Supervision requirements by
type of provider.
4.5.1 Occupational Therapists in Private Practice
(OTPP) as defined below.
4.5.1.1 Direct supervision is required for OTAs supervised
by OTPPs.
4.5.1.2 A licensed registered occupational therapist
is considered to be an OTPP if the occupational therapist meets
the following requirements:
4.5.1.2.1 Legally authorized to engage in the private
practice of occupational 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 occupational 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 occupational therapist (not
the OTA) 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 an OTPP. If
a provider is considered by TRICARE to be a CSP, but meets the requirements
of an OTPP, the supervision rules for an OTPP apply.
4.5.3.2 Comprehensive
Outpatient Rehabilitation Facilities (CORFs). In addition to the
requirement for general supervision, CORF occupational therapy services
require that the occupational therapist be on the premises of the
CORF or shall be available to the OTA 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 occupational therapist is present or readily available
to offer supervision when an OTA furnishes services.
4.5.3.3.2 If a licensed
registered occupational 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 an
OTA provides services off the organization’s premises, those services
are supervised by a licensed registered occupational 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 OTAs 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.