Beneficiary Non-Compliance

Beneficiary Non-Compliance Medicaid does not cover therapy services when documentation supports that the beneficiary: A. Has not reached therapy goals and is unable to participate and/or benefit from skilled intervention, B. Refuses to participate, or C. Is otherwise noncompliant with the therapy regimen. Medicaid defines noncompliance as failure to follow therapeutic recommendations which may include any or all of the following: 1. Failure to attend scheduled therapy sessions, which is defined by Medicaid as cancellation or ‘no show’ to three (3) consecutive therapy sessions and/or missing half or more of the scheduled visits without documentation of valid reasons such as personal illness/hospitalization or illness/death in the family, 2. Failure to perform home exercise program as instructed by the therapist, 3. Failure to fully participate in therapy sessions, 4. Failure of the parent/caregiver to attend therapy sessions with beneficiary who is incapable of carrying out the home program without assistance, 5. Failure to properly use special equipment or adaptive devices, or 6. Failure of parent/caregiver/beneficiary to otherwise comply with therapy regimen as documented in the medical record.