|Page posted: 3/31/04||Page reviewed:||Page updated: 8/4/11|
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:
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:
Home care therapies are classified as one of the following.
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.
|Provider Standards and Qualifications|
Therapists must be employed by or contracted with a Medicare-certified home health agency enrolled with MA. Services may be provided by:
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.
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:
There is no requirement for prior authorization of home care therapy services.