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Direct access states
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Direct access states - March 3, 2005 8:51:00 AM
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Diane
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From: Vancouver, B.C., Canada
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Just in case anyone is curious, this was posted on another PT site, (along with a nice map, which I don't know how to bring here unfortunately..), showing direct access states and the year they gained it.
Alaska 1986
Arizona 1983
Arkansas 1997
California 1968
Colorado 1988
Delaware 1993
Florida 1992
Idaho 1987
Illinois 1988
Iowa 1988
Kentucky 1987
Louisiana 2003
Maine 1991
Maryland 1979
Massachusetts 1984
Minnesota 1988
Montana 1987
Nebraska 1957
Nevada 1985
New Hampshire 1988
New Jersey 2003
New Mexico 1989
North Carolina 1985
North Dakota 1989
Ohio 2004
Oregon 1993
Pennsylvania 2002
Rhode Island 1992
South Carolina 1998
South Dakota 1986
Tennessee 1999
Texas 1991
Utah 1985
Virginia 2001
Vermont 1988
Washington 1988
West Virginia 1984
Wisconsin 1989
Wyoming 2003
Total=39
Those of you in states that still don't have direct access, take heart, see how many have it already, and get busy getting it, ASAP.
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Re: Direct access states - March 3, 2005 9:07:00 AM
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JLS_PT_OCS
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From: USA
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Thanks Diane, great post.
I wonder if that addresses direct access for first contact, for evaluation only, for evaluation and treatment, etc.
I also wonder about insurance reimbursement. This is as important if not more so than the state act. What good does this do if the insurance company won't pay unless you get a referral first?
Sorry to seem like a wet blanket...
J
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Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Direct access states - March 3, 2005 9:31:00 AM
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Diane
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From: Vancouver, B.C., Canada
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Hi J,
Haven't got a clue how it breaks down. I think the deal is, being able to legally see patients without doctor referral. Just the fact of direct access means no ball and chain. You can have an insurance free cash practice if you want one. Leave it up to the patients how they want to get reimbursed, if they have some coverage.
There are tons of people willing to pay out of pocket for homeopathy, massage, spas, you name it. As PTs those in direct access states can announce their availability to all, and start to build a patient base from amongst those people willing to pay cash. Such PTs can freely set their own boundaries around how many visits they'll let someone come. My average is two or three visits per patient. I get a few dozen new patients each month, referred by other patients. Sometimes patients refer their doctors. I'm seeing two MDs right now, for shoulder problems. One has just been discontinued after three sessions, all painfree and full range and better from her AC problem/tight up one side of neck problem, has agreed to stop carrying her huge leather weighs-a-ton shoulder bag, in which she carries a couple files, a fat daytimer, and her lunch, and has agreed to try sleeping on both sides of herself, not just one the left (cranky) side every night/all night. Behavioral modification. And changing society's perception of PT one patient at a time.
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Re: Direct access states - March 3, 2005 9:37:00 AM
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JLS_PT_OCS
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Diane, that sounds great, and well put.
You're right in that I don't think we as PTs do enough in the cash practice area for our services.
What a great adjunct to your referrals...
J
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Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Direct access states - March 3, 2005 9:39:00 AM
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gerry
Posts: 238
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From: Montgomery, AL, USA
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Diane,
I think these are the states that allow some treatment without a referral, although some have limitations. All but 2 states allow evaluation without referral. Alabama is one, and we are working toward direct access this year.
gerry
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Re: Direct access states - March 3, 2005 9:59:00 AM
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Nicole Matoushek PT MPH CSHE CEES
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From: St. Petersburg, FL
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Thank you Diane,
That is a very useful list! Many states that offer Direct Access, do so with Omissions and Provisions, such as: Eval only, prohibition of care on surgical or hospital patients, or may even require an initial diagnosis by an MD before commencing therapy.
The APTA has an excellent web page detailing this.
Nicole
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Nicole Matoushek, PT, MPH, CSHE, CEES
http://www.ErgoRehabinc.com
http://www.ErgoRehabBlog.com
http://www.ComputerAccessoriesOnlineStore.com
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Re: Direct access states - March 4, 2005 2:35:00 PM
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tc
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From: Los Angeles area
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Following along with Nicole's post, I know that in CA, we are on that list, but it does have stipulations. We cannot be "diagnosticians", so yes if a patient has a diagnosis and wants to be treated cash-pay (insurance requires doctor prescriptin), they can probably be seen legally, but if they have some sort of unknown injury or pain, they need to be seen first by a "diagnostician" (physician) for a diagnosis.
*Nicole, where exactly is the web site on the APTA about this? I'd like to read it.
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Re: Direct access states - March 4, 2005 3:16:00 PM
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steve
Posts: 470
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From: Canada
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Diane,
Got a list of when Canadian provinces got direct access?
Steve
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Re: Direct access states - March 4, 2005 4:06:00 PM
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jma
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From: NY
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Hello,
Here is the specific APTA website for the states that have direct access and the provisons each state has.
http://www.apta.org/documents/public/GovtAffairs/DirectAccessLaws.pdf
Hopefully, this will clarify some issues that were asked.
JMA
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Re: Direct access states - March 4, 2005 4:16:00 PM
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Diane
Posts: 1507
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From: Vancouver, B.C., Canada
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Steve,
No I don't have a list for Canadian provinces. All I know is that here in BC, a PT who registered obtained direct access, from the origins of PT in BC, and a PT who chartered, didn't, until 1994. The difference was $10 and a piece of paper that said, "Registered" instead of "Chartered." Anyone with a lisence to practice PT could register if they wanted, and have direct access if they wanted, historically. I don't know what's been going on in other provinces in this matter, or when PTs gained direct access. My understanding is that it is now universal in Canada.. anyone know anything different?
Thanks JMA.
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Re: Direct access states - March 5, 2005 9:27:00 AM
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tc
Posts: 137
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From: Los Angeles area
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jma - thanks for the link. that's very interesting info. i wish my state (ca) would update like a lot of others. we're stuck back in 1968.
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Re: Direct access states - March 7, 2005 4:14:00 AM
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NorthernPT
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From: MN
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North Dakota Blue Cross/Blue Shield no longer requires a referral for PT. Hopefully this will catch on in other states and other third-party payers.
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Re: Direct access states - March 7, 2005 4:27:00 AM
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hmgross
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From: Minnesota
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Certain BCBS plans in MN do not require a referral--I always have patients call their 800# on their ins. card to verify this.
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Holly Gross PT
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Re: Direct access states - March 7, 2005 5:08:00 AM
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JLS_PT_OCS
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From: USA
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You guys in the midwest have always been leaders in this way...that's great.
Did I read that Nebraska has had direct access since something like 1968??
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Direct access states - March 12, 2005 12:48:00 PM
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ptdan23
Posts: 224
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From: Orlando, FL
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Here in FL you can evaluate and treat for up to 21 days. After that you must consult w/ another practitioner (MD/DO, etc). I think another stipulation is that it has to be a new problem. If the pt is under the care of another practitioner for the problem they want to see you for then they need a referral. Problem is that a lot of insurance companies that cover FL residents still require a physician referral in order for them to have therapy covered. Hopefully that will start changing soon!
Dan, PT.
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Re: Direct access states - August 29, 2005 8:52:00 PM
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webrehab
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From: San Diego
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CA is far from a direct access state.
I second TC's wishes that we had direct access in CA. From what I hear in the political grape vine, we keep getting stuck on the "diagnotician" part of the proposed bills. The MD's just won't give up the power.
As far as a cash business goes in CA, to do it legally, you would probably be filing for unemployment unless you were doing wellness care.
Would love to hear any other thoughts.
_____________________________
David Straight, MPT, OCS
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Re: Direct access states - August 29, 2005 9:36:00 PM
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goodlooks58
Posts: 425
Joined: October 21, 2002
From: CA
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Give examples of wellness care. Is it personal training? Can a massage be wellness under PT license?
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Re: Direct access states - August 31, 2005 8:11:00 AM
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jma
Posts: 2414
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From: NY
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That is definitely a must.
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Re: Direct access states - September 1, 2005 5:12:00 AM
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ehanso
Posts: 355
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From: Minnesota
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In Minnesota it the practice act allows evaluation and treatment for up to 30 days without referral. However, most insurances will not pay without the referral.
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