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Many state legislatures are still in session, but positive changes are already in the works. Here's a progress report.

PTs in North Dakota now may to order x-rays, thanks to a new state law that added explicit language to the profession's practice act. The state becomes one of only a small handful that explicitly allow PTs to order imaging, with Rhode Island PT x-ray referral legislation still pending.

The legislation, signed into law on March 31 by North Dakota Gov. Doug Burgum, permits PTs licensed in the state to order only x-rays, a compromise from an original proposal that would've permitted other types of imaging, namely MRIs.

According to APTA North Dakota President Cindy Flom-Meland, PT, MPT, PhD, the big advocacy win was the result of careful planning and timely communication to members, legislators, and stakeholders.

"We started planning our 2021 legislation in the fall of 2019," Flom-Meland said. "We began collecting data and insights from other states, such as Wisconsin, that had accomplished something similar, and we committed ourselves to strong ongoing communications with our members."

"All in all, it was a positive, exhilarating process that in the end is exciting for the patients we get to serve in North Dakota," she added. "We now have a law that incorporates improved efficiencies in care and will save health care dollars."

North Dakota isn't the only state that's seeing progress in legislation supported by the profession. Here's quick roundup of where things stand on some other important issues.

Physical Therapy Compact

With the addition of Ohio and Alabama this year, the system that allows PTs and PTAs licensed in one compact state to obtain practice privileges in other compact states now includes 31 states and the District of Columbia. Of those, 21 are issuing compact privileges.

The list of participating states is expected to grow in 2021, with legislation still in the works in Alaska, Illinois, Indiana, Kansas, Massachusetts, Michigan, Nevada, and Rhode Island.

Direct Access

Improving direct access to physical therapy, ideally with no restrictions or limitations, is a longstanding priority for the association and its chapters. With all states having some form of direct access to evaluation and treatment, advocacy is now being devoted to improving the more restrictive systems, such as time or visit limits.

Virginia: Legislation that increases direct access from 30 to 60 days was signed by Gov. Ralph Northam earlier this year.

Missouri: A bill that would allow PTs to treat without a referral for 10 visits or 21 days, whichever comes first, passed a House committee unanimously, and is waiting on further action. Missouri currently has the most restrictive direct access laws.


Telehealth has been at center stage for policymakers ever since the COVID-19 pandemic led many governors to issue executive orders temporarily expanding the ability of providers, including PTs and PTAs, to treat patients remotely. Several state legislatures are looking to codify their expanded telehealth abilities, including many that are proposing permanent coverage and payment parity.

Prior Authorization

The push is on for greater transparency and better customer and provider service in prior authorization systems.

California: A bill designed to increase patient access to physical therapist and other health care services and to stop the use of computer algorithms and automated systems to make care decisions will soon be heard in committee. The bill would end prior authorization for physical or occupational therapy services, and would require an appropriate physician or licensed health care professional to make the ultimate decision to deny or modify care.

Maine: Maine APTA is supporting a bill designed to regulate commercial insurance company practices by requiring claims under prepayment review to be paid or denied within 30 days, prohibit the denial of a claim because of a correctable filing mistake, and require commercial carriers to provide a process for appealing claim denials.  Maine is the first state to advocate legislation to regulate prepayment review.

Michigan: Support is mounting for legislation that would reduce prior authorization administrative burden.

Georgia: A bill that applies review and adjudication standards for prior authorization requests, recognizes "utilization review entities," and sets out guidelines for insurance rulemaking and enforcement has passed both chambers of the Georgia legislature and is awaiting signature by the governor.

Practice Act Updates

Montana: The physical therapy practice act has been amended to provide strong title protection for physical therapist assistants. It also provides for term protection for “DPT” and “Doctor of Physical Therapy,” Additional changes to the practice act include allowing PT licensure applicants to take the licensure examination prior to graduation.

APTA Centennial Resolutions

Several state legislatures have passed resolutions that recognize the physical therapy profession in conjunction with APTA's 100th anniversary, with more expected to join. States with resolutions include Georgia, Kentucky, Michigan, Minnesota, New Hampshire, South Carolina, Tennessee, Washington, and West Virginia.

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