2025 is rapidly coming to a close – seriously where did November go? Maybe it’s just because I put my Christmas decorations up early this year, (I’m usually a wait till after Thanksgiving person) but I feel like Fall flew by. There’s been a lot going on in the PT policy and legislative world recently that could have some big implications for both PTs and patients. There’s definitely still things to be thankful for on the legislative front this year, but also stuff we will be keeping an eye on going into 2026. Here’s an end of 2025 legislative update so you know what they are.
1. Cigna Plans not approving Outpatient PT in Hospital Settings
So I actually had a personal experience with this one. My clinic just became aware that as of October 1st, many Cigna plans will only allow their beneficiaries to get PT at a free standing clinic unless deemed medically necessary.
This means patients are not allowed to go to a hospital based outpatient clinic unless the insurance company thinks the patient’s condition is complex enough that they need it.
This is absolutely absurd to me. For one, insurance companies already suck at determining what patients actually need. Two, there are plenty of both free standing and hospital-based outpatient clinics that are equipped to handle complex cases. Three this is just another shameless tactic to put more money in their pockets, screw their beneficiaries, and screw practices.
Now I have seen a fair amount of PTs praising this policy change. Many PTs made the argument that this was a patient-centered decision because hospital-based outpatient clinics double book or over-charge patients.
I work in a hospital based outpatient clinic and I see only one patient at a time. Personally I won’t work anywhere that doesn’t schedule 1 on 1. From my knowledge that’s how most of the hospital-based outpatient clinics in my area are. I actually know of more free standing clinics that are guilty of double and triple booking. So the generalization of hospital outpatients being more guilty of this is inaccurate in my opinion. Nationally, both free standing and non-free standing clinics have guilt to share in this.
When it comes to billing, do mistakes happen? 100%. I can totally admit that. But patients get bills from hospitals when the insurance doesn’t pay them. Hospitals employ people to haggle reimbursement rates and ensure payments which usually results in insurance companies paying more or paying more often. Employees like this are not always a luxury that free standing clinics can afford. So, insurance companies get away with a lower reimbursement rate and no one fighting their denials to pay up.
So, make no mistake. This was NOT a patient-centered decision. This is not Cigna trying to reward free standing clinics for their standards of care. This is another insurance company continuing to take advantage of patients and free standing clinics. I’ll be honest I don’t know what the answer is to this problem but what I do know is patients, hospital based clinics, and free standing clinics should all be pissed.
2. APTA Joins Lawsuit Over Healthcare Price Fixing
A good place to start on fixing the last issue might be this lawsuit that APTA and APTA Private Practice has become a part of. Claritev (aka MultiPlan), Cigna (shocking considering #1), United Health, Humana, Aenta, various Blue Cross Blue Shield entities, and other major insurance companies have allegedly been part of a joint conspiracy to underpay physical therapists (and other healthcare providers) for out of network services.
Basically they consistently set increasingly low reimbursement rates to increase their profit margins. Now some of you might be going “well duh” that’s been happening forever. The kicker is that according to this alleged conspiracy theory they’ve all been in on it together. By doing this as a united front it keeps the status quo. No one starts increasing reimbursements, creating too much market competition and talk. All their profit margins continue to increase, and everyone wins … well except patients and healthcare providers. But who cares about them, am I right?
I am personally very happy to see this from the APTA. Kyle Covington, the APTA president, made a good statement about the lawsuit as it pertains to PTs. I do think this is more the kind of approach we’re going to need to take in order to see things change one day. Legislative lobbying is important too, but I unfortunately think that will only be so effective. If this case goes in favor with the APTA and the other healthcare organizations involved I actually think this could be a very important first step in real change happening.
3. Bill Introduced to House to Make PTs Part of the National Health Service Corps
Back in October, The Physical Therapist Workforce and Patient Access Act was reintroduced to Congress. The bill would make physical therapists eligible to participate in the National Health Service Corps (NHSC) loan repayment program.
In this program, PTs who work for a designated medically underserved area for at least two years could receive up to $50,000 in student loan repayment. The program aims to attract healthcare providers to rural and other underserved locations. It’s considered highly successful as it benefits both patients and healthcare providers.
With increased student loans interest rates, decreased access to student loans, and the rising cost of education having another avenue for assistance would be good. So, we’ll continue to watch and see what happens with this. I can’t think of a good reason why we shouldn’t be approved to participate in this program, but you never know I guess.
4. PTs Dropped From Professional Program List By Department of Ed
Okay, this last one is the one you’ve all been hearing about. PTs were one of the several healthcare providers dropped from the list of professional programs by the Department of Ed.
Now, this isn’t official, at least not yet. As of right now this is a proposed change, set to possibly take effect this Summer. I’m not going to get thick in the weeds just yet because I plan on writing a separate post just on this. However I know it’s been on everyone’s minds and I do think there are some pretty serious implications.
For current PTs how much does this change? I don’t think much, at least not at first. Some PTs have made the argument they think this could be good because it would drive up demand for PTs due to not as many people going to PT school. They think overall this may result in an increase in salaries.
Personally I’m VERY skeptical about this. “Do more with less” is a toxic cornerstone motto of healthcare. Without changes in reimbursement, I don’t think demand for PTs/lack of PTs is going to matter to those writing our checks at the end of day.
Current PTs are worried about this because they think it will lead to decreased autonomy. Do I think this could stop PTs from advancing in our autonomy and privileges, yes. Do I think it’s going to cause us to take steps backward? No. For one, all U.S. states have some form of direct access. I don’t think we’ll see that go away. Secondly, I don’t think that’s the main goal of this proposed change.
I believe the main goal was to limit the number of people able to go to professional degree programs such as PT. This would affect future PT students the most as a lifetime student loan cap of $100,000 would now apply to them.
The average debt for DPT graduates is around $150,000. Therefore under these new guidelines, a DPT would be out of reach for many. This significantly affects the healthcare pipeline. I think it’s going to make staffing shortages worse. I think it will make care and burnout worse. I also think it’s wrong to severely limit the opportunity for students to get a post-graduate healthcare degree. I just don’t really see how a lot of good can come from this.
Again, you’ll be hearing more about this from me in 2026, but these are just my initial thoughts.
What do you think about some of these legislative updates? What are your concerns or opinions and what do you hope to see happen in 2026? Share them in the comments section. I hope you and your families have a great Thanksgiving! Hit subscribe below and check back on the blog page in a couple weeks for a new post. And thank you for coming to The PT Page to keep up on all things PT.
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