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ADVANCE Perspective: Physical Therapy & Rehab Medicine

CSM 2012: Issues in the Statehouse

Published February 11, 2012 5:30 AM by Lisa Lombardo

Defending the PT profession can take not much more than becoming more active in your own state, as drivers of the Public Policy Practice and Professional Affairs group (PPPPA) are calling PTs and PTAs to action.

On Feb. 9 at the Combined Sections Meeting, Justin Elliott, director of state government affairs and Angela Chasteen, senior state affairs specialist for APTA, pushed members to get involved at their state level during  "PT Issues in the Statehouse: From POPTS and Infringement to Direct Access and Scope of Practice."

The main mission of PPPPA is to help advocate for state who are revising their PT practice acts, to lobby for using the title "Dr." for DPT therapists, combating POPTS conflicts, advocating for direct access, developing independent state boards of PT, and getting more PTs elected to state office.

Sounds like a tall order-but both speakers emphasized that getting involved at the state level could prove to help PTs and PTAs protect their profession at the most critical level.

"Be involved at the state level," encouraged Chasteen.  "We rely on PTs and even student members to get involved in state affairs. It's a very contentious political environment right now, and that trickles down to states and their economies. There are [fewer] dollars to spend on health care and more people demanding services. Medicaid is a growing part of all state budgets."

Health care reform law affects states directly in two specific ways, Chasteen said: in insurance exchanges and in essential health benefits (EHB) provisions. States need to set up exchanges whereby both businesses and individuals can choose policies that best suit their needs, or leave it to the federal government to set the exchanges. PT as a profession does not want to be left out of provider options, she emphasized. Also, among EHB choices, there are currently 10 categories of care that all insurance policies must cover-and PT is not specifically included, but outpatient services are.

"States are being given a little more leeway, so we're confronted with 50 different state care standards rather than one mandated standard," Chasteen said. APTA has submitted comments on the proposals to the states. The target date is March 26-28, 2012, when the U.S. Supreme Court will hear arguments on the constitutionality of the Health Care Affordability Act-including the individual mandate clause. "The question is, if the individual mandate clause is ruled unconstitutional, can the rest of the law stand?' she noted.

Also at issue is the concept of Medicaid coercion-that unless states agree to expand their share of Medicaid costs and administration, they will lose whatever funding they currently receive. At present, 26 states are challenging the constitutionality of the law, but the Court may decide they can't decide on it's lawfulness until it actually goes into effect on Jan. 1, 2014. Therefore, the PT profession needs to be prepared to confront imminent changes, she said.

Defending PT

Some of the more pervasive hurdles to the advancement of the POT profession aren't new, but Elliott reiterated where the battles for PT are the hottest.

  1. Restricting PT access. This involves entities such as the American Medical Association and chiropractors trying to limit the scope of practice of PTs;
  2. Emerging Encroachment from other professions. This involves entities such as exercise physiologists and others who aren't regulated but whose practice areas might overlap with PT;
  3. Encroachment from regulated professions. This involves professions such as certified athletic trainers who are looking to expand their scopes of practice and who might overlap with PT;
  4. State actions that might compromise the profession, such as forced consolidation of state licensing boards (where a PT state board might be forced to combine with a state OT or speech therapy board) to save revenue.


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