Current Medicare rules require direct supervision in outpatient clinical settings—this requires the supervising therapist to be in the same physical location as the therapist assistant. However, for the duration of the COVID-19 Public Health Emergency (PHE), CMS temporarily changed the definition of “direct supervision” to allow for therapists to provide direct supervision of PTAs and OTAs via real time audio-visual (A/V) technologies instead of requiring their physical presence. This flexibility will definitely last through December 31, 2022, because this policy will remain in place through the end of the year in which the PHE ends. 

However, it looks increasingly likely that the PHE will be extended into 2023. If that is the case, the use of A/V communications to achieve direct supervision will be in place until December 31, 2023.  Unless the policy is changed, the pre-PHE rules for supervision will return on January 1, 2024, at the latest. 

It is important to note that the ability to use A/V communications to achieve direct supervision is close but not equal to general supervision because current general supervision policy only requires the supervising provider to be available through “telecommunications” and doesn’t include a visual component. 

This is an advocacy opportunity!  Take action now to tell your Representatives to cosponsor the Stabilizing Medicare Access to Rehabilitation and  Therapy (SMART) Act  (HR 5536) which would permanently change Medicare’s supervision standard for outpatient therapy settings.

Together we can make a difference.