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Direct access, the compact, and more.

Many state legislatures across the country are or soon will be back in session, and that means APTA chapters, assisted by APTA national, will be there to press for needed changes around everything from direct access to supporting a PT's ability to authorize imaging orders. APTA Manager of State Affairs Tajah Franklin provides a preview of some of the issues likely to be taken up in statehouses this year.

Our Speaker

Tajah “Taj” Franklin is manager of state affairs for APTA.

The following transcript was created using artificial intelligence and may contain typos, omissions, or other errors.

Troy: Welcome to this APTA podcast. I'm Troy Elliott, and thanks for joining us in this podcast. We're going to be looking at some of the advocacy priorities at the state level, led by APTA State with assistance from APTA National and this is an important area for advocacy. Yes, federal level legislative and regulatory developments can have sweeping effects, but changes to state laws and regulations can sometimes have immediate, varied direct results. States have the power to expand direct access provisions, regulate private pay rules and define what PTs and PTAs can and can't do, so it's crucial to pay attention and to get involved. To help us get focused in this podcast, we turn to APTA Manager of State affairs Taj Franklin. Now one thing to note, this podcast was recorded in late 2023, so when you hear us talking about this year or last year or next year, please keep that in mind. Now on with the podcast.

I'm sure you know this. Just about better than anyone, but 2023 was generally speaking, a pretty good year for state. Nancy and I know that the specifics of these various state advocacy priorities for 2024 are still taking shape. So that means we'll need to stay fairly general in that regard. But as we go along, I'm hoping that you can give us some examples from this year that help us kind of see, you know, what do we mean, what changes we mean when we talk about wins? And like imaging, direct access and all these other areas. And imaging is where I wanted to start. So first, what did we see happen this year and what can you tell us about what's coming in 2024?

Tajah: Well, Troy, you know, this year we saw two imaging wins in Iowa and Rhode Island. APTA Iowa scored a major victory with HB174 being made into law, which allows licensed PTs in Iowa to order X-rays and MRIs, while APTA Rhode Island champion HB 5013 that extended the allowance for licensed PTs in the state to order X-ray imaging for another two years. You know looking. We had to 2024. We have exciting developments with 13 states expressing their intent to pursue imaging privileges for physical therapists. You know, this is a monumental step enhancing patient access to imaging services and we are definitely eager to continue these positive strides in the upcoming year yeah, if. You look at just the sheer numbers of states.

Troy: I mean, it's really climbed pretty, pretty sharply just in the past few years. So that's a great sign. What kind of other trends are you seeing?

Tajah: You know, as we prepare for 2024, another noteworthy trend involves states modernizing their practice acts. In July of this year, FSBPT organized a Model Practice Act workshop, bringing together state boards and APTA state chapters to collaborative review. The 7th edition of the Model Practice Act alongside their state’s current rules and regulations. You know the goal of this was to strategize and outline a list of priorities for change in the near future, and we are seeing the fruit of that now as 11 chapters are looking to modernize their practice acts this legislative season.

Additionally, 10 states are directing their attention to the nation's largest public insurance provider, Medicaid, which covers health services for millions of Americans most vulnerable patient populations, and 19 states are looking to make changes to prior authorization and administrative burdens that ultimately affect patients’ clinical outcomes. And result in delays for medically necessary physical therapist services.

Troy: Yeah, all of which are very important. And again, it's great to see that kind of movement happening. I wanted to shift over to what I think are essentially both access issues to varying degrees and that's direct access of, of course and the pursuit of fair co-pays. I mean, I think it's fair to consider high co-pays as a barrier to patient access too. So I'm. And kind of lumping those two together. So first tell us about where states have come from and where they're headed in terms of direct access. I mean, I know that all jurisdictions have some form of it, but some states are more restrictive than others. What kind of progress have we seen there and what's on the table for 2024?

Tajah: So this past legislative season, we've experienced one of our most successful periods for direct access with Maine, Missouri, Tennessee and Virginia making significant strides and expanding access to physical therapy services. Maine LD 1453 removed restrictions tied to the time limit for treatment without referral. Introducing exemptions for health promotion, injury prevention and Wellness, the chapter also eliminated the requirement for spinal manipulation to be performed only upon referral.

Now Missouri, previously one of our more restrictive states for direct access, they successfully advocated for SB51, allowing PTs with five years of experience or a DPT degree to provide services without a referral. The chapter also championed the removal of the one year from diagnosis, time frame, and restrictions on qualifying illnesses, and injuries. However, the new access does come with the stipulation that PTs must consult with an approved health care provider with every 10 visits or 30 days, whichever occurs first.

And now in Tennessee, the chapter achieved the removal of education and training requirements for PTs, providing direct access treatment. And lastly, in Virginia, they eliminated their previous sixty day time limit on treatment without a referral, remove restrictions on dry needling, and clarified PT's ability to provide services to infant toddlers and students without a referral for specific plans and services. Looking ahead to the next year, 7 chapters have reported their intent to pursue direct access legislation in their states. It's thrilling to witness their dedication and with anticipation, you know, their success in expanding access to physical therapy services.

Troy: And I know states are making progress on fair co-pays too, right?

Tajah: Well, this year, ABTA West Virginia achieved a monumental victory by championing HB 2436 and acting a substantial change with insurer regulations stipulating that carriers are prohibited from charging co-pays, coinsurance, CES and office visit deductibles for physical therapy visits. Additionally, insurers are now mandated to transparently communicate their physical therapy coverage policies, encompassing coverage rates and terms and conditions. We hope that this groundbreaking legislation serves as a model for other chapters, encouraging them to consider similar measures and advancing equitable access to physical therapy services.

Troy: Great. And you know, of course, we couldn't talk about state advocacy efforts without talking about the physical therapy license compact. It's the system that makes it possible for PT's and PTA's licensed in one state to gain privileges to practice in other states that are part of the compact system. Given that joining the compact requires legislative action, and knowing how slow it can be to turn the legislative ship, sometimes the rate of uptake on the on the compact since this introduction about seven years ago has been pretty amazing, especially when you compare it to other professions’ Compact systems. Where do we stand in terms of participation now and what's on the horizon for next year?

Tajah: Troy, as of today, the PT Compact has 30 Member States in the District of Columbia that are actively issuing and accepting compact privileges. 6 states have enacted the necessary legislation for the compact. However, they are not yet issuing or accepting compact privileges at this time. You know this is normal, as this process typically takes between 8 and 12 months, we'd like to say from the date of enactment and in some cases even longer. Once a state does meet the necessary requirements to issue compact privileges, it will be announced on ptcompact.org and the PT Compact Newsletter. Now for 2024. We anticipate 8 states to pursue model legislation necessary to join the PT compact until both legislation is enacted and fully implemented, the state will not be able to issue or accept any compact privileges.

Troy: We've covered a lot of ground here and you've told me in private conversations that there's more out there. Especially in terms of states pursuing inclusion of PTs among the providers who can make disability placard determinations and of course advocacy for dry needling, which is almost a constant these days. But I wanted to talk about something APTA produced this year that could be a major resource for, I would think nearly all of these issues. Which is the economic value of physical therapy in the United States for listeners who might not know, this is a major macroeconomic report from APTA that shows how seeing a PT first or early on delivers cost effectiveness. I recommend checking out value of pt.com for all the details, but I wanted to ask you about your take on the report as an advocacy tool at the level.

Tajah: Well, you know, Troy, the economic value of physical therapy in the United States report holds a special place in my heart given my involvement with the work group, this groundbreaking report not only evaluates the impact of eight interventions on a patient's quality of life, but also highlights the true value of physical therapy services that we all know. the evidence presented in the report supports the efforts of payers, governmental entities and employers aiming to enhance health outcomes, broaden patient access and choice and foster cost effective care.

This is why APTA has prepared two policy papers available on value of pt.com, providing individuals with valuable insights to inform policymakers and commercial payers. These papers encourage stakeholders to consider the findings of the report advocating for improved access coverage and payment for physical therapist services. Additionally, the report can serve as a viable resource to guide legislative and regulatory efforts concerning healthcare delivery and payments under Medicare, Medicaid and commercial payers.

By leveraging the insights provided, decision makers can make informed choices that take action that contribute to the acceleration of value based care, ensuring that every healthcare dollar goes further for both payers and beneficiaries.

Troy: And cross promotion here we actually did just a little bit ago record a podcast with some of the folks involved at state level and federal and regulatory and commercial payer advocacy. Talking about specifically about this report and how it can be, as you say, leveraged in so many different ways, keep checking back at value of pt.com because we are adding resources, we'll be adding resources over the coming months to as we as we keep growing this resource, it's an important one, so. Thanks so much for all this information, Tajah, before we go, we want to go back to like sort of boots on the ground here. What can the listeners do if they want to get involved in advocacy on any of these issues? Where do they start?

Tajah: You know, getting involved in advocacy is a powerful way to make a difference, and I always encourage anyone looking to start to start at the local level. Our state chapters are consistently going above and beyond to advance the physical therapy profession to enhance the health of our Society. Your voice matters and APTA state chapters need passionate individuals like you to join the cause. Start by connecting with your state chapter through their website, attending local events, and signing up to stay informed about relevant issues. Your active participation can have a significant impact on advocating for positive change for the physical therapy profession.

Troy: And along the way, you meet some really great people too, so it's worth it on multiple levels to get involved. Again thanks Tajah for taking the time to talk today. As always, we encourage you to stay in touch with the broader range of issues and advocacy and payment in so many other areas. In addition to our weekly e-mail blast, we offer podcasts like this one, APTA live events, webinars and other resources to help you stay informed. And if you want to tune in to all the activity going on in payment relative to physical therapy and really an advocacy relative to physical therapy, sign up for our Friday Focus monthly collection of payment related articles and sources delivered direct to your inbox on the 4th Friday of every month, all for free. Just search for e-mail preferences in the search bar at apta.org and sign up. It's very, very easy. Thanks again to Tajah Franklin, APTA manager of State Affairs. As a final reminder, be sure to visit apta.org, where you'll find advocacy resources and background on many of the issues we've discussed today and follow us on Facebook X, Instagram and LinkedIn, APTA podcasts like this one are available on Apple Podcasts, Google Play and Spotify, or by visiting apta.org/podcasts. I'm Troy Elliott, and thanks for listening.


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