Before we discuss the relevant aspects of the change in our practice act in Illinois, we would like to make it clear that it is our opinion as licensed Physical Therapists in our practice, that even though this change in our practice act is now a fact, we prefer to continue a healthy referral relationship with your primary care physician or specialist. We consider the PCP the entry point in our healthcare system and we are very aware of the fact that many patients (especially the elderly or frail) have a significant amount of co-morbidities and take a significant amount of medication.
Nevertheless, in August of 2018, a bill was signed into law that allows Illinois residents direct access to a physical therapist.
"Direct Access" is the removal of physician referrals, as previously mandated by state law, to access services provided by physical therapists. This means, in Illinois, you can now access a physical therapist WITHOUT a script or referral from your physician.
However, direct access in Illinois is "provisional', which means that patients can access evaluation and treatment with some provisions such as a time or visit limit, or referral requirement for a specific treatment intervention (see below).
Also, even though this is now law, the new law still gives healthcare insurance providers the discretion to allow direct access to physical therapy, but it is not required. In other words: you need to contact your healthcare insurance before making an appointment to confirm if a referral is still required; prior to your first visit. Otherwise, they may deny payments and you will be responsible for the bill.
The "provisions" that the law specified to us are:
We will refer you to your physician:
- If there are no measurable or functional improvement after 10 visits or 15 business days.
- If you return for services for the same or similar condition after 30 calendar days, following discharge by your physical therapist.
- If your condition is evaluated and determined to be beyond the scope of practice of your physical therapist.
We, the PT's in our practice, also adopted additional guidelines and will ask you to see a physician
- If you are seeing us following an injury
- If you are seeing us for rehab following surgery
- If you are demonstrating additional symptoms that are not considered part of a recognized clinical pattern for which we are seeing you (e.g., high blood pressure, fever and other abnormal vital signs)
As a professional courtesy to you and your primary care physician, we will be asking your permission to send a copy of your initial evaluation to your Primary Care Physician.