(1) The requirements and restrictions in this rule apply for purposes of coverage and reimbursement of therapy services under the Montana Medicaid program.

(2) Except as otherwise provided by these rules, therapy services must be provided by a therapist or assistant/aide within the scope of practice permitted by state law. The provider's records maintained under ARM 37.85.414 must demonstrate compliance with applicable supervision and protocol requirements.

(a) Services provided by an assistant/aide may only be billed by a supervising therapist.

(3) Therapy services may be provided to a member only upon a current written or verbal order or referral by a physician or mid-level practitioner. All verbal orders or referrals must be followed up by a written order received by the provider within 30 days of the verbal order or referral.

(a) The provider is not entitled to Medicaid reimbursement if services are provided prior to actual receipt of the written or verbal order or referral. Referral and orders are valid for Medicaid purposes for no more than 180 days.

(b) The provider must maintain the referral or order of the physician or mid-level practitioner and appropriate records that demonstrate compliance with Medicaid requirements. The provider must provide copies of these documents at no charge to the department or its agents upon request.

(4) Services that do not require the performance or supervision of a licensed therapist are not reasonable and necessary even if the services are performed by or under the supervision of a licensed therapist.

(5) Medicaid reimbursement for therapy service procedures includes all related supplies and items used in the performance of the service, except that the design, fabrication, fitting, and instruction by a licensed therapist in the use of splints, braces, and slings are reimbursable as provided in ARM 37.86.1801 through 37.86.1807

History: 53-2-201, 53-6-113, MCA; IMP, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA; NEW, 1996 MAR p. 1687, Eff. 6/21/96; AMD, 1998 MAR p. 676, Eff. 3/13/98; TRANS, from SRS, 2000 MAR p. 481; EMERG, AMD, 2003 MAR p. 999, Eff. 5/9/03; AMD, 2016 MAR p. 829, Eff. 5/7/16.