South Dakota Physical Therapy CoPay Legislation Becomes Law!

South Dakota Governor Dennis Daugaard signed House Bill 1183 on February 27th, 2012 protecting physical therapists' patients with legislation promoted by the South Dakota Physical Therapy Association (SDPTA).

The Republican super-majority in both the South Dakota House and Senate limited the amount a health insurer may charge a patient for an out-of-pocket copayment or coinsurance amount when they visit a physical therapist or occupational therapist.

After the bill takes effect on July 1, 2012 those copayment and coinsurance amounts cannot be higher than those charged when a patient visits a primary care physician or practitioner.

"The idea behind HB 1183 is that through reduction of financial barriers to care patients will be better able to access the care they need and focus on getting better," said Ronald Van Dyke, PT, OCS, president of SDPTA.  

"We believe it will also save healthcare dollars in the long run by preventing unnecessary delays in care that might allow a patient's problem to worsen, requiring higher-cost services like surgery and prescription medication."

Read the Press Release at the website of the American Physical Therapy Association (APTA).

The Kentucky Blueprint for Legislative Success

Building on the 2011 successful Kentucky Physical Therapy Association (KPTA) copayment legislation, Dave Pariser, PT, PhD KPTA Legislative Chair and Leigh Ann Thacker, Chapter Lobbyist gave a breakout demonstration at the American Physical Therapy Association (APTA) State Payment and Policy Forum in Austin, Texas on the process physical therapists can follow to successfully implement co-payment legislation in your state.

Here is the actual bill language that KPTA passed in the Kentucky Senate.

1. An insurer shall not impose a copayment or coinsurance amount charged to the insured for services rendered for each date of service by an occupational therapist licensed under KRS Chapter 319A or a physical therapist licensed under KRS Chapter 327 that is greater than the copayment or coinsurance amount charged to the insured for the services of a physician or an osteopath licensed under KRS Chapter 311 for an office visit.
2. An insurer shall state clearly the availability of occupational and physical therapy coverage under its plan and all related limitations, conditions, and exclusions.

Here is how the actual vote went down in Kenucky:

Date	Venue	Yes	No
Feb. 23, 2011	Kentucky Senate	30	6
March 13,2011	Kentucky House	98	0

However, when you go to implement YOUR state physical therapy copayment bill the KPTA recommends this ideal language for your state's legislation: 

1. An insurer shall not impose a copayment, coinsurance OR DEDUCTIBLE amount charged to the insured for services rendered for each date of service by an occupational therapist licensed under KRS Chapter 319A or a physical therapist licensed under KRS Chapter 327 that is greater than the copayment or coinsurance amount charged to the insured for the services of a PRIMARY CARE physician or an osteopath licensed under KRS Chapter 311 for an office visit.
2. An insurer shall state clearly the availability of occupational and physical therapy coverage under its plan and all related limitations, conditions, and exclusions.

Physical therapists can help move their copayment legislation forward by doing the following:

• Survey your state membership FIRST to see if MOST of the membership perceive copayment legislation important enough to get behind - believe it or not you may encounter opposition, either overt or covert.
• Collecting copayment information for your patients' PT, MD and medical sub-specialty co-payments.
• Collecting insurance company remisions, especially those amounts that are for $1 or $2.
• Talking to patients and collecting stories about patient hardships related to difficulty accessing necessary physical therapy services due to high co-pays.
• Talking to friends and neighbors about hardships related to difficulty accessing necessary physical therapy services due to high co-pays.