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Department of Human Services Department of Human Services  
 
Rehabilitative Services

Revised: 01-22-2014



Overview
This section provides policy and billing information for outpatient rehabilitative and therapeutic services including physical therapy, occupational therapy, speech-language pathology, and audiology.


Eligible Providers
• Audiologists
• Comprehensive Outpatient Rehabilitation Facilities (CORFs)
• Indian health service (IHS)
• Long term care facilities
• Medicare certified rehabilitation agencies
• Occupational therapists
• *Occupational therapy assistants
• Outpatient hospitals
• Physical therapists
• *Physical therapist assistants
• Rural health clinics (RHCs)
• Speech-language pathologists

* Practitioner not eligible to enroll with Minnesota Health Care Programs (MHCP)

Enrollment Requirements
Audiologists
An individual is eligible to enroll as an audiologist if he/she maintains state licensure and registration requirements. If the state does not license providers of audiology services, the applicant for enrollment with MHCP must demonstrate that he/she either holds a Certificate of Clinical Compliance (CCC) from the American Speech-Language-Hearing Association (ASHA) or meets all the following clinical practicum standards:

• Has demonstrated successful completion of a minimum of 350 clock-hours of supervised clinical practicum (or is in the process of accumulating that supervised experience)
• Has performed not less than nine months of supervised full-time audiology services after obtaining a master’s or doctoral degree in audiology
• Has successfully completed a national exam in audiology approved by the Secretary

Audiologists employed by outpatient hospitals, skilled nursing facilities, comprehensive outpatient rehabilitation facilities (CORFs), physician clinics, Medicare certified rehabilitation agencies, IHS or RHCs may enroll with MHCP.

Comprehensive Outpatient Rehabilitation Facilities (CORFs)
A non-residential facility that is established and operated exclusively to provide diagnostic, therapeutic and restorative services to outpatients for the rehabilitation of injured, disabled, or sick persons, at a single fixed location, by or under the direction of a physician and that meets the conditions of participation. Additionally, a facility that qualifies as a CORF may be enrolled to provide mental health services.

Occupational Therapists (OTs)
An individual is eligible to enroll as an occupational therapist if he/she meets the following requirements:
• Maintains applicable state licensure or is in compliance with state regulatory requirements in states that do not license
• Graduated after successful completion of an occupational therapist education program accredited by the Accreditation Council for Occupational Therapy Education (ACOTE) of the American Occupational Therapy Association, Inc. (AOTA), or successor organizations of ACOTE
• Is eligible to take, or has successfully completed the entry-level certification examination for occupational therapists developed and administered by the National Board for Certification in Occupational Therapy, Inc.(NBCOT)

Occupational therapists employed by outpatient hospitals, skilled nursing facilities, CORFs, physician clinics, Medicare certified rehabilitation agencies, IHS or RHCs may enroll with MHCP.

Physical Therapists (PTs)
An individual is eligible to enroll as a physical therapist if he/she meets the following requirements:

• Maintains applicable state licensure requirements or is in compliance with state regulatory requirements in states that do not license
• Graduated after successful completion of a physical therapy education program accredited by the Commission on Accreditation in Physical Therapy Education (CAPTE), or its equivalent
• Passed an examination for physical therapists approved by the State in which the physical therapy services are provided

Physical therapists employed by outpatient hospitals, skilled nursing facilities, CORFs, physician clinics, Medicare certified rehabilitation agencies, IHS or RHCs may enroll with MHCP.

Rehabilitation Agencies
A provider certified by Medicare to provide restorative, specialized maintenance therapy, and social or vocational adjustment services. Services provided by Medicare certified rehabilitation agencies must be provided at:

• A site surveyed by the Minnesota Department of Health and certified according to Medicare standards
• A site that meets State Fire Marshall standards, as documented in the providers' records
• The recipient's residence

MHCP does not require individual therapists employed by rehabilitation agencies to enroll with MHCP. Rehabilitation agencies are responsible to ensure and maintain proper credentialing of therapists employed with their organization.

Speech-Language Pathologists
An individual is eligible to enroll as a speech-language pathologist if they meet the following requirements:

• Maintains applicable state licensure requirements or is in compliance with state regulatory requirements in states which do not license
• Has a Certificate of Clinical Competence in speech-language pathology from the American Speech-Language-Hearing Association, or is completing the clinical fellowship year required for certification as a speech-language pathologist

Speech-language pathologists employed by outpatient hospitals, skilled nursing facilities, CORFs, physician clinics, Medicare certified rehabilitation agencies, IHS or RHCs may enroll with MHCP.

Therapists in Private Practice
Occupational therapists, physical therapists, speech-language pathologists and audiologists who are in private practice must maintain a private office even if services are furnished in a recipient’s home. A private office is space that is leased, owned, or rented by the practice and used for the exclusive purpose of operating the practice. For example: a private practice therapy practitioner may not furnish covered services in a skilled nursing facility. Therefore, if a private practice therapy practitioner wishes to locate his/her private office on site at a nursing facility, the private office space may not be part of the Medicare participating SNF space and the therapist's services may be furnished only within the therapist's private office space.

Rehabilitative Service Practitioners, Not Eligible to Enroll
Physical Therapist Assistants (PTAs) and Occupational Therapy Assistants (OTAs)
MHCP reimburses providers for the services of a physical therapist assistant or an occupational therapy assistant when services are provided under the supervision of a qualified therapist as indicated below.

Physical Therapist Assistants (PTA):

• Must have successfully completed all academic and field work requirements of a physical therapist assistant program accredited by the Commission on Accreditation in Physical Therapy Education
• Must maintain state licensure requirements or be in compliance with state regulatory requirements in states that do not license physical therapist assistants

Supervision of a PTA
A qualified physical therapist must provide on-site observation of the treatment and documentation of its appropriateness at least every sixth treatment session when services are provided by a physical therapist assistant. A therapist may delegate patient treatment procedures only to a physical therapy assistant who has sufficient didactic and clinical preparation. The physical therapist may not delegate the following activities to the physical therapist assistant or to other supportive personnel: patient evaluation or reevaluation, treatment planning, initial treatment, change of treatment, and initial or final documentation. A licensed physical therapist may supervise no more than two physical therapist assistants at any time.

Occupational Therapy Assistant (OTA):
• Must be certified by the National Board for Certification of Occupational Therapy as an occupational therapy assistant
• Must maintain applicable state licensure requirements or be in compliance with state regulatory requirements in states that do not license occupational therapy assistants

Supervision of an OTA
An occupational therapist must determine the frequency and manner of supervision of an occupational therapy assistant performing treatment procedures based on the condition of the patient or client, the complexity of the treatment procedure, and the proficiencies of the occupational therapy assistant.

Face-to-face collaboration between the occupational therapist and the occupational therapy assistant must occur, at a minimum, every two weeks, during which time the occupational therapist is responsible for:

• Planning and documenting an initial treatment plan and discharge from treatment
• Reviewing treatment goals, therapy programs, and client progress
• Supervising changes in the treatment plan
• Conducting or observing treatment procedures for selected clients and documenting appropriateness of treatment procedures. Clients will be selected based on the occupational therapy services provided to the client and the role of the occupational therapist and the occupational therapy assistant in those services
• Ensuring the service competency of the occupational therapy assistant in performing delegated treatment procedures

Face-to-face collaboration must occur more frequently than every two weeks if necessary to meet the above requirements.

Evaluations and reevaluations will not be reimbursed if provided by occupational therapy assistants.

The occupational therapist must document supervision compliance in the client's file or chart.

Practitioners with Temporary License

• Speech-Language Pathology and Audiology Supervision during Fellowship Year: A person completing the clinical fellowship year required for certification may provide audiology services or speech-language pathology services under the supervision of an audiologist or speech-language pathologist but is not eligible to enroll as a provider. See specific requirements regarding supervision during clinical fellowship year. Speech-language pathologists or Audiologists who hold a valid temporary license to practice are not eligible to enroll as MHCP providers
• Physical therapists with a valid temporary permit to practice and occupational therapists with a valid temporary license to practice may provide services under the supervision of a licensed physical therapist/occupational therapist, but may not enroll as MHCP providers.

Therapy Students Providing Care
Only the direct one-to-one patient contact services of the qualified therapist as defined in this section are billable when a student is involved in the delivery of services. Services performed by a student are not reimbursed even if provided under “line of sight” supervision of a qualified therapist. Qualified therapists may bill and be paid for the provision of services in the following scenarios:

• A qualified therapist is present and in the room for the entire session. The student participates in the delivery of services when the qualified therapist is directing the treatment, making the skilled judgment, and is responsible for the assessment and treatment.
• A qualified therapist is present in the room guiding the student in service delivery when the therapy student is participating in the provision of services, and the practitioner is not engaged in treating another patient or doing other tasks at the same time. Documentation of the therapy service must clearly indicate the qualified therapist was present in the room, guiding the student in the delivery of the service(s) and not simply “on the premises.” The therapist must be focused on the services provided by the student and not involved with other activities or other patients.
• The qualified therapist is responsible for the services delivered and required to sign all the documentation. The student may complete the documentation as part of their education or hands-on training, but the qualified therapist is responsible for the services and the documentation and is required to sign all the documentation. In signing the documentation, the therapist indicates they have read it and are responsible for its contents, which must clearly indicate the services were provided by the student with the therapist directing them. The student may also sign the documentation but it is not required for payment.

Eligible Recipients
Recipients of:

• Medical Assistance (MA)
• MinnesotaCare

Covered Services
Rehabilitation Services
Audiology Services

Occupational Therapy, Physical Therapy, Speech-Language Pathology Services
Casting, Strapping
Services and Supplies

Orthotic Procedures (L-codes)

Augmentative
Communication Devices

Audiology Service
s

Effective July 1, 2013, medical authorization is no longer required for outpatient rehabilitative and therapeutic services: physical therapy, occupational therapy and speech-language pathology. Authorization requirements were suspended for service dates July 1, 2011, through June 30, 2013. Rehabilitative and therapy services are now subject to post-payment review which could result in a provider being required to request authorization for certain services.

Audiology Services
Audiology service have an annual threshold, the number of units of service available without authorization renew January 1 of each year.

• Recipients may require a greater number of evaluations, modalities or procedures than are available in the annual service threshold. Recipients may receive additional medically necessary services with authorization.
• Medicare crossover claims for coinsurance and/or deductible do not debit against the audiology annual thresholds.
• Third-party liability (TPL) claims submitted to MHCP for payment debit against the audiology annual thresholds. Providers are not required to bill MHCP; if the provider is aware the TPL payment will equal or exceed the MHCP payment, providers may consider not billing MHCP because all claims debit against the threshold, even if the claim pays zero dollars.

Occupational and Physical Therapy Services
To be covered as a rehabilitative and therapeutic service, occupational therapy and physical therapy must be prescribed by a physician or other licensed practitioner of the healing arts and must require the skills of at least one of the following:

• A physical therapist
• An occupational therapist
• A physical therapist assistant who is working under the supervision of a physical therapist
• An occupational therapy assistant working under the supervision of an occupational therapist

Speech-language Pathology and Audiology Services
To be covered as a rehabilitative and therapeutic service, speech-language pathology and audiology services require written referral by a physician or other licensed practitioner of the healing arts, or in the case of a long-term care facility resident on the written order of a physician; and must require the skills of at least one of the following:

• A speech-language pathologist
• An audiologist
• An individual completing the clinical fellowship year required for certification as a speech-language pathologist
• An individual completing the clinical fellowship year required for certification as an audiologist and working under the supervision of an audiologist

Treatment must be specified in a Plan of Care that is reviewed and revised as medically necessary by the recipient's attending physician, or other licensed practitioner of the healing arts, at least once every 90 days (see Plan of Care for additional requirements). MHCP accepts electronic signatures for this requirement.

• The recipient's functional status must be expected by the physician or other licensed practitioner of the healing arts as defined in this section, to progress toward or achieve the objectives in the recipient's plan of care within a 90-day period
• If the service is a Medicare covered service, and is provided to a recipient who is eligible for Medicare, the plan of care must be reviewed at the intervals required by Medicare

Providers must comply with Medicare’s site requirements when services are provided to Medicare eligible recipients.

Specialized Maintenance Therapy
Effective January 1, 2012, specialized maintenance therapy coverage is limited to MHCP recipients age 20 and under. Specialized maintenance therapy is a health service specified in the recipient's plan of care and certified by a physician, or other licensed practitioner of the healing arts within the practitioner's scope of practice under state law, that is necessary for maintaining a recipient's functional status at a level consistent with the recipient's physical or mental limitations, and that may include treatments in addition to rehabilitative nursing services. Specialized maintenance therapy is covered only when provided by:

• A physical therapist
• A physical therapist assistant
• An occupational therapist
• An occupational therapy assistant
• A speech-language pathologist

Specialized maintenance therapy must be specified in a Plan of Care that meets the requirements of this section, and provided to recipients whose condition cannot be maintained or treated only through:

• Rehabilitative nursing services
• Services of other care providers
• The recipient, because the recipient's physical, cognitive or psychological deficits result in:
• Spasticity or severe contracture that interferes with the activities of daily living or the completion of routine nursing care, or has resulted in decreased functional ability compared to the recipient's previous level of function
• A chronic condition that results in physiological deterioration and that requires specialized maintenance therapy services or equipment to maintain strength, range of motion, endurance, movement patterns (functional mobility such as gait, transfers, ambulation, bed/chair mobility), activities of daily living, cardiovascular function, integumentary status, or positioning necessary for completion of the recipient's activities of daily living, or decreased abilities relevant to the recipient's current environmental demands

Specialized maintenance therapy must have expected outcomes that are:

• Functional
• Realistic
• Relevant
• Transferable to the recipient's current or anticipated environment, such as home, school, community, work
• Consistent with community standards

Specialized maintenance therapy must meet at least one of the following characteristics:

• Prevent deterioration and sustain function
• Provide interventions, in the case of a chronic or progressive disability, that enable the recipient to live at the recipient's highest level of independence
• Provide treatment interventions for recipients who are progressing but not at a rate comparable to the expectations of restorative care

Documentation Requirements
Providers must document all evaluations, and re-evaluations, services provided, recipient’s progress, attendance records, and discharge plans. Documentation must be kept in the recipient's records. Documentation must demonstrate that rehabilitative and therapeutic services are:

• Medically necessary as determined by prevailing community standards or customary practice and usage
• Appropriate and effective for the recipient’s medical needs
• Timely, considering the nature and present medical condition of the recipient
• Provided by a provider with appropriate credential
• The least expensive, appropriate alternative available
• An effective and appropriate use of MHCP funds

Rehabilitative and therapeutic services must be documented as specified in this section whether MHCP is the primary or secondary payer.

Example: Recipient has other third-party insurance. Providers must comply with MHCP documentation standards even if other insurance documentation standards are not the same.

Refer to the professional documentation guidelines for your therapy discipline for guidance on effective documentation:


Refer to the Documentation Requirements for Therapy Services in the Medicare Benefit Policy Manual (PDF) when providing treatment to a recipient who is dually eligible for Medicare and Medicaid.

Plan of Care
Rehabilitative and therapeutic services, specialized maintenance therapy and audiology services must be provided under a written Plan of Care (POC). The service(s) must be specified in the recipient’s POC that the physician or licensed practitioner of the healing arts reviews and revises as medically necessary at least once every 90 days. If the service is to a recipient who is also eligible for Medicare and the service is a Medicare covered service, the POC must be reviewed in compliance with federal regulations.

The Plan of Care must specifically state:

• The recipient’s medical and treatment diagnosis and any contraindications to treatment
• A description of the recipient’s functional status/limitations
• The objectives of the rehabilitative and therapeutic service
• A description of the recipient’s progress toward the objectives
• The treatment plan including interventions to be provided
• Outcomes of the rehabilitative and therapeutic service, which include treatment goals that are:
• Functional
• Measurable
• Time-specific
• Projected frequency and duration of treatment
• Plans for discharge from treatment
• A description of the recipient's progress toward the outcomes for subsequent POC:
• Home program teaching
• Collaboration with other professionals and services
• Progress toward goals with updating as indicated
• Modifications to the initial plan of care
• Plans for continuing care

The Plan of Care must be signed by the prescribing or ordering physician, or licensed practitioner of the healing arts.

Record of Service
The recipient’s record of service must show the:

• Date, type, length, and scope of each service
• Name(s) and title(s) of the person(s) providing each service
• Name(s) and title(s) of the person(s) supervising or directing the care
• Documented evidence of progress at least every 30 days, by the therapist providing or supervising the services that the therapy's nature, scope, duration and intensity are appropriate to the medical condition of the recipient

See documentation requirements specified in Authorization.


Non-Covered Services
• Physical or occupational therapy that is provided without a prescription from a physician, or other licensed practitioner of the healing arts
• Speech-language or audiology services provided without a written referral from a physician, or other licensed practitioner of the healing arts
• Services for physical or occupational therapy provided by a person, who was issued a temporary permit for physical therapy or a temporary license for occupational therapy and the temporary permit or license has expired
• Services for speech-language pathology or audiology services provided by a person whose temporary license has expired
• * Services for contracture that are not severe and do not interfere with the recipient's functional status or the completion of nursing care as required for licensure of the LTC facility
• * Ambulation of a recipient who has an established functional gait pattern
• * Services for conditions of chronic pain that do not interfere with the recipient's functional status and that can be treated by routine nursing measures
• * Services for activities of daily living when performed by the therapist, therapy assistant or therapy aide
• * Bowel and bladder retraining programs
• Specialized maintenance therapy for MHCP recipients age 21 and over (effective January 1, 2012)
• Art and craft activities for the purpose of recreation
• Services that are not:
• Medically necessary
• Documented in the recipient's health care record
• Part of the recipient's plan of care
• Designed to improve or maintain the functional status of a recipient with a physical impairment or a cognitive or psychological deficit
• Services specified in a plan of care that is not reviewed and revised as medically necessary by the recipient’s attending physician or practitioner of the healing arts as defined in this section
• Services by more than one provider of the same type for the same diagnosis unless the service is provided by the school district as specified in the recipient's IEP
• A rehabilitative and therapeutic service that is denied Medicare payment because of the provider's failure to comply with Medicare requirements
• Vocational or educational services, including functional capacity evaluations, except as provided under IEP-related services
• Services provided by a therapy aide or therapy student (see Therapy Students Providing Care)
• Psychosocial services
• Record keeping, documentation, and travel time (the transport and waiting time of a recipient to and from therapy sessions)
• Services provided by a rehabilitation agency that take place in a sheltered workshop, Day Training and Habilitation center (DT&H), Day Activity Center (DAC), or a residential or group home which is an affiliate of the rehabilitation agency
• *Yearly assessments of LTC residents to meet OBRA regulations
• Training or consultation provided by an audiologist to an agency, facility, or other institution

* These items are considered rehabilitative nursing and are part of the LTC facility per diem payment.


Billing
• Bill using MN–ITS Interactive 837P or 837I
• Refer to the Rehab (837P) Professional MN–ITS User Guide or the Outpatient Rehab (837I) MN–ITS User Guide for instructions
• X12 Batch users: Refer to Minnesota Uniform Companion Guide and Best Practices for billing instructions
• Enter the NPI of the referring/ordering physician or other practitioner of the healing arts on claims for OT, PT, SLP and audiology. Referring/ordering physicians must be enrolled with MHCP

Codes and Modifiers
MHCP uses outpatient rehabilitative service codes as defined in CPT/HCPCS billable in timed units (15 minutes, 30 minutes, 1 hour). Bill outpatient rehabilitative services with codes that most closely describe the service provided.

Timed Codes
Do not bill for services represented by 15 minute timed codes when performed for less than 8 minutes on any date of service.

Follow these guidelines when billing services that are spent directly with the recipient:

Bill this many units: If the duration of the service equals:
1 8 minutes through 22 minutes
2 23 minutes through 37 minutes
3 38 minutes through 52 minutes
4 53 minutes through 67 minutes
5 68 minutes through 82 minutes
6 84 minutes through 97 minutes
Bill only direct patient contact by the provider as time the patient is treated.

Untimed Codes

• Bill CPT/HCPCS codes that do not have a timed component/unit assigned as one unit per visit, regardless of the time spent during the session
• Bill only one unit for any date of service that is a “per visit/session” code

Modifiers
The following modifiers are required when billing to indicate the therapy discipline delivering the outpatient rehabilitative services:

Modifier Description
GN Speech-language pathology
GO Occupational therapy
GP Physical therapy
U7 Required to indicate the service was provided by a physical therapy assistant or occupational therapy assistant when a physical therapist or occupational therapist, under whose supervision the assistant was working, was not on the premises
59 Follow the National Correct Coding Initiative (NCCI) instructions for use of the 59 modifier on claims for codes that may not be billed together unless performed on a different anatomic site or represents a different encounter.
UC Use only to indicate that the therapy service provided was specialized maintenance therapy. Document specialized maintenance therapy in the patient’s record.
Telemedicine modifiers:

GQ
GT
Use these modifiers to indicate services delivery via telemedicine applications. Only those services that are appropriate for delivery via telemedicine may be billed as such:
• Services delivered via asynchronous telecommunications system (via computer)
• Services delivered via interactive audio and video telecommunication system

Use the correct HCPCS code and appropriate modifier from the Casting & Strapping Services/Supplies chart to bill therapeutic supplies fabricated by the therapist, such as splints, casts, and adaptive aids. Do not bill for ready-made or pre-fabricated supplies that can be obtained from a medical supplier.

Include the most relevant ICD diagnosis code for the provided service.

Co-therapy: Split the time between therapy disciplines for billing purposes when services are delivered to a recipient by two or more therapy disciplines in the same block of time. Total time billed should not exceed the actual length of time spent with the patient.

Follow Medicare guidelines for MHCP recipients who are dually eligible for Medicare and Medicaid when providing Medicare covered services.

Therapists in Private Practice
Bill only for services you provide using your individual NPI number.

Rehabilitative Services Provided in Facility Settings
• Enter the NPI of the facility (physician clinic, outpatient hospital, rehabilitation agency, or CORF) as the Pay-to-Provider when billing rehabilitative services provided in these settings
• The Pay-to-Provider’s NPI and the rendering provider’s NPI must be the same on the claim; do not enter an individual therapist’s NPI as the rendering provider when billing for services provided in these types of facilities

Rehabilitative Services Provided in an LTC Facility
Long-term care facilities may provide rehabilitative services to both residents and members of the community, employing either therapists employed by the LTC or by contracting with an outside vendor such as a rehab agency or therapist in private practice.

• Services must be provided on the LTC premises
• Rehabilitative services included in the LTC per diem rate may not be billed as an outpatient service
• LTC facilities located in Minnesota no longer include rehabilitative services in their per diem
• Bill services provided to recipients who are also eligible for Medicare following Medicare’s requirements
• The LTC facility must bill for services provided by its employees
• Services provided by contracted outside vendors may be billed by either the vendor or the LTC facility; however, the provider billing for and receiving payment for services is responsible for the accuracy of the claims and for maintaining patient records that fully disclose the extent of the benefits provided
• The Pay-to-Provider’s NPI and the and the rendering provider’s NPI must be the same on the claim; do not enter the therapist’s NPI as the rendering provider when billing for services provided in a nursing home

Definitions
Audiologic Evaluation: An assessment administered by an audiologist or otolaryngologist to evaluate communication problems caused by hearing loss.

Delegation of duties: The actions of a physical or occupational therapist who delegates to the physical therapist assistant or occupational therapy assistant in specific duties to be performed, monitors the provision of services, as the therapy assistants provide the service, and meets the supervisory requirements of MN Statutes 148.706 and 148.6432 respectively, when treatment is provided by a physical therapist assistant or occupational therapy assistant.

Functional Status: The ability to carry out the tasks associated with daily living.

Long Term Care Facility (LTC): Nursing facility (NF), skilled nursing facility (SNF), or intermediate care facility for persons with developmental disabilities (ICF/DD).

Otolaryngologist: A physician specializing in diseases of the ear and larynx who is certified by the American Board of Otolaryngology or eligible for board certification.

Practitioner of the Healing Arts: For the purposes of this section, practitioner of the healing arts includes any person who engages in, or holds out to the public as being engaged in, the practice of medicine or surgery, the practice of osteopathy, or other practitioner of the healing arts whose scope of practice under state law includes diagnosis of disease or health condition and prescribing treatment; e.g., physician assistant, nurse practitioner, podiatrist, oral surgeon, dentist, optometrist.

Rehabilitative and Therapeutic Services: Restorative therapy, specialized maintenance therapy, and rehabilitative nursing services.

Rehabilitative Nursing Services: Nursing homes must have active program of rehabilitation nursing care directed toward assisting each resident to achieve and maintain the highest practicable physical, mental and psychosocial well-being according to the comprehensive resident assessment and plan of care. Continuous efforts must be made to encourage ambulation and purposeful activities.

Restorative Therapy: A health service specified in the recipient's plan of care, ordered by a physician or other licensed practitioner of the healing arts within the practitioner's scope of practice under state law, who has certified that the service is designed to restore the recipient's functional status to a level consistent with the recipient's physical or mental limitations.

Specialized Maintenance Therapy: A health service specified in the recipient’s plan of care and certified by a physician or other licensed practitioner of the healing arts within the practitioner's scope of practice under state law that is necessary for maintaining a recipient’s functional status at a level consistent with the recipient’s physical or mental limitations and that may include treatments in addition to rehabilitative nursing services.


Legal References
MS 256B.0625 subd. 8, 8a; 8b; 8c. and subd. 31a. Covered Services
MS 148.515
, subd. 4. Speech-Language Pathology and Audiology Supervision During Fellowship Year
MS 148.5175
Speech-language pathologists and Audiologists who hold a temporary license
MS 148.6410
Licensure Qualifications for Occupational Therapy Assistants
MS 148.6418
Occupational therapists with a temporary license
MS 148.6430
Occupational Therapists - Delegation of Duties; Assignment of Tasks
MS148.6432
Supervision of Occupational Therapy Assistants
MS 148.706 Physical Therapist Assistants, Aides and Students

MS 148.71
Physical therapists with a temporary permit
MS 148.65
License requirement for physical therapist assistants
Minnesota Rules 4658.0525
Rehabilitative Nursing Services
Minnesota Rule
s 9505.0175
Definitions
Minnesota Rules 9505.0210
Covered Services: General Requirements
Minnesota Rules
9505.0220
Health Services Not Covered by Medical Assistance
Minnesota Rules 9505.0385
Rehabilitation Agency Services
Minnesota Rules 9505.0386
Comprehensive Outpatient Rehabilitation Facilities
Minnesota Rules 9505.0390
Rehabilitative and Therapeutic Services
Minnesota Rules 9505.0391
Therapists Eligible to Enroll as Providers
Minnesota Rules 9505.0392
Compliance With Medicare Requirements
Minnesota Rules 9505.0410
Long-Term Care Facilities; Services to Residents
Minnesota Rules 9505.0
411
Long-Term Care Facilities; Services to Non-residents
Minnesota Rules 9505.0412
Required Documentation of Rehabilitative and Therapeutic Services
Minnesota Rules 9505.5010
Prior Authorization
42 CFR 440.110
42 CFR 483.45
42 CFR sub. H, 485.701 to 485.729
42 CFR sub. D, 486.150 to 486.163


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