AGENCY FOR HEALTH CARE ADMINISTRATION
MedicaidRULE NO: RULE TITLE
59G-4.320: Therapy ServicesNOTICE OF CHANGE
Notice is hereby given that the following changes have been made to the proposed rule in accordance with subparagraph 120.54(3)(d)1., F.S., published in Vol. 34, No. 25, June 20, 2008 issue of the Florida Administrative Weekly.
These changes are in response to written material received before and on the date of the final public hearing and comments made at the public hearing.
The rule incorporates by reference the Florida Medicaid Therapy Services Coverage and Limitations Handbook, July 2008. The following revisions were made to the handbook.
Page 1-2, Purpose and Definitions, Physical Therapy, Provider Qualifications and Enrollment. We added a third paragraph, which reads, “Pursuant to Section 486.021(11), F.S. The practice of physical therapy means the performance of physical therapy assessments and the treatment of any disability, injury, disease, or other health condition of human beings, or the prevention of such disability, injury, disease, or other condition of health, and rehabilitation as related thereto by the use of the physical, chemical, and other properties of air; electricity; exercise; massage; the performance of acupuncture only upon compliance with the criteria set forth by the Board of Medicine, when no penetration of the skin occurs; the use of radiant energy, including ultraviolet, visible, and infrared rays; ultrasound; water; the use of apparatus and equipment in the application of the foregoing or related thereto; the performance of tests of neuromuscular functions as an aid to the diagnosis or treatment of any human condition; or the performance of electromyography as an aid to the diagnosis of any human condition only upon compliance with the criteria set forth by the Board of Medicine. A physical therapist may implement a plan of treatment for a patient. The physical therapist shall refer the patient to or consult with a health care practitioner licensed under Chapter 458, Chapter 459, Chapter 460, Chapter 461, or Chapter 466, F.S., if the patient's condition is found to be outside the scope of physical therapy. If physical therapy treatment for a patient is required beyond 21 days for a condition not previously assessed by a practitioner of record, the physical therapist shall obtain a practitioner of record who will review and sign the plan. A health care practitioner licensed under Chapter 458, Chapter 459, Chapter 460, Chapter 461, or Chapter 466, F.S., and engaged in active practice is eligible to serve as a practitioner of record. The use of roentgen rays and radium for diagnostic and therapeutic purposes and the use of electricity for surgical purposes, including cauterization, are not authorized under the term “physical therapy” as used in this chapter. The practice of physical therapy as defined in this chapter does not authorize a physical therapy practitioner to practice chiropractic medicine as defined in Chapter 460, F.S., including specific spinal manipulation. For the performance of specific chiropractic spinal manipulation, a physical therapist shall refer the patient to a health care practitioner licensed under Chapter 460, F.S. Nothing in this subsection authorizes a physical therapist to implement a plan of treatment for a patient currently being treated in a facility licensed pursuant to Chapter 395, F.S.”
Previous page 1-2, now page 1-3, Purpose and Definitions, Occupational Therapy. We replaced the first paragraph with, “In accordance with Section 468.203, F.S., occupational therapy is the use of purposeful activity or interventions to achieve functional outcomes by maximizing the independence and maintenance of health of any individual who is limited by a physical injury or illness, a cognitive impairment, a psychosocial dysfunction, a mental illness, a developmental or a learning disability, or an adverse environmental condition. Occupational therapy addresses the developmental or functional needs of a child related to the performance of self-help skills; adaptive behavior; and sensory, motor and postural development.”
Previous page 1-2, now page 1-3, Purpose and Definitions, Speech-Language Pathology. We replaced the second paragraph with, “In accordance with Section 468.1125, F.S., services include the identification, evaluation and treatment, and prevention of disorders of verbal and written language, nonverbal or nonoral forms of language, articulation, voice, fluency, phonology, accent, mastication, deglutition, cognition, communication (including the pragmatics of verbal communication), auditory processing, visual processing, memory, comprehension and interactive communication as well as the use of instrumentation, techniques, and strategies to remediate and enhance the recipient’s communication needs, when appropriate. Services also include the evaluation and treatment of oral pharyngeal and laryngeal sensorimotor competencies.”
Previous page 1-3, now page 1-4, Purpose and Definitions, Respiratory Therapy. We revised the first paragraph to read, “In accordance with Section 468.352, F.S., respiratory therapy services include evaluation and treatment related to pulmonary dysfunction; diagnostic and therapeutic use of respiratory equipment, devices, or medical gas; and administration of drugs, as duly ordered or prescribed by a physician licensed under Chapter 458 or Chapter 459, F.S., and in accordance with protocols, policies, and procedures established by a hospital or other health care provider or the board.”
We revised the second paragraph to read, “Examples are ventilatory support; therapeutic and diagnostic use of medical gases; respiratory rehabilitation; management of life support systems and bronchopulmonary drainage; breathing exercises; chest physiotherapy; insertion and maintenance of artificial airways and intravascular catheters; and education of patients, families, the public, or other health care providers, including disease process and management programs and smoking prevention and cessation programs.”
Previous page 1-4, now page 1-5, Prepaid Therapies Program, Services Exempt from Authorization by the Prepaid Therapies Program. In the third bullet, we added “or private” before school. The bullet now reads, “Therapy services provided in a public or private school.”
Previous page 1-4, now page 1-5, Prepaid Therapies Program, Fee-for-Service Billing. We revised the section to read, “Recipients who are not eligible for the Prepaid Therapies Program receive therapy services through the Medicaid Therapy Program, which is described in this handbook. Services provided under the Medicaid Therapy Services program are reimbursed through fee-for-service billing.”
Previous page 1-6, now page 1-7, Provider Qualifications, Therapy Assistants. We revised the second sentence to read, “The physical therapist, occupational therapist, speech-language pathologist who supervises, or home health agency that employs the therapy assistant may be reimbursed for the therapy assistant’s visits.”
Previous page 1-8, now page 1-9, Provider Responsibilities, Solicitation. We added the following new first paragraph, “In accordance with Section 456.054(2), F.S., it is unlawful for any health care provider or any provider of health care services to offer, pay, solicit, or receive kickbacks, directly or indirectly, overtly or covertly, in cash or in kind, for referring or soliciting patients. Any violations by a provider shall be considered patient brokering and shall be punishable as provided in Section 817.505, F.S.” We added the following to the beginning of the first sentence of the second paragraph, “In accordance with Section 409.920(2)(e), F.S., it is unlawful to.”
Page 2-10, Therapy and Speech-Language Treatment Visits, Reimbursement Limitations. We revised the second paragraph to read, “The billing standard for therapy treatment is either one or two units-of-service. The units-of-service may be combined to form one 30-minute treatment visit or provided as two individual treatment visits.”
In addition, the following technical changes were made:
Table of Contents; Page 1-1; previous page 1-3, now page 1-4; and previous page 1-7, now page 1-8. The name “Prepaid Therapy Program” was changed to “Prepaid Therapies Program.”
Pages 1-2; previous page 1-5, now page 1-6; and pages 2-3, 2-4, 2-7, 2-10, 2-12, and 2-22. We corrected the fiscal agent’s Web Portal path to read, “Click on Public Information for Providers, Provider Support, and then click on Provider Handbooks.”
