The Military Health System (MHS) is modernizing TRICARE to better serve its members and respond to changes in law and policy. Most provisions will go into effect on January 1, 2018, with full implementation occurring on January 1, 2019. Changes will impact TRICARE health plans, changes to the 3 TRICARE Regions and new regional contractors that will process claims. These changes will impact practices and organizations that provide therapy services to TRICARE beneficiaries. I will address all these changes in this article.
Changes to TRICARE health plans include the following:
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Will PTA’s be able to treat Tricare when the South and North Regions combine into the East? It was my understanding that in the previous South region they could and that when the regions combined the North states would now be allowed to have PTA’s treat Tricare. Any word on that?
Right now, assistants can’t treat TRICARE patients and have those services billed to TRICARE in ANY region.
I just got this information from one of my PTAs. ??
SESEC. 721. AUTHORIZATION OF PHYSICAL THERAPIST ASSISTANTS AND OCCUPATIONAL THERAPY ASSISTANTS TO PROVIDE SERVICES UNDER TH SEC. 721. AUTHORIZATION OF PHYSICAL THERAPIST ASSISTANTS AND OCCUPATIONAL THERAPY ASSISTANTS TO PROVIDE SERVICES UNDER THE TRICARE PROGRAM.
(a) ADDITION TO LIST OF AUTHORIZED PROFESSIONAL PROVIDERS OF CARE.—The Secretary of Defense shall revise section 199.6(c) of title 32, Code of Federal Regulations, as in effect on the date of the enactment of this Act, to add to the list of individual professional providers of care who are authorized to provide services to beneficiaries under the TRICARE program, as defined in section 1072 of title 10, United States Code, the following types of health care practitioners:
(1) Licensed or certified physical therapist assistants who meet the qualifications for physical therapist assistants specified in section 484.4 of title 42, Code of Federal Regulations, or any successor regulation, to furnish services under the supervision of a physical therapist.
(2) Licensed or certified occupational therapy assistants who meet the qualifications for occupational therapy assistants specified in such section 484.4, or any successor regulation, to furnish services under the supervision of an occupational therapist.
(b) SUPERVISION.—The Secretary of Defense shall establish in regulations requirements for the supervision of physical therapist assistants and occupational therapy assistants, respectively, by physical therapists and occupational therapists, respectively.
(c) MANUALS AND OTHER GUIDANCE.—The Secretary of Defense shall update the CHAMPVA Policy Manual and other relevant manuals and subregulatory guidance of the Department of Defense to carry out the revisions and requirements of this section.
What you are citing is the NDAA that President rump signed in December. http://gawendaseminars.com/2017/current-news-posts/president-trump-signs-ndaa/
Any word on whether TRICARE will begin reimbursing for treatment provided by a PTA?
At this time, TRICARE does not pay for services provided by an assistant.
From my understanding it literally takes an “act of Congress” to modify or change this and it is currently being proposed and to be heard early 2018.
The changes listed in this article will occur at the time frames listed.
It’s also my understanding that they are going to require reporting FLR (G codes).
We currently are not contracted in outpatient with TRICARE but we are with TRIWEST and they recently started to require G Codes.
Does Tricare pay for services provided by an OTA?
You can find the answer here: http://gawendaseminars.com/2017/current-news-posts/tricare-and-use-of-assistants/
Will Tricare reimburse assistants providing treatment for inpatient care in a critical access Hospital
I would say no.