23 Miss. Code. R. 213-3.7 - Evaluation/ Re-Evaluation
A. Medicaid
requires a Certificate of Medical Necessity for Initial Referral/Orders must be
completed by the prescribing provider, and it must be received by the therapist
prior to performing the initial evaluation. The evaluation does not require
prior authorization.
B. Medicaid
requires that before therapy is initiated, a comprehensive evaluation of the
beneficiary's medical condition, disability, and level of functioning must be
performed to determine the need for treatment and, when treatment is indicated,
to develop the treatment plan. Medicaid requires the evaluation must be written
and must demonstrate the beneficiary's need for skilled therapy based on
functional diagnosis, prognosis, and positive prognostic indicators. The
evaluation must form the basis for therapy treatment goals, and the therapist
must have an expectation that the patient can achieve the established
goals.
C. Initial evaluations
should, at a minimum, contain the following information:
1. Beneficiary demographic
information,
2. Name of the
prescribing provider,
3. Date of
the evaluation,
4.
Diagnosis/functional condition or limitation being treated and onset
date,
5. Applicable medical
history: mechanism of injury, diagnostic imaging/testing, recent
hospitalizations including dates, medications, co-morbidities, complicating or
precautionary information,
6. Prior
therapy history for same diagnosis/condition and response to therapy,
7. Level of function, prior and
current,
8. Clinical status
including cognitive function, sensation/proprioception, edema, vision and
hearing, posture, active and passive range of motion, strength, pain,
coordination, bed mobility, balance by sitting and standing, transfer ability,
ambulation on level and elevated surfaces, gait analysis, assistive/adaptive
devices currently in use or required, activity tolerance, presence of wounds
including description and incision status, assessment of the beneficiary's
ability to perform activities of daily living and potential for rehabilitation,
age appropriate information on all children chronological age/corrected age,
motivation for treatment, other significant physical or mental
disabilities/deficiencies that may affect therapy,
9. Special/standardized tests including the
name, scores/results, and dates administered,
10. Social history: effects of the disability
on the beneficiary and the family, architectural/safety considerations present
in the living environment, identification of the primary caregiver, caregiver's
ability/inability to assist with therapy,
11. Discharge plan including requirements to
return to home, school, and/or job,
12. Impression/interpretation of findings,
and
13. Speech therapist's
signature including name and title and date of service.
D. Medicaid covers re-evaluations based on
medical necessity. Re-evaluations do not require prior authorization through
the UM/QIO. Documentation must reflect significant change in the beneficiary's
condition or functional status. Medicaid defines significant change as a
measurable and substantial increase or decrease in the beneficiary's present
functional level compared to the level documented at the beginning of
treatment.
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.