PRIVATE REHABILITATIVE THERAPY & AUDIOLOGICAL SERVICES .
PRIVATE REHABILITATIVETHERAPY & AUDIOLOGICALSERVICES PROVIDER MANUALNOVEMBER 1, 2020South Carolina Department of Health and Human Services
PRIVATE REHABILITATIVE THERAPY &AUDIOLOGICAL SERVICES PROVIDERMANUALSOUTH CAROLINA DEPARTMENT OFHEALTH AND HUMAN SERVICESCONTENTS1. Program Overview .1 Program Description.12. Covered Populations .3 Eligibility/Special Populations . 33. Eligible Providers .4 Provider Qualifications . 44. Covered Services and Definitions . 95. Utilization Management. 19 Prior Authorization . 19 Other Service/Product Limitations . 206. Reporting/Documentation . 22 Clinical Records . 22 Medical Service Documentation . 24i
PRIVATE REHABILITATIVE THERAPY &AUDIOLOGICAL SERVICES PROVIDERMANUALSOUTH CAROLINA DEPARTMENT OFHEALTH AND HUMAN SERVICES1PROGRAM OVERVIEWPROGRAM DESCRIPTIONSpeech Language Pathology ServicesIn accordance with 42 CFR 440.110(c)(1), speech-language pathology services include diagnostic,screening, preventive or corrective services provided by or under the direction of a speech-languagepathologist, for which a patient is referred by a physician or other licensed practitioner of the healingarts within the scope of his or her practice under State law. It includes any necessary supplies andequipment. Speech-language pathology services mean evaluative tests and measures utilized in theprocess of providing speech-language pathology services and must represent standard practiceprocedures. Only standard assessments (i.e., curriculum-based assessments, portfolioassessments, criterion referenced assessments, developmental scales and language samplingprocedures) may be used. Tests or measures described as “teacher-made” or “informal” are notacceptable for purposes of Medicaid reimbursement. Specific services rendered: speech evaluation,individual speech therapy and group speech therapy (and group may consist of no more than sixchildren).Speech-language pathology services involve the evaluation and treatment of speech and languagedisorders for which medication or surgical treatments are not indicated.Services include preventing, evaluating and treating disorders of verbal and written language,articulation, voice, fluency, mastication, deglutition, cognition/communication, auditory and/or visualprocessing and memory, and interactive communication, as well as the use of augmentative andalternative communication systems (e.g., sign language, gesture systems, communication boards,electronic automated devices and mechanical devices) when appropriate.Audiological ServicesIn accordance with 42 CFR 440.110(c)(1), audiological services for individuals with hearingdisorders means diagnostic, screening, preventive or corrective services provided by or under thedirection of an audiologist for which a patient is referred by a physician or other licensed practitionerof the healing arts within the scope of his or her practice under state law. It includes any necessarysupplies, equipment and services related to hearing aid use. Audiological services involve testingand evaluation of hearing-impaired children less than 21 years of age who may or may not beimproved with medication or surgical treatment.1
PRIVATE REHABILITATIVE THERAPY &AUDIOLOGICAL SERVICES PROVIDERMANUALSOUTH CAROLINA DEPARTMENT OFHEALTH AND HUMAN SERVICESAudiological services include diagnostic, screening, preventive and/or corrective services providedto individuals with hearing disorders or for the purpose of determining the existence of a hearingdisorder by or under the direction of an audiologist. A physician or other licensed practitioner of thehealing arts (LPHA), within the scope of his or her practice under state law, must refer individuals toreceive these services. A referral occurs when the physician or other LPHA has asked anotherqualified health care provider (licensed audiologist) to recommend, evaluate or perform therapies,treatment or other clinical activities for the beneficiary.Physical Therapy ServicesIn accordance with 42 CFR 440.110(a), physical therapy means services prescribed by a physicianor other LPHA within the scope of his or her practice under state law and provided to a beneficiaryby or under the direction of a qualified physical therapist. It includes any necessary supplies andequipment. Physical therapy services involve evaluation and treatment to prevent, alleviate orcompensate for movement dysfunction and related functional problems for maximum reduction ofphysical or mental disability and restoration of a beneficiary to his/her best possible functional level.Specific services rendered: physical therapy evaluation and individual therapy.Physical therapy services involve the use of physical agents, mechanical means and other remedialtreatment to restore normal physical functioning following illness or injury.Occupational Therapy ServicesIn accordance with 42 CFR 440.110(b)(1), occupational therapy means services prescribed by aphysician or other LPHA within the scope of his or her practice under state law and provided to abeneficiary by or under the direction of a qualified occupational therapist. It includes any necessarysupplies and equipment. Occupational therapy services are channels to improve or restorefunctional abilities for maximum reduction of physical or mental disability and restoration of abeneficiary to his/her best possible functional level.Occupational therapy services are related to self-help skills, adaptive behavior, fine/gross motor,visual, sensory motor, postural and emotional development that have been limited by a physicalinjury, illness or other dysfunctional condition. Occupational therapy involves the use of purposefulactivity interventions and adaptations to enhance functional performance. Specific servicesrendered: occupational therapy evaluation, individual fabrication of orthotic, fabrication of thumb andfinger splints.NOTE: References to supporting documents and information are included throughout the manual.This information is found at the following locations: Provider Administrative and Billing Manual Forms Section 4 - Procedure Codes2
PRIVATE REHABILITATIVE THERAPY &AUDIOLOGICAL SERVICES PROVIDERMANUALSOUTH CAROLINA DEPARTMENT OFHEALTH AND HUMAN SERVICES2COVERED POPULATIONSELIGIBILITY/SPECIAL POPULATIONSBeneficiary RequirementsThe South Carolina Department of Health and Human Services (SCDHHS) provides Medicaidreimbursement for medically necessary services provided to Medicaid-eligible individuals. Thisincludes, but is not limited to, child individuals who have or are at risk of developing sensory,emotional, behavioral or social impairments, physical disabilities, medical conditions, intellectualdisabilities or related disabilities and developmental disabilities or delays, as well as individuals ofany age who are covered under the Head and Spinal Cord Injury Waivers (HASCI).In order to be eligible for private rehabilitative therapy and audiological services, an individual mustmeet one of the following: Be a Medicaid beneficiary under the age of 21 years whose need for services is identifiedthrough an early and periodic screening, diagnostic and treatment (EPSDT) examination Be a Medicaid beneficiary between 0 years and 65 years of age and covered under the HASCIWaiver Program Be a Medicaid beneficiary under the age of 21 years who has a current and valid individualizedtreatment plan (ITP) that identifies the need for rehabilitative therapy or audiology services,when appropriate Be a qualified Medicare beneficiary eligible for payment of the Medicare cost sharing forservices that are covered by Medicare without regard to whether the service is covered bySouth Carolina Medicaid Be a Medicaid beneficiary over the age of 21 years who is eligible to receive physical medicineand therapy — Age 21 years and over servicesNote: Reimbursement for these services will be consistent with the South Carolina State MedicaidPlan.3
PRIVATE REHABILITATIVE THERAPY &AUDIOLOGICAL SERVICES PROVIDERMANUALSOUTH CAROLINA DEPARTMENT OFHEALTH AND HUMAN SERVICES3ELIGIBLE PROVIDERSPROVIDER QUALIFICATIONSPrivate rehabilitative therapists and audiologists must meet all applicable Medicaid providerqualifications and state licensure regulations specified by the South Carolina Department of Labor,Licensing and Regulation (LLR). Medicaid reimbursement is available for private rehabilitativetherapy (e.g., speech-language pathology, physical therapy and occupational therapy) andaudiological services when provided by or under the direction of the qualified rehabilitativetherapy/audiology services provider to whom the beneficiary has been referred. A physician or otherLPHA acting within the scope of his or her practice under state law must make the referral.The following categories of private providers are eligible to enroll with SCDHHS to providerehabilitative therapy and audiology services to individuals with special needs: Speech-language pathologists, an independent or group practice Audiologists, an independent or group practice Speech and hearing clinics Physical therapists, an independent or group practice Occupational therapists, an independent or group practice Multi-therapy groups Ambulatory rehabilitation centers, defined as freestanding facilities that utilize a team ofspecialized rehabilitation personnel to provide integrated and multidisciplinary programs. Theseprograms are designed to improve the physical functioning of individuals with disabilities. Inorder to enroll with Medicaid as an ambulatory rehabilitation center, the facility must meet one ofthe following requirements:–Certified by the Commission on Accreditation of Rehabilitation Facilities (CARF). CARF is aprivate, not for profit organization that accredits rehabilitation facilities that meet establishedstandards of quality for services to individuals with disabilities. SCDHHS recognizes thosefacilities that have CARF accredited programs in outpatient medical rehabilitation and /orearly childhood development as ambulatory rehabilitation centers.–Certified by South Carolina Department of Health and Environmental Control (DHEC) as acertified outpatient rehabilitation facility (CORF). A CORF is a non-residential rehabilitation4
PRIVATE REHABILITATIVE THERAPY &AUDIOLOGICAL SERVICES PROVIDERMANUALSOUTH CAROLINA DEPARTMENT OFHEALTH AND HUMAN SERVICESfacility that is operated exclusively for the purpose of providing diagnostic, therapeutic andrestorative services for the rehabilitation of injured, disabled or sick persons at a single fixedlocation by or under the supervision of a physician (42 CFR 485.51).–Developmental evaluation centers, defined as independent freestanding facilities that furnisha comprehensive array of developmental pediatric services. Emphasis within this facility isplaced on neurodevelopment assessment and psychological evaluation provided to childrenunder the age of 21 years who have developmental delays and have been referred by aphysician or other LPHA.Supervisor/Under the Direction ofIn accordance with the Centers for Medicare and Medicaid Services (CMS) directives, CMS hasinterpreted “under the direction of” to mean that the provider is individually involved with the patientand accepts ultimate legal responsibility for the services rendered by the individuals that he or sheagrees to direct. The supervisor is responsible for all of the services provided or omitted by theindividual that he or she agrees to directly supervise.The supervisor must be readily available to offer continuing supervision. “Readily available” meansthat the supervisor must be physically accessible to the individual being supervised within a certainresponse time, based upon the medical history and condition of the beneficiary and competency ofpersonnel. Supervision should involve specific instructions to the individual regarding the treatmentregimen, responses to signs of adverse reactions from the beneficiary and communication of anyother information or provision necessary to ensure that the appropriate treatment is being rendered.All clinical service notes made by staff who require supervision must be co-signed by the supervisor(unless otherwise indicated for a specific Medicaid-reimbursable service).The individual being supervised may not perform tasks when the supervisor cannot be reachedthrough personal contact, phone, pager or other immediate means. The supervisor must makeprovisions in writing for emergency situations, including designation of another qualified providerwho has agreed to be available on an as-needed basis to provide supervision and consultation tothe individual when the supervisor is not available.All supervisory staff licensed by LLR must adhere to any provisions as required by LLR.In addition to the above requirements, South Carolina Medicaid requires a supervising entity(physician, dentist or any program that has a supervising health professional component) to bephysically located in South Carolina or within the 25-mile radius of the South Carolina border.Program Staff — Speech Language Pathology ServicesSpeech-language pathology services are provided by or under the direction of a licensedspeech-language pathologist. These individuals are licensed through LLR as speech-languagepathologists, speech-language pathology assistants or speech-language pathology interns. Theselicensed individuals will need to adhere to any provisions as required by LLR. The licensed5
PRIVATE REHABILITATIVE THERAPY &AUDIOLOGICAL SERVICES PROVIDERMANUALSOUTH CAROLINA DEPARTMENT OFHEALTH AND HUMAN SERVICESspeech-language pathologist can supervise the licensed speech-language pathology intern andspeech-language pathology assistant.A speech-language pathologist in accordance with 42 CFR 440.110(c)(2)(i)(ii)(iii) is an individualwho meets one of the following conditions: (i) Has a certificate of Clinical Competence from theAmerican Speech and Hearing Association. (ii) Has completed the necessary equivalenteducational requirements and work experience to qualify for the certificate. (iii) Has completed theacademic program and is acquiring supervised work experience to qualify for the certificate.A speech-language pathology assistant is an individual currently licensed by the South CarolinaBoard of Examiners in speech-language pathology. A licensed speech-language pathologyassistant works under the direction of a qualified speech-language pathologist, pursuant to42 CFR 440.110(c)(2)(i) and (ii).A speech-language pathology intern is an individual who is currently licensed in speech-languagepathology by the South Carolina Board of Examiners and is seeking the academic and workexperience requirements established by the American Speech and Hearing Association for theCertification of Clinical Competence in Speech-Language Pathology. A speech-language pathologyintern works under the direction of a qualified speech-language pathologist, pursuant to42 CFR 440.110(c)(2)(i) and (ii).Program Staff — Audiological ServicesThe following requirements are cited from Section 440.110(c)(3) of the Code of FederalRegulations:Audiological services are services for individuals with speech, hearing and language disorders.Services for individuals with speech, hearing and language disorders means diagnostic, screening,preventive or corrective services provided by or under the direction of a speech pathologist oraudiologist for which a patient is referred by a physician or LPHA within the scope of his or herpractice under state law. It includes any necessary supplies and equipment.A “qualified audiologist” means an individual with a masters or doctoral degree in audiology thatmaintains documentation to demonstrate that he or she meets one of the following conditions: The state in which the individual furnishes audiology services meets or exceeds state licensurerequirements in paragraph (c)(3)(ii)(A) or paragraph (c)(3)(ii)(B) of this section, and theindividual is licensed by the state as an audiologist to furnish audiology services. In the case of an individual who furnishes audiology services in a state that does not licenseaudiologists, or an individual exempted from state licensure based on practice in a specificinstitution or setting, the individual must meet one of the following conditions:6
PRIVATE REHABILITATIVE THERAPY &AUDIOLOGICAL SERVICES PROVIDERMANUALSOUTH CAROLINA DEPARTMENT OFHEALTH AND HUMAN SERVICES–Have a Certificate of Clinical Competence in Audiology granted by the AmericanSpeech-Language-Hearing Association–Have successfully completed a minimum of 350 clock-hours of supervised clinical practicum(or is in the process of accumulating that supervised clinical experience under thesupervision of a qualified master- or doctoral-level audiologist); performed at leastnine months of full-time audiology services under the supervision of a qualified masteror doctoral-level audiologist after obtaining a masters or doctoral degree in audiology or arelated field and successfully completed a national examination in audiology approved by theSecretaryProgram Staff — Physical Therapy ServicesPhysical therapy services are provided by or under the direction of a physical therapist.Physical TherapistsA physical therapist is a person licensed to practice physical therapy by the South Carolina Board ofPhysical Therapy Examiners. In accordance with 42 CFR 440.110(a)(2)(i)(ii), a qualified physicaltherapist is an individual who is (i) a graduate of a program of physical therapy approved by both theCommittee on Allied Health Education and Accreditation of the American Medical Association andthe American Physical Therapy Association or its equivalent; and (ii) where applicable, licensed bythe state.Physical Therapy AssistantsA physical therapist Assistant is a person who is licensed by the board to assist a physical therapistin the practice of physical therapy and whose activities are supervised and directed by a licensedphysical therapist.Supervision of Physical Therapy AssistantsPhysical therapy assistants shall perform their duties in accordance with applicable licensurerequirements only after examination and evaluation of the child and development of a treatmentplan have been completed by a licensed physical therapist. Additionally, the supervising therapistmust review and initial each summary of progress completed by the assistant. These licensedindividuals must adhere to any provisions as required by LLR.Program Staff — Occupational therapyOnly occupational therapists or occupational therapy assistants provide occupational therapyservices.Occupational TherapistsAn occupational therapist (OT) is a person
1 PROGRAM OVERVIEW PROGRAM DESCRIPTION Speech Language Pathology Services In accordance with 42 CFR 440.110(c)(1), speech-language pathology services include diagnostic, screening, preventive or corrective services provided by or under the direction of a speech-language
All newborns, infants, children and young people have access to the audiological services they require in a timely fashion, with clearly defined referral pathways to audiological services that are widely disseminated and reviewed regularly. Correct referral information results i
Occupational Therapy Occupational Therapy Information 29 Occupational Therapy Programs 30 Occupational Therapy Articulation Agreements 31 Occupational Therapy Prerequisites 33 Physical Therapy Physical Therapy Information 35 Physical Therapy Programs and Prerequisites 36 Physical Therapy Articulation Agreements 37 Physical Therapy vs .
This document gives guidance on the early audiological assessment and management of babies referred from the newborn hearing screen. The term “early” is used to denote the period between newborn screen referral to the time at which reliable behavioural assessment
in the history of family therapy. They include Bowen Natural Systems Theory, contex-tual therapy, Virginia Satir’s Growth Model, brief therapy of the Mental Research Insti-tute, strategic family therapy, Milan Systemic Family Therapy, structural family therapy, solution-focused brief therapy, and narrative therapy.
Texas Medicaid MH Rehab and TCM services Agenda Eligibility for services MCO requirements Provider requirements . Review Mental Health Rehabilitative and Mental Health Targeted Case Management services effective Nov. 1, 2016. Utilize the current (Department of State Health Services) DSHS utilization management guidelines -Texas .
September 1, 2016 Attachment A Children's Treatment Services (CTS) Catalog Of Services Table of Contents Service Title Page # Therapeutic Services Assessment 2 Behavioral Health Services 4 Crisis Intervention 6 Family Therapy 7 Group Therapy 9 Individual Therapy 10 Speech Therapy 12 Testing 14 Vision Therapy 16 Service Title Page # Non .
Natural medicine Mistletoe- thymus-, pancreas peptide therapy Oxygen therapy, oxygen multistep-therapy according to Prof. von Ardenne, Ozone therapy and colozon-therapy for the intestine Deferring methods Colon irrigations, colon-hydro-therapy Hirudin treatment Phytotherapy Vitamin therapy Traditional Chinese medicine and
In recent years, there has been an increasing amount of literature on . A large and growing body of literature has investigated . In recent years, several studies have focused on
