D.C. Mun. Regs. tit. 29, r. 4246

Current through Register Vol. 71, No. 39, September 27, 2024

Rule 4246 - PROGRAM SERVICES: OCCUPATIONAL THERAPY

4246.1

In order to receive Medicaid reimbursement, Occupational Therapy (OT) services shall be designed to maximize independence, prevent further disability, maintain health, and the beneficiary's functionality.

4246.2

Occupational therapy services shall be provided in accordance with the beneficiary's PCSP and delivered in the beneficiary's home or in a day service setting.

4246.3

Each occupational therapy professional shall conduct an assessment of the occupational therapy needs within the first four (4) hours of service delivery, and develop a therapy plan (Plan of Care) to provide services.

4246.4

The therapy plan shall include the anticipated and measurable, functional outcomes, based upon what is important to and for the beneficiary as reflected in his or her person-centered goals in his or her PCSP and a schedule of approved occupational therapy services to be provided, and shall be submitted by the Medicaid provider to the case manager before services are delivered.

4246.5

Medicaid reimbursable occupational therapy services shall consist of the following ongoing activities:

(a) Conducting an initial assessment and annual re-assessment;

(b) Consulting with the beneficiary, his or her family, caregivers and interdisciplinary team to develop the therapy plan;

(c) Implementing therapies described in the therapy plan;

(d) Recording progress notes during each visit, which shall contain the following:

(1) Progress in meeting each goal in the therapy plan;

(2) Any unusual health or behavioral events or change in status;

(3) The start and end time of any services received by the beneficiary; and

(4) Any matter requiring follow- up on the part of the service provider, case manager, or DHCF.

(e) Developing quarterly reports based on the progress notes and indicating progress in meeting each goal in the therapy plan, and any progress made on matters requiring follow-up in the progress notes;

(f) Submitting quarterly reports to DHCF, which shall be uploaded in the EPD Waiver electronic case management system;

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

(h) Completing documentation required to obtain or repair adaptive equipment in accordance with insurance guidelines and Medicare and Medicaid guidelines, including required timelines for submission;

(i) Conducting periodic examinations (at least annually and more frequently as needed) and modified treatments for the beneficiary, as needed to determine which services are most appropriate to enhance the beneficiary's well-being and meet the therapeutic goals; and

(j) Updating the therapy plan and communicating with the case manager to make any updates to the PCSP with any modifications to the therapy plan.

D.C. Mun. Regs. tit. 29, r. 4246

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