Under prior law, a physical therapist could evaluate a patient, but was not permitted to begin treatment without a physician referral. Traditionally the referral to a physical therapist would come from a plenary-licensed physician, i.e., an MD or DO. Within the last several years, regulations were issued permitting chiropractors to refer patients to physical therapists for treatment of spine-related problems.
The new law gives physical therapists broad rights to evaluate and treat patients without any referral whatsoever. New Jersey thus joins a large majority of other states in permitting "open access" to physical therapists.
The new law is subject to several important qualifications, including the following:
- A physical therapist is permitted to evaluate and treat only those conditions within the scope of physical therapy practice.
- A patient who does not respond to treatment within 30 days must be referred to another health care professional.
- Within 30 days of beginning treatment for a functional limitation or pain, a physical therapist must consult with the patient's licensed health care professional of record (typically a plenary-licensed physician or chiropractor) or, if the patient has no licensed health care professional of record, must recommend that the patient consult with a licensed health care professional of the patient's choosing.
- A physical therapist must immediately refer a patient to another health care professional if therapy is contraindicated or if symptoms are present requiring treatment outside the scope of physical therapy.
Three other important limitations will restrict the concept of complete open access. One, a referral is still required if the physical therapy services are to be reimbursed under the PIP program. Two, the New Jersey law has no effect on reimbursement under the Medicare program. Three, many private insurance policies that is, major medical policies require such a referral as a condition of reimbursement. It is not clear whether these policies will be changed as a result of the new law.
Of course, the foregoing is merely a summary of the new statute, and should not be relied upon as legal advice in a specific situation. If you would like a copy of the statute, or would like to discuss how it may apply to your own practice, please let us know.
- Markley Roderick