If you’ve heard some buzz about Tricare changing its reimbursement policy for services provided by therapist assistants, you’re not alone—after all, we recently reported on those changes on the WebPT Blog. But, there’s been some confusion regarding when, exactly, the changes will go into effect—and we’re here to clear it up. Below are the frequently asked questions in regards to Tricare.
Does Tricare cover services performed by a therapist assistant?
Tricare pays for the healthcare services of authorized providers under the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS). Only providers listed as authorized CHAMPUS providers can receive reimbursement from Tricare, and while occupational and physical therapists are listed as authorized CHAMPUS providers, occupational therapist assistants (OTAs) and physical therapist assistants (PTAs) are not. Thus, Tricare does not currently reimburse for OTA and PTA services, even if the services are supervised by a licensed occupational or physical therapist.
What happens if a therapist assistant treats a Tricare patient?
If a therapist assistant treats a Tricare patient, a waiver form must be signed by the beneficiary BEFORE the treatment is provided because it’s a non-covered service. There are separate forms for Tricare East and Tricare West that can be accessed below.
Again, there are non-covered services. Tricare will deny payment if you submit a claim for these services. Remember too that you cannot balance bill patients for a remaining amount when Tricare denies payment.
Does Tricare align with Medicare rules as they’re both government payers?
The Tricare reimbursement policy for assistants is confusing in that it deviates from Medicare and most Medicaid programs. Furthermore, Tricare interprets the rules as applying to all therapy settings. For this reason, the AOTA and APTA recommend that only occupational therapists and physical therapists—not therapist assistants—treat Tricare beneficiaries. Otherwise, therapy providers may run afoul of the payment rules.
Are there any changes coming to the Tricare reimbursement policies?
Luckily, the rules are changing! On December 21, 2017, President Trump signed the National Defense Authorization Act FY 2018 (NDAA) into law, which includes a directive for the Secretary of Defense to update CHAMPUS policies to include OTAs and PTAs as authorized providers under TRICARE and establish supervision requirements for licensed therapists. The policy updates have not gone into effect.
There is still more work to be done before PTAs and OTAs officially become authorized Tricare providers. The exciting news is that in the near future, Tricare will possibly align with Medicare’s policies for the reimbursement and supervision of therapist assistants. In the meantime, stay tuned to the WebPT Blog, where we’ll continue to provide updates on this important development.