Introduction:
The new direct access law for physical therapy approved by the General Assembly in 2007 is now in place. Regulations have been adopted by the Board of Physical Therapy and to date about 200 physical therapists in Virginia have received their direct access certification allowing them to use the new portion of the law. This document is to provide a brief overview and current update on direct access. You may access the Statute (law) or the Rules and Regulations for Practice specific to direct access at http://www.dhp.state.va.us/PhysicalTherapy/default.htm if you desire more detailed information.
Changes from the old law to the new law:
The previous diagnosis section of the law was removed and replaced by the following language:
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
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 is available on the Board of Physical Therapy website at http://www.dhp.state.va.us/PhysicalTherapy/physther_forms.htm . 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.
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Items that remain unchanged under the new direct access law in Virginia:
1) 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.
2) 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.
The Process to Garner Direct Access Certification Under the New Law:
The 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 (this is transcripts from education in a DPT program or evidence of completion of an appropriate continuing education course or other university course related to direct access), and the application fee. The application for direct access certification is available on the Board of PT website at http://www.dhp.state.va.us/PhysicalTherapy/physther_forms.htm .
The application fee for the initial certification process is $75.00.
The certification application process is ongoing – a PT can apply at any time.
Renewal of the Direct Access Certification:
The Board of PT will require renewal of the direct access certification during our bi-annual renewal of licenses beginning for the renewal in 2010. 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 as follows:
Physical therapists holding certification to provide direct access without a referral shall include 4 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. This means that you will not be required to garner additional hours of continuing education, but you should include some continuing education courses that are clinical in nature and address in some way aspects of practicing in a direct access setting (i.e. – safe practice, differential diagnosis, medical screening, assessment of patients in direct access, etc) They may not necessarily be separate courses but may be content included in a broader clinical course. The course syllabus should reflect some of these aspects in the objectives so that you can provide evidence of meeting this requirement.
The fee for renewal on a direct access certification shall be $35 and will be paid at time of license renewal.
