Prescribing Provider Orders/Responsibilities

Prescribing Provider Orders/Responsibilities E. Medicaid covers therapy services that are medically necessary, as certified by the prescribing provider. Medicaid defines prescribing provider as a state-licensed physician, nurse practitioner, or physician assistant who refers the beneficiary for therapy services. 13. The prescribing provider must complete a Certificate of Medical Necessity for Initial Referral/Orders form and submit it to the therapist prior to therapy evaluation. 3. Therapy services must be furnished according to a written plan of care (POC). The plan of care must be approved by the prescribing provider before treatment is begun. The review can be done in person, by telephone, or facsimile. An approved plan does not mean that the prescribing provider has signed the plan prior to implementation, only that he/she has agreed to it. The plan of care must be developed by a therapist in the discipline. A separate plan of care is required for each type of therapy ordered by the prescribing provider. 14. Medicaid requires the POC must, at a minimum, include the following: 1. Beneficiary demographic information, 2. Name of the prescribing provider, 3. Dates of service, 4. Diagnosis/symptomatology/conditions and related diagnosis codes, 5. Specific diagnostic and treatment procedures/modalities and related procedure codes, 6. Reason for referral, 7. Frequency of therapeutic encounters, 8. Duration of therapy, 9. Precautions, if applicable 10. Short and long term goals that are specific, measurable, and age appropriate, 11. Plan for the home program, 12. Discharge plan, and 13. Therapist’s signature, including the name and title, and date of the therapy session, 15. The plan of care (POC) must be developed to cover a period of treatment not to exceed six (6) months. The projected period of treatment must be indicated on the initial POC and must be updated with each subsequent revised POC. A POC for a projected period of treatment beyond six (6) months is not covered by Medicaid. 16. Medicaid requires a revised POC in the following situations: 1. The projected period of treatment is complete and additional services are required, or 2. A significant change in the beneficiary’s condition and the proposed treatment plan requires that: a) A therapy provider propose a revised POC to the prescribing provider, or b) The prescribing provider requests a revision to the POC. Information/documentation submitted to the UM/QIO indicates that the POC needs further review/revision by the therapist/prescribing provider at intervals different from the proposed treatment dates. 17. All therapy plans of care, initial and revised, must be authenticated, signed and dated, by the prescribing provider. The prescribing provider must sign the POC before initiation of treatment or within thirty (30) calendar days of the verbal order approving the treatment plan. This applies to both initial and revised plans of care. 18. Medicaid accepts the signature on the revised plan of care as a new order. 19. The prescribing provider may make changes to the plan established by the therapist, but the therapist cannot unilaterally alter the plan of care established by the prescribing provider. 20. Medicaid requires the prescribing provider to participate in the delivery of care by communicating with the treating therapist and by assessing the effectiveness of the prescribed care. It is mandatory that the prescribing provider has a face-to- face visit with the beneficiary at least every six (6) months and that the encounter is documented.