A. The Division of
Medicaid covers physical therapy services in the outpatient setting when
medically necessary, ordered by a physician, physician assistant or nurse
practitioner, and prior authorized by a Utilization Management/Quality
Improvement Organization (UM/QIO), the Division of Medicaid or a designated
entity to treat a beneficiary's illness, condition, or injury and the following
requirements are met:
1. The services require
the knowledge, skill and judgment of a state-licensed physical therapist.
2. The Certificate of Medical
Necessity (CMN) for the initial referral/order is completed by the prescribing
provider prior to the physical therapy evaluation.
3. The plan of care (POC) is developed by a
state-licensed physical therapist.
4. The prescribing provider approves the
initial/revised POC with a signature and date:
a) Before the initiation of treatment or
change in treatment, or
b) Within
thirty (30) calendar days of the verbal order for the initial treatment plan or
change in treatment.
5.
The services are rendered as individualized therapy consistent with the
symptomatology/diagnosis and do not exceed the beneficiary's needs.
6. The services do not duplicate another
provider's services including those services provided in a school-based
setting.
B. The
Division of Medicaid reimburses for covered physical therapy services provided
by:
1. A state-licensed physical therapist.
2. A state-licensed physical
therapist assisted by a state-licensed physical therapist assistant under
direct, on-site supervision by a state-licensed physical therapist.
a) The Division of Medicaid defines direct,
onsite supervision as face-to-face oversight by a state-licensed physical
therapist at regular intervals, as prescribed in regulations adopted by the
Mississippi State Board of Physical Therapy and does not include:
1) Contacts by telephone,
2) Contacts by pager,
3) Video conferencing, and/or
4) Any method not approved by the Division of
Medicaid.
b) The
initial evaluation, POC, and discharge summary must be completed by a
state-licensed physical therapist.
3. A state-licensed physical therapist
assisted by a physical therapy student who is enrolled in an accredited
physical therapy program while completing the clinical requirements necessary
for graduation under direct, on-site supervision of a state-licensed physical
therapist, referred to as student assisted physical therapy services.
a) The Division of Medicaid defines direct,
on-site supervision of a physical therapy student as the face-to-face oversight
by a state-licensed physical therapist.
b) The state-licensed physical therapist must
be physically present and engaged in student oversight during the entirety of a
physical therapy session such that the state-licensed physical therapist is
considered to be providing the physical therapy service.
C. The state-licensed physical
therapist cannot supervise at the same time during the work day more than:
1. One (1) physical therapy student,
2. A total of four (4)
state-licensed physical therapist assistants, or
3. One (1) physical therapy student and three
(3) state-licensed physical therapist assistants.
42 CFR §§
410.60 -61, 440.110; Miss. Code Ann. §§
43-13-121,
73-23-31,
et seq.
