States Reshape PT & SLP Practice: Access & Scope Evolve

Expanding Roles: How New Laws Are Changing Therapy Access

Physical therapists (PTs), speech-language pathologists (SLPs), and audiologists play crucial roles in helping people recover from injury, manage chronic conditions, overcome communication disorders, and maintain their quality of life. Recent legislative trends across numerous states indicate a significant push to modernize how these allied health professionals practice. Lawmakers are grappling with how to best regulate these fields to improve patient access to care, address workforce needs, and adapt to evolving healthcare demands. This involves defining roles for support personnel like assistants and expanding the types of services licensed therapists can provide, potentially changing how patients interact with the healthcare system.

Formalizing the Role of Therapy Assistants

A prominent theme emerging from state legislatures is the formalization and regulation of assistants, particularly Speech-Language Pathology Assistants (SLPAs). Several states are establishing clear licensure requirements, defining scopes of practice, and setting supervision standards for these roles. The primary driver appears to be a need to increase service capacity. By leveraging qualified assistants working under the supervision of licensed SLPs, states hope to extend the reach of therapy services, especially in settings like schools or geographically underserved areas where recruiting fully licensed therapists can be challenging. This approach aims to make therapy more accessible and potentially more affordable.

For example, Virginia House Bill 2040 (VA HB2040) establishes specific qualifications, scope of practice, and supervision requirements for SLPAs, adding them to the purview of the state's Board of Audiology and Speech-Language Pathology, albeit with implementation timelines stretching to 2026 and 2027. Similarly, Colorado House Bill 1075 (CO HB1075) focuses on regulating SLPAs. North Dakota also addressed SLPA licensure requirements in its House Bill 1049 (ND HB1049). Montana took a slightly different approach with House Bill 744 (MT HB744), authorizing both SLP aides and audiology aides. Indiana included SLPAs in telehealth practitioner definitions under House Bill 1572 (IN HB1572), recognizing the growing importance of remote service delivery. West Virginia Senate Bill 443 (WV SB443) took steps towards ensuring practitioner suitability by authorizing criminal background checks for SLP/A assistants seeking licensure.

Expanding the Scope for Physical Therapists

Simultaneously, legislatures are considering expansions to the scope of practice for licensed physical therapists. A key area is granting PTs the authority to order diagnostic imaging, such as X-rays or MRIs, under specific circumstances. Proponents argue this can significantly streamline patient care. Instead of requiring a separate physician visit solely to order imaging suggested by a PT's assessment, allowing PTs to order tests directly could speed up diagnosis and the initiation of appropriate treatment plans. This increased autonomy aims to reduce delays and potentially lower overall healthcare costs by eliminating redundant consultations.

North Dakota addressed this directly in Senate Bill 2273 (ND SB2273) and also touched on PT patient management in Senate Bill 2169 (ND SB2169). Arizona House Bill 2583 (AZ HB2583) also tackled PT authority regarding imaging and laboratory tests. Rhode Island House Bill 6060 (RI H6060) sought to make permanent the existing authority for PTs to order diagnostic imaging. Beyond imaging, Montana Senate Bill 109 (MT SB109) proposed revising the definition of a 'treating physician' within the workers' compensation system to include physical therapists, potentially giving them greater authority in managing work-related injury cases.

Impacts Across the Healthcare Landscape

These legislative shifts ripple outwards, affecting various stakeholders:

• Physical Therapists, Speech-Language Pathologists, and Audiologists: Licensed professionals face both opportunities and new responsibilities. Expanded scope, like PT imaging authority, offers greater autonomy and potentially enhanced professional standing. However, the rise of regulated assistants necessitates clear understanding and implementation of supervisory roles. Bills like Missouri House Bill 765 (MO HB765), modifying clinical fellowship requirements for SLPs, also adjust the pathway into the profession.
• Therapy Assistants: Formal licensure provides professional recognition, defined practice boundaries, and clearer career pathways. It also brings accountability through regulation and potential requirements like continuing education or background checks (WV SB443).
• Patients: The primary goal is improved access. Patients, including Children and Youth needing developmental therapy, Older Adults requiring rehabilitative or maintenance care, and individuals with Physical or Developmental Disabilities, stand to benefit from potentially shorter wait times, more provider options (including assistants), and streamlined care pathways (like faster diagnosis through PT-ordered imaging). Telehealth options, as highlighted in Indiana (IN HB1572), further enhance accessibility, particularly for those with mobility issues or in remote areas.
• Healthcare Facilities and Schools: Employers must adapt staffing models, develop robust supervision protocols for assistants, and potentially adjust workflows to accommodate expanded PT scope.
• State Licensing Boards: These bodies face increased administrative responsibilities, including developing new regulations, processing applications for assistant licenses, managing background checks, and overseeing expanded scopes of practice. Legislation like Oklahoma Senate Bill 1042 (OK SB1042) can also directly alter board composition or authority.
• Insurance Providers: Payors (commercial, government, workers' compensation) will need to adapt policies regarding reimbursement for services provided under expanded PT scope or by licensed assistants.

Geographic Variations and Unique State Approaches

While the core themes of assistant regulation and scope expansion are common, states tailor legislation to their specific contexts. Virginia (VA HB2040) and Colorado (CO HB1075) show a strong focus on formalizing SLPA licensure. Arizona (AZ HB2583) and Rhode Island (RI H6060) prioritize PT diagnostic imaging authority. North Dakota addressed both SLPA licensure (ND HB1049) and PT scope (ND SB2273, ND SB2169) within the legislative session.

Montana stands out for addressing multiple facets within this set of bills: authorizing therapy aides (MT HB744), revising provider rates for PT, SLP, and Occupational Therapy (MT HB585), and redefining the PT's role in workers' compensation (MT SB109). Indiana's bill (IN HB1572) uniquely integrated telehealth for SLPAs and addressed regulations concerning over-the-counter hearing aids alongside SLP/A practice. Kansas House Bill 2039 (KS HB2039) focused on clarifying definitions within its credentialing act to distinguish certain therapy providers from home health agencies. Implementation timelines also vary, with Virginia (VA HB2040) notably setting delayed effective dates into 2026 and 2027 to allow time for regulatory development.

Navigating Implementation: Challenges and Risks

Translating these legislative changes into practice presents several challenges. Regulatory bodies must develop clear, detailed rules for expanded scopes (e.g., protocols for PT imaging, referral requirements) and assistant supervision. Ensuring an adequate number of qualified supervisors are available to oversee an potentially increased number of assistants is crucial for maintaining quality of care. Scope of practice debates are almost inevitable, with potential resistance from physician groups, radiologists, or other established professions concerned about encroachment.

Establishing efficient administrative processes for new licensure categories, including background checks as mandated in West Virginia (WV SB443), requires resources and careful planning. A significant hurdle lies in ensuring that insurance providers recognize and provide adequate reimbursement for services delivered under expanded scopes or by newly licensed assistants; without this, the intended access improvements may not fully materialize. Legal risks include potential lawsuits challenging the new scope boundaries or increased malpractice exposure related to expanded duties or assistant actions. Fiscally, states incur costs for managing new licensure systems, and the net impact on overall healthcare spending remains uncertain – potential savings from efficiency could be offset by increased utilization.

Equity Implications: Ensuring Fair Access and Quality

These policy shifts carry important equity considerations. On the one hand, increasing the number and types of providers, particularly through assistants and telehealth, holds promise for improving access for historically underserved populations, including certain racial and ethnic groups (Black/African American, Latinx, Indigenous/Native American) and residents of rural areas. Expanded PT scope could mean faster access to diagnostic services in areas with specialist shortages. Veterans, especially Disabled Veterans who frequently utilize PT services, may also benefit from more streamlined care.

However, there are risks. Care must be taken to avoid creating a tiered system where patients in underserved areas or from specific demographics disproportionately receive care from assistants without equivalent quality assurance. Robust supervision standards and quality monitoring across all settings and demographics are essential mitigation strategies. Background check requirements, like those in West Virginia (WV SB443), need careful implementation to avoid creating undue barriers for individuals from marginalized communities or Immigrant Communities who may face documentation challenges. Furthermore, telehealth accessibility gaps related to internet availability or technology literacy, particularly among Older Adults or some individuals with disabilities, must be addressed. As PT and SLP are female-dominated professions, ensuring pay equity and leadership opportunities as practice models evolve is also important.

Broader Context and Historical Perspective

These legislative efforts are part of a larger national movement towards optimizing the healthcare workforce. For decades, there has been a trend of expanding the practice authority of non-physician providers (like nurse practitioners, physician assistants, and pharmacists) to meet growing healthcare demands, particularly with an aging population and persistent provider shortages in many areas. Granting PTs authority to order imaging, for instance, mirrors similar scope expansions sought or achieved by other health professions aiming for greater practice autonomy and system efficiency.

The formal regulation of assistants also represents an evolution. Historically, many fields utilized aides or technicians with varying levels of training and oversight. The current push towards formal licensure and regulation, as seen with SLPAs in states like Virginia (VA HB2040) and Colorado (CO HB1075), reflects a desire for greater standardization, quality control, and professional accountability. It's a balancing act between leveraging different skill levels to improve access and ensuring patient safety through defined scopes and supervision.

The Road Ahead: Continued Evolution in Therapy Practice

The flurry of legislative activity surrounding physical therapy and speech-language pathology suggests this policy area will remain dynamic. We can likely expect more states to consider formally licensing SLP assistants as workforce pressures continue, particularly in educational settings. The momentum behind expanding PT scope of practice, especially concerning diagnostic imaging and potentially direct access provisions, is also likely to persist, fueled by arguments for efficiency and cost savings.

Future legislation will likely focus on refining the details: standardizing supervision ratios, developing clear competency requirements for expanded tasks, and critically, addressing reimbursement structures to ensure financial viability for practices utilizing assistants or expanded scopes. The adoption and impact of interstate licensure compacts for PT and SLP/A will also interact with these state-level changes. Ultimately, the real-world experiences of states currently implementing these changes – their impact on patient safety, healthcare costs, access equity, and workforce dynamics – will heavily influence the direction of future policy debates across the country. Ongoing dialogue between professional groups, regulators, and patient advocates will be key to navigating this evolving landscape.