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After a trying year as the country struggled through a pandemic, most state legislatures reconvened in 2021 for very active sessions. Some legislatures are still in session, but APTA state chapters, in collaboration with the association, have already earned a number of wins at the state level. Here's a review of what's happened so far.

(While a few state legislatures are still in session, APTA continues to monitor legislation and assist state chapters with their legislative advocacy efforts. However, the most effective voices continue to be PTs, PTAs, and student physical therapists. To get involved, visit APTA's advocacy page.)

Payment, Prior Authorization, Administrative Burden

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

Maine: Tightening Up on Insurers
APTA Maine succeeded in its efforts for passage of LD 1317, a bill designed to regulate prepayment review practices by commercial insurance companies by requiring claims under prepayment review to be paid or denied within 30 days, prohibiting the denial of a claim because of a correctable filing mistake, and requiring commercial carriers to provide a process for appealing claim denials. The bill was signed by Gov. Janet Mills.

Oregon: Reining in Prior Authorization
APTA Oregon successfully advocated for the passage of HB 2517, a utilization management bill that requires all health insurers subject to the jurisdiction of the Oregon Department of Consumer and Business Services to report the number of prior authorizations requested and denied, as well as the number of denials overturned on appeal, each year. The bill also mandates that insurance companies post prior authorization processes and all treatments and drugs subject to prior authorization on their websites. Additionally under the new law, companies must have at least one clinician with the same specialty as the requesting provider on review panels, and must state the reason for denials in language understandable to both providers and patients. The bill was signed by Gov. Kate Brown.

Georgia: Prior Authorization Guardrails
Gov. Brian Kemp has signed into law SB 80, 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. 

Nebraska: No MPPR for Medicaid
APTA Nebraska succeeded in efforts for passage of LB 100, legislation that will prohibit the state’s Medicaid program from implementing Multiple Procedure Payment Reductions, better known as MPPR, which are used by CMS in the administration of the Medicare program.

Under MPPR only the procedure code with the highest practice expense value is paid at 100% when multiple therapy services are billed to the same patient on the same date; the practice expense value of subsequent codes are reduced. APTA has opposed MPPR at the federal level since CMS started applying it to "always therapy" services in 2011, asserting that it’s a flawed policy because the practice expense values for physical medicine CPT codes already have been reduced to avoid duplication during the valuation process. APTA Nebraska is leading the way in making sure this flawed practice does not filter down to state programs such as Medicaid. The bill was signed by Gov. Pete Ricketts.

Imaging

The number of states that explicitly allow physical therapists to order imaging through statute, regulation, or regulatory board policy has increased to eight.

North Dakota and Rhode Island: PTs Can Now Order X-Rays
In North Dakota, SB 2122, which permits physical therapists to order X-rays, was signed into law by Gov. Doug Burgum. A similar bill in Rhode Island was signed into law by Gov. Daniel McKee.

Direct Access

Improving direct access to physical therapy is a longstanding priority for APTA and its chapters. With all states having some form of direct access to evaluation and treatment, advocacy is now being devoted to removing restrictions, such as time or visit limits.

Virginia: Increased Treatment Time Before Referral
SB 1187, which expands treatment without referral from 30 days to 60 days, was signed into law by Gov. Ralph Northam. 

Texas: Technical Fix
Gov. Greg Abbott signed HB 1363 into law, which made a technical change to add PTs certified by an entity approved by the licensing board among those allowed to treat patients for up to 15 days without prior referral. 

Opioid Crisis and Pain Management

As the opioid epidemic continued to rage—and even worsen—during the pandemic, more conversations in statehouses began to include ways to increase access to nonpharmacologic pain management approaches.

Colorado: Making it Easier to Access PT Services To Treat Pain
After three years of lobbying by APTA Colorado, legislation was passed that will improve the public's ability to access PTs for pain management. Among the provisions of HB 1276: changes to co-pay and cost-sharing rules to bring patient expenses for nonpharmacological treatment in line with primary care amounts in cases where an opioid might be prescribed, and reduced third-party administrative requirements. The required cost-sharing benefit must include at least 6 physical therapy visits per year. 

PT Scope of Practice Act Updates

State chapters regularly pursue practice act updates to keep their laws and regulations in line with current practices, as well as reauthorization of acts that sunset after a specified period of time.

Montana: NPTE Before Graduation
Montana passed SB 70, revising its physical therapy practice act to allow student PTs to sit for the National Physical Therapist Licensing Examination before graduation.The legislation was signed into law by Gov. Greg Gianforte.

New Mexico: Back from Sunset Review
SB 145 reauthorized the New Mexico Physical Therapy Practice Act, which was up for sunset review this year. The practice act will sunset again in 2028.

Telehealth

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, to treat patients remotely.

Arkansas, Arizona, Connecticut, Indiana, Maryland, Nebraska, Nevada, Oklahoma, Oregon, Texas, and Virginia: Telehealth Provisions for PTs (similar pending bills in California and Ohio)

Physical Therapy Compact

With the addition of Alabama, Indiana, Kansas, and Ohio this year, the system that allows PTs and PTAs licensed in one compact state to obtain practice privileges in other compact states now includes 33 states and the District of Columbia. Of those, 23 states are now issuing compact privileges.

Kansas: Overcoming Resistance to the Compact
Passage of the compact in Kansas was especially significant, as it came after several unsuccessful attempts to enact compact legislation in previous sessions. Lawmaker concerns about liability insurance requirements and disciplinary reporting requirements for licensees and holders of compact privileges were issues that APTA Kansas and their lobbyists worked hard to assuage. The bill was signed by Gov. Laura Kelly.

South Carolina: A Fix Allows the Compact To Move Ahead
Compact legislation was also successful in South Carolina. Although the state had already adopted the legislation, the system could not be implemented until “clean-up” legislation was enacted that fixed a provision related to FBI background checks, a requirement of the compact. A bill addressing that obstacle passed this year, and licensees in South Carolina are now required to submit to FBI background checks.

More Work To Be Done

As always, some bills in a few states didn’t make it across the finish line before adjournment or are still awaiting their fate in committee or elsewhere. Among them:

  • Legislation supported by the California chapter that would have increased patient access to physical therapists services and other health care service by strengthening laws that govern utilization management review protocols, decision-making and transparency in health plans, insurers, and third-party administrators was held in committee.
  • In Michigan, advocacy by the chapter to make insurer prior authorization decisions easier to understand continues to be a priority, but the bill hasn't received committee review yet.
  • Bills aimed at expanding the number of days that PT services could be provided without referral in Alabama, Mississippi, and Missouri did not pass before legislatures in those states adjourned for the year. 
  • Fair copay legislation in Rhode Island was referred for further study; in Texas and New York, the state legislatures adjourned before bills to limit physical therapy copays could be heard.
  • The PT Compact came close in Rhode Island but was stripped from the state budget bill before the budget was signed. Compact legislation also came up short in New Mexico, Nevada, and Illinois. Bills related to the compact are pending in Massachusetts and Michigan.

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