit of 6 NPTE attempts, while Utah, Pennsylvania, and South Carolina are considering changes that would allow PT students to take the NPTE before they graduate.