D.C. Mun. Regs. tit. 29, r. 4245

Current through Register Vol. 71, No. 49, December 6, 2024

Rule 4245 - SPECIFIC PROVIDER REQUIREMENTS: OCCUPATIONAL THERAPY

4245.1

Occupational Therapy services shall only be reimbursed by Medicaid if they are provided by the following Medicaid-enrolled providers:

(a) A home care agency licensed pursuant to the Health-Care and Community Residence Facility, Hospice and Home Care Licensure Act of 1983, effective February 24, 1984 (D.C. Law 5-48; D.C. Official Code, §§ 44-501et seq.), and implementing rules; or

(b) An independent licensed occupational therapist.

4245.2

Medicaid reimbursable occupational therapy services shall be provided by an occupational therapist or an occupational therapy assistant working under the direct supervision of an occupational therapist.

4245.3

In order to receive Medicaid reimbursement all practitioners shall meet the following requirements:

(a) Be licensed to practice occupational therapy in accordance with the District of Columbia Health Occupations Revisions Act of 1985, effective March 25, 1986 (D.C. Law 6-99; D.C. Official Code §§ 3-1201.01et seq. (2016 Repl.)), and implementing rules, Chapter 63 (Occupational Therapy) of Title 17 DCMR; or

(b) Be an occupational therapy assistant who is licensed to practice as an occupational therapy assistant in accordance with the District of Columbia Health Occupations Revisions Act of 1985, effective March 25, 1986 (D.C. Law 6-99; D.C. Official Code §§ 3-1201.01et seq. (2016 Repl.)), and implementing rules, Chapter 73 (Occupational Therapy Assistants) of Title 17 DCMR.

4245.4

In order to be eligible for reimbursement, each Medicaid provider must obtain prior authorization from the DHCF or its designee prior to providing, or allowing any professional to provide occupational therapy services. In its request for prior authorization, the Medicaid provider shall document the following:

(a) The EPD Waiver beneficiary's need for occupational therapy services as demonstrated by a physician's order; and

(b) The name of the professional or home care agency that will provide the occupational therapy services.

4245.5

In order to be eligible for Medicaid reimbursement, each individual providing occupational therapy services shall participate in the PCSP and interdisciplinary team meetings to provide consultative services and recommendations specific to the expert content with a focus on how the beneficiary is doing in achieving the functional goals that are important to him or her.

4245.6

Each Medicaid provider shall maintain the following documents for monitoring and audit reviews:

(a) A physician's order;

(b) A copy of the occupational therapy assessment and therapy plan developed in accordance with the requirements of this section; and

(c) Any documents required to be maintained by DHCF per Section 4255 (Audits and Monitoring/Oversight Reviews).

D.C. Mun. Regs. tit. 29, r. 4245

Final Rulemaking published at 64 DCR 6787 (7/21/2017)