The wait for Direct Access in Texas for physical therapy is nearly over (this means treatment with out referral)! The Texas Board of Physical Therapy Examiners has approved a draft of the proposed Rules that will govern the new provisions for Direct Access in the Practice Act. These Rules are the vehicle that give Direct Access its wings as well as its brakes. The purposed Rules was sent to the Governor and will be published in the Texas Register for public comments. Please note that the Rules are not official until after the public comment period ends and the Rules are codified in the Texas Administrative Code. This is estimated to take approximately 30-45 days.
Frequently Asked Questions Regarding Direct Access in Texas:
Q: When can physical therapists begin treating patients without a referral?
A: Effective September 1, 2019 a physical therapist may begin accepting patients without a referral, if all specified qualifications and requirements are met.
Q: What qualifications must a physical therapist possess to be eligible to treat patients under the direct access law?
A: Qualifications & requirements of a physical therapist include the following:
- A physical therapist with a doctoral degree in physical therapy will be able to treat patients without a referral for not more than ten (10) consecutive business days;
- A physical therapist who does not have a doctoral degree but has completed thirty (30) CCUs in the area of differential diagnosis will be able to treat patients without a referral for not more than ten (10) consecutive business days;
- A physical therapist with a doctoral degree in physical therapy who has completed a residency or fellowship will be able to treat patients without a referral for not more than fifteen (15) consecutive business days;
- A physical therapist must have been licensed to practice physical therapy for at least one year;
- A physical therapist must be covered by professional liability insurance; (proposed amount $100,000 per claim and $300,000 aggregate per year);
- A physical therapist must obtain a signed disclosure from the patient receiving Treatment Without Referral. (This requirement does not go into effect until 11-1-19)
Q: What happens when the allotted days for direct access has been reached?
A: Once the number of allotted days has been reached, a referral from a qualified healthcare practitioner will be required in order to continue physical therapy treatments.
Q: What individuals are considered qualified healthcare practitioners for referring to physical therapists?
A: Qualified referrers have not changed since 1990’s when the rules were expanded to include healthcare practitioners licensed in the state or country in which they practice and have the authority to refer, they are:
- Physician Assistants
- Advanced Nurse Practitioners
Q: What is meant by Direct Access Disclosure Statement?
A: The Physical Therapy Practice Act requires that physical therapists who utilize direct access provide his/her patients with a disclosure document (to be drafted by the TBPTE) relating to Treatment Without Referral. This Disclosure Document becomes mandatory November 1, 2019.
Q: Did the new direct access language replace the previous ‘limited’ direct access provisions?
A: Yes and No.
The direct access provisions that were not eliminated by the new law apply to physical therapists regardless of what degree level they have obtained and without any additional requirements. The remaining provisions are:
- Physical therapists will still be able to evaluate a patient without a referral;
- Physical therapists will still be able to provide instructions to a person who is asymptomatic relating to the instructions being given, including instruction to promote health, wellness, and fitness;
- Physical therapists will still be able to provide emergency medical care to a person after the sudden onset of a medical condition manifesting itself by acute symptoms of sufficient severity if the absence of immediate medical attention could reasonably be expected to result in a serious threat to the patient’s health, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part.
Unfortunately, it appears that there was an oversight and the following “Prior Referral” provision is no longer permitted.
**Please note: The section below is what is no longer permitted:
Prior referrals. A physical therapist may treat a patient for an injury or condition that is the subject of a prior referral, if all the following conditions are met.
- The physical therapist must notify the original referring healthcare personnel of the commencement of therapy by telephone within five days, or by letter postmarked within five business days;
- The physical therapy provided must not be for more than 20 treatment sessions or 30 consecutive calendar days, whichever occurs first. At the conclusion of this time or treatment, the physical therapist must confer with the referring healthcare personnel before continuing treatment; Texas Board of Physical Therapy Examiners January 2019.
- The treatment can only be provided to a client/patient who received the referral not more than one year previously; and
- The physical therapist providing treatment must have been licensed for one year. The physical therapist responsible for the treatment of the patient may delegate appropriate duties to another physical therapist having less than one year of experience or to a physical therapist assistant. A physical therapist licensed for more than one year must retain responsibility for and supervision of the treatment.
Q: According to billing requirements physical therapists affix both medical and impairment ICD-10 codes on the 1500 and UB-04 forms or their electronic equivalent. Will Texas physical therapist be permitted to affix medical ICD-10 codes on claims?
A: No, not if it means they are making a medical diagnosis related to a disease. The TexasPhysical Therapy Practice Act states in Sec. 453.006 Practice of Medicine. (a) A person may not engage in diagnosing diseases or in practicing medicine (b) A person may not use an affix indicating or implying that the person is a physician…
However, Texas physical therapists have been coding impairment diagnoses for years and may continue to do so. The APTA has an extensive list of codes frequently used by physical therapists, please go to this link: https://www.apta.org/ICD10/IdentifyingCodes/.
Physical therapist should continue to document what the patient relates about diagnoses or conditions they have or have had in the clinical record in order to assist indetermining the complexity of the patient’s case and the selection of the correctevaluation code. Therapists should also list signs, symptoms, characteristics,observations and the patient’s medical history.
Example: Patient states that he/she has diabetes and takes medication to control it. Thetherapist should relate that statement and confirm that a diabetic medication wasincluded in his/her medication list.
Q: Should physical therapists engage in Direct Access, in Texas, without having the rules approved?
A: BCMS’ position is that it is risky to carry out a law prior to rules being promulgated; the proposed rules are posted in on the TBPTE website (Click Here for proposed rule). They will be also posted in the Texas Register by September 6, 2019 for at least 30 – 45 days.
Q: When will the Treatment Without Referral Waiver Form be available for use?
A: The Waiver Form is being drafted by the TBPTE and will be available for use November 1, 2019. BCMS will send it to Texas clients as soon as it is approved. The form will be available on the TBPTE’s website.
Q: How do we handle Medicare patients with the new law granting Treatment Without Referral?
A: Medicare does not require a referral and hasn’t for many years, but it does require two things that are stumbling blocks for Treatment Without Referral:
- The first issue is that therapists must still obtain a signed Plan of Care in the same time frames as dictated in the Medicare Benefit Policy Manual (MBPM)…i.e. by 30 days and recertifications within 90 days. Medicare does state that it does not expect treatments to be held until the Plan of Care is certified.
- The second issue is that Medicare claims must contain the NPI of the certifying physician.
Please remember that if you believe you will have problems with either of the two items above you should engage the patient to assist in expediting the cooperation of his/her physician. Medicare considers an uncertified Plan of Care to result in a technical denial which transfers the financial liability to the patient for therapists in private practice; unfortunately, this is not the case for Rehab Agencies as the provider assumes the financial liability when there is no signed Plan of Care.
Q: Will the Texas Division of Worker Compensation honor the new treatment without Referral?
A: No, the DWC is governed by laws that require physicians and other specified individuals to refer patients and under Texas laws physical therapists do not have that authority.
Learn More or Get Help!
Do you like getting timely information like above? If yes, and if you want to continue to get timely information like above or learn how to better understand how compliance plays a role in your over all outpatient physical therapy compliance requirements, contact Alicia N. Mahoney at 713-899-9812 or schedule time for a free compliance program overview.
*What are the provisions to the Direct Access Law in Texas? Texas law allows physical therapists to provide direct physical therapy evaluation and treatment services for a period of up to 10 or 15 consecutive business days—the length of time depends varies depending upon the therapists training.What does direct access mean in physical therapy? ›
Direct access means the removal of the physician referral mandated by state law to access physical therapist services for evaluation and treatment. Every state, the District of Columbia, and the US Virgin Islands allow for evaluation and some form of treatment without physician referral.Is Texas A direct access state? ›
Direct Access in Texas. Referral is no longer needed to evaluate and treat patients. A disclosure form must be given to patients who are treated by a physical therapist without a referral.Why is direct access to PT important? ›
Direct access gives patients more control to make their own treatment choices. The physical therapist is recognized as a licensed professional of choice to manage musculoskeletal and movement disorders in patients. Less costly: Being able to go directly to physical therapy is cost-effective.Can I go to physical therapy without a referral? ›
All 50 states and the District of Columbia have approved direct access to physical therapists, meaning you do not need to go to a doctor first when you are seeking physical therapy.Do you need a referral to see a PT in Texas? ›
Stipulations on treatment without a referral are the PT must have been licensed to practice physical therapy for at least one (1) year and must be covered by professional liability insurance. Before treatment can exceed the authorized number of days, a referral must be obtained from a qualified healthcare practitioner.What is an example of DirectAccess? ›
Common direct access storage devices include solid-state drives (SSDs) and hard disk drives (HDDs). Direct access storage devices include RAID arrays like the one pictured here, hard disk drives, solid state drives, systems like magnetic drums and data cells, optical discs and PC storage devices.What is DirectAccess and how does it work? ›
“DirectAccess provides users transparent access to internal network resources whenever they are connected to the Internet.” DirectAccess does not require any user intervention or any credentials to be supplied in order to connect. It can be thought of as if the machine makes the connection to internal resources.When did PT become DirectAccess? ›
On January 1, 2014, a new California law was enacted which allows California consumers direct access to physical therapists (individual physical therapist). Direct Access is your ability to be evaluated and treated by a licensed Physical Therapist without first seeing your physician for a referral.Can a non physical therapist own a physical therapy practice in Texas? ›
The answer is generally no, but with important qualifiers. The Texas Occupations Code (in Chapter 453) prohibits any person from practicing or representing himself or herself as being able to practice physical therapy unless licensed by the Texas Board of Physical Therapy Examiners.
4th at 311 (“From the Texas Supreme Court's no-direct-action rule decisions, we know that 'the general rule is that an injured party cannot sue the [insured-defendant's] insurer directly until the [insured-defendant's] liability has been finally determined by agreement or judgment. '. . .Do all 50 states have direct access for physical therapy? ›
Although all 50 states, D.C., and the U.S. Virgin Islands all enjoy a form of direct access to physical therapist services, provisions and limitations vary among jurisdictions.How does DirectAccess affect physical therapy? ›
Thanks to Direct Access legislation, physical therapy patients can now get evaluations and treatments directly from a licensed physical therapist (PT) without first obtaining a doctor's prescription or referral. It essentially means anyone can visit a physical therapist whenever they want.What is an advantage of using DirectAccess to retrieve files? ›
Direct-access file design is much more efficient than searching an entire data file for a particular record. It is useful when information must be updated and retrieved quickly and when current information is crucial.How can I make my physical therapy more accessible? ›
- Offer sliding scale options.
- Take on a few free to very low fee clients ($5-10)
- Provide teletherapy services.
- Educate yourself on how folks are limited in accessibility to therapy.
Every state allows for evaluation and treatment from a physical therapist without a doctor's referral with Direct Access legislation. Eliminating barriers results in more effective and quicker healthcare. Think about it. You wake up with an aching back that gets worse instead of better.Can you go to PT without an injury? ›
No, you don't have to be injured to see a physical therapist (PT). While many people end up in physical therapy because they are hurt and experiencing chronic or acute pain, PTs deal with more than rehabilitating injuries.What can a physical therapist not do? ›
Physical therapy never includes sex. It also never includes verbal sexual advances or any other kind of sexual contact or behavior.How long is a PT referral good for in Texas? ›
Is there a limit on how long a referral is valid? There is NO specific length of time a referral is valid or good; the Board leaves it to the professional judgment of the PT to determine whether the referral is valid.Can a doctor refuse to treat a patient in Texas? ›
Justice dictates that physicians provide care to all who need it, and it is illegal for a physician to refuse services based on race, ethnicity, gender, religion, or sexual orientation.
PT prescriptions are good for the same body part/injury for up to 1 year.What are the requirements for DirectAccess? ›
- The DirectAccess server must be a domain member. ...
- If the DirectAccess server is located behind an edge firewall or NAT device, the device must be configured to allow traffic to and from the DirectAccess server.
DirectAccess uses IPv6 with IPsec to create a secure connection between DirectAccess client computers and the internal corporate network. However, DirectAccess does not necessarily require connectivity to the IPv6 Internet or native IPv6 support on internal networks.What is tool used for DirectAccess? ›
DirectAccess, also known as Unified Remote Access, is a VPN technology that provides intranet connectivity to client computers when they are connected to the Internet.How do I use DirectAccess? ›
Configure DirectAccess with the Getting Started Wizard
In Server Manager click Tools, and then click Remote Access Management. In the Remote Access Management console, select the role service to configure in the left navigation pane, and then click Run the Getting Started Wizard. Click Deploy DirectAccess only.
DirectAccess is “free” … assuming your Microsoft licence agreement permits unlimited deployment of Windows servers, and the cost of underlying server infrastructure or ongoing management and security of server instances hits someone else's budget.What is the most basic requirement for a DirectAccess implementation? ›
What is the most basic requirement for a DirectAccess implementation? The DirectAccess server must be part of an Active Directory domain.Is DirectAccess being deprecated? ›
While DirectAccess has not been formally deprecated, Microsoft is actively encouraging organizations considering DirectAccess to deploy Always On VPN instead, as indicated here.What are the three levels of DirectAccess in the United States? ›
As different jurisdictions passed laws and regulations that granted varying degrees of access, the terms “unrestricted access,” “patient access with provisions,” and “limited patient access,” became three main categories used to identify a state's level of direct access to PT services.Why did PT switch to a doctorate? ›
Doctorate of Physical Therapy (PT, DPT)
As a profession physical therapy has moved towards a doctorate degree since 2005. A major consideration in doing this was to allow for direct access to physical therapy without a script from a primary care provider being required.
The average salary for a physical therapist in Texas is around $99,040 per year.What is a physical therapist salary in Texas? ›
The average salary for a physical therapist is $45.04 per hour in Texas. 1.6k salaries reported, updated at November 30, 2022.Is Texas a compact state for physical therapy? ›
Texas joined the PTLC with the enactment of the enabling statutes in Senate Bill 317 that was signed into law by Governor Greg Abbott on June 9, 2017.Can I sue the State of Texas for emotional distress? ›
Fortunately, Texas personal injury law does allow injury victims to pursue compensation for emotional distress damages.Is Texas A debtor friendly state? ›
Texas, as a debtor-friendly state, provides debtors with generous exemptions to protect assets that are directly owned by the client. For example, the total value of a debtor's homestead is protected, regardless of its value, from seizure by creditors.Does Texas have a one action rule? ›
a, reporters' note (1997) (identifying six states with “one-action” legislation); and (2) no Texas statute establishes such a one-action rule, see, e.g., Tex. Bus. & Com. Code Ann.What state is the best for physical therapy? ›
|Rank||State||Average Number of Physical Therapist Job Openings per Year|
Best-Paying States for Physical Therapists
The states and districts that pay Physical Therapists the highest mean salary are Nevada ($108,580), California ($104,500), Alaska ($101,190), New Jersey ($100,740), and Connecticut ($100,580). How Much Do Physical Therapists Make in Your City?
- Billing Errors. ...
- Eligibility Issues. ...
- Modifier 59 Use. ...
- Lack of Medical Necessity.
*What are the provisions to the Direct Access Law in Texas? Texas law allows physical therapists to provide direct physical therapy evaluation and treatment services for a period of up to 10 or 15 consecutive business days—the length of time depends varies depending upon the therapists training.
neurological conditions, such as stroke, spinal cord injuries, Parkinson's disease, multiple sclerosis, vestibular dysfunction, and traumatic brain injuries. pediatric conditions, including cerebral palsy and muscular dystrophy. sports-related injuries, such as concussion and tennis elbow.What is the main advantage of DirectAccess? ›
Direct access provides individuals with convenient, easy, and early access to physical therapy services while also reducing costs for individuals by not requiring a physician or referring provider office visit to obtain the referral.Is DirectAccess safe? ›
DirectAccess connections are established by the machine, not the user. They are secure and authenticated, and are established automatically whenever the DirectAccess client has an active Internet connection. DirectAccess connections are also bidirectional, which is an important distinction.What is replacing DirectAccess? ›
Windows 10 Always On VPN replaces Microsoft DirectAccess
But unlike traditional VPNs, users don't need to establish a connection to a server using a client. One stop solution for all your identity and access management needs!
Direct access means the removal of the physician referral mandated by state law to access physical therapist services for evaluation and treatment. Every state, the District of Columbia, and the US Virgin Islands allow for evaluation and some form of treatment without physician referral.Can I hug my physical therapist? ›
Hugs may be acceptable in therapy, and sometimes they aren't. This is all dependent on various factors in the therapeutic relationship and individual characteristics of you and your therapist. Remember, your relationship with your clinician can be close — but it should remain a professional one.What are 3 challenges for the career of physical therapy? ›
- The Legislation on Healthcare. ...
- The Expansion of Telehealth Services. ...
- Practice Adaptations. ...
- Retaining Patients. ...
- Staying Healthy. ...
- Hygiene Concerns of Employees and Patients. ...
- Management of The Practice. ...
- Employee Management.
Although all 50 states, D.C., and the U.S. Virgin Islands all enjoy a form of direct access to physical therapist services, provisions and limitations vary among jurisdictions. This map and the key below identify each jurisdiction's level of direct access.Does Medicaid cover physical therapy in Texas? ›
Acute PT, OT, and ST Services Acute PT, OT, and ST services are benefits of Texas Medicaid for the medically necessary short term treatment of an acute medical condition or an acute exacerbation of a chronic medical condition.When did PT become direct access? ›
On January 1, 2014, a new California law was enacted which allows California consumers direct access to physical therapists (individual physical therapist). Direct Access is your ability to be evaluated and treated by a licensed Physical Therapist without first seeing your physician for a referral.
How much does a Physical Therapist II make in Texas? The average Physical Therapist II salary in Texas is $93,877 as of October 27, 2022, but the range typically falls between $86,834 and $101,432.Can physical therapists dry needle in Texas? ›
They can use the credentials and practice it. But they should be competent enough and have the complete knowledge and safety rules of it. For TX Licensed PTA : The Texas PT Practice Act/rules do not prohibit a PTA from performing dry needling.How much does physical therapist make in Texas starting out? ›
Wages typically start from $62,240 and go up to $136,870.
HHS offers mental health and substance use services for families and people of all ages. For general information on mental health and to locate treatment services in your area, call the SAMHSA Treatment Referral Helpline at 1-800-662-HELP (4357).Does Texas Medicare cover therapy? ›
Medicare helps cover mental health services.
Part A covers your room, meals, nursing care, therapy or other treatment for your condition, lab tests, medications, and other related services and supplies.
In computer storage, direct access is the process of reading and writing data on a storage device by going directly to where the data is physically located on the device rather than having to move sequentially from one physical location to the next to find the correct data.How does Direct Access affect physical therapy? ›
Thanks to Direct Access legislation, physical therapy patients can now get evaluations and treatments directly from a licensed physical therapist (PT) without first obtaining a doctor's prescription or referral. It essentially means anyone can visit a physical therapist whenever they want.What are the three levels of direct access in the United States? ›
As different jurisdictions passed laws and regulations that granted varying degrees of access, the terms “unrestricted access,” “patient access with provisions,” and “limited patient access,” became three main categories used to identify a state's level of direct access to PT services.