With this year's state legislative season closing out, many APTA chapters achieved significant victories in various areas of physical therapy legislation. Key successes include improvements in direct access, streamlining prior authorization processes, and advancing PT Compact legislation.

Additionally, there have been major strides in PTs' imaging authority, scope of practice, business operations and tax credits, background checks for certifications, and health care advocacy. Here's a detailed look at the impactful changes either already in effect or soon to be enacted.

Improved Direct Access to Physical Therapist Services (Alabama, Mississippi, and South Carolina)

After years of dedicated advocacy, the profession reached a landmark achievement in 2024 with the removal of severe restrictions on direct access to physical therapist services in all states — with APTA Alabama leading the final state to pass legislation to that effect. The state's initial law permitting direct access in 2012 was heavy with restrictions, placing it at the "limited" level of direct access,  meaning it permitted PT services without referral only under a narrow range of circumstances. The new law eliminates many of these restrictions and moves the law to the less-restrictive "provisional" category. Provisional direct access 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.

The legislation also provides title protection for "DPT" and "doctor of physical therapy."

See APTA's map and state-by-state descriptions of levels of direct access.

Mississippi, which initially enacted direct access in 2006 with severe limitations, also loosened its restrictions, moving it from "limited" to "provisional" direct access.

In South Carolina, a regulatory change published in May clarified the term "referral" in the context of the state's 1998 direct access law, which states that after 30 days of treatment the PT must refer the patient to a medical doctor or dentist. As clarified, a referral is a written communication from the PT to the patient after the 30-day treatment period advising them to see a medical doctor or dentist; however, the PT may continue treating after the 30 days.

Prior Authorization for PT Services (Mississippi, Vermont, and Wyoming)

In Wyoming, new regulations require health insurers and contracted utilization review entities to follow prior authorization regulations governing the availability of information about prior authorization requirements and restrictions to providers and the public, and timely notice of new or amended policies.

Mississippi also made pivotal prior authorization progress in terms of transparency, standardizing processes, denials, and periodic review of prior authorization requirements for health insurers and health care providers.

Vermont established new prior authorization parameters that require health plans to create impact reports, make information more readily available to providers and the public, and follow new protocols and response timelines for prior authorization requests.

Fair Copayment and Reimbursements (Michigan and Pennsylvania)

APTA Michigan helped ensure access and copay parity in telemedicine and in-person services provided by PTs with a significant change in laws that now subject telemedicine services to all terms and conditions agreed upon by policy holders and insurers and require that telemedicine services receive the same insurance and medical assistance program coverage as in-person services. Additionally, insurers cannot dictate whether services are provided in person or via telemedicine unless they are contractually obligated or deemed clinically appropriate by the health care professional.

In Pennsylvania, health insurance policies will now cover medically necessary telemedicine services that are consistent with the standard of care and provided by an in-network provider. This means that a contract that includes payment for covered health care services delivered through telemedicine may not be prohibited solely because of the delivery method.

Physical Therapy License Compact Expansion (Florida, Minnesota, Rhode Island)

This year marked continued success for the PT Compact, which enables PTs and PTAs to gain privileges to work in multiple states with a single license. APTA chapters in Florida, Minnesota, and Rhode Island successfully advocated for the passage of compact legislation, while Kansas adopted background check clarifications to its existing legislation. These additions bring the number of states participating or intending to participate in the compact to 39.

See which states are participating in the compact.

Expansion of Imaging Authority (Arizona and Louisiana)

APTA Arizona scored a major victory under a new law that expands PTs' authority to order imaging, from ordering only musculoskeletal plain film radiographs to ordering all imaging.

Louisiana's Physical Therapy Board has clarified that physical therapists are not prohibited from referring patients directly to radiologists for diagnostic imaging. This change aligns with the Louisiana Physical Therapy Practice Act, ensuring that such referrals do not constitute "use" of ionizing radiation by the therapists themselves.

Scope of Practice (Arizona, Colorado, District of Columbia, Idaho, and Montana)

Arizona enacted legislation elevating the level of regulation of PTAs from certified to licensed.

Colorado extended the regulation of PTs and PTAs until September 2035, allowing PTs to prescribe durable medical equipment.

In Washington, D.C., the term "physical therapist assistant" was officially adopted, aligning terminology used by APTA, Medicare, and other U.S. jurisdictions. Additionally, PTA supervision was expanded from direct to general supervision.

Meanwhile, Idaho's and Montana's physical therapy licensure boards confirmed through formal letters that performing Department of Transportation evaluations falls within the scope of practice for physical therapists, pending certification from the U.S. Department of Transportation's Federal Motor Carrier Safety Administration.

Increased Authority to Certify Disability Placard Applications (Utah, Wisconsin)

Both Utah and Wisconsin passed legislation adding PTs to the list of providers who can certify applications for disability placards and license plates.

Improved Tax Credits and Business Operations (New Hampshire and New Mexico)

Advocacy efforts by APTA New Mexico helped strengthen health care access to physical therapist services in rural communities through a new law that adjusted income tax brackets to benefit physical therapy providers in underserved rural areas.

In New Hampshire, a new measure has been introduced to facilitate licensure verification for Medicaid providers by establishing a data match process between the state's Department of Health and Human Services and Office of Professional Licensure and Certification. This process aims to ensure that Medicaid providers maintain current and valid licensure.

Continuation of Regulatory Board Operations (Arizona)

APTA Arizona was successful in advocating for the safe and professional practice of physical therapy in the state through the continuation of the Arizona State Board of Physical Therapy for eight years until July 1, 2032.

Better Background Screenings for Certifications/Licensure (Florida, Kansas, Maine, and Pennsylvania)

Several states updated their background check requirements for licensure. Florida expanded background screening to all health care practitioners and introduced new qualifications for certification based on lived experience. Pennsylvania now requires criminal history background checks for health care practitioners. Maine implemented fingerprint-based FBI background checks for applicants in physical therapy. And Kansas standardized fingerprinting procedures for criminal history record checks.

Health Care Advocacy Wins (Connecticut, Illinois, Louisiana, Maine, Michigan, Tennessee, and Washington)

In Connecticut, access to safe home health services was strengthened by laws establishing new mechanisms and work groups to support providers in these settings, and a new law has extended COVID-19 telehealth provisions until June 30, 2027.

In Illinois, PTs and PTAs may now provide physical therapy through telehealth services under specified conditions, allowing them to address access issues to care, enhance care delivery, and increase the PT's ability to assess and direct patient performance in the patient's own environment.

Louisiana marked funding to improve providers' access to health care career training and educational programs through the Health Care Employment Reinvestment Fund, helping to ensure that PTs and PTAs have more opportunities to advance their skills.

Thanks to the advocacy of APTA Maine and other health care providers in the state, independent providers now have an advocacy program to help navigate the state insurance laws and rules, and a complaint process within the Bureau of Insurance to investigate alleged insurance violations.

Michigan has passed laws that provide clarity on guidelines and billing, and ensures qualified usage of complex rehab technology. With these laws, physical therapists and other qualified professionals now have access to complex rehabilitation technology, definitions of those technologies, and specific HCPCS billing codes designated for complex rehabilitation technology and any appropriate future new codes.

Washington established a health care cost transparency board that will improve consumer affordability. This board will implement improvements to the measure of underinsurance, issue annual reports, hold hearings with testimony from health care stakeholders, and provide opportunities for public comment.

In Tennessee, physical therapists who solely provide outpatient services have been deemed exempt from the definition of "home health service."