5101:3-8-03 Covered occupational therapy services and limitations.

(A) Definitions.

Additional definitions are described in rule 5101:3-34- 01.1 of the Administrative Code.

(1) “Direct supervision” or “directly supervised” means that the occupational therapist must be present throughout the time the occupational therapy assistant is providing the service and immediately available to provide assistance and direction throughout the time the occupational therapy assistant is performing services.

(B) Medicaid eligible provider of occupational therapy services.

(1) Occupational therapy services described in this rule may be billed by occupational therapists in independent practice who are currently licensed under Chapter 4755. of the Revised Code, who are working within the scope of their practice as defined by state law and set forth in rule 5101:3-8-01 of the Administrative Code, and who have executed the standard Ohio medicaid provider agreement.

(2) Other independently practicing providers authorized to be reimbursed by the department for occupational therapy are described in Chapter 3-34 of the Administrative Code.

(3) Occupational therapy services provided in a school, hospital, or long term care facility must be billed by the school, hospital, or long term care facility in which the services were provided.

Medicaid coverage and limitations of occupational therapy services are described in Chapter 5101:3-34 of the Administrative Code.

(1) Modality guidelines.

(a) Supervised modalities must have direct (one-on-one) provider to consumer contact. The provider must be licensed to provide the modality and must be directly supervised by a medicaid-authorized prescriber or therapist.

(b) The following modalities are considered part of the associated therapy procedure or medical encounter and are not separately reimbursable:

(i) Electrical stimulation-unattended; and

(ii) Iontophoresis therapy.

(c) Certain modalities are considered part of an associated occupational therapy procedure or medical encounter and are not separately reimbursable.

(D) Provider claims, billing, payment, and reimbursement are addressed in Chapters 5101:3-1, 5101:3-2, and 5101:3-3 of the Administrative Code.

Effective: 01/01/2008

R.C. 119.032 review dates: 01/01/2013

Promulgated Under: 119.03

Statutory Authority: 5111.02

Rule Amplifies: 5111.01, 5111.02, 5111.021, 5111.029