• FAQs:Direct Access Frequently Asked Questions
• April 29, 2008 - Update on the new Direct Access Law
• November 1, 2007 Direct Access Emergency Regulations became effective today, November 1, 2007.  However, the law does not go into effect until April 29, 2008. 
• Aug 14, 2007 Update on Direct Access Legislation and Development of Regulations
• Feb 28, 2007 Update on VA Direct Access Legislation
  
• Download Direct Access Legislation Document
• Direct Access Press Release
• Continuing Education Courses

April 29, 2008 - Update on the new Direct Access Law

History of the New Law

After the new direct access law was passed in early 2007 there were several important steps that had to be taken before the law went into effect. The Board of Physical Therapy had to develop regulations for the new law and a 6 month initial certification application process was put in place so that a core group of practitioners would be able to utilize the new law when it went into effect on April 29, 2008. VPTA has been providing information about these processes for the last several months. I hope that many of you have applied for the direct access certification. Since the law has now gone into effect it seemed appropriate to remind you about the elements of the previous law, the changes and specifics of the new law, and answer some of the common questions that have arisen.

The Previous Direct Access Law

The previous direct access law from 2001 included the following elements:

A -With 3 years of active practice as a PT you could do the following without a physician referral:

1. Perform a one time evaluation that did not include treatment. 
2. Provide 14 consecutive calendar days (2 weeks total) of PT if the individual had the same previous diagnosis for which he/she had received PT within the previous 2 years.

B - Also, any licensed PT could provide the following without a physician referral:

1. PT services to children in the school system under an IEP
2. Employees for evaluation and consultation related to workplace ergonomics
3. PT services to a student athlete participating in a school-sponsored athletic event if  the PT was a sports clinical specialist or an ATC
4. Wellness, fitness, and health screenings, health promotion and education to the public for prevention.

 

The New Direct Access Law

The Direct Access Law for 2008 only changes 1 item from the previous law – item A2 above. A1 and all of the items in B remain in effect and DO NOT REQUIRE THE DIRECT ACCESS CERTIFICATION.

A2 has been modified and the previous diagnosis wording has been removed. The new Direct Access Law states the following:

A PT who has obtained a certificate of authorization may evaluate and treat a patient for no more than 14 consecutive business days (defined as Monday –Friday and not including state holidays) without a referral if :

  a) At the time of presentation to PT the patient is not being currently cared for, as attested to in writing by the patient, by a licensed doctor of medicine, osteopathy, chiropractic, podiatry, dental surgery, nurse practitioner, or physician assistant for   the symptoms giving rise to the presentation.

  b) The patient identifies a practitioner from whom the patient intends to seek   treatment if the condition does not improved after evaluation and treatment
  by the PT .
 
  c) The patient gives written consent for the PT to release all personal health information and treatment records to the practitioner identified by the patient.

  d) The PT notifies the practitioner identified by the patient no later than 3 days after the treatment commences and provides a copy of the initial evaluation.

  e) A PT may utilize this direct access law no more than every 90 days from the date of the previous initial evaluation by a PT.

The really positive thing about the new law is that for the first time in Virginia a PT with the direct access certification will be able to evaluate and treat a patient without a referral or need for a previous diagnosis from a physician. This means PTs can now market and advertise their services to consumers who will no longer need a referral.
 
If a patient does not qualify to be seen under the new law as described above, the “one time evaluation” rule which we have had since 2001 would apply. You could evaluate the patient and then contact the practitioner to garner a referral for treatment.

IMPORTANT NOTE: If you choose not to apply for the direct access certification you will no longer be able to treat individuals who have a previous diagnosis as that portion of the law has been eliminated and replaced with the new language noted above.

The Direct Access Certification Process 

 A PT who wishes to utilize the new direct access section of the law will need to apply for this certification through the Virginia Board of PT – our licensing board at the department of health professions. There is an application online at www.dhp.virginia.gov. The PT may qualify in 1of 3 ways:

1) Have an entry level DPT degree, or
2) Have a transitional DPT degree, or
3) Have 3 years of practice experience and show proof of completion of at least a 15 contact hour course in the area of medical screening/differential diagnosis. The course must also include a testing component as part of the 15 hours.

The cost for the initial application is $100.00.
The applicant must complete the following:

1)Application
2)Payment
3)An official transcript  or certificate of completion showing he or she has completed the needed continuing education. If an applicant is not currently licensed in Virginia additional education verifications will be needed.

Once you receive this certification you will receive a written certificate that you will post in your office or clinic. This certification will renew at each biennial renewal and the PT must indicate that he/she has completed 4 hours of  continuing education in the area of medical  screening/differential diagnosis as part of clinically based courses taken during that licensing period.

The certification is for an individual PT who has applied and been granted the certification. If a patient is seen under direct access at a clinical location (hospital, OP clinic, etc) only those PTs with individual certification may evaluate and treat that patient.

November 1, 2007: Direct Access Emergency Regulations became effective today, November 1, 2007. However, the law does not go into effect until April 29, 2008. 

August 14, 2007: UPDATE ON DIRECT ACCESS LEGISLATION AND DEVELOPMENT OF REGULATIONS

What has been happening since the law was passed?

The Governor signed the direct access legislation earlier this year which prompted a 280- day count down to develop emergency regulations to oversee the new law. The Board of Physical Therapy, with input from VPTA, has worked over the last few months to develop the emergency regulations. On July 20, 2007, the Board of PT finalized the emergency regulations for the direct access legislation. These emergency regulations must now go through several levels of administrative review ending with approval by the Governor. They must be in effect no later than November 26, 2007.  When the administrative process is complete the regulations will be published. At that time a NOIRA (notice of intended regulatory activity) will be published as well noticing the public that the Board of PT will promulgate the final regulations within a one-year period. Following the NOIRA Licensees will have a 30-day opportunity to comment on the emergency regulations. Meanwhile, the emergency regulations will go into effect. During the year that follows the publication of the emergency regulations, the Board of PT will determine what the final regulations will include. When the replacement regulations are proposed there will be an additional 60-day public comment period. It is EXTREMELY important for all Licensees to follow this process and comment on the emergency regulations and, ultimately, the proposed regulations around our direct access law. VPTA will continue to provide information to members and non-members about this process.

When will the new direct access law go into effect?

The emergency regulations will go into effect sometime between when you read this information and November 26, 2007. When that date is published you will have 180 days to apply for certification before the new law is implemented. During that period of time physical therapists who wish to practice under the new direct access must complete the application process for certification and submit that application to the Board of Physical Therapy. At the end of the 180-day period the law will become effective and those PTs who have been granted the certification will be able to practice the new direct access. Other PTs may apply for the certification beyond that 180-day period, but it is hoped that most currently licensed PTs who wish to certify will do so during the initial period.

What has changed in the law around our direct access in Virginia? 

This paragraph will provide a brief overview of the legislation. The 2007 legislation removed the section in the law that required a previous diagnosis in order to treat a patient under direct access. It was replaced by the following: (this is a paraphrase of the legislation for ease of reading)

A PT who has obtained a certificate of authorization may evaluate and treat a patient for no more than 14 consecutive business days (business days are defined as Monday-Friday excluding state holidays) after evaluation without a referral under the following conditions: 1) the patient at the time of presentation to the PT for services attests that he/she is not currently being cared for by another health care practitioner who is on our list of referral sources, 2) the patient identifies a practitioner from whom they intend to seek treatment for the condition if it does not improve during the PT care, 3) the patient gives written consent for the PT to release personal health information to that practitioner, and 4) the PT provides the written initial evaluation/plan of care to the identified practitioner no later than 3 days after treatment of the patient begins. This aspect of direct access under the new law can be applied to a patient only if it has been 90 days from the last initial evaluation on that same patient if they were seen under this part of the direct access law. (In other words, this timeframe does not apply if they were seen by referral from a practitioner within 90 days).

NOTE: The Board of Physical Therapy has developed a “Patient Attestation and Medical Release Form” for use by the PT to document the patient meets the requirements under this portion of the direct access law. This form will be available on the Board of Physical Therapy website at www.dhp.virginia.gov. If a clinical facility chooses not to use this form the information on the form must all be included in the patient record as determined by the clinical facility.

What has NOT changed in the law around our direct access in Virginia?

The one time evaluation after 3 years of practice has not changed. A PT does not need to apply for the certification process if he/she only wishes to perform an initial evaluation on a patient as described under our current law. This clause in the law also provides a mechanism for the PT to evaluate a patient who does not meet the conditions noted in the paragraph above. The PT can at least evaluate the patient and then contact the practitioner for a referral as you do now.

Also, the ability to provide services without referral remains the same for the following groups under our current law: 1) a student athlete participating in a school-sponsored activity if the PT is an ATC or SCS, 2) [the] employees solely for the purposes of evaluation and consultation related to workplace ergonomics, 3) special education students under an IEP, and 4) the public for the purpose of health promotion and wellness, fitness, and health screening and prevention. A physical therapist will NOT need to apply for the certification process in order to continue using these aspects of our direct access law.

What is the certification process and how will that work?

The new emergency regulations state the following about the certification process for direct access: An applicant for certification to provide services to patients without a referral as specified in 54.1-3482.1 shall hold an active, unrestricted license as a physical therapist in Virginia and shall submit evidence satisfactory to the board that he has one of the following qualifications- 1) Completion of a doctor of physical therapy program approved by the APTA (specifically, the Commission on Accreditation in Physical Therapy Education, or 2) Completion of a transitional program in physical therapy as recognized by the board, or 3) at least three years of post-licensure, active practice with evidence of 15 contact hours of continuing education in medical screening or differential diagnosis, including passage of a post-course examination. The required continuing education shall be offered by a provider or sponsor listed as approved by the board… and may be face-to-face or on-line education courses.

In addition to the evidence of qualification for certification required above, an applicant seeking direct access certification shall submit to the board – 1) a completed application as provided by the board, 2) any additional documentation as may be required by the board to determine eligibility of the applicant; and the application fee.

The application form will be available on the Department of Health Professions, Board of Physical Therapy website. It is expected that the required documentation of completion of a DPT or transitional DPT will be a transcript reflecting completion of the degree. Documentation of completion of continuing education as noted above will be required for those physical therapists without a DPT or transitional DPT degree.

The application fee for the certification process will be $100. 

What will I need to do to maintain the direct access certification?

In order to renew a direct access certification a licensee shall be required to: 1) hold an active, unrestricted license as a physical therapist and comply with the continuing education requirements.

Physical therapists holding certification to provide direct access without a referral shall include five contact hours related to carrying out direct access duties as part of the required 30 contact hours of continuing education. Courses for direct access continuing education shall relate to clinical practice in a direct access setting.

NOTE: This regulation provides the PT with a great deal of flexibility in determining continuing education, as most courses related to clinical practice and patient/client management will include elements of practice in a direct access setting.

The fee for renewal on a direct access certification shall be $35 and shall be due by December 31st in each even-numbered year when the other license renewal is paid.

Where can I get more information on the direct access legislation and regulation?

Information is available on the Department of Health professions website at www.dhp.virginia.gov. Once there click on Board of Physical Therapy to view the information. Once you are on the homepage there will be a link to the Direct Access resource area. Please review the actual legislation, the full regulation, and the Patient Attestation and Medical Release Form.

Who do I contact if I wish to make public comment to the Board of Physical Therapy?

To make public comment on the emergency regulations, or the proposed regulations once they have been developed, contact the Board of Physical Therapy by e-mail at Lisa.Hahn@dhp.virginia.gov or by mail to the Board of Physical Therapy, Department of Health Professions, 9960 Mayland Drive, Suite 300, Richmond, VA 23233-1463. VPTA members who have additional questions about the direct access legislation or regulation may contact the VPTA office by e-mail at vpta@apta.org.

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February 28, 2007: UPDATE ON DIRECT ACCESS LEGISLATION:

Legislation to broaden direct access to Physical Therapy in Virginia (HB 2087 and SB 1305) was signed into law by Governor Tim Kaine (D) at the end of last week.

The final legislation removes the previous diagnosis requirement and permits a physical therapist to evaluate a patient and treat them for 14 business days before a physician referral is needed. The legislation requires that a direct access certification process be implemented for those physical therapists seeking to practice without referral under this new legislation. This certification is to ensure that individuals practicing under the new law have appropriate education in the area of direct access, such as medical screening and differential diagnosis. We expect that this can be accomplished through continuing education, which is already required for our profession in Virginia.

Regulations to implement the certification process will be promulgated by the Board of Physical Therapy. This process will be taking place over the next year and VPTA will be participating actively as the regulations are developed. There will be multiple opportunities for licensees to comment on the proposed regulations. Once the regulations are completed there will be an initial 180-day period in which PT licensees will be asked to submit an application to the Board of Physical Therapy if they wish to be certified to practice direct access under this new law.

Normally, a new law would go into effect on July 1, 2007, however, since regulations around the certification process must be promulgation by the Board of Physical Therapy the changes in our law will not go into effect July 1, 2007. The current direct access laws will remain in place until such time as the certification regulation is completed by the Board of Physical Therapy and the licensees have had the initial 180-day time period to apply for certification. At that time the new law will go into effect in Virginia. This was done at the request of the licensing board in order to ensure that anyone wishing to practice under the new direct access law would have sufficient time to gain certification. This will take place sometime in 2008. The Board of Physical Therapy and VPTA will provide ongoing information on this process so that licensees will be kept abreast of the timeline. In the interim, the current direct access laws remain in effect.

Thanks to everyone who worked to make this legislative effort successful. The real winners are our patients and clients who will have enhanced access to our physical therapy services in Virginia.

Please feel free to contact the VPTA Board of Directors if you have questions. To view a copy of the bill and related information, click here

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NEW LAW ALLOWS VIRGINIA PATIENTS IMPROVED ACCESS TO
 PHYSICAL THERAPIST SERVICES

ALEXANDRIA, VA February 28, 2007--Patients in Virginia who need physical therapist services will soon be allowed to go directly to a physical therapist without having to wait to receive a referral from a physician. The new law (HB 2087 and SB 1305), sponsored by Delegate William R Janis (R-Henrico County) and Senator Stephen D Newman (R-Lynchburg City) and recently signed into law by Governor Tim Kaine (D), allows patients to seek treatment from a licensed physical therapist without a physician’s referral if the physical therapist also holds a direct access certificate. The law also establishes a 14-day window of time when a physical therapist may evaluate and treat a patient before referral for additional treatment is necessary.  The law will go into effect after regulations to allow patients direct access to physical therapist services are promulgated by the Virginia Board of Physical Therapy in the coming months.

“This is a great day for patients needing physical therapist services in the commonwealth of Virginia. The current referral requirement represents a barrier to care that results in an increase in health care costs, including unnecessary co-payment charges, and perhaps most important, a delay in treatment. In some cases, patients are waiting two or more weeks for an appointment with their physician in order to obtain a referral to a physical therapist; and then another two or more weeks for an appointment with a physical therapist for initial treatment,” said Lisa Shoaf, PT, PhD of Richmond and president of the Virginia Physical Therapy Association (VPTA).

According to Senator Newman, “I am proud to have championed this important legislation granting Virginians better access to physical therapist services. This new law is a huge step forward to ensuring patients in Virginia get they care they need without unnecessary delays."

“Too often in Richmond, when we talk about legislation that changes the scope of practice in the various healing professions, we ask ‘who wins and who loses?’ That is why these bills are so often controversial, and the debate between the various professions can become contentious. I was proud to patron House Bill 2087 this year, which represents the best efforts of representatives of the doctors and physical therapists, to reach a consensus on reform with the proper focus, where the patient wins, by gaining greater access to physical therapy services here in the commonwealth,” said Delegate Janis.

“The American Physical Therapy Association (APTA) applauds the passage of this important legislation to provide patients with direct access to physical therapist services,” said APTA President R Scott Ward, PT, PhD.  “Direct access helps to remove unnecessary barriers to healthcare and gives consumers a choice in accessing physical therapist services. Several states have had direct access laws on the books for nearly 30 years and evidence has shown that direct access to physical therapist services is cost-effective and safe and has improved access to care. Now patients seeking care in the Commonwealth of Virginia will benefit from improved access to quality physical therapist services.”

  Physical therapists (PTs) are health care professionals who diagnose and treat individuals of all ages, from newborns to the elderly, who have medical problems or other health-related conditions that limit their abilities to move and perform functional activities in their daily lives.  PTs examine each individual and develop a plan of care using treatment techniques to promote the ability to move, reduce pain, restore function, and prevent disability. 

The Virginia Physical Therapy Association (VPTA) is a non-profit professional association of physical therapists, physical therapist assistants and students in Virginia. VPTA is a chapter of the American Physical Therapy Association, a national professional organization representing more than 70,000 physical therapists, physical therapist assistants, and students. Its goal is to foster advancements in physical therapy practice, research, and education. Consumers can access “Find a PT” to find a physical therapist in their area, as well as physical therapy news and information at www.apta.org/consumer.