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.