Physical therapists to no longer require referrals after Governor signs new law

      The first legislation signed into law out of this session will get Missourians in front of the caregivers they need more quickly and with less cost.

Governor Mike Parson signs into law Senate Bill 51, as its sponsor, Senator Karla Eslinger, and its House handler, Representative Brenda Shields, look on. (Photo: the Office of Governor Mike Parson)

      Governor Mike Parson (R) on Thursday signed Senate Bill 51, sponsored by Senator Karla Eslinger (R-Wasola), which will allow people to go to physical therapists without having to first visit another doctor and get a referral. 

“Currently, patients must visit a physician before they can make an appointment with a physical therapist.  This costs the patient additional money and delays in returning to their life before the injury,” said Representative Brenda Shields (R-St. Joseph), who handled the bill in the House.  “It is time for Missourians to choose their own healthcare path and get their lives back.”

Shields has spoken passionately about this proposal largely because of the role physical therapists have played in her own life.

      “I’m excited to be able to carry, I’m honored to be able to carry this bill this year.  If it wasn’t for physical therapists I would not be before this body this year.  When I had my brain bleed stroke almost seven years ago, it took them to give me back my life and I cannot thank them enough.”

      Shields said no matter what she does from here on, she expects the passage of this language will stand as a highlight of her political career.

      “You almost bring me to tears when I think about that … with my experience that I’ve had a physical therapist when I had my stroke seven years ago and the work that they did and the continued support that they gave me through my recovery.  Even when I became depressed or sad, or questioned if I was ever going to return to normal, their continued work and their support … I just really wanted to [get this passed] to thank them for the care that they provided me.”

Shields announced to her colleagues in the chamber on Thursday morning that the bill would be signed, and her physical therapist Dr. Ben Perkins was her guest in the chamber then and at the bill signing.

      Representative Deb Lavender (D-Manchester) is a physical therapist.  She said it’s frustrating to have to turn away people who come to her, knowing she could ease their pain.

“I have actually lost business in my small, private practice physical therapy because when somebody would call me and say, ‘I want to see you,’ I’d say, ‘You have to see the physician first.’”

      The proposal has been around for years in the legislature, with Governor Parson saying he handled it early in his legislative career which began in 2005.

Representative Brenda Shields carried the House version of Senate Bill 51 for multiple years. She said its passage into law will likely always be one of the highlights of her legislative career. (Photo: Tim Bommel, Missouri House Communications)

“I couldn’t be more pleased signing this, being the first bill that we’re really going to sign,” said Parson.  “I think one thing we learned is how important healthcare is no matter where you live in the State of Missouri, and how many opportunities people have to get it.  By doing this bill we’re going to expand that to many more people and cut a lot of bureaucracy out of the way simply to care for people, and I think that’s what we all wanted to do.”

      Under the bill, a physical therapist can refer a patient to another health care provider if they exhibit certain conditions which the physical therapist is unable to treat, or if the patient’s condition doesn’t improve within 30 days or ten visits. 

      The House voted on April 12 to pass SB 51, 146-2.  With its signing, Missouri joins 47 other states who already allowed people to go to physical therapists without first getting a referral.  The bill’s provisions take effect August 28.

Missouri law now includes expanded therapy coverage for children with disabilities

More Missouri children and teenagers with specific developmental or physical disabilities will have insurance coverage for therapeutic care under a House proposal that became law this year.

Representative Chuck Basye (right) stands with Robyn Schelp (center), her son Nathan (in yellow) and their family. (photo: Tim Bommel, Missouri House Communications)

The language, included in Senate Bill 514, expands Missouri law that mandates coverage for therapy for children with autism spectrum disorder.  It includes physical, speech, and occupational therapies.  It will apply to plans renewed or enacted beginning January 1.

It was sponsored by Rocheport representative Chuck Basye (R), who said estimates placed the number of children this would impact at between 5,000 and 6,000.

“It was the last thing I ever thought I would get behind because I do not have anybody in my family that has a developmental disability,” said Basye.  “My brother-in-law is blind … that’s not really a developmental disability but that played a role in it.”

Basye said when he met Robyn Schelp, President of Missouri Disability Empowerment, and her 11 year-old son Nathan, who has a genetic disorder, he heard their plight and thinking about his brother-in-law put it into context.

“Bob had a lot of struggles but he ended up being very, very successful in his life because he got resources he needed at a very young age,” said Basye.

Basye also developed a special bond with Nathan, which we wrote about in March.

Schelp worked in the Capitol for three years, often with Nathan at her side, pushing for this legislation.  She said the law will now help children who have a broad array of conditions.

“The ones you’re familiar with; Downs syndrome, CP, MS, but it’s also going to apply to kids like my son, whose diagnoses are so rare that you’ve never even heard of them.  It’s any developmental disability,” said Schelp, “Which is really one of our goals, is that we start thinking of disabilities inclusively; that we don’t pick and choose who gets funding, who gets the services, but that we make sure that every child with a disability gets what they need to be successful.”

Legislators heard that making therapies more available to children when they are young makes those therapies more effective, and the benefits are seen in other aspects of their lives.

“Just speech alone, speech and language, the ability to communicate your needs is so important for day-to-day functioning, so it gives them that ability just to be independent and to function in day-to-day life, and it gives them confidence to go up and engage with people, so that’s huge, but it also helps them academically,” said Schelp.  “This is a big picture thing.  We’re not talking just, ‘Oh, great, now he can say the S sound.’  We are talking, he can now go and engage in his daily life with other people, and the same can be said for occupational therapy and physical therapy.”

Making such therapies available to children earlier in life can also lead to cost savings for families and the state.

“For example, speech, some children need help swallowing.  They will aspirate.  If they get that therapy then great, they’re going to be able to swallow properly, and if they don’t they might end up with pneumonia and   end up in the hospital,” said Schelp.  “There are a lot of health consequences that come when kids aren’t getting the therapies that they need.  Even just the ability to communicate your needs can keep you healthier and safer.”

Schelp said it is difficult for her to think about how different Nathan’s life might have been if this law had been in place when he was growing up.  He was limited to one session of each type of therapy a week, early in his life.

“Had we have had this he could’ve started getting speech therapy three times a week at the age of 2 or at the age of 3.  We had to wait until Nathan was 9 before he could start getting those therapies.  Just the progress he’s made in the last two years … I just think if he would’ve had that when he was 2 and 3, and early intervention when the development is so crucial, where might we be today?” said Schelp.  “If we would’ve had just a solid foundation of speech and language therapies at the beginning to help him, I don’t even want to think about where we could be today, but he went until the age of 9 not able to get, fully, the therapy that he needed.”

Schelp went from being so, as she put it, “out of the loop” in state politics she had to look up who her state representative was.  She encourages others to be willing to lobby for the changes they want or need in government.

“You really can do this, and if you don’t do it, it may not get done,” said Schelp.  “People don’t know what they don’t know, and if you don’t share your story and let [legislators] know what’s happening, they’re not going to be able to change anything.”

“People will listen if you talk to them.  I think we tend to think they won’t listen so we don’t even try, but they will listen … and there are more issues that, now, we’re talking on because we’re realizing we can do this, and if we work together we can get it even farther; we’ll be stronger.”

All 50 states have an autism mandate.  This legislation made Missouri the third state to expand that to cover all developmental and physical disabilities.

Basye’s legislation passed out of the House with broad support, 138-4.  That bill, House Bill 399, was eventually vetoed by Governor Mike Parson (R) because of an issue with another measure that was amended to it, but the language became law as part of SB 514, which was signed into law July 11.

Schelp’s organization has other issues that it’s working on and Basye said he would be working with her on a least one of them.