D.C. Mun. Regs. tit. 29, r. 29-9904

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

Rule 29-9904 - OCCUPATIONAL THERAPY SERVICES

9904.1

Medicaid reimbursable Occupational Therapy services are skilled services designed to maximize independence, gain skills, prevent further disability, and develop, restore, or maintain a beneficiary's daily living and work skills.

9904.2

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

9904.3

In accordance with the District's Medicaid State Plan, Occupational 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.

9904.4

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

9904.5

Medicaid reimbursable Occupational Therapy services shall be provided by an occupational 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.

9904.6

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

(a) Conducting an initial evaluation and assessment that:

(1) Summarizes the physician's order;

(2) Documents the beneficiary's strength, range of motion, balance, coordination, muscle performance, respiration, and motor functions; and

(3) Reflects the beneficiary's employment and living goals;

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

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

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

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

(f) 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;

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

(h) Conducting and documenting quarterly assessments to verify the condition of the adaptive equipment; and

(i) Conducting periodic examinations to modify treatments for the beneficiary, when necessary, and ensure that Occupational Therapy recommendations are incorporated into the plan of care.

9904.7

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

9904.8

Occupational 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. 29-9904

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