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Physical therapists and physical therapist assistants in Vermont, Maine, and Connecticut are on track to be able to join the physical therapy license compact; access to physical therapy in Maine, Missouri, Tennessee, and Virginia is now easier than ever for patients; term protection in Maine has been improved; and MRIs can be ordered by PTs in Iowa: Those are just a few of the state-level advocacy wins spearheaded by APTA chapters across the country during the 2023 legislative season.

Here's a rundown of changes either already on the books or soon to be enacted across the states.

Physical Therapy License Compact (Connecticut, Maine, Vermont)
It was another good year for the PT Compact system that allows PTs and PTAs to gain privileges to work in multiple states through a single license, with APTA chapters in Maine, Connecticut, and Vermont advocating to pass compact legislation this year, and Alabama adopting clarifications to its already-enacted legislation. The additions bring the number of states participating or intending to participate in the compact to 37. (A map that tracks the states currently participating in the compact is available at the PT Compact website.)

Direct Access (Maine, Missouri, Tennessee, and Virginia)
Gains continue to be made to eliminate restrictions tied to PT treatment provided via direct access, including in Maine which removed some restrictions tied to treatment without a referral. As part of a major practice act revision, Maine was successful in adding exemptions to the time limit tied to treatment without referral, including services provided for purposes of health promotion, injury prevention, wellness, fitness, athletic performance or maintenance therapy; for patients with previously diagnosed neuromuscular or developmental chronic conditions; and as part of an individualized education plan or individual family service plan under federal law. Maine also removed the requirement that spinal manipulation be performed only upon referral.

In Missouri, which previously had one of the more restrictive direct access laws in the country, APTA Missouri was successful in its multi-year effort to remove severe limits tied to treatment absent a referral. Legislation signed into law this year allows PTs with five years of experience or a DPT degree to provide services via direct access, and eliminates the one-year-from-diagnosis timeframe as well as restrictions on qualifying illnesses and injuries. The new access comes with the stipulation that PTs must consult with an approved health care provider after every 10 visits or 30 days, whichever occurs first, to verify patient improvement. The change also allows PT services to continue if deemed reasonable and necessary based on the PT's evaluation and permits PTs to provide education, fitness, or wellness to symptomatic individuals.

APTA Tennessee was successful in eliminating education and training requirements tied to PTs who provide treatment services via direct access. The legislation eliminates the requirement that a physical therapist must have a DPT degree, or three years of experience plus 15 hours of post-graduate education to provide treatment absent a referral.

APTA Virginia was successful in the enactment of HB 2359/SB 1005, which eliminated the previous 60-day time limit on treatment absent a referral. The bill also eliminated the requirement that dry needling by a PT be performed only upon referral. Additionally, the bill clarifies that a licensed physical therapist may provide, without referral, services to infants and toddlers who require physical therapist services to fulfill the provisions of their individualized services plans, as well as students with disabilities who require physical therapist services to fulfill the provisions of their individualized education plans or services related to the Rehabilitation Act of 1973.

Prior Authorization (Maine)
More good news out of Maine, where changes set to go into effect this September will prohibit insurers from requiring prior authorization for new episodes of care for the first 12 physical therapy, occupational therapy, or chiropractic visits (carriers can still retroactively deny claims determined not medically necessary, however). In addition, insurers will be required to appoint a qualified medical director to oversee prior authorization policies and to provide clear instruction to providers on how to obtain prior authorization when required.

Fair Copay (West Virginia)
APTA West Virginia was successful in adopting a significant change in regulations for insurers, mandating that carriers cannot charge copays, coinsurance, or office visit deductibles for physical therapy visits. In addition, the insurers must clearly state their physical therapy coverage policies, including coverage rates and terms and conditions.

Imaging (Iowa, Rhode Island)
APTA Iowa scored a major victory under a new law that allows PTs in the state to order both x-ray imaging and MRIs, while APTA Rhode Island passed changes that extend an allowance for PTs to order x-rays for another two years.

Dry Needling (Virginia, Washington)
As previously noted, Virginia eliminated a requirement for referral for a PT to provide dry needling. In Washington, which previously prohibited PTs from performing dry needling based on a state attorney general opinion, APTA Washington was successful in amending the PT licensure law to allow PTs who meet certain education and training requirements to perform the intervention.

Scope of Practice (North Dakota, Tennessee, Iowa)
Both Tennessee and North Dakota passed legislation adding PTs to the list of providers who can certify disability for purposes of placards. Iowa added PTs to the list of providers empowered to evaluate whether a hunter qualifies for use of a crossbow.

Business Operations and Tax Credits (Washington)
Washington reduced restrictions on PTs and occupational therapists in forming professional service corporations.

Regulatory Board Operations (Mississippi, South Dakota)
APTA South Dakota was successful in their advocacy for the establishment of an independent state board of physical therapy. In Mississippi, the state board of physical therapy was granted the power to issue subpoenas for testimony and documents.

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