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When it comes to state legislation relevant to PTs, PTAs, and students, the current COVID-19 pandemic hasn't slowed things down. In fact, if anything, issues arising from the pandemic have kept state lawmakers busier than ever. Legislation being addressed this year ranges from core physical therapy concerns such as direct access and fair copays to telehealth policy, which the pandemic has pushed to the forefront of physical therapist practice.

In preparation for what promises to be another busy year, we've put together a list of some of the issues that will get attention from lawmakers in the coming weeks and months. Take a look at what's coming — and then don't forget to help press for needed change by contacting your APTA chapter to see how you can get involved, and the national office to join the APTA Advocacy Network for regular legislative updates and action alerts.


1. Direct Access

States that have or are expected to introduce legislation in 2021: Alabama, Kansas, Minnesota, Mississippi, Missouri, Oklahoma, Texas, and Virginia.

Background: Improving direct access to physical therapy, ideally without a physician referral, is a longstanding priority for the association and its chapters. And we've made progress: All states now have some form of direct access, but some forms are more limited than others, imposing restraints such as referral requirements and visit limits for specific interventions. Legislative energy is now being devoted to improving these more restrictive systems, bolstered by an APTA cosponsored study that found that unrestricted direct access to physical therapy for low back pain saves money and lowers utilization of services overall.

Resources: APTA advocacy webpage on levels of patient access to physical therapist services in the U.S.

2. Telehealth

States that have or are expected to introduce legislation in 2021: Nationwide.

Background: Last spring, the shutdowns imposed in response to the COVID-19 pandemic led to many governors issuing executive orders expanding the ability of health care providers, including PTs, to treat patients via telehealth. Some states also mandated commercial and Medicaid payment for PT services delivered via telehealth, and the Centers for Medicaid & Medicare Services issued rules expanding telehealth services for Medicare recipients in April 2020.

While APTA has long advocated for telehealth as a safe, effective method for the delivery of physical therapist services, the past year has made the necessity and efficacy of telehealth services even more evident. During their reconvened sessions last summer and fall,  state legislators in Colorado, Connecticut, and New Hampshire voted to codify their governors’ executive orders expanding the use of telehealth and mandating payment for telehealth services. A number of state legislatures will be looking to codify their expanded telehealth abilities, including some that are proposing permanent coverage and payment parity, during the 2021 session.

Resources: APTA Telehealth webpage

3. Physical Therapy Compact

States that have or are expected to introduce legislation in 2021: Alabama, Alaska, Connecticut, Indiana, Kansas, Michigan, Nevada, New Mexico, Ohio, and Vermont.

Background: The system that allows PTs and PTAs licensed in one compact state to obtain practice privileges in other compact states grew to include 29 states in 2020, with three more — Pennsylvania, South Dakota, and Wisconsin — adopting the legislation and waiting on enactment. Widespread participation in the compact is a professional game-changer, particularly as PTs' and PTAs’ ability to participate in telehealth grows.

Resources: Physical Therapy Compact webpage

4. Fair Copays

States that have or are expected to introduce legislation in 2021: Connecticut, New York Rhode Island, and Vermont.

Background: Like direct access, the issue of fair copays has been a central advocacy focus for some time at both the state and federal levels. Many insurance provisions classify PTs as specialists and impose higher copays; it's an approach that ignores the fact that physical therapy often requires multiple visits, making seeing a PT cost prohibitive.

APTA and its chapters want to change that by, at the very least, following a lead established in Kentucky in 2011 that limits physical therapy copays to no more than the copay for a visit to a primary care provider. Georgia became the latest state to enact a fair copay law in 2020.

Resources: APTA  Fair Physical Therapy Copays webpage

5. Imaging

States that have or are expected to introduce legislation in 2021: Connecticut, North Dakota, and Rhode Island.

Background: In 2016, the APTA House of Delegates underscored the importance of PTs achieving practice authority for ordering and performing appropriate imaging studies when it charged the association with working to lift restrictions in state law. Currently, only Colorado, Wisconsin, and Utah expressly allow PTs to order imaging under certain conditions.

Resources: APTA  Imaging and Physical Therapy webpage

6. Utilization Management

States that have or are expected to introduce legislation in 2021: Oregon.

Background: Used properly, utilization management can help PTs provide patient-centered and timely care to patients. Too often, however, it is little more than a barrier to needed care and an excessive administrative burden for providers. States are looking for ways to better regulate the practice so that it doesn't get in the way of patient access to needed services.

Resources: APTA Utilization Management and Utilization Review webpage.

7. Practice Act and Scope of Practice Updates

States that have or are expected to introduce legislation in 2021: Colorado, Connecticut (pending a court ruling on dry needling), Georgia, Massachusetts, Minnesota, Mississippi, Montana, Oklahoma, and Pennsylvania.

Background: Times change, and so do concepts of legal scopes of practice for PTs and scopes of work for PTAs. A large-scale revision of a state's PT and PTA regulatory language can be a major undertaking, but chapters regularly step forward to take on the challenge and ensure that PTs in their states are practicing under laws that aren't antiques. Other states are looking to expand the PT scope of practice to include dry needling.

Resources: APTA Scope of Practice webpage.

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