With the dust just about settled around most state legislatures, APTA, its state chapters, and supporters are beginning to assess how the practice and payment landscape has changed at the state level for physical therapists, (PTs), physical therapist assistants (PTAs), and the patients they serve. The news is decidedly good.

"This has been an extremely busy year for physical therapy-related legislation in many states, and the hard work and collaborative efforts of chapters and APTA have paid off," said Angela Shuman, director of state legislative affairs for APTA. "We have a lot to be proud of."

Among the highest-profile wins is the steady expansion of states joining the Physical Therapy Licensure Compact (PTLC), the game-changing system that allows PTs and PTAs licensed in 1 state to obtain practice privileges in other participating states. Mississippi, Missouri, North Dakota, and Tennessee have officially enacted the compact system. Other states have passed the necessary legislation and are preparing to flip the switch on the compact, with this year's addition of Iowa, Louisiana, Nebraska, New Jersey, Oklahoma, South Carolina, and West Virginia bringing the total number of compact states to 21. A bill to adopt the compact is pending in Pennsylvania.

But that's not all that's been happening in state capitols. Here's a rundown of some of the big issues addressed across the country.

The issue: direct access
Bottom line: direct access provisions are expanding
Illinois could be strengthening its direct access provisions by permitting PTs to provide physical therapy without a referral as long as the PT notifies the patient's treating health care profession within 5 business days after the first visit. The bill is pending the governor's approval. California's legislature is considering a bill that would permit direct access to a PT for wellness services and services provided as part of an individualized education or family service plan.

The issue: the opioid epidemic and access to nonopioid pain management approaches, including physical therapy
Bottom line: states are pressing payers, providers, and policymakers to take action
Connecticut will convene a work group to investigate the efficacy of physical therapy, acupuncture, massage, and chiropractic care in reducing the need for opioids for individuals with chronic pain. Florida, Oklahoma, West Virginia, and Tennessee will put more pressure on physicians to educate themselves and their patients on nonopioid options for pain management, with Tennessee requiring providers to obtain informed consent from patients acknowledging that they have been offered information on reasonable alternatives to opioids. Vermont will require reductions in copay amounts for PT services under certain health plans and has established a work group to study insurance coverage for nonopioid approaches to pain management, including cost-sharing for physical therapy. West Virginia will require that health plans, including Medicaid and state health plans, provide coverage for 20 PT visits when related to treatment of chronic pain, with deductibles prohibited from being higher than deductibles for a primary care visit; Delaware is taking similar action, pending the governor's approval. The Massachusetts legislature is considering establishing a commission to make recommendations on nonpharmacological strategies for pain management, and the commission would include a representative from the state's APTA chapter.

The issue: dry needling
Bottom line: more states have added or may add dry needing to their physical therapy practice acts
In Idaho and South Dakota, where dry needling by PTs had been prohibited, language is now in place permitting PTs to perform the treatment. The New Jersey legislature is considering a bill to allow dry needing. Colorado has added dry needling to its physical therapy practice act, effectively ending a debate and legal challenge over dry needling rules that the Colorado licensure board had enacted several years ago.

The issue: concussions
Bottom line: states are recognizing the PT's role in making return-to-play determinations
Arizona and Oregon have cleared the way for PTs to provide clearance for student athletes to return to play after a concussion or suspected concussion, with Arizona's law limiting the ability to only PTs with a sports specialist certification, and Oregon's law permitting all PTs to make the determinations. A similar bill is pending in New Jersey.

The issue: telehealth
Bottom line: states are acknowledging the validity of telehealth and including PTs in the mix
Illinois has added PTs to the state's telehealth act, authorizing delivery of services through telehealth if the PT is licensed to practice in Illinois and acting within the PT scope of practice in the licensing law. Iowa and Kentucky adopted laws requiring health plans to cover telehealth services.

The issue: certification of disability by a PT
Bottom line: states are recognizing the PT's role in disability certification
Kentucky and Michigan became the latest states to add PTs to the list of providers who may provide certification of disability for purposes of parking placards and license plates. In Kentucky, PTs can make determinations for temporary parking placards, while in Michigan, PTs can make determinations for temporary parking placards, license plates, and free parking stickers.

More wins

• Connecticut: The use of the title "DPT" and "Doctor of Physical Therapy" is now protected by law.
• New Mexico: A group has been commissioned to investigate whether state workforce incentives, including student loan repayment assistance, are adequately incentivizing PTs and PTAs to relocate to and remain in the state—the group includes representatives from the APTA New Mexico Chapter and the state's physical therapy licensing board.
• New York: The annual visit limit for physical therapy under Medicaid has been expanded from 20 to 40.
• Ohio: The legislature is considering a bill to modernize the definition of physical therapy, including a clarification that diagnosis is a part of PT practice.
• Utah: Licensed radiologic technologists are now permitted to accept an order from PTs for plain radiographs and magnetic resonance imaging if the PT designates a physician to receive the results and the physician agrees to accept them.
• Washington: Health care payers are no longer permitted to impose prior authorization requirements for initial evaluation and up to 6 treatment visits for chiropractic, physical therapy, occupational therapy, East Asian medicine, massage therapy, or speech and hearing therapies provided the services meet the standards of medical necessity and are subject to quantitative treatment limits.