23 Miss. Code. R. 213-2.6 - Prescribing Provider Orders/Responsibilities
A. Medicaid
provides benefits for therapy services that are medically necessary, as
certified by the prescribing provider.
B. The prescribing provider must complete a
Certificate of Medical Necessity for Initial Referral/Orders form and submit it
to the therapist prior to therapy evaluation.
C. Therapy services must be furnished
according to a written plan of care (POC). The plan of care must be approved by
the prescribing provider before treatment is begun. Medicaid defines approval
as the prescribing provider has reviewed and agreed with the therapy plan. The
review can be done in person, by telephone, or facsimile. An approved plan does
not mean that the prescribing provider has signed the plan prior to
implementation, only that he/she hasagreed to it. The plan of care must be
developed by a therapist in the discipline. A separate plan of care is required
for each type of therapy ordered by the prescribing provider. The plan must, at
a minimum, include the following:
1.
Beneficiary demographic information,
2. Name of the prescribing
provider,
3. Dates of
service,
4.
Diagnosis/symptomatology/conditions and related diagnosis codes,
5. Reason for referral,
6. Specific diagnostic and treatment
procedures/modalities and related procedure codes,
7. Frequency of therapeutic
encounters,
8. Duration of
therapy,
9. Precautions, if
applicable,
10. Short and long term
goals that are specific, measurable, and age appropriate,
11. Plan for the home program,
12. Discharge plan, and
13. Therapist's signature, name and title,
and date.
D. Medicaid
requires the POC to cover a period of treatment up to six (6) months. The
projected period of treatment must be indicated on the initial POC and must be
updated with each subsequent revised POC. Medicaid does not cover a POC for a
projected period of treatment beyond six (6) months.
E. Medicaid requires a revised POC in the
following situations:
1. The projected period
of treatment is complete and additional services are required,
2. A significant change in the beneficiary's
condition and the proposed treatment plan requires that a therapy provider
propose a revised POC to the prescribing provider, or the prescribing provider
requests a revision to the POC. In either case, the therapy provider must
submit a revised POC to the UM/QIO for certification prior to rendering
services, and
3.
Information/documentation submitted to the UM/QIO indicates the POC needs
further review/revision by the the rapist/prescribing provider at intervals
different from the proposed treatment dates. The therapy provider must submit a
revised POC to the UM/QIO for authorization/certification prior to rendering
services,
F. All therapy
plans of care, initial and revised, must be authenticated, with signature and
date, by the prescribing provider. The prescribing provider must sign the POC
before initiation of treatment or within thirty (30) calendar days of the
verbal order approving the treatment plan. This applies to both initial and
revised plans of care.
G. Medicaid
accepts the signature on the revised plan of care as a new order.
H. The prescribing provider may make changes
to the plan established by the therapist, but the therapist cannot unilaterally
alter the plan of care established by the prescribing provider.
I. The servicing provider, the licensed
therapist, is responsible for providing a copy of the initial plan of care and
all revisions to the prescribing provider.
J. Medicaid does not cover therapy services
when documentation supports that the beneficiary has not reached therapy goals
and is unable to participate and/or benefit from skilled intervention, refuses
to participate, or is otherwise noncompliant with the therapy regimen.
Noncompliance is defined as failure to follow therapeutic recommendations which
may include any or all of the following:
1.
Failure to attend scheduled therapy sessions,
2. Failure to perform home exercise program
as instructed by the therapist,
3.
Failure to fully participate in therapy sessions,
4. Failure of the parent/caregiver to attend
therapy sessions with beneficiary who is incapable of carrying out the home
program without assistance, and
5.
Failure to properly use special equipment or adaptive devices. Failure of
parent/caregiver/beneficiary to otherwise comply with therapy regimen as
documented in the medical record.
K. Medicaid requires a mandatory face-to-face
visit with the beneficiary by the prescribing provider at least every six (6)
months and, requires the encounter is documented.
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.