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 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."