State legislatures are returning to something a little closer to business as usual as pandemic-related disruptions continue to ease. 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.
(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 students. To get involved, visit APTA's advocacy page.)
Prior Authorization, Payment, and Administrative Burden
States are increasingly looking at how insurers may be impeding care through unnecessarily burdensome prior authorization practices.
Iowa: No More After-the-Fact Payment Changes
A new law in Iowa restricts utilization review organizations from revoking or limiting payment for a service that has received prior authorization and was provided to a covered patient. The change holds commercial payers to the terms of the authorization initially received by a provider (HB 2399).
Louisiana: A Push Toward More Provider-Sensitive Prior Authorization Systems
Commercial payers in Louisiana will now be required to create programs that factor in a provider's "performance and adherence to evidence-based medicine" when establishing the level of prior authorization that will be required (SB 112).
Michigan: Guardrails for Prior Authorization
Commercial insurers are now subject to more parameters around prior authorization, including standardized transaction processes, an emphasis on prior authorization decisions that are based on peer-reviewed clinical criteria, established timelines for payers’ prior authorization response, and more transparency from insurers (HB 247).
Rhode Island: Expiration Dates on Post-Payment Audits and Underpayment Claims
The new law, which applies to accident and sickness insurance policies, puts a 12-month limit on how long payers have to seek recoupment of a payment. The same 12-month timeline is required for providers who want to rectify an underpayment (SB 2086).
Wisconsin: Medicaid Will Reimburse for Group Physical Therapy
New legislation will require the state's Medicaid system to reimburse for group physical therapy under the Medical Assistance program (AB 765).
The ability for PTs and PTAs to provide telehealth — and lawmakers' more general acceptance of the concept as a whole — continues to grow in many states.
Indiana: PTAs Can Now Provide Telehealth Services
Physical therapy advocates were successful in their efforts to include PTAs in the list of health care personnel permitted to provide services via telehealth (SB 284).
Kentucky: Licensing Boards Reined in on Regulating Telehealth In and Out of State
Under a new law, Kentucky's professional licensing boards can't prohibit the delivery of telehealth services to a person who is not a permanent resident of Kentucky but is temporarily located in the state by a provider who is credentialed by a professional licensure board in that person's state of permanent residence. Additionally, Kentucky boards cannot prohibit licensed providers in Kentucky from providing telehealth services to Kentucky residents temporarily located outside the state (although other states could impose prohibitions). Lastly, Kentucky boards cannot require a health care provider to be physically located in the state that they are credentialed in by a professional licensure board in order to provide telehealth services to a person who is a permanent resident of the same state as the provider. (HB 188).
Louisiana: Physical Therapy Gets Telehealth Nod
Payers are now required to accept physical therapy delivered through telehealth, with payment not reduced in comparison with in-person services (HB 304).
Vermont: Telehealth-Only License and Registration
Providers from outside the state can now get a “telehealth-only” license or registration that allows them to see patients when the patients are physically in Vermont. The license and registration are easier to obtain than a full license; however, providers can't open up physical offices or provide in-person services to consumers located in Vermont, are limited in the number of patients that they can see, and can engage in the telehealth services only for a limited period of time (HB 655).
Illinois, Iowa, and Missouri have added licensed PTs to the list of providers who can certify for disability placards and license plates.
Arizona: PTs Expressly Allowed to Order Imaging
A new law permits PTs to order x-rays in Arizona, but they will be required to report results for all imaging tests to a patient’s health care practitioner of record or the referring health care practitioner. Nine states and the District of Columbia now expressly allow PTs to order imaging (SB 1312).
Licensure and Practice Clarifications
Several states have tweaked their professional licensing laws in ways that may make things a little easier on PTs and PTAs.
Missouri: PT, PTA Students Can Get a Jump on Licensing Exams
PT and PTA students in Missouri are now permitted to take their respective licensing exams before they graduate, a change that advocates believe will provide a more seamless transition from education to employment (HB 2149).
New Mexico: Licensing Hoops Reduced for PTs Relocating to the State
New Mexico has adopted an expedited process for health care practitioners who have moved to the state (HB 191).
New York: PTA Licensure Replaces PTA Certification
Under a new New York law, PTAs will be licensed rather than certified beginning in February 2024. This level of licensure regulation for PTAs conforms to that of most states in the country (S. 8746).
Oklahoma: Use of the Term "Doctor" Okayed for DPTs
The new law clarifies that licensed PTs who have earned a DPT from an accredited program may be referred to as "Doctor" and use the title "Doctor of Physical Therapy" (SB 399).
Rhode Island: PTs Granted Wider Latitude for Services Delivered in Schools
Licensed PTs in Rhode Island are now authorized to provide PT services, in accordance with an Individualized Education Plan, to a student in a school without a prescription or referral recertification for the duration of that student’s established plan of care (SB 2328).
Michigan: PTs, PTAs Now Mandated Reporters of Child Abuse or Neglect
PTs and PTAs in the state are now included in the list of providers who are required to report indications of child abuse or neglect (HB 4880).
South Dakota: Restrictions on LLCs Eased
PTs, occupational therapists, and speech-language pathologists in the state now can form limited liability corporations for the purposes of practicing together (HB 1229).