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  • CMS Clarifies Medicaid Definition of 'Qualified' Physical Therapist: Aligns With Medicare Definition

    In a final rule released today, the Centers for Medicare and Medicaid Services (CMS) has removed the outdated personnel qualifications language in the current Medicaid regulations and cross referenced them to the updated Medicare personnel qualifications for physical therapists and occupational therapists. (Personnel qualifications can be found under 42 CFR §484.4.)

    The final rule has the potential to ensure that certain physical therapists are not excluded from providing services under Medicaid. In addition, it strengthens the consistency of standards across Medicare and Medicaid. APTA has worked since 2010 to eliminate the outdated qualifications.

    Specifically, APTA is hopeful that today's rule is a major victory for many foreign-trained physical therapists, in states such as New York, who were previously considered qualified to treat Medicaid patients but were told around 2010-2011 that they were no longer considered qualified to provide services under Medicaid. 

    In response to comments received regarding certain states that have excluded PTs from treating Medicaid patients due to being trained in foreign countries, CMS states in the final rule, “If practices at the State level are prohibiting individuals from meeting Medicaid qualifications, we suggest addressing those concerns with the State Medicaid Agency."

    CMS' comments also stated that, although the Medicaid regulations are silent on the use of physical therapist assistants for Medicaid services, "States utilizing PT or OT assistants would be well served to follow the Medicare definition found at 42 CFR §484.4, to ensure consistency across programs."

    Under Medicare, physical therapists are licensed providers in all states and physical therapist assistants are licensed providers in the majority of states. As licensed providers, the state practice act governs supervision requirements. Some state practice acts mandate more stringent supervision standards than Medicare laws and regulations. In those cases, the physical therapist and physical therapist assistants must comply with their state practice act.  More information can be found on APTA's Use of Physical Therapist Assistants (PTAs) Under Medicare webpage.  


    • HI, So it is fine to use foreign non CAPTE trained for Medicade patients in New York. So the answer we can. Correct? Thanks, Kathy

      Posted by Kathleen on 5/11/2012 3:59 PM

    • Can PTA's treat Medicaid patients in the state of Delaware?

      Posted by Margaret Kniele -> =NWaC on 5/13/2012 11:10 AM

    • So it is fine to use foreign trained therapists, but not PT graduates of an approved school for Medicare,who have not yet passed their exam due to the short schedule of tests available for some states, even though the graduate can obtain a temporary license. Does not seem right.

      Posted by Lynn Berry on 7/3/2012 10:55 AM


      Posted by MONICA on 11/14/2013 4:47 PM

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