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It's been years in the making, but thanks to the efforts of APTA chapters across the country, the profession has reached a long-awaited milestone: The elimination of severe limits on direct access to PT services in all states.

The achievement was reached earlier this year, when Alabama — the last of three holdout states including Mississippi and Missouri — moved to a provisional direct access model that gives patients more flexibility in seeking care. Mississippi made a similar change earlier in 2024; Missouri upgraded their direct access provisions in 2023.

While the ability for patients to receive PT services without a referral has existed in all states and the District of Columbia for several years, states have taken different approaches in their definition of what "direct access" means. APTA and its chapters characterize these approaches as "unrestricted," "provisional," and "limited." (APTA’s online "Levels of Patient Direct Access to PT Services in the U.S." includes a map and state-by-state history of enactment.)

Unrestricted direct access, currently in place in 21 states, is exactly what it sounds like: Patients have the ability to receive care from a PT without a referral. Provisional direct access — now in place in all other states — puts restrictions on that access, most often by way of limits on how many visits are allowed before a referral must be made, or referral requirements for certain interventions only.

Alabama became the last state to employ limited direct access, which only allowed PT services without referral for a narrow range of circumstances.

Eliminating limited direct access provisions across the country has been a longstanding goal for APTA and its chapters, often requiring years-long advocacy efforts in individual states. Tajah Franklin, APTA manager of state affairs, sees the milestone as an opportunity for the profession to focus on the future.

"Limited direct access provisions such as the ones recently eliminated in Alabama were clearly inconsistent with the needs of today's health care system," Franklin said. "Thanks to the diligence of the last three chapters in lifting their state's limited access restrictions, we can now fully focus our advocacy efforts on addressing the other important challenges that need to be tackled to enhance care and increase patient access to physical therapy."

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