Home Care in Roseville, Minnesota

42 C.F.R. 440.110; Minn. Stat. §256B.0625, subd. 8, Minn. Stat. §256B.0651, Minn. Stat. §256B.0653, Minn. R. 9505.0295 and Minn. R. 9505.0390

Home care therapies: Therapies provided in the home to improve or maintain a person’s functioning. Home care therapies include physical, occupational, speech-language pathology and respiratory.

The following groups of people are eligible for home care therapies:

• Medical Assistance (MA) recipients
• MinnesotaCare recipients

If a person is able to obtain the needed services at a rehabilitation center, they are not eligible for payment through home care services.

Home care therapies include:

• Occupational therapy
• Physical therapy
• Respiratory therapy
• Speech-language pathology

Home care therapies are classified as one of the following.
Restorative therapy
Health service ordered by a physician, specified in the person’s care plan and designed to restore the person’s functional status to a level consistent with the person’s physical or mental limitations.
Specialized maintenance therapy
Health service ordered by a physician, specified in the person’s care plan and necessary for maintaining a person’s functional status at a level consistent with the person’s physical or mental limitations.

Therapies provided in other settings such as a clinic, day program or as an in-patient.

The physician or other licensed practitioner of the healing arts within the practitioner’s scope of practice under state law must expect the person’s functional status to progress toward, achieve or maintain the objectives in the person’s care plan within a 60-day period.

Therapists must be employed by or contracted with a Medicare-certified home health agency enrolled with MA. Services may be provided by:

• Licensed physical therapist (PT)
• Physical therapist assistant (PTA)
• Licensed occupational therapist (OT)
• Licensed occupational therapists assistant (OTA)
• Licensed speech-language pathologist (SLP)
• Registered respiratory therapist (RT)

MA reimburses providers for the services of a PTA or an OTA when services are provided under the direction of a PT or OT. The therapist must provide on-site observation of the treatment and documentation of its appropriateness at least every sixth treatment session when the therapist assistant provides services. Therapists will not be reimbursed for assistant providing evaluations or reevaluations.

MHCP Provider Manual, chapter 17.
Rates – See Continuing Care and other provider rate changes page

Referral to a Medicare-certified home health agency starts the process. For dual eligible persons, MA pays for therapies only after other resources have been used.

Providers must document all evaluations, services provided, client progress, attendance records and discharge plans. Documentation must be kept in the person’s record. The record of therapy services must contain the following:

• The date, type, length and scope of each service provided
• The name and title of the person(s) providing each service
• A statement, every 30 days, by the therapists providing or supervising the services, that the nature, scope, duration and intensity of the therapy are appropriate to the medical condition of the person in accordance with Minnesota Statutes.

There is no requirement for prior authorization of home care therapy services.