CHAPTER 1400 Adult Physical Therapy Services

CHAPTER 1400
SPECIFIC PROGRAM REQUIREMENTS
FOR
ADULT PHYSICIAL THERAPY SERVICES
SCOPE OF SERVICES
1401 General
Adult Physical Therapy Services cover evaluation and therapeutic services that are not otherwise covered by Medicaid State Plan services. These services address the physical therapy needs of the adult participant that result from his or her developmental disability. Adult Physical Therapy Services include physical therapy evaluation, participant/family education, and therapeutic exercises to develop sitting and standing balance, strength and endurance, and range of motion and flexibility. Adult Physical Therapy Services also consist of muscle strengthening and endurance to facilitate transfers from wheelchairs and the use of other equipment.
Adult Physical Therapy Services are provided by a Georgia licensed physical therapist and by order of a physician. These services may be provided in a participant’s own or family home, the Physical Therapist’s office, outpatient clinics, facilities in which Community Access or Prevocational Services are provided, Supported Employment work sites, or other community settings specific to community-based therapy goals specified in the Individual Service Plan. Adult Physical Therapy Services may not be provided to participants receiving Community Residential Alternative Services in the Comprehensive Supports Waiver.
1402 Special Requirements of Participation
1402.1 Individual Provider
In addition to those conditions of participation in the Medical Assistance Program as outlined in Part I, Policies and Procedures for Medicaid/PeachCare for Kids Manual applicable to all Medicaid providers, Section 106 (General Conditions of Participation), and PART II, Chapter 600 Policies and Procedures for the COMP Program, Adult Physical Therapy Services providers must meet the following requirements:
1. Service Provision: Adult Physical Therapy Services are
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provided by a Georgia licensed physical therapist and by order of a physician. Physician orders must be on letterhead or as a prescription from the physician and must indicate either the frequency of PT therapy services or a PT evaluation to determine the frequency of PT therapy services.
2. Documentation Requirement: Providers, except for providers of participant-directed services, must document the following in the record of each participant receiving Adult Physical Therapy Services:
i. Specific evaluation, training or therapeutic assistance provided;
ii. Date and the beginning and ending time when the service was provided;
iii. Location where the service was delivered;
iv. Verification of service delivery, including first and last name and title of the person providing the service and his or her signature;
v. Progress towards moving the participant towards independence by meeting the participant ISP, which includes person-centered goals, desired outcomes in the participant’s action plan, and the amount/type of assistance/support in the Current Service Summary and the Health and Safety sections of the ISP.
vi. Adult Physical Therapy providers maintain documentation for: the identified need of therapies, frequency and duration of therapy, interventions to be provided, and goals addressing therapies.
3. Participant-Directed Services Documentation and other Requirements: Documentation and other requirements for individual providers of participant-directed services are specified in Part II Policies and Procedures for COMP, Chapter 1200.
4. Adult Physical Therapy Services at Community Access and Prevocational Service Facilities: Providers can provide Adult Physical Therapy Services at facilities where Community Access and Prevocational Services are rendered; however, the services must be documented and billed separately, and any
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waiver participant receiving multiple waiver services may not receive these services at the same time of the same day.
1402.2 Provider Agencies
In addition to those conditions of participation in the Medical Assistance Program as outlined in Part I, Policies and Procedures for Medicaid/PeachCare for Kids Manual applicable to all Medicaid providers, Section 106 (General Conditions of Participation), and PART II, Chapter 600 Policies and Procedures for the COMP Program, Adult Physical Therapy Services provider agencies must meet the following requirements:
1. Service Provision: Adult Physical Therapy Services are provided by a Georgia licensed physical therapist and by order of a physician. Physician orders must be on letterhead or as a prescription from the physician and must indicate either the frequency of PT therapy services or a PT evaluation to determine the frequency of PT therapy services.
2. Types of Agencies: Agencies that provide Adult Physical Therapy Services are:
a. Accredited or Certified DD Service Agencies;
b. Home Health Agencies.
3. Staffing Qualifications and Responsibilities:
a. Accredited or Certified DD Service Agencies rendering Adult Physical Therapy Services must have staffing that meets the following requirements:
1) A designated agency director who must:
 Have either a bachelor’s degree in a human service field (such as social work, psychology, education, nursing, or closely related field) and five years of experience in service delivery to persons with developmental disabilities, with at least two of these years serving in a supervisory capacity; or
 Have an associate degree in nursing, education or a related field and six years of experience in service delivery to persons with developmental disabilities,
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with at least two of these years serving in a supervisory capacity; or
2) Duties of the Agency Director include, but are not limited to:
 Oversees the day-to-day operation of the agency;
 Manages the use of agency funds;
 Ensures the development and updating of required policies of the agency;
 Manages the employment of staff and professional contracts for the agency;
 Designates another agency staff member to oversee the agency, in his or her absence.
3) At least one agency employee or professional under contract with the agency must be a Developmental Disability Professional (DDP) (for definition, see Part II Policies and Procedures for COMP, Appendix I);
4) The same individual may serve as both the agency director and the Developmental Disability Professional;
5) Duties of the DDP include, but are not limited to:
 Overseeing the services and supports provided to participants;
 Supervising the formulation of the participant’s plan for delivery of Adult Physical Therapy Services;
 Conducting functional assessments; and
 Supervising high intensity services.
6) Provider agencies must have available a sufficient number of employees or professionals under contract that are Georgia licensed physical therapists to provide Adult Physical Therapy Services as specified in the Individual Service Plans of participants served.
5) Duties of the physical therapists include all covered services in Section 1406.
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b. Home Health Agencies rendering Adult Physical Therapy Services must have staffing that meets the conditions of participation in the Medical Assistance Program as outlined in PART II, Chapter 600 Policies and Procedures for Home Health Services.
4. Agency Policies and Procedures: Each provider agency must develop written policies and procedures to govern the operations of Adult Physical Therapy services, which follow the Standards for the Georgia Department of Behavioral Health and Developmental Disabilities refer to Part II Policies and Procedures for COMP.
5. Documentation Requirement: Providers, except for providers of participant-directed services, must document the following in the record of each participant receiving Adult Physical Therapy Services:
a. Specific evaluation, training or therapeutic assistance provided;
b. Date and the beginning and ending time when the service was provided;
c. Location where the service was delivered;
d. Verification of service delivery, including first and last name and title of the person providing the service and his or her signature;
e. Progress towards moving the participant towards independence by meeting the participant ISP, which includes person-centered goals, desired outcomes in the participant’s action plan, and the amount/type of assistance/support in the Current Service Summary and the Health and Safety sections of the ISP.
f. Adult Physical Therapy providers maintain documentation for: the identified need of therapies, frequency and duration of therapy, interventions to be provided, and goals addressing therapies.
6. Participant-Directed Services Documentation and other Requirements: Documentation and other requirements for providers of participant-directed services are specified in Part
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II Policies and Procedures for COMP, Chapter 1200.
7. Adult Physical Therapy Services at Community Access and Prevocational Service Facilities: Providers can provide Adult Physical Therapy Services at facilities where Community Access and Prevocational Services are rendered; however, the services must be documented and billed separately, and any waiver participant receiving multiple services may not receive these services at the same time of the same day.
8. DBHDD Contract/LOA and DBHDD Community Service Standards: Providers must adhere to DBHDD Contract/LOA, DBHDD Community Service Standards and all other applicable DBHDD Standards, including accreditation by a national organization (CARF, JCAHO, The Council, Council on Accreditation) or certification by the DBHDD (see Part II Policies and Procedures for COMP, Chapter 603).
1403 Licensure
A. Adult Physical Therapy Services are provided by a licensed Physical Therapist in accordance with the applicable Georgia license as required under OCGA Title 43-33-1.
B. Home Health Agencies providing Adult Physical Therapy services must have a Home Health Agency License (State of Georgia Rules and Regulations 290-5-38).
1404 Special Eligibility Conditions
A. Adult Physical Therapy Services are not available until the waiver participant’s 21st birthday.
B. The need for Adult Physical Therapy Services must be reflected in the Intake and Evaluation Team approved Individual Service Plan (ISP).
C. There is a reasonable expectation by the licensed physical therapist that the participant can achieve the goals in the necessary time frame.
D. All services must be ordered by a physician.
1405 Prior Approval
Adult Physical Therapy Services must be authorized prior to service
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delivery by the operating agency at least annually in conjunction with the Individual Service Plan development and with any ISP revisions. The need for Adult Physical Therapy must be an identifiable assessed need in the ISP and directly related to the disability.
1406 Covered Services
Reimbursable Adult Physical Therapy Services include the following based on the assessed need of the participant and as specified in the approved ISP:
1. Physical therapy evaluation.
2. Therapeutic procedures.
3. Therapeutic exercises to develop strength and endurance, and range of motion and flexibility.
4. Participant/family education.
5. Therapeutic exercise programs including muscle strengthening, neuromuscular facilitation, sitting and standing balance and endurance and increased range of motion
6. Muscle strengthening and endurance to facilitate transfers from wheelchairs and the use of other equipment.
1407 Non-Covered Services
1. Adult Physical Therapy Services do not include in-home therapeutic services for the treatment of an illness or injury that are covered in Home Health Services under the regular Medicaid State Plan.
2. Participants cannot receive Adult Physical Therapy Services if receiving Community Residential Alternative Services.
3. Adult Physical Therapy Services may not be provided at Community Residential Alternative Services sites.
4. Transportation to and from these services is not included in the rate.
5. Group Therapy Activities.
6. Not covered for conditions not related to DD diagnosis.
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7. Services that have not been ordered by a physician.
8. Services in a hospital.
9. Payment is not made for those goods and services covered by the State Medicaid Plan except where a participant’s need exceeds State Plan coverage limits and exceptions to the coverage limits are not available.
1408 Basis for Reimbursement
The reimbursement rates for Adult Physical Therapy Services are found in Appendix A.
The rate cannot exceed the established Medicaid rates for the Children Intervention Services Program.
A. Unit of service for PT evaluation is one (1) evaluation and for PT Therapeutic Practices is fifteen (15) minutes.
B. The annual maximum of units for PT Evaluation (97001 and 97001-UC) is one (1) unit.
C. The daily maximum number of units for PT Therapeutic Practices (97110 and 97110-UC) is four (4) units.
D. $1,800.00 annual maximum for all adult therapy waiver services (including PT, OT, and SLT).
1409 Participant-Direction Options
A. Participants can choose the self-direction option with Adult Physical Therapy Services.
B. An individual serving as a representative for a waiver participant in self-directed services is not eligible to be a participant-directed provider of Adult Physical Therapy Services.
C. For details on participant-direction, see Part II Policies and Procedures for COMP, Chapter 1200.
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