Occupational Therapy Services (OT) Services

Revised: May 24, 2023

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Overview

Occupational therapy means the use of purposeful activity to maximize the independence and maintain the health of a person who is limited by a physical injury or illness, a cognitive impairment, a psychosocial dysfunction, a mental illness, a developmental or learning disability, or an adverse environmental condition.

Authorization

The Individualized Education Program (IEP) team authorizes services included in an IEP or Individualized Family Service Plan (IFSP). Physicians (primary care providers) do not need to give an order or referral. The licensed occupational therapist working within their scope of practice will do any of the following:

· Evaluate what services the child or youth needs

· Develop the intervention plan and goals, or the care plan

· Treat according to the IEP and intervention plan

· Supervise and give direction to an occupational therapy assistant

Qualified Service Providers

· Occupational therapist (OT): A person who meets the qualifications listed in the occupational therapists and occupational therapy assistants section in Minnesota Statutes, chapter 148 – Public Health Occupations and is licensed by the Minnesota Board of Occupational Therapy Practice. The occupational therapists and occupational therapy assistants sections are Minnesota Statutes, 148.6401-148.6450.

· Occupational therapy assistant (OTA): A person who meets the qualifications listed in the occupational therapists and occupational therapy assistants section in Minnesota Statutes, chapter 148 – Public Health Occupations. The occupational therapists and occupational therapy assistants sections are Minnesota Statutes, 148.6401-148.6450.

Supervision and Direction of an OTA

· The OT is responsible for all duties delegated to the occupational therapy assistant or tasks assigned to direct service personnel. The OT may delegate to an OTA those portions of a member’s evaluation, reevaluation and treatment that the OTA can perform, according to prevailing practice standards of the American Occupational Therapy Association. The OT may not delegate portions of an evaluation or reevaluation of a person whose condition is changing rapidly. Delegation of duties related to use of physical agent modalities to OTAs is governed under Minnesota Statutes.

· The OT determines the frequency and manner of supervision of an OTA performing intervention procedures based on the condition of the child, the complexity of the intervention procedure and the proficiencies of the OTA.

· Face-to-face collaboration between the OT and the OTA must be, at a minimum, every 10 intervention days or every 30 days, whichever comes first. Face-to-face collaboration must occur more often if necessary. During the face-to-face collaboration, the OT is responsible for the following:

· Planning and documenting the initial intervention plan and discharge from treatment

· Reviewing intervention goals, therapy programs and the child’s progress

· Supervising changes in the intervention plan

· Conducting or observing intervention procedures for selected children or youths and documenting the appropriateness of the intervention procedure

· Ensuring the service competency of the OTA in performing the delegated intervention procedures

Covered Services

Covered occupational therapy services include the following:

· Individual, group and specialized maintenance therapy provided by an OT or OTA under the direction of an OT

· Specialized maintenance therapy provided by an OT or OTA that is specified in the child’s IEP or IFSP and is necessary for maintaining a child’s functional status at a level consistent with the child’s physical or mental limitations. Specialized maintenance therapy must meet one of the following: prevent deterioration and sustain function; provide interventions that enable the child to live at their highest level of independence (in the case of chronic or progressive disability); or, provide treatment interventions for children who are progressing, but not at a rate comparable to expectations of restorative care

· Administering face-to-face assessments, interpreting test results and writing reports (meetings to discuss evaluation results or make recommendations are not covered)

· Refer to the Covered and Noncovered IEP Health-Related Services section in the Minnesota Health Care Programs (MHCP) Provider Manual for an overview of covered services criteria for all IEP services.

Coordinate services with other service providers who serve the same child when appropriate.

Noncovered Services

Refer to the Covered and Noncovered IEP Health-Related Services section in the MHCP Provider Manual for an overview of noncovered services that would apply to all IEP services.

Health Records and Documentation

Review the Record Keeping and Documentation section in the MHCP Provider Manual for an overview of the basic IEP record keeping, documentation service time and encounter reporting requirements.

Billing

Submit claims using the 837P Professional claim type. Refer to the MN–ITS IEP User Manual for step-by-step instructions for direct data entry claims. Batch billers submitting X12 837P claims, may review the MHCP 5010/D.0 Compliance web page and the AUC Minnesota Uniform Companion Guide for transaction guidelines.

Review the IEP Billing and Authorization Requirements section of the MHCP Provider Manual for general billing requirements.

Legal References

Minnesota Statutes, 148.6430 (Delegation of Duties; Assignment of Tasks)
Minnesota Statutes, 148.6401 (Supervision of Occupational Therapist Assistants)
Minnesota Statutes, 256B.0625, subdivision 26 (Covered Services – Special education services)