Yesterday, I broke down the what’s what of direct access laws by state, starting in Alabama and ending in Hawaii. Today, I’m continuing our guided tour of direct access law by kicking things off in Idaho and making our way down the list to Mississippi. (Don’t worry about gas money: we’ll do it all from the comfort of our homes or offices.) Just to reiterate, I’m not a legal or compliance expert, and all of the following information has been adapted from this APTA document. So, if you’re ready to up your practice’s direct access game, be sure to consult an attorney or PT compliance guru who is familiar with your state’s physical therapy practice act beforehand. With that said, let’s get to it:

Idaho

  • Idaho is one of 20 states that allow patients total, unrestricted access to a physical therapist. No type of physician referral is required for a physical therapist to treat a patient.
  • While direct access to a physical therapist is not restricted in Idaho, a PT must refer a patient to the appropriate healthcare provider if the therapist feels the patient’s condition is beyond the physical therapy scope of practice.
  • PTs are prohibited from radiological, surgical, or medical diagnosis of disease.  

Illinois

  • Illinois is one of 28 states that allow direct patient access to PT with some provisions.
  • A physical therapist must refer the patient to the appropriate physician when his or her condition is beyond the PT scope of practice.
  • A PT must notify the patient’s physician:
    • within 5 days of the initial visit if he or she is treating the patient without a referral; or
    • if the patient is receiving PT services pursuant to a diagnosis the physician diagnosed.
  • A PT must refer the patient to his or her treating health care professional of record (or to a healthcare provider of the patient’s choosing when a professional of record does not exist) if:
    • the patient does not improve after 10 visits or 15 business days (whichever occurs first);
    • the patient returns for PT services for the same or similar condition within 30 calendar days after discharge; or
    • the patient’s condition is beyond the PT scope of practice.
  • A physical therapist may only offer wound debridement services with written authorization from a health care professional.
    • A physical therapist shall promptly consult and collaborate with the appropriate health care professional anytime a patient’s condition indicates that it may be related to temporomandibular disorder so that a diagnosis can be made by that health care professional for an appropriate treatment plan.

Indiana

  • Indiana is one of 28 states that allow direct patient access to PT with some provisions.
  • To practice via direct access, a PT must:
    • Treat the patient for no more than 42 calendar days (beginning with the initial date of service) without a referral.
      • If the patient requires additional treatment, the physical therapist must obtain a referral from the appropriate healthcare provider.  
    • Obtain an order or referral from a physician, osteopath, or chiropractor when PT treatment involves spinal manipulation. The referring provider must have conducted his or her own examination of the patient before issuing the order or referral.
      • The APTA defines “spinal manipulation” as “a method of skillful and beneficial treatment by which a physical therapist uses direct thrust to move a joint of the patient’s spine beyond its normal range of motion, but without exceeding the limits of anatomical integrity.”
    • Obtain an order or referral from a physician, osteopath, or podiatrist in the case of sharp debridement.
      • The APTA defines “sharp debridement” as “the removal of foreign material or dead tissue from or around a wound, without anesthesia and with generally no bleeding, through the use of: (A) a sterile scalpel; (B) scissors; (C) forceps; (D) tweezers; or (E) other sharp medical instruments…to expose health tissue, prevent infection, and promote healing.”

Iowa

  • Iowa is one of 20 states that allow patients total, unrestricted access to a physical therapist. No type of physician referral is required for a physical therapist to treat a patient.
  • PTs may evaluate and treat direct access patients without a referral. However, some hospitals may require that any PT evaluations and treatments performed in the hospital only be provided upon prior authorization from a member of the hospital’s medical staff.  
  • Physical therapists may not:
    • perform operative surgery;
    • conduct osteopathic or chiropractic manipulation; or
    • prescribe drugs and medicine.

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Kansas

  • Kansas is one of 28 states that allow direct patient access to PT with some provisions.
  • In Kansas, a PT may evaluate and initiate treatment on a patient without a referral. If a direct access patient does not progress toward documented treatment goals within 10 visits or 15 business days (whichever comes first) from the first date of treatment following the initial evaluative visit, the PT must obtain a referral from an appropriate licensed healthcare practitioner.
  • Before treatment can begin, the physical therapist must provide written notice to any self-referring patient that a physical therapy diagnosis and a medical diagnosis are not one in the same.  
  • The PT must obtain approval from an appropriate, licensed healthcare provider before performing wound debridement.  
  • If the patient is currently being treated in a hospital or ambulatory surgery center, the facility may require a physician order or referral for PT services.  
  • Physical therapists may provide—without a referral—services that do not treat a specific condition in the following scenarios:
    1. workplace injury prevention; or
    2. public education related to fitness, disease prevention, and health promotion.  
  • PTs can also provide services to special education students without a referral if the treatment or services will allow the students to meet the provisions of their individualized education plans (IEPs) or individualized family service plans (IFSPs).

Kentucky

  • Kentucky is one of 20 states that allow patients total, unrestricted access to a physical therapist. No type of physician referral is required for a physical therapist to treat a patient.
  • While Kentucky allows unrestricted direct access to PT services, a physical therapist must refer a patient to an appropriate licensed healthcare provider when the patient’s condition exceeds the physical therapy scope of practice.  
  • Additionally, when a patient is referred to a physical therapist for treatment, the PT shall confer with the referring provider.

Louisiana

  • Louisiana is one of 28 states that allow direct patient access to PT with some provisions.
  • To practice via direct access, a PT must:
    • Obtain a doctorate-level degree or have five years of clinical practice experience.
      • These providers may only treat a patient without physician referral for 30 calendar days.  
      • After 30 days, the PT must obtain a referral from an appropriate healthcare provider, unless there is measurable or functional improvement.

Maine

  • Maine is one of 28 states that allow direct patient access to PT with some provisions.
  • To practice via direct access, the physical therapist:
    • Must not apply manipulative thrust to the vertebrae of the spine.
    • Must not administer drugs.
    • Must make a referral when the patient’s condition requires treatment beyond the PT’s scope of practice.
  • When treating a patient without referral, the PT:
    • Cannot make a medical diagnosis;
    • Must refer the patient to an appropriate licensed healthcare provider if no improvement is noted in the patient record within 30 days of the first treatment date;
    • Must consult or refer the patient to an appropriate licensed healthcare provider if PT treatment is required beyond 120 days.  
  • Employers may not cover workers’ compensation charges for PT services unless the employee has been specifically referred to the PT.

Maryland

  • Maryland is one of 20 states that allow patients total, unrestricted access to a physical therapist. No type of physician referral is required for a physical therapist to treat a patient.

Massachusetts

  • Massachusetts is one of 20 states that allow patients total, unrestricted access to a physical therapist. No type of physician referral is required for a physical therapist to treat a patient.
  • If the PT feels that the patient’s care goes beyond the physical therapy scope of practice, or if PT is contraindicated, the therapist must refer the patient to an appropriate licensed practitioner.
  • If the patient was referred to the PT, the PT must communicate with the licensed referring practitioner throughout duration of treatment.
    • The PT must also disclose to the patient any financial interest if the referring physician derives income from the PT services.

Michigan

  • Michigan is one of 28 states that allow direct patient access to PT with some provisions.
  • A PT may treat direct access patients when:
    • The treatment lasts for 21 days or 10 individual treatments—whichever occurs first.
      • The PT must confirm that the patient requires physical therapy before allowing a physical therapist assistant to perform treatment interventions.
    • A patient receives services for injury prevention, wellness, or fitness.  
    • The patient is referred to an appropriate healthcare professional if the PT feels that the patient’s care goes beyond his or her scope of practice.
    • An appropriate healthcare provider is consulted if the patient does not respond to treatment in an appropriate length of time based on the standards of practice determined by the Board of Physical Therapy.

Minnesota

  • Minnesota is one of 28 states that allow direct patient access to PT with some provisions.
  • A PT treating direct access patients is contingent upon the following:
    • A PT may not determine medical diagnosis.
    • A patient may be seen by a PT without referral for up to 90 days.  
    • A physical therapist who has been licensed for less than one year may only provide PT services when working alongside a physical therapist who has more than one year of practicing experience.
    • The PT must refer the patient to an appropriate healthcare professional if the PT feels that the patient’s care goes beyond his or her scope of practice.
  • A PT may treat a direct access patient without a time limitation if the patient is seeing the PT for disease prevention, wellness, fitness education, or exercise services.

Mississippi

  • Mississippi is one of three states that allow limited direct patient access to a physical therapist.
  • A physical therapist may only provide services on a direct access basis:  
    • To any child diagnosed with a developmental disability if physical therapy is pursuant to the patient’s plan of care.  
    • If the PT is acting as part of a home health agency or long-term care facility and therapy aligns with the patient’s determined plan of care.
    • If the patient is seeing the PT for injury prevention, wellness, stress reduction, or fitness services.
    • If the patient has previously received a diagnosis for any condition(s) within the last 180 days that necessitate PT services—and the therapist has notified the provider who determined the diagnosis.
      • Within the first 15 days of therapy, the PT must provide a plan of care to the provider who determined the diagnosis.

Well folks, we’ve made it to the halfway point. I’ll be back at it on Monday covering the finer details of direct access law from Missouri to Pennsylvania. Itching to learn more about direct access across the nation? Be sure to check out The PT’s Guide to Direct Access Law in All 50 States. Hasta luego!