Connecticut stakeholders split over proposal to drop 6-visit/30-day referral requirement for physical therapy

The Connecticut Physical Therapy Association asked a Department of Public Health convened stakeholder group to remove a rule in the state Physical Therapy Practice Act that requires physical therapists to refer a patient to another provider after six visits or 30 days if no improvement is documented.

Supporters said the six-visit/30-day requirement can interrupt care for patients with chronic or progressive conditions and does not reflect contemporary physical therapy education. Mary Claire Capata, program director of the University of Connecticut Doctor of Physical Therapy program and a representative of the Connecticut Physical Therapy Association, said the provision "interrupts care for those with chronic and progressive conditions, such as Parkinson's disease or multiple sclerosis," and argued that modern training and continuous competency requirements better protect patients than an arbitrary visit cap.

Opponents — including physicians representing orthopedic, emergency medicine, primary care and specialty societies — urged maintaining the referral requirement for patient-safety and diagnostic reasons. Dr. Lisa Lattanza, an orthopedic hand and upper-extremity surgeon and chair of orthopedics at Yale representing the Connecticut Orthopedic Society, said, "This is a patient safety issue," and warned that "there is still a difference between having a medical degree and being able to diagnose things outside of musculoskeletal care that can look like something else." Dr. Brian Steiner of the Connecticut College of Emergency Physicians said emergency clinicians "see the downstream effects, usually when things unfortunately go wrong," and gave examples of non-musculoskeletal diagnoses presenting as back or hip pain.

Several physician speakers emphasized concern about less-experienced clinicians. Mary Anne Hakim Sagar, representing the Connecticut State Medical Society, said the law must account for "the weakest link" — newly graduated physical therapists — and cited a case she described in which a young patient initially treated for knee pain later required major hip surgery after a delayed diagnosis.

PT association leaders and educators disputed the safety argument as a generalization. Joseph Grabicki, president of APTA Connecticut, said physical therapists "refer out the vast majority on the first or second visit" when indicated and that contemporary Doctor of Physical Therapy (DPT) education includes competencies in screening and imaging interpretation pathways. Capata noted that Connecticut has allowed direct access since 2006 and that "there has not been a change in the safety profile of physical therapist practice in that time." The presenters also cited a January 2025 letter from the Healthcare Provider Service Association stating that malpractice loss experience does not differ between states with varying direct-access rules.

Stakeholders debated the evidence base. Physicians asked for more non‑anecdotal, peer‑reviewed research across body regions (noting much published work focuses on low-back pain), and PT speakers urged the committee to consider prognosis-based practice rather than an absolute visit or time cap.

No formal motion or vote occurred during the meeting. The facilitator said the Department of Public Health will compile the comments into a report to the legislature and scheduled a follow-up meeting to cover the remaining parts of the PT association's request (removal of the referral/continuing-education requirement for grade‑5 spinal manipulation, workers' compensation access without referral, and authority to order plain‑film x-rays).