La. Admin. Code tit. 50 § XXI-8323

Current through Register Vol. 50, No. 11, November 20, 2024

Section XXI-8323 - Skilled Maintenance Therapy

A. Skilled maintenance therapy is therapy services that may be received by participants in the home or rehabilitation center.

B. Skilled maintenance therapy services include physical therapy, occupational therapy, and speech and language therapy.

C. Therapy services provided to participants are not necessarily tied to an episode of illness or injury and instead focus primarily on the participant's functional need for maintenance of, or reducing the decline in, the participant's ability to carry out activities of daily living.

D. Skilled maintenance therapies may also be used to assess a participant's need for assistive devices or home modifications, training the participant and family members in the use of the purchased devices, performance of in-home fall prevention assessments, and participation on the POC planning team.

E. Services may be provided in a variety of locations including the participant's home or as approved by the POC planning team.

F. Skilled maintenance therapy services specifically include:

1. physical therapy services which promote the maintenance of, or the reduction in, the loss of gross/fine motor skills, and facilitate independent functioning and/or prevent progressive disabilities including:

a. professional assessment(s), evaluation(s) and monitoring for therapeutic purposes;

b. physical therapy treatments and interventions;

c. training regarding physical therapy activities, use of equipment and technologies;

d. designing, modifying or monitoring the use of related environmental modifications;

e. designing, modifying, and monitoring the use of related activities supportive to the POC goals and objectives; or

f. consulting or collaborating with other service providers or family members, as specified in the POC;

2. occupational therapy (OT) services which promote the maintenance of, or reduction in, the loss of fine motor skills, coordination, sensory integration, and/or facilitate the use of adaptive equipment or other assistive technology including:

a. teaching of daily living skills;

b. development of perceptual motor skills and sensory integrative functioning;

c. design, fabrication, or modification of assistive technology or adaptive devices;

d. provision of assistive technology services;

e. design, fabrication, or applying selected orthotic or prosthetic devices or selecting adaptive equipment;

f. use of specifically designed crafts and exercise to enhance function;

g. training regarding OT activities; and

h. consulting or collaborating with other service providers or family members, as specified in the POC;

3. speech language therapy (SLT) services which preserve abilities for independent function in communication, facilitate oral motor and swallowing function, facilitate use of assistive technology, and/or prevent progressive disabilities including:

a. identification of communicative or oropharyngeal disorders;

b. prevention of communicative or oropharyngeal disorders;

c. development of eating or swallowing plans and monitoring their effectiveness;

d. use of specifically designed equipment, tools, and exercises to enhance function;

e. design, fabrication, or modification of assistive technology or adaptive devices;

f. provision of assistive technology services;

g. adaptation of the participant's environment to meet his/her needs;

h. training regarding SLT activities; and

i. consulting or collaborating with other service providers or family members, as specified in the POC.

G. Where applicable, the participant must use Medicaid State Plan, Medicare, or other available payers first. The participant's preference for a certain therapist or agency is not grounds for declining another payer in order to access waiver services.

H. All services must be based on a verified need of the participant and the service must have a direct or remedial benefit to the participant with specific goals and outcomes. The authorized service will be reviewed/monitored by the support coordinator to verify the continued need for the service and that the service meets the participant's needs in the most cost effective manner.

La. Admin. Code tit. 50, § XXI-8323

Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing and the Office of Aging and Adult Services, LR 37:3522 (December 2011), amended LR 39:321 (February 2013), Amended by the Department of Health, Bureau of Health Services Financing and the Office of Aging and Adult Services, LR 441899 (10/1/2018), Amended by LR 47885 (7/1/2021), Amended LR 50786 (6/1/2024).

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act.