Direct Access
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Direct access:
As of January 2015, all 50 states, the District of Columbia, and the U.S. Virgin Islands have some form of direct access with provisions to physical therapist services. Please refer to Virginia-specific laws.
Who can complete a screen or evaluation under the Virginia direct access law?
A physical therapist who has completed a doctor of physical therapy program approved by the Commission on Accreditation of Physical Therapy Education or who has obtained a certificate of authorization to § 54.1-3482.1 2 (according to 18VAC112-20-81, Requirements for Direct Access Certification. The minimum education, training, and experience requirements for certification shall include evidence that the applicant has successfully completed (i) a transitional program in physical therapy as recognized by the Board or (ii) at least three years of active practice with evidence of continuing education relating to carrying out direct access duties under § 54.1-3482)
How do I obtain my certificate for Direct Access?
Take from 18VAC112-20-81. Requirements for Direct Access Certification.
In addition to the evidence of qualification for certification required, an applicant seeking direct access certification shall submit to the board:
1. A completed application as provided by the board;
2. Any additional documentation may be required by the board to determine the eligibility of the applicant; and
3. The application fee as specified in 18VAC112-20-27.4
Can I complete a community Screen without a referral?
Yes, under specific parameters.
"The regulations shall include but not be limited to provisions for (i) the promotion of patient safety; (ii) an application process for a one-time certification to perform such procedures; and (iii) minimum education, training, and experience requirements for certification to perform such procedures."
Are there any exceptions to providing therapy without a referral (i.e. community screens)?
Yes, a licensed physical therapist may provide, without referral or supervision, physical therapy services to…
(i) a student-athlete participating in a school-sponsored athletic activity while such student is at such activity in a public, private, or religious elementary, middle or high school, or public or private institution of higher education when such services are rendered by a licensed physical therapist who is certified as an athletic trainer by the National Athletic Trainers' Association Board of Certification or as a sports certified specialist by the American Board of Physical Therapy Specialties;
(ii) employees solely for the purpose of evaluation and consultation related to workplace ergonomics;
(iii) special education students who, by virtue of their individualized education plans (IEPs), need physical therapy services to fulfill the provisions of their IEPs;
(iv) the public for the purpose of wellness, fitness, and health screenings;
(v) the public for the purpose of health promotion and education; and
(vi) the public for the purpose of prevention of impairments, functional limitations, and disabilities.
What if I screened a patient and I notice something medically is wrong?
It is vital to know when to refer to an appropriate provider. “Upon determining that the patient's medical condition is beyond the scope of practice of a physical therapist, a physical therapist shall immediately refer such patient to an appropriate practitioner” (§ 54.1-3482, Practice of physical therapy; certain experience and referrals required; physical therapist assistants.)
Can a PT complete a Physical Therapy Evaluation and treatment under direct access?
You may evaluate and treat a patient for no more than 30 consecutive days after an initial evaluation without a referral, under the following conditions, 18VAC112-20-81
1. The patient is not under the care of another provider for what he/she needs physical therapy services for.
2. The patient is under the care of another provider at the time of his presentation to the physical therapist for the symptoms giving rise to the presentation for physical therapy services and
a. the patient identifies a provider
b. the patient gives written consent to release medical records to the provider
c. the physical therapist notifies the practitioner identified by the patient no later than 14 days after treatment commences and provides the practitioner with a copy of the initial evaluation along with a copy of the patient history obtained by the physical therapist
3. Within 30 calendar days, if the PT continues to treat the patient, a referral is needed.
Things to consider:
There may be regulations that are driven by insurance. For reimbursement questions please check with your specific insurer’s contract on the requirement of a doctor’s prescription.
References:
1. Statutory Authority §§ 54.1-2400 and 54.1-3482.1 of the Code of Virginia.
2. § 54.1-3482. The practice of physical therapy; certain experience and referrals required; physical therapist assistants
3. 18VAC112-20-81. Requirements for Direct Access Certification.
4. 18VAC112-20-27. Fees
Historical Notes Derived from Virginia Register Volume 25, Issue 18, eff. June 10, 2009; amended Virginia Register Volume 32, Issue 3, eff. November 4, 2015.
