Occupational therapy – the
functional evaluation of the student and the planning and utilization of a
program of purposeful activities to develop or maintain adaptive skills
designed to achieve maximal physical and mental functioning of the student in
daily life tasks.
To claim Medicaid reimbursement, providers must
abide by the following:
·
Services
must be listed on IEP.
·
Occupational
therapy orders must be signed and dated by a NYS licensed and registered
physician, physician’s assistant or nurse practitioner and must indicate that
services should be delivered as indicated on the IEP. Orders exist for the life of the IEP (see Appendix A).
·
Occupational
therapy may be provided by a NYS licensed and registered occupational therapist
(OT) or by an occupational therapy assistant (OTA) under the direct supervision
of a NYS licensed and registered OT (Article 156).
·
The
NYS licensed OT must sign all service provider sheets, whether delivering the
service directly or providing supervision to an OTA.
·
There
should be at least quarterly progress notes prepared by the service provider
and signed by the NYS licensed physical therapist occupational
therapist (updated 10/17/05). We
recommend use of the progress notes sent home to parents (Part 200 of the
Regulations of the Commissioner of Education). Refer to page 11 for documentation requirements.
·
For
OTA, Article 156 Section 7906 (6) requires that documentation of direct
supervision of an OTA be maintained.
The following are some examples of ways to document the required
supervision of OTA:
·
Sign
and date the treatment plan.
·
Sign
and date the monthly service sheet used for Medicaid billing.
·
Sign
and date evaluations and assessment documents that are used to determine the
method of treatment.
·
Sign
and date the progress notes completed by the assistants.
·
Review,
sign and date the weekly service notes.
·
Performance
appraisals and evaluation of the assistants signed and dated by the therapist.
The credentials of the occupational therapists and occupational therapy
assistants should be kept on file.
Codes and Fees:
|
SSHSP
Monthly Fee |
5330 |
$ 422 |
|
PSHSP
Individual Monthly Fee |
5333 |
$ 299 |
|
PSHSP
Center based Monthly Fee |
5325 |
$ 397 |