405 IAC 5-16-4 - Rehabilitation center services; limitations

Current through December 29, 2021

Authority: IC 12-15-1-10; IC 12-15-1-15; IC 12-15-21-2

Affected: IC 12-13-7-3; IC 12-15

Sec. 4.

Medicaid reimbursement is available for rehabilitation center services provided by appropriately licensed, certified, or registered staff members subject to the following limitations:

(1) All rehabilitation center services require prior authorization by the department, except those services ordered in writing by a physician prior to the patient's discharge from a hospital. Any combination of therapy services ordered in writing may not exceed thirty (30) hours, sessions, or visits in thirty (30) calendar days unless prior authorization is obtained from the department.

(2) All services must be ordered in writing by a physician.

(3) All services must be provided in accordance with a written plan of care developed cooperatively between the therapist or psychologist and the attending physician.

(4) All services must be medically necessary. Educational services, including, but not limited to, the remediation of learning disabilities are not covered by Medicaid.

(5) All therapies provided in a rehabilitation center must be provided in accordance with 405 IAC 5-22.

Notes

405 IAC 5-16-4

Office ofthe Secretary of Family and Social Services; 405 IAC 5-16-4; filed Jul 25, 1997, 4:00p.m.: 20 IR 3326; readopted filed Jun 27, 2001, 9:40 a.m.: 24 IR 3822; readopted filed Sep 19, 2007, 12:16p.m.: 20071010-IR-405070311RFA; readopted filed Oct 28, 2013, 3:18 p.m.: 20131127-IR-405130241RFA Readopted filed 11/13/2019, 11:54 a.m.: 20191211-IR-405190487RFA