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It's that time: Across the country, most state legislatures are either back in session or headed that way. And again this year, issues important to PTs, PTAs, and the patients they serve are on the radar in many statehouses.

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 and the national office to sign up for action alerts, and see how you can get involved. 

Direct Access
States with potential legislation in 2020: Alabama, Kansas, Minnesota, Mississippi, Missouri, New York,  South Carolina, Tennessee

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 a recent APTA consponsored study that found unrestricted direct access to physical therapy for low back pain saves money and lowers utilization of services overall.

Resources: Direct Access at the State Level webpage

States with potential legislation in 2020: Arizona, Georgia, Rhode Island

Background: Telehealth provisions for PTs are explicitly included in laws and/or regulations in 16 states, with nine states allowing Medicaid reimbursement for telerehab and 11 more including language that opens up that possibility. The U.S. Department of Veterans Affairs allows PTs to engage in telehealth, to successful results. The states listed above want to add telehealth the PT scope of practice, allow for Medicaid reimbursement for telehealth delivered by PTs, or both.

Resources: Telehealth webpage

Physical Therapy Compact
States with potential legislation in 2020: District of Columbia, Massachusetts, Michigan, Ohio, Pennsylvania, Rhode Island, South Dakota, Vermont, Wisconsin

Background: The system that allows PTs and PTAs licensed in one compact state to obtain practice privileges in other compact states grew to include 26 states in 2019, with five more — Arkansas, Delaware, Georgia, Maryland, and Virginia — having adopted the legislation in advance of 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 Licensure Compact webpage

Dry Needling
States with potential legislation in 2020: California, Connecticut (pending a court ruling), Hawaii, New Jersey (held over from 2019)

Background: Currently, 35 states and the District of Columbia allow PTs to perform dry needling, seven states prohibit it, and eight states are silent on the issue. Chapters from the states listed above are looking to add a specific mention of dry needling to their PT practice acts.

Resources: Dry Needling in Physical Therapy webpage

Fair Copays
States with potential legislation in 2020: Georgia, New York, Ohio, Rhode Island, Virginia

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.

Resources: Fair Physical Therapy Copays webpage

States with potential legislation in 2020: Connecticut, Illinois, Rhode Island

Background: The importance of PTs to achieve practice authority for ordering and performing appropriate imaging studies was underscored by the APTA House of Delegates in 2016, when it directed the association to press for changes to imaging restrictions. Currently, only Colorado, Wisconsin, and Utah expressly allow PTs to order imaging under certain conditions.

Resources: Imaging webpage

Utilization Management
States with potential legislation in 2020: Oregon

Background: Used properly, utilization management can help PTs provide patient-centered and timely care to patients; too often, however, it serves as 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.


Practice Act Updates
States with potential legislation in 2020: Alaska, Florida, Tennessee

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.

Resources: Jurisdictional Scope of PT Practice webpage

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