If you haven’t been keeping up with the WebPT Blog over the past few days, here’s what you’ve missed: I’ve been breaking down all of the state-level direct access laws from coast to coast. (You can check out the laws for Alabama to Hawaii here and Idaho to Mississippi here.) If you have been keeping up, then welcome back! (Cue the “Welcome Back, Kotter” theme song.) Today, I’m tackling the laws from M to P—that’s Missouri to Pennsylvania. But, as I’ve stated in the previous two posts, I’m not a legal expert. So, before you start evaluating and/or treating patients sans physician referral, be sure to consult with an attorney or PT compliance expert. Now, let’s get back to it:

Missouri

  • Missouri is one of three states that allow limited direct patient access to a physical therapist.
  • A physical therapist may only see direct access patients under the following circumstances:
    • When the therapist is providing services for educational purposes and training, developing fitness or wellness programs, or providing screenings or consultations.
    • When the therapist is treating a patient with an injury or condition that could resolve itself without therapy, and that patient received the diagnosis within one year or has a chronic illness that has been previously diagnosed by an appropriate healthcare provider.
      • In this instance, the physical therapist must:
        1. Contact the patient’s current healthcare provider within the first seven days of therapy.
        2. Not alter any existing PT referrals without the consent of the patient’s current healthcare provider.
        3. Refer the patient to an appropriate healthcare professional if the PT determines during the initial evaluation or treatment that the patient’s care goes beyond the physical therapy scope of practice.
        4. Refer the patient to an appropriate healthcare provider if he or she does not show any documented progress toward treatment goals within six visits or 14 days.
        5. Notify the patient’s current healthcare provider if treatment continues beyond 30 days.
          1. The PT must contact the patient’s provider prior to the continuation of treatment.
          2. The PT must provide notification every 30 days.

Montana

  • Montana is one of 20 states that allow patients total, unrestricted access to a physical therapist. According to state law, no type of physician referral is required for a physical therapist to evaluate or treat a patient.
  • The PT must refer the patient to an appropriate healthcare professional if the PT feels that the patient’s care goes beyond the physical therapy scope of practice.
    • Failure to do so will result in license revocation.

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Nebraska

  • Nebraska 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 evaluate or treat a patient.
  • The PT must refer the patient to an appropriate healthcare professional if the PT feels that the patient’s care goes beyond the physical therapy scope of practice.
  • Failure to do so is considered unprofessional conduct.

Nevada

  • Nevada 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 evaluate or treat a patient.
  • The state’s direct access law specifies that diagnosis of physical disabilities, massage services, and chiropractic adjustment do not fall under the physical therapy scope.

New Hampshire

  • New Hampshire is one of 28 states that allow direct patient access to PT with some provisions.
  • A PT must refer a patient to an appropriate healthcare provider:
    • If the PT feels that the patient’s care goes beyond the physical therapy scope of practice.
    • If physical therapy treatment is contraindicated.
    • If the patient shows no documented progress within the first 25 calendar days of therapy.

New Jersey

  • New Jersey 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 shall refer a patient to a healthcare professional licensed in this state to practice dentistry, podiatry, medicine, or surgery—or another appropriate licensed healthcare professional:  
      • When the PT performing the examination, evaluation, or intervention has reason to believe that therapy is contraindicated or symptoms or conditions are present that require services outside the physical therapy scope of practice; or  
      • When the patient has failed to demonstrate reasonable progress within 30 days of the date of the initial treatment.
    • Within 30 days from the date of initial treatment, a physical therapist shall inform the patient’s licensed healthcare professional of record of the patient’s plan of care.
      • In the event that there is no identified licensed healthcare professional of record, the physical therapist shall recommend that the patient consult with a licensed healthcare professional of the patient’s choice.
      • In a school setting, the schedule of PT services shall be reported to a child study team by the physical therapist within 30 days of the date of initial treatment.

New Mexico

  • New Mexico is one of 28 states that allow direct patient access to PT with some provisions.
  • In order for a PT to treat direct access patients:
    • The PT must refer a patient to the patient’s licensed healthcare provider if the patient has not made measurable or functional improvement 30 days after starting therapy treatment.
      • If the patient is making measurable progress and improving, the 30-day limit does not apply.
      • The 30-day provision also does not apply to:
        • Treatment provided for complaints related to chronic neuromuscular or developmental conditions for patients previously diagnosed with such a condition.
        • Health promotion, wellness, fitness, or health maintenance services.
        • Services provided to patients who are, under federal law, participating in programs involving an education or family service plan.

New York

  • New York is one of 28 states that allow direct patient access to PT with some provisions.
  • Treatment may be administered with the following provisions:
    • A licensed PT may treat a patient without a referral for 10 visits or 30 days, whichever comes first.  
    • The PT must have at least three years of full-time practicing experience.
    • The PT must be at least 21 years old.  
    • The PT must notify the patient that PT services might not be covered by the patient’s health insurer if he or she did not receive a referral for PT.
      • Notification must be in written form.
      • Notification must also state that said services could potentially be covered by the health insurer with a referral.
      • The PT must keep a copy of the written notification in the patient’s file.

North Carolina

  • North Carolina is one of 20 states that allow patients total, unrestricted access to a physical therapist. According to state law, no type of physician referral is required for a physical therapist to evaluate or treat a patient.
  • A PT must refer any patient with a medical diagnosis of disease or treatment beyond his or her scope of practice to an appropriate physician.
  • PTs may not determine medical diagnosis.
  • The PT must refer the patient to an appropriate healthcare professional if the PT feels that the patient’s care goes beyond the physical therapy scope of practice.
    • Failure to do so is considered unlawful practice.

North Dakota

  • North Dakota is one of 20 states that allow patients total, unrestricted access to a physical therapist. According to state law, no type of physician referral is required for a physical therapist to evaluate or treat a patient.
  • The PT must refer the patient to an appropriate healthcare professional if the PT feels that the patient’s care goes beyond the physical therapy scope of practice.
    • Failure to do so will result in license revocation.

Ohio

  • Ohio is one of 28 states that allow direct patient access to PT with some provisions.
  • Treatment may be administered with the following provisions:
    • The PT must obtain a master’s degree or have two years of clinical experience.
    • If the patient does not demonstrate progress within 30 days, the PT must refer him or her to an appropriate healthcare provider.  
    • The PT must notify the patient’s healthcare provider within the first five days following the initial PT evaluation.
    • The PT may only apply certain orthotic devices.

Oklahoma

  • Oklahoma is one of 28 states that allow direct patient access to PT with some provisions.
  • Treatment may be administered with the following provisions:
    • The PT must obtain a physician’s referral after 30 days.
    • Patients must obtain a physician’s referral if they are seeking PT for any workers’ compensation claims.

Oregon

  • Oregon is one of 20 states that allow patients total, unrestricted access to a physical therapist. According to state law, no type of physician referral is required for a physical therapist to evaluate or treat a patient.
  • The PT must refer the patient to an appropriate healthcare professional if the person presents symptoms:
    • That require treatment or diagnosis from a physician;
    • For which PT is contraindicated; or
    • For which care is beyond the scope of practice or education of a physical therapist.

Pennsylvania

  • Pennsylvania is one of 26 states that allow direct patient access to PT with some provisions.
  • Treatment may be administered with the following provisions:
    • Licensee may obtain certification from the board of physical therapy that allows him or her to practice without a physician’s referral.  
      • This certificate shall not authorize a PT to (1) treat a patient for any non-neurologic, non-muscular, or non-skeletal condition or (2) treat a patient who has an acute cardiac or acute pulmonary condition.
      • The PT may treat the aforementioned patients only if he or she has consulted the patient’s healthcare provider or has referred the patient to an appropriate healthcare provider.  
      • The certificate holder shall publicly display the certificate.  
      • The PT shall renew the certificate whenever he or she renews his or her therapy license.
      • A PT with this certification may treat a direct access patient for 30 days from the date of the first treatment.
        • The PT may not exceed 30 days of treatment without obtaining a referral from an appropriate healthcare provider.

Three posts down; one more to go! Tomorrow, I’ll be tackling all the laws from Rhode Island to Wyoming. So, if you practice in any states between R and W, be sure to swing by the WebPT Blog for the final installment of this series. And, of course, if you want to have direct access law for all 50 states compiled in one, easy-to-read document, The PT’s Guide to Direct Access in All 50 States is available for download right here. Until next time!