Hawaii Administrative Rules
Title 17 - DEPARTMENT OF HUMAN SERVICES
Department of Human Services
Chapter 1739.1 - AUTHORIZATION, PAYMENT, AND CLAIMS IN THE FEE-FOR-SERVICE MEDICAL ASSISTANCE PROGRAM FOR NON-INSTITUTIONAL SERVICES
Section 17-1739.1-7 - Payments to individual practitioners providing therapy services in long-term care facilities

(a) Payment for physical and occupational therapy, and speech, language, and hearing disorder services provided to a Medicaid recipient in a long-term care facility shall be based on a fee schedule established by the department for services provided at fifteen minute time increments.

(b) Payment shall be made for only those covered therapy services specified in sections 17-1737-79, which are determined to be medically necessary, prescribed by a physician, and provided by a licensed or certified therapist approved by the Medicaid program.

(c) Payment shall be made only upon submission of a Hawaii claim form (UB-82 or DHS-1500), by a provider eligible to bill for the services under the Medicare and Medicaid programs. Facilities with Medicare numbers shall use the form UB-82. Individual therapists shall use the form DHS-1500.

(d) In the case of speech evaluation and training, and hearing evaluation and hearing aids, an authorization form (DHS 1144), shall be attached to the claim form.

(e) In the case of persons eligible for both Medicare and Medicaid who reside in an intermediate care facility, payment shall be made only if Medicare payment has been sought and denied.