Consumer Choice to Directly Access Physical Therapy Services

By Patrick J. VanBeveren, PT, DPT, Legislative Chair

The enactment date of our consumer choice to direct access legislation was 11/23/06. As of that date it became legal for a physical therapist with 3 years of experience to treat a patient without a referral from a physician, nurse practitioner, dentist or podiatrist. Treatment, not including evaluation, can proceed for 10 visits or 30 days whichever comes first before a referral must be obtained to continue physical therapy treatment. The patient also needs to be advised in writing that their insurance carrier may not pay for services without a physician referral. Regardless of this change in our practice act, No-fault patients will continue to need a referral for payment.

The State Board for Physical Therapy is continuing to promulgate regulation to further define this legislation. We have included information from the State Education Department's web site below to help you interpret this new provision in our practice act.

Payment is not mandated by this change in law and insurance carriers may have certain regulations, including physician referral and prior authorization, before they will reimburse for physical therapy services. You are advised to contact carriers before providing services to insure that your services will be covered.

NYPTA will continue to work with insurers, referral sources, policy makers and the public to maximize the effect of this law in providing consumers the right to directly access our services.

The following is from the State Education Department's Web Site:

§77.9 Providing treatment in the practice of physical therapy without referral.
(Effective November 23, 2006)

• (a) In accordance with Education Law section 6731(d), a licensed physical therapist may provide a patient with treatment in the practice of physical therapy without a referral from a physician, dentist, podiatrist, or nurse practitioner, for 10 visits or 30 days whichever occurs first, provided the licensed physical therapist meets the following requirements:
  • (1) the licensed physical therapist has practiced physical therapy on a full-time basis equivalent to not less than three years prior to beginning such treatment, meaning the licensed physical therapist has completed at least 4,320 clock hours of physical therapy practice over a minimum of 36 months anytime prior to beginning such treatment; and
  • (2) the licensed physical therapist meets all requirements of subdivision
  • (b) of this section relating to the notice of advice.
• (b) Notice of advice. A physical therapist providing treatment in the practice of physical therapy without a referral from a physician, dentist, podiatrist, or nurse practitioner, in accordance with Education Law section 6731(d) and the requirements of this section, shall advise the patient in writing prior to beginning treatment of the possibility that treatment may not be covered by the patient's health care plan or insurer without a referral from a physician, dentist, podiatrist, or nurse practitioner and that treatment may be a covered expense if rendered pursuant to such referral. This notice of advice shall be provided on a form, a copy of which shall be kept on file by the licensed physical therapist as a patient record and a copy of which shall be given to the patient. The notice of advice form shall include the following information:
  • (1) a statement of such advice and a statement attesting that the patient has read the notice of advice;
  • (2) the date treatment will begin;
  • (3) the patient's name and address;
  • (4) the patient's signature and date the patient signed the form;
  • (5) the treating physical therapist's name and address; and
  • (6 ) the treating physical therapist's signature and the date the physical therapist signed the form.

   

  Posted 1/2/07

   

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