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  • PTAs Will be Authorized TRICARE Providers Beginning Mid-April

    In a win for PTAs and OTAs, the Department of Defense has issued a final rule, effective April 16, that establishes them as providers in ways similar to Medicare provisions.

    In this review: TRICARE; Addition of Physical Therapist Assistants and Occupational Therapy Assistants as TRICARE-Authorized Providers (final rule)
    Effective date: April 16, 2020

    The Big Picture
    A big win is finally (nearly) here: The Department of Defense has issued a final rule that establishes PTAs and OTAs as authorized providers under TRICARE, the health insurance system used throughout the military. The rule, set to take effect on April 16, largely follows the PTA approach used by CMS, and includes requirements related to supervision, the reach of state and local law, and the scope of allowable PTA activities. The inclusion of PTAs in TRICARE was a major advocacy focus for APTA. DoD estimates that the cost of increased utilization, along with a first-year implementation cost of $350,000, will be $20 million over five years.

    Also Notable in the Final Rule

    • Qualification and supervision requirements for the most part mirror Medicare provisions for PTAs and OTAs.
    • Direct supervision will be required in the private practice setting, with the supervising PT required to be in the office suite where the PTA is working and immediately available to provide assistance and direction — but not required to be in the room with the PTA while the procedure is being performed.
    • Outside of private practice, the rule calls for "general supervision" that does not require the PT’s presence during the PTA's performance of the procedure. The supervising PT will have continuing responsibility for training the PTA.
    • Where state or local supervision laws are more stringent, PTs and PTAs will be required to follow those laws.
    • Physical therapy aides will not be covered, even if working under the supervision of a TRICARE authorized PTA or PT.
    • DoD adopted APTA's recommendation to change its terminology and is now using the term "physical therapist assistants" in reference to the PTA, abandoning its use of "physical therapy assistants."

    "Although we've known that this change would be happening since 2017, we're pleased that DoD issued the final rule slightly ahead of schedule, and with virtually all of the suggestions provided by APTA," said Kara Gainer, APTA's director or regulatory affairs. "PTAs are crucial members of the service delivery team, and their inclusion in TRICARE will significantly improve patient access to effective, needed care."


    • Finally so good news today! Glad to hear this.

      Posted by Amber Hornbeck on 3/16/2020 6:32 PM

    • Well done . So many military in need of therapy . I will be honored to now be able to provide the best possible care to those men and woman who have served our country . And to be part of the team PT / PTA . Thanks

      Posted by Mary McGone on 3/17/2020 3:18 AM

    • Yes! It's been a long time coming! That's great news and nice that PTA's are also viewed as respected part of the healthcare team!

      Posted by Alma on 3/17/2020 2:55 PM

    • As a veteran and PTA I will finally be able to care for my fellow service members. A long time coming!

      Posted by John Salkoskas on 3/20/2020 8:29 AM

    • Tricare/Humana - can the APTA request approval for PT/OT initial evaluations using Telehealth platform? Critical in pediatrics clinic based now Telehealth platform. Thank you!

      Posted by Janelle Mann on 4/6/2020 4:13 PM

    • What is the ruling for supervision in skilled nursing facility? Especially in a rural setting.

      Posted by Cory Reynolds on 4/16/2020 12:29 PM

    • @Cory: Until TRICARE and the contractors issue additional guidance, please follow Medicare supervision rules when a PTA or OTA is furnishing services to TRICARE beneficiaries in a SNF as well as your state practice act requirements.

      Posted by APTA staff on 4/17/2020 9:05 AM

    • Does anyone know if this applies to Triwest as well?

      Posted by Ashley Wilson on 5/13/2020 11:24 AM

    • @Ashley: TriWest is a Dept. of Veterans Affairs contractor that administers the Patient Centered Community Care Program and Community Care Network (CCN) contract for Region 4. Optum is the CCN contractor for Regions 1-3. Both TriWest and Optum reimburse for services furnished by PTAs. In recent correspondence with APTA staff, Optum indicated that services provided by PTAs under the direction of PTs in accordance with regulatory requirements are payable services; TriWest stated there is no change from VA’s PC3 program (Patient Centered Community Care Program) to CCN, so services furnished by PTAs with proper oversight are payable.

      Posted by APTA staff on 5/16/2020 7:18 AM

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