Yesterday, we covered direct access regulations from Alabama to Hawaii. Now is a good time to mention again: I am not a legal expert, and I’ve sourced all of the following information from the APTA and various state association websites. If you have any questions about your state’s law, please consult your state’s practice act, a PT compliance expert, or your attorney.

Today, we’ve made it all the way to regulations in Idaho. Po-tay-toe, po-tah-toe? Not exactly when it comes to direct access.

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Idaho

There are no restrictions to access in this state. If a therapist thinks the care is outside of his or her scope, he or she must refer the patient to an appropriate healthcare provider. Also, the therapist can’t use radiology, perform surgery, or diagnose a medical disease.

Illinois

A physical therapist can treat direct access patients when:

  • The therapist thinks the care is within his or her scope. If a therapist thinks the care is outside of his or her scope, he or she must refer the patient to an appropriate healthcare provider (e.g., a physician, dentist, or podiatrist).
  • The therapist is only performing an initial evaluation. A referral is necessary for continued treatment.
  • The PT has notified the patient’s physician, dentist, or podiatrist when the PT provides care in accordance with the diagnosis the healthcare provider gave.

Indiana

A physical therapist can treat direct access patients when:

  • The treatment does not continue for more than 24 calendar days, beginning with the initial evaluation. The PT must then get a referral from the patient’s primary healthcare provider (e.g., physician, podiatrist, psychologist, chiropractor, dentist, nurse practitioner, or physician assistant).
  • Spinal manipulation is not performed, unless the therapist has an order or referral from a physician, osteopath, or chiropractor.
  • The PT does not remove any foreign material from a wound using sharp medical instruments. An order or referral is required from a physician, osteopath, or podiatrist for “sharp debridement.”

Iowa

A physical therapist can treat direct access patients when he or she does not perform osteopathic, chiropractic manipulation, or surgery. That being said, a hospital may require a member of the hospital medical staff to review the patient’s case before that patient receives in-hospital therapy. Additionally, physical therapists can not prescribe or administer drugs or medicine to patients.

Kansas

A physical therapist can treat direct access patients when:

  • The patient is progressing toward reaching his or her goals in a measurable way. If he or she is not progressing within 10 visits or 15 business days from the initial evaluation, the PT must get a referral from an appropriately licensed healthcare provider.
  • The therapist has given the patient notice that the therapy diagnosis is not a physician’s medical diagnosis.
  • A licensed healthcare provider has approved wound debridement.
  • A patient is not being treated in a hospital or ambulatory surgery center. If the patient is being treated in a hospital or ambulatory surgery center, the facility might require an order or referral.
  • Treatment is for employees to educate them on how to avoid workplace injury, or the public is being treated in a wellness setting to prevent injury, provide conditioning, promote fitness, or reduce stress.
  • A patient has an IEP (individualized education plan) or IFSP (individualized family service plan) and therapy can help fulfil the needs outlined by the IEP or IFSP.

Kentucky

There are no restrictions to direct access in Kentucky. If a therapist thinks the care is outside of his or her scope, he or she must refer the patient to a physician or dentist. When a patient is directly referred, the PT can discuss the patient’s case with the referring provider.

Louisiana

A physical therapist can treat direct access patients when:

  • The patient is a child diagnosed with a developmental disability. Therapy must be in accordance with the child’s plan of care.
  • Physical therapy is in accordance with the plan of care for a patient seen in a home health agency setting.
  • The patient is in a nursing home and physical therapy is in accordance with the plan of care.
  • Physical therapy is used preventatively in a wellness setting to prevent injury, provide conditioning, promote fitness, or reduce stress.
  • Therapy is appropriate treatment for a condition diagnosed within the last 90 days. Within the first 15 days of therapy, the therapist also has to notify the physician who gave the diagnosis.

Maine

A physical therapist can treat direct access patients when:

  • The therapist thinks the care is within his or her scope. If a therapist thinks the care is outside of his or her scope, he or she must refer the patient to an appropriate healthcare provider.
  • The therapist is not making a medical diagnosis.
  • The patient is showing improvement within the first 30 days of treatment. Otherwise, the therapist must refer the patient to a licensed physician, osteopath, podiatrist, dentist, or chiropractor.
  • Treatment does not continue for more than 120 days. After 120 days the patient must be referred to a licensed physician, osteopath, podiatrist, dentist, or chiropractor.

Some things to note:

  1. A PT cannot conduct spinal manipulation or administer drugs.
  2. If the patient is not referred, his or her employer is not responsible under workers’ compensation for services.

Maryland

A physical therapist is free to treat patients without restriction in this state.

Massachusetts

If a therapist thinks the care is outside of his or her scope, he or she must refer the patient to an appropriate healthcare provider. The PT must tell the patient if he or she has any financial interest in treating the patient.

Michigan

A physical therapist can treat direct access patients when:

  • Treatment does not extend beyond 21 days or 10 visits. At that point, the physical therapist has to get a referral.
  • Physical therapy is used preventatively in a wellness setting to prevent injury, provide conditioning, or promote fitness.

This law officially goes into effect January 1, 2015.

Minnesota

A physical therapist can treat direct access patients when:

  • Therapy does not continue beyond 90 days without a referral.
  • A therapist who has more than one year of experience supervises any therapists licensed for less than one year.
  • The therapist thinks the care is within his or her scope. If a therapist thinks the care is outside of his or her scope, he or she must refer the patient to an appropriate healthcare provider.
  • Physical therapy is used preventatively in a wellness setting to prevent injury, provide education or conditioning, or promote fitness.

Mississippi

A physical therapist can treat direct access patients when:

  • The patient is a child who has a diagnosed developmental disability. Physical therapy must follow the plan of care.
  • Physical therapy is in accordance with the plan of care for a patient seen in a home health agency setting.
  • The patient is in a nursing home and physical therapy follows the plan of care.
  • Physical therapy is used preventatively in a wellness setting to prevent injury, provide education or conditioning, or promote fitness.
  • Therapy is appropriate treatment for a condition diagnosed within the last 180 days. Within the first 15 days of therapy, the therapist also has to provide the patient’s plan of care to the physician who gave the diagnosis.

Tune in tomorrow, when I’ll tackle part three of our four-part series on direct access. Hope you’re ready for Mizzou through Penn.

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