Does Your State Have Laws Related to Copays?

The below map provides information on existing copays laws on a broad range of services and providers in the states. In performing the research, a number of relevant issues were noted in certain jurisdictions that may be beneficial in the future as APTA and its chapters and sections analyze the treatment of copayments in different states.

Depending on the state, certain current limitations are based on provider type (eg, physical therapist, occupational therapist, chiropractor), diagnosis (eg, autism, diabetes), and patient population (eg, Medicaid beneficiaries, children aged 0–3). States have used a number of parameters, including fixed dollar amounts, percentages, references to the most common amount, references to other providers, and amounts that do not discriminate against certain providers. Many states use a combination of these limitations. Some limitations are based on a per-visit determination, while others are based on an annual cap or maximum.

Hawaii Washington, D.C. Maryland Delaware New Jersey Connecticut Rhode Island Massachusetts New Hampshire Vermont West Virginia Maine New York Pennsylvania Virginia North Carolina South Carolina Georgia Florida Alabama Ohio Michigan Indiana Kentucky Tennessee Mississippi Illinois Wisconsin Louisiana Arkansas Missouri Iowa Minnesota Texas Oklahoma Kansas Nebraska South Dakota North Dakota Alaska New Mexico Arizona Colorado Wyoming Montana Utah Idaho Nevada California Oregon Washington Puerto Rico

Please note: For current pending legislation in your state related to fair PT copays, please check the APTA state legislative tracking map at:

Last Updated: 04/21/2015

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