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(a) The division will enroll as a Medicaid provider of outpatient physical therapy services
(1) a physical therapist practicing independently who is licensed under AS 08.84; and
(2) an outpatient physical therapy center that is certified by the division under 42 C.F.R. 488.26 as in compliance with 42 C.F.R. 485.701 - 485.729.
(b) Reimbursement for physical therapy services is limited to
(1) evaluations;
(2) physical agents;
(3) massage and manipulation;
(4) therapeutic exercise;
(5) hydrotherapy; and
(6) other forms of treatment for rehabilitation and restoration of normal bodily functions following acute physical illness or acute physical trauma.
(c) Maintenance physical therapy services related to conditions caused by developmental disabilities or developmental delay to a recipient under age 21 will be reimbursed if the services prevent a condition from worsening or the development of an additional health problem.
(d) To be reimbursed by the division, all physical therapy services after the initial evaluation must be
(1) ordered by a physician, advanced nurse practitioner, or other licensed health care practitioner who may order those services as within the scope of the practitioner' s license;
(2) specified in a written treatment plan under (f) of this section;
(3) within the scope of practice of the physical therapist; and
(4) provided by or under the direction of a qualified physical therapist as provided in AS 08.84.
(e) Non-reimbursable physical therapy services are those that are for maintenance of bodily function, swimming therapy, physical fitness, habilitation, or weight loss.
(f) A written treatment plan that specifies the diagnosis, anticipated treatment goals, and the type, amount, frequency, and duration for each service must be established by the physical therapist. A treatment plan must be reviewed as often as the recipient's condition requires, or at least every 30 days for recipients age 21 or older, every six months for recipients under age three, and annually for recipients age three through 20. Changes to the treatment plan must be noted in the clinical record. The initial treatment plan and each review must be signed by the ordering health care practitioner. Before or at the time of initiating treatment, the physical therapist shall obtain
(1) the recipient's significant past medical history;
(2) diagnosis, if established, and the extent to which the recipient is aware of the diagnosis and prognosis;
(3) prescribing health care practitioners' orders, if any;
(4) rehabilitation goals and potential for achievement;
(5) contraindications, if any; and
(6) a summary of any prior treatment, if known.
(g) The division will reimburse in-state physical therapy services provided by an independent practice physical therapist or an outpatient physical therapy center in accordance with 7 AAC 43.040, except that the division will pay 85 percent of the rate identified in the fee schedule established under 7 AAC 43.108. The division will calculate maximum allowable rates for covered services by using the factors and formula described in 7 AAC 43.108. The division will reimburse an enrolled independent practice physical therapist, and an enrolled outpatient physical therapy center for the procedures identified in the Medicaid Procedures Guide dated January 1999. The January 1999 version of the Medicaid Procedures Guide is adopted by reference. The descriptions and billing codes for these procedures are provided in the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services's (CMS) Healthcare Common Procedure Coding System (HCPCS) 1998, as amended from time to time, and adopted by reference.
(h) The division will reimburse out-of-state physical therapy services at the lesser of the Medicaid rate in the state in which service is provided or billed charges. To be reimbursed by the division, an out-of-state independent physical therapist, outpatient physical therapy center, or a home health agency must
(1) either be or employ a licensed physical therapist to deliver physical therapy services in the state in which service is provided;
(2) be certified for Medicare participation;
(3) be enrolled in Medicaid in the state in which service is provided; and
(4) be enrolled as a Medicaid provider in this state.
History: Eff. 2/1/97, Register 141; am 6/26/98, Register 146; am 5/5/99, Register 150; am 7/11/2002, Register 163
Authority: AS 47.05.010
Editor's note: The reimbursement rates for physical therapy services calculated under this section and 7 AAC 43.108 appear in Table I-3 of the physical therapy section and Table I-4 of the physical/speech therapy section of the Alaska Medicaid Provider Billing Manual, which may be obtained by contacting the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Anchorage, Alaska 99503-7167.
The Medicaid Procedures Guide may be obtained by contacting the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Anchorage, Alaska 99503-7167.
The United States Department of Health and Human Services, Centers for Medicare and Medicaid Services's (CMS) Healthcare Common Procedure Coding System (HCPCS) may be obtained by contacting the Superintendent of Documents, United States Government Printing Office, Washington, D.C. 20402. A copy of the HCPCS is available for examination at the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Anchorage, Alaska 99503-7167.
On December 10, 1999, as required by AS 44.62.245 and AS 47.05.012 , the department gave notice that the following amended version of material, previously adopted by reference in 7 AAC 43.921, would be in effect on January 1, 2000: the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services's (CMS) Healthcare Common Procedure Coding System (HCPCS) 2000. The amended version may be be reviewed at the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Anchorage, Alaska, 99503-7167.
On February 1, 2001, as required by AS 44.62.245 and AS 47.05.012 , the department gave notice that the following amended version of material, previously adopted by reference in 7 AAC 43.921, would be in effect on February 5, 2001: the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services's (CMS) Healthcare Common Procedure Coding System (HCPCS) 2001. The amended version may be reviewed at the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Anchorage, Alaska, 99503-7167.
On January 4, 2003, as required by AS 44.62.245 and AS 47.05.012 , the department gave notice that the following amended version of material, previously adopted by reference in 7 AAC 43.921, would be in effect on January 1, 2003: the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services's (CMS) Healthcare Common Procedure Coding System (HCPCS) 2003. The amended version may be reviewed at the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Anchorage, Alaska, 99503-7167.
As of Register 165 (April 2003), the regulations attorney made a technical revision under AS 44.62.125 (b)(6) and AS 44.62.245 (d), to 7 AAC 43.921(g) , to set out the full title of the Healthcare Common Procedure Coding System (HCPCS), and to reflect a change in the name in the federal agency that issues the document, from the Healthcare Financing Administration (HCFA) to the Centers for Medicare and Medicaid Services (CMS).
On December 5, 2003, as required by AS 44.62.245 and AS 47.05.012 , the department gave notice that the following amended version of material, previously adopted by reference in 7 AAC 43.921, would be in effect on January 1, 2004: the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services's (CMS) Healthcare Common Procedure Coding System (HCPCS) 2004. The amended version may be reviewed at the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Anchorage Alaska, 99503-7167.
On December 1, 2004, as required by AS 44.62.245 and AS 47.05.012 , the department gave notice that the following amended version of material, previously adopted by reference in 7 AAC 43.921, would be in effect on January 1, 2005: the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services's (CMS) Healthcare Common Procedure Coding System (HCPCS) 2005. The amended version may be reviewed at the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Anchorage, Alaska 99503-7167.
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Last modified 7/05/2006