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.