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It can't be stressed enough: Individual states are the decision-makers around much of what PTs and PTAs can and can't do in response to the COVID-19 pandemic. These regularly updated resources can help you make fact-based practice decisions.

Have a question about what you can and can't do amid all the regulatory and payment changes happening in response to the COVID-19 pandemic? The answer will probably be the same no matter what:

Check with your state physical therapy licensing board and each of your payers.

"While there have been changes at the federal and commercial insurer levels around, for example, the kinds of digital communications PTs can have with patients, state laws often take precedence," said Daniel Markels, APTA state affairs manager. "If your state laws and regulations don’t allow you to do it, even if the insurer you're working with says they'll pay for it, you can't do it. On the other hand, states have made temporary changes to various laws that may provide additional opportunities for PTs and PTAs, so it's crucial to keep up with what's happening at the state level."

Here are four key resources to help you do just that.

An APTA chart tracking state orders allowing PTs to provide telehealth services
"Can I provide telehealth?" is the question on the minds of nearly every PT and PTA these days. This chart, updated weekly, breaks down the answer to that question by state, with links to specific orders. But remember: Review your state practice act and check in with your state licensing board to verify what you are and aren't allowed to do.

An APTA chart on state actions related to telehealth in Medicaid, commercial, and workers' comp coverage, updated weekly
States have been adjusting their Medicaid and commercial insurance regulations in a variety of ways when it comes to telehealth, including some mandates that nonfederal payers must pay for telehealth services as if the services were performed in person. But it's a patchwork, and many states don't mention PT services specifically. (Again, check with your state licensing board or specific insurance companies for the most accurate and current information.) The chart is updated weekly.

A rundown of state licensure exemptions and requirements for PTs and PTAs related to the COVID pandemic
This chart, created by the Federation of State Boards of Physical Therapy, provides a detailed listing of every change made to licensing laws and regs in response to the health emergency, with a particular focus on exemptions and changes to licensure requirements — everything from the issuance of temporary licenses without an examination to allowances for PTs licensed in another state. Of note is the number of states that temporarily allow a PT or PTA licensed in another state to come in and practice without having to obtain a license from the state during declared national or state emergencies.

Contact information for state physical therapy licensing boards
This is just what it sounds like: a regularly updated listing of every licensing board, including email addresses, websites, and phone numbers, courtesy of FSBPT.

The Pandemic, Telehealth, and the Physical Therapy Compact

In the U.S., the regulation of professions is a power invested with the states, not the federal government, meaning that each state has the authority to regulate and license providers. That's great for states’ rights, but it can create challenges for practice across state lines — including challenges associated with remote digital communications that know no borders.

The current trend toward increased ability for PTs and PTAs to provide remote services, though sparked by a health crisis, was one of the motivating factors behind the creation of the Physical Therapy Compact in 2016, the system that allows PTs and PTAs licensed in one compact state to obtain practice privileges in other compact states. Currently, 28 states have enacted the required legislation to join the compact, with five more states introducing compact legislation this year. Enactment of the compact in all U.S. jurisdictions has been a top priority for APTA and FSBPT, and the current pandemic has demonstrated the need for it.

Creators of the compact (APTA, FSBPT, and the Council of State Governments) were focused on interstate licensure portability — moving from one state to another with minimal disruptions in practice, obviously, but also on the potential growth of telehealth.

Markels says the compact can be a useful tool in these times but warns that PTs and PTAs in the compact still need to pay careful attention to individual state laws and regs, especially related to telehealth (see the resources above).

"If you're in the compact, and your home state — the state of your primary residence — allows telehealth, that doesn't mean you can provide telehealth services to a patient who’s in a compact state that doesn't allow it," Markels cautioned. "PTs and PTAs with compact privileges must abide by the laws and regulations of the physical therapy board in the state in which the patient is located and where services are being delivered."

So, in other words … keep up with what the states are doing.

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