Building the Foundation for What Comes Next

As physical therapist education, practice, and the health care environment continue to evolve, APTA Maryland is working to ensure that Maryland’s laws, regulations, payment policies, and health care system evolve with them.

An important part of that work is advancing the role of physical therapists as first-contact providers for musculoskeletal care and evaluating where Maryland’s Physical Therapy Practice Act and regulations may need to evolve to better reflect contemporary practice.

Maryland physical therapists already have direct access, allowing patients to seek physical therapy without first obtaining a referral. But realizing the full potential of PT as an entry point into the health care system involves more than changing a single statute or regulation. It requires progress across practice, payment, insurance benefit design, data, and public policy.

Work Is Already Underway

APTA Maryland is pursuing several interconnected strategies:

• Building the evidence for PT in primary MSK care.
  Maryland practices are participating in EQIP, helping generate data demonstrating outcomes, utilization, and the value of physical therapy within the health care system.
• Addressing patient access and payment.
  Our fair copay initiative uses a primary care visit as the benchmark for reasonable PT cost-sharing—addressing an immediate access concern while reinforcing the role of PT as first-contact care.
• Exploring opportunities in rural health.
  APTA Maryland is examining opportunities for PTs to expand access to musculoskeletal care in rural and underserved communities.
• Working with the Maryland Board of Physical Therapy Examiners.
  The Board continually evaluates how changes in education, clinical practice, technology, and professional standards fit within Maryland’s regulatory framework.
• Preparing for future regulatory and legislative opportunities.
  APTA Maryland continues to evaluate where modernization may be appropriate and the best pathway for achieving meaningful, sustainable change.

An Ongoing Process for Modernizing Practice

Modernization of practice does not begin or end with legislation. As part of its regulatory responsibilities, the Maryland Board of Physical Therapy Examiners regularly considers questions about how the Practice Act and regulations apply to evolving practice. The Board also participates in the required periodic review of its regulations, including the comprehensive eight-year regulatory review process.

Through these processes, the Board can determine whether an emerging issue can be addressed through interpretation of existing authority, requires a regulatory update, or may ultimately require a targeted change to the Practice Act.

Just a few examples demonstrate how that process has worked:

• Telehealth (2022–2023):
  Developed PT-specific regulations as telehealth became a more established component of practice.
• Continuing Competency (2023):
  Updated continuing education and competency regulations as approaches to professional learning evolved.
• Diagnostic Imaging (2014): Building on the Board’s longstanding interpretation permitting PTs to refer for diagnostic imaging.
• Dry Needling (2021–2026):
  Addressed education and competency questions and continues to review training, supervision, and practice requirements as professional standards evolve.

Dry needling also demonstrates why changing one area can have implications elsewhere. Changes to practice requirements may also affect education, competency, supervision, and other provisions within the regulatory framework.

Why the Process Matters

There are provisions within Maryland’s physical therapy statutes and regulations that reflect an earlier era of practice and warrant thoughtful review. APTA Maryland supports that conversation.

But identifying language that may need to change is only the beginning.

The Board brings essential regulatory expertise and institutional knowledge about how provisions of the Practice Act and regulations interact. Engaging the Board helps identify what existing authority already permits, what can be addressed through regulation, and what truly requires statutory change.

It also helps identify unintended consequences before a proposal reaches the legislature. Changes in one section can affect education requirements, supervision standards, other regulatory provisions, or potentially other health occupations.

Thoughtful coordination is not a reason to avoid modernization. It is how we make modernization more likely to succeed.

Building Toward the Future of PT Practice

APTA Maryland believes physical therapists have an increasingly important role as first-contact providers for musculoskeletal conditions.

Our goal is not simply to change the Practice Act or introduce legislation. Our goal is to achieve meaningful and sustainable change that improves patient access, strengthens the profession, and reflects the education and capabilities of today’s physical therapists.

That requires deliberate sequencing: building the evidence, advancing payment and insurance policy, working with our licensing Board, educating policymakers and stakeholders, and pursuing regulatory or legislative changes where they are needed.

APTA Maryland will continue working with the Maryland Board of Physical Therapy Examiners, APTA, members, policymakers, payers, educators, and other stakeholders as this work moves forward.

Modernizing physical therapy practice in Maryland is not a single action—it is an ongoing process, and that work is already underway.