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.