Administrative Rules of Montana
Department 37 - PUBLIC HEALTH AND HUMAN SERVICES
Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES
Subchapter 37.86.6 - Therapy Services
Rule 37.86.606 - THERAPY SERVICES, SERVICE REQUIREMENTS AND RESTRICTIONS

(1) The requirements and restrictions in this rule apply for purposes of coverage and reimbursement of therapy services under the Montana Medicaid program.

(2) Except as otherwise provided by these rules, therapy services must be provided by a therapist or assistant/aide within the scope of practice permitted by state law. The provider's records maintained under ARM 37.85.414 must demonstrate compliance with applicable supervision and protocol requirements.

(3) Therapy services may be provided to a member only upon a current written or verbal order or referral by a physician or mid-level practitioner. All verbal orders or referrals must be followed up by a written order received by the provider within 30 days of the verbal order or referral.

(4) Services that do not require the performance or supervision of a licensed therapist are not reasonable and necessary even if the services are performed by or under the supervision of a licensed therapist.

(5) Medicaid reimbursement for therapy service procedures includes all related supplies and items used in the performance of the service, except that the design, fabrication, fitting, and instruction by a licensed therapist in the use of splints, braces, and slings are reimbursable as provided in ARM 37.86.1801 through 37.86.1807