Earlier this month, NASL met with the Defense Health Agency (DHA), which is the Department of Defense (DoD) agency that oversees the military’s TRICARE program for active duty and retired military and their families. The focus of NASL’s meeting with DHA was implementation of  the therapy assistants provision included in the 2018 National Defense Authorization Act (NDAA), which was signed into law last December. 

The NDAA provision recognizing occupational and physical therapy (OT and PT) assistants as authorized providers under TRICARE requires regulatory changes be made to TRICARE’s Policy Manuals. Such changes are required to go through the formal regulatory rulemaking process. 

NASL thanked DHA for its hard work and for including the therapy assistants provision into the NDAA. We also discussed what to expect in terms of a realistic timeline for implementation, and urged DHA to align TRICARE’s policy regarding therapy assistants with existing Medicare policy. 

NASL urged DHA to move expeditiously to implement the new law, to align with existing supervision standards and practices, and give due consideration and deference to the existing Medicare laws, regulations and standards with respect to policy on OT and PT assistants. NASL was pleased to learn that DHA already is aware of Medicare policy and that DHA has a “statutory link” to the Medicare program for reimbursement when addressing new categories of providers. NASL shared our belief that therapy assistants could help to fill the gap in terms of access problems that beneficiaries have experienced with TRICARE.

Because the rulemaking process is underway, DHA staff were limited in terms of the amount of information that could be shared.  Even so, DHA staff provided NASL with a general overview of its regulatory and rule making process, which generally results in a multi-year process. Typically, DHA drafts a proposed rule, which is open for public comment that is considered before a final rule is promulgated. Once the final rule is published in the Federal Register, DHA updates its Policy Manuals – a process that can take an additional 90 days. Accordingly, even though the NDAA became effective on February 9, it could take close to 18 months for the therapy assistants provision to be implemented under the Code of Federal Regulations. 

NASL emphasized the need for timely implementation of the rule. DHA suggested that providers interested in this regulation track and work closely with TRICARE Managed Care support contractor networks within each region. Additional contractor-related assistance can be accessed here.