Supervision requirements by
type of provider.
4.5.1 Physical Therapists in Private Practice (PTPP)
as defined below.
4.5.1.1 Direct supervision is required for PTAs supervised
by PTPPs.
4.5.1.2 A licensed registered physical therapist is
considered to be a PTPP if the physical therapist meets the following
requirements:
4.5.1.2.1 Legally authorized to engage in the private
practice of physical therapy by the state in which he or she practices,
and practices only within the scope of his or her licensure.
4.5.1.2.2 Engages
in the private practice of physical therapy on a regular basis as
an individual, in one of the following practice types: a solo practice,
partnership, or group practice; or, as an employee of one of these.
4.5.1.2.3 Bills TRICARE
only for services furnished in his or her private practice office
space, or in the patient’s home. Private practice office space shall
be owned, leased, or rented by the practice and used for the exclusive
purpose of operating the practice. A patient’s home does not include
any institution that is a hospital, critical access hospital, or
a skilled nursing facility.
4.5.2 Institutional providers.
4.5.2.1 General
supervision is required.
4.5.2.2 Home Health
Agencies (HHAs).
4.5.2.2.1 In addition to the requirement for general
supervision, the licensed registered physical therapist (not the
PTA) shall provide the ordered therapy service at least once every
thirty days to functionally reassess the patient and compare the
new measurements to the previous measurements.
4.5.2.2.2 It shall
be the responsibility of the HHA for ensuring services are provided
in accordance with the requirements outlined in the Medicare Benefit
Policy Manual, Chapter 7, “Home Health Services” (or successor policy).
HHAs shall also be responsible for maintaining medical records and
ensuring all records are documented as required by the Medicare
Conditions of Participation at 42 CFR 484.110, or successor regulation.
4.5.2.2.3 If there
is conflict between this section and Medicare’s requirements for
HHAs, Medicare’s requirements shall take precedence.
4.5.3 Corporate Service Providers
(CSPs).
4.5.3.1 General
supervision is required for all settings other than a PTPP. If a
provider is considered by TRICARE to be a CSP, but meets the requirements
of a PTPP, the supervision rules for a PTPP apply.
4.5.3.2 Comprehensive
Outpatient Rehabilitation Facilities (CORFs). In addition to the
requirement for general supervision, CORF physical therapy services
require that the physical therapist be on the premises of the CORF
or shall be available to the PTA through direct telecommunications
for consultation and assistance during the CORF’s operating hours.
4.5.3.3 Rehabilitation
Agencies. In addition to the requirement for general supervision,
the following requirements also apply:
4.5.3.3.1 A licensed
registered physical therapist is present or readily available to
offer supervision when a PTA furnishes services.
4.5.3.3.2 If a licensed
registered physical therapist is not on the premises during all
hours of operation, patients are scheduled so as to ensure that
the therapist is present when special skills are needed, for example,
for evaluation and reevaluation.
4.5.3.3.3 When a
PTA provides services off the organization’s premises, those services
are supervised by a licensed registered physical therapist who makes
an on-site supervisory visit at least once every 30 days (or more
frequently if required by state or local laws or regulation).
4.5.3.4 Other CSPs.
When a type of CSP not specifically listed here is of a provider-type
that is substantially similar to a provider-type certified by Medicare,
the provider and its PTAs shall meet any supervision requirements
established by Medicare in Medicare’s regulations or policy manuals
for that type of provider, unless those requirements are less stringent
than those offered in this Section.