You want to know (1) how many states allowed consumers to access a physical therapist's services without a referral from a physician or other healing arts practitioner (“direct access”) and (2) whether any states have repealed direct access laws. You also want copies of direct access laws from nearby states.

The American Physical Therapy Association (APTA) is the only comprehensive source we found of information on states' direct access practices. We have attached a chart it prepared on the topic (Attachment 1).

The chart indicates that 33 states allow direct access to physical therapists for both evaluation and treatment. Twelve states and the District of Columbia allow direct access only for client evaluation. (The 12 include Connecticut. APTA's analysis is apparently based on our statutes defining the practice to include evaluation and treatment but requiring a referral only for treatment.) Five states require referrals for both evaluation and treatment.

APTA distinguishes between two ways state laws provide direct access: omission (14 states) and provisions (19). “Omission” states have no referral language in their statutes; typically their statutory definition of physical therapy practice permits evaluation and treatment. “Provision” states' laws usually spell out the conditions under which consumers can see a physical therapist without referral. These include select populations that can use direct access, years of therapist experience, and treatment periods after which the therapist must refer the patient to a physician.

Attached are statutes from New Hampshire (N.H. Stat Ann. 328-A) and Rhode Island (R.I. Stat. Ann., 5-40-1, 13(b)), which are provision states and Vermont, an omission state (26 Vt. Stat. Ann., ch. 38).

We were unable to locate any state that has reversed its decision to allow direct access. Dean Griffith, APTA's state government affairs specialist, affirms this and states further that no state that has established direct access has even moved to repeal it. Generally, a profession's practice scope is rarely constricted once it is expanded.

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