Illinois Expands Access to Physical Therapy
ATI Physical Therapy to Offer Guidance on New Direct Access Law
ATI Physical Therapy (ATI), one of the nation’s largest providers of physical therapy, is offering patients guidance on how to navigate the new process for directly accessing physical therapy services under a new Illinois law signed August 16, 2018, by Illinois Governor Bruce Rauner.
The Illinois Physical Therapy Practice Act allows patients to seek physical therapy without a prescription from a healthcare professional. Until now, Illinois residents were required to have a referral from a physician, dentist, podiatric physician, advanced practice registered nurse or physician assistant. As of August 16, 2018, patients in Illinois can go directly to an ATI clinic or an Illinois-licensed physical therapist for evaluation and treatment. Illinois becomes the 27th state to allow direct access to physical therapy.
“ATI believes that this new law is an important first step in Illinois to bring the state on par with the rest of the country and help consumers realize the value physical therapy provides as a initial, cost-effective step for the treatment of many muscular-skeletal issues,” said ATI’s Bridget Morehouse, MPT, MBA, Senior Vice President of Contracts & Pricing. “With any treatment like physical therapy, transparent communication with the patient’s healthcare provider and doctor still remains imperative to insure an integrated approach to total care.”
Consumers should note that the new Illinois law gives health plans the discretion to allow direct access to physical therapy, but it is not required. Limitations remain for some healthcare policies, including Medicare and Medicaid. There are also provisions that physical therapists and patients must follow. It is important for patients to consider their healthcare benefits as well as their health plans’ medical policy.
- Direct Access may be applied to patients in Illinois with the following health plans: United Healthcare, Aetna, personal injury coverage, auto insurance coverage, out of network plans (excluding Cigna).
- At this time, a prescription for physical therapy services may still be needed for patients with Blue Cross Blue Shield, Tricare, Medicaid, Cigna and worker’s compensation coverage.
- Medicare continues to require a signed plan of care as condition of payment and in nearly all instances, a prescription from a licensed physician, physician assistant or nurse practitioner.
To assure the highest level of accuracy for individual cases, patients should still contact their employer’s healthcare plan to confirm whether a referral is still required, in light of this new law.
It is important for patients to note that the law requires physical therapists to report visits to the patients’ healthcare professional within five business days after the first visit for an injury or ailment. The patient will also be referred to a healthcare professional under the following circumstances:
- If there is no measurable or functionable improvement after 10 visits or 15 business days;
- If a patient returns for services for the same or similar condition after 30 calendar days following being initially discharged by the physical therapist;
- Or, a patient whose condition is evaluated and determined to be beyond the scope of practice for physical therapists.
Currently, 26 states, D.C. and the U.S. Virgin Islands allow patient access to physical therapy services with provisions, similar to what the Illinois Physical Therapy Practice Act will entail. This means that patients have access to evaluation and treatment with some provisions, such as a time or visit limit, or referral requirement for a specific treatment intervention. Eighteen states allow unrestricted access with no limitations or restrictions whatsoever. Six states have limited patient access meaning limited treatment is available based on the patient population or certain circumstances such as a physician referral or previous medical diagnosis. For more information on physical therapy treatment options by state, visit the American Physical Therapy Association.
For additional resources on the new law, please visit the Illinois Physical Therapy Association website.
The new law does not affect ATI’s ability to offer complimentary injury screenings to any consumer that might be experiencing muscular-skeletal pain or discomfort. Complimentary injury screenings are available at the more than 800 ATI clinics from coast to coast, including more than 180 throughout Illinois.