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Ohio Administrative Code (Last Updated: January 12, 2021) |
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5160 Medicaid |
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Chapter5160-8. Limited Practitioner Services |
5160-8-33. Skilled therapy: documentation of services [RESCINDED]
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(A) A clinical evaluation and assessment of the need for skilled therapy services includes the following elements:
(1) A diagnosis of the type and severity of the disorder or a description of the deficit in physical or sensory functionality;
(2) A review of the individual's current physical, auditory, visual, motor, and cognitive status;
(3) A case history, including, when appropriate, family perspectives on the individual's development and capacity to participate in therapy;
(4) The outcomes of standardized tests and any non-standardized tests that use age-appropriate developmental criteria;
(5) Other test results and interpretation;
(6) An evaluation justifying the provision of skilled therapy services, which may be expressed as one of two prognoses of the patient's rehabilitative or developmental potential:
(a) The patient's functionality is expected to improve within sixty days after the evaluation because of the delivery of rehabilitative skilled therapy services or within six months after the evaluation because of the delivery of developmental skilled therapy services, and the patient is expected to attain full functionality or make significant progress toward expected developmental milestones within twelve months; or
(b) The patient is not expected to attain full functionality or make significant progress toward expected developmental milestones within twelve months, but a safe and effective maintenance program may be established; and
(7) Any recommendations for further appraisal, follow-up, or referral.
(B) A treatment or maintenance plan for skilled therapy services is based on the clinical evaluation and assessment. It should be coordinated, when appropriate, with services provided by non-medicaid providers or programs (e.g., child welfare, child care, or prevocational or vocational services), and it should provide a process for involving the patient or the patient's representative in the provision of services. A complete treatment or maintenance plan includes the following elements:
(1) The patient's relevant medical history;
(2) Specification of the amount, duration, and frequency of each skilled therapy service to be rendered; the methods to be used; and the areas of the body to be treated;
(3) A statement of specific functional goals to be achieved, including the level or degree of improvement expected within the appropriate time period;
(4) The date of each treatment;
(5) The signature of the practitioner responsible for the treatment plan;
(6) Documentation of participation by the patient or the patient's representative in the development of the plan;
(7) Specific timelines for reevaluating and updating the plan;
(8) A statement of the degree to which the patient has made progress; and
(9) A recommendation for one of several courses of action:
(a) The development of a new or revised treatment plan;
(b) The development of a maintenance plan; or
(c) The discontinuation of treatment.