Current through Register Vol. 63, No. 9, September 1, 2024
(1) There must be a rehabilitative or
habilitative therapy plan of care to receive payment.
(2) The Division shall authorize for the
level of care or type of service that meets the client's medical need
consistent with the Health Evidence Review Commission's (HERC) Prioritized List
of Health Services (Prioritized List) and guideline notes.
(3) The rehabilitative or habilitative
therapy plan must adhere to the licensing board requirements of care and shall
include:
(a) Client's name, ICD diagnosis
code, and type, amount, frequency, and duration of the proposed rehabilitative
or habilitative therapy;
(b)
Individualized, measurably objective functional goals;
(c) Documented need for extended service,
considering 60 minutes as the maximum length of a treatment session;
(d) Plan to address implementation of a home
management program as appropriate from the initiation of therapy
forward;
(e) Dated signature of the
therapist or the prescribing practitioner establishing the therapy plan of
care; and
(f) For home health
clients, any additional requirements included in OAR chapter 410 division
127.
(4) The therapy
treatment plan and regimen shall be taught to the client, family, foster
parents, or caregiver during the therapy treatments. The client must be present
for demonstrating therapy during teaching to assure therapy regimen is
performed safely and correctly. The division may not authorize extra treatments
for teaching.
(5) A therapy plan
must comply with the relevant state licensing authority's standards.
(6) If a state licensing authority has not
adopted therapy plan of care standards, the therapy plan of care shall include:
(a) The need for continuing rehabilitative or
habilitative therapy clearly stated;
(b) Changes to the rehabilitative or
habilitative therapy plan of care, including changes to duration and frequency
of intervention; and
(c) Any
changes or modifications to the therapy plan of care shall be documented,
signed, and dated by the prescribing practitioner or therapist who developed
the plan.
(7) Therapy
records shall include:
(a) A written
referral, including:
(A) The client's
name;
(B) The ICD-10-CM diagnosis
code; and
(C) Specification of the
type of services, amount, and duration required.
(b) A copy of the signed therapy plan of care
must be on file in the provider's therapy record prior to billing for
services;
(c) Documents,
evaluations, re-evaluations, and progress notes to support the rehabilitative
or habilitative therapy treatment plan and prescribing provider's written
orders for changes in the therapy treatment plan;
(d) Modalities used on each date of
service;
(e) Procedures performed,
and amount of time spent performing the procedures, documented and signed by
the therapist; and
(f)
Documentation of splint fabrication and time spent fabricating the
splint.
Statutory/Other Authority: ORS
413.042
Statutes/Other Implemented: ORS
688.135 &
414.065
