D.C. Mun. Regs. tit. 29, r. 29-9903

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

Rule 29-9903 - PHYSICAL THERAPY SERVICES

9903.1

Medicaid reimbursable Physical Therapy services are skilled services designed to treat a beneficiary's identified physical dysfunction or reduce the degree of pain associated with movement, injury or long term disability. Physical Therapy services should also maximize independence and prevent further disability, maintain health, and promote mobility.

9903.2

Medicaid reimbursable Physical Therapy services shall be provided in accordance with the beneficiary's plan of care described in Subsection 9900.4.

9903.3

In accordance with the District's Medicaid State Plan, Physical Therapy is provided as part of a plan of care in a hospital, skilled care facility, intermediate care facility or through a Home Care agency.

9903.4

In order to be eligible for Medicaid reimbursement for Physical Therapy services, a Home Care agency shall meet the requirements under Subsection 9901.2.

9903.5

Medicaid-reimbursable Physical Therapy services shall be provided by a physical therapist with at least two (2) years of experience and licensed in accordance with the District of Columbia Health Occupations Revision Act of 1985, as amended, effective March 25, 1986 (D.C. Law 6-99; D.C. Official Code §§ 3-1201.01et seq.) and implementing rules.

9903.6

Medicaid-reimbursable Physical Therapy services shall consist of the following duties:

(a) Conducting an initial evaluation and assessment that summarizes the physician's order and documents the beneficiary's strength, range of motion, balance, coordination, muscle performance, respiration, and motor functions;

(b) Developing and describing therapy plans which explain therapeutic strategies, rationale, treatment approaches and activities to support treatment goals;

(c) Maintaining ongoing involvement and consulting with other service providers and caregivers;

(d) Consulting and instructing the beneficiary, family, or other caregivers on the therapy plan;

(e) Recording daily progress notes and summary notes at least quarterly, or more frequently as needed;

(f) Assessing the beneficiary's need for the use of adaptive equipment;

(g) Routinely assessing (at least annually and more frequently as needed) the appropriateness, quality, and functioning of adaptive equipment to ensure it addresses the beneficiary's needs;

(h) Accurately completing documentation required to obtain or repair adaptive equipment in accordance with established insurance, Medicare and Medicaid guidelines; and

(i) Conducting periodic examinations and modifying treatments for the beneficiary receiving services and ensuring that Physical Therapy recommendations are incorporated into the plan of care.

9903.7

In accordance with Subsection 9900.14, Physical Therapy services shall only be reimbursed by Medicaid with prior authorization and approval by DHCF.

9903.8

Physical Therapy services shall be reimbursed pursuant to the District of Columbia's Medicaid fee schedule, available at www.dc-medicaid.com. [File Link Not Available].

D.C. Mun. Regs. tit. 29, r. 29-9903

Final Rulemaking published at 64 DCR 418 (1/19/2018)