Rehabilitation Therapy. The Contractor shall provide occupational, physical and speech therapies. Therapies must be prescribed by the member’s PCP or attending physician for an acute condition and the member must have the potential for improvement due to the rehabilitation. Occupational and Speech therapy is covered for all members receiving inpatient hospital (or nursing facility services). Occupational Therapy and Speech therapy services provided on an outpatient basis are only covered for members under the age of 21. Physical Therapy is covered for all members in both inpatient and outpatient settings. Outpatient physical therapy for members 21 years of age or older are subject to a 15 visit limit per contract year as described in the AMPM. Respiratory Therapy: Respiratory therapy is covered when prescribed by the member’s PCP or attending physician and is necessary to restore, maintain or improve respiratory functioning.
Rehabilitation Therapy. As discovered during other ongoing investigations conducted by the Department of Justice or OIG-HHS, for fraudulent claims to Medicare and Medicaid submitted by Debtors' Rehability subsidiary between 1996 and 1998, which were false in that they (1) were for services which were not medically necessary, and; (2) were for bad debts which were improperly claimed on cost reports filed by the Debtors' Rehability subsidiary from 1996 until 2000.
Rehabilitation Therapy. The Contractor shall provide occupational, physical and speech therapies. Therapies shall be prescribed by the member’s PCP or attending physician for an acute condition and the member shall have the potential for improvement due to the rehabilitation. Therapies provided under the home health benefit shall adhere to the requirements specified in AMPM Policy 310-X. Occupational Therapy (OT), is covered for all members in both inpatient and outpatient settings. Outpatient OT for acute care members 21 years of age or older are subject to visit limits per Contract year. Physical Therapy (PT) is covered for all members in both inpatient and outpatient settings. Outpatient PT for members 21 years of age or older is subject to visit limits per Contract year as. Speech therapy is covered for all members receiving inpatient hospital (or NF services). Speech therapy services provided on an outpatient basis are only covered for members under the age of 21. Respiratory Therapy: Respiratory therapy is covered when prescribed by the member’s PCP or attending Substance Abuse Transitional Facility: A class of health care institution that provides behavioral health services to an individual over 18 years of age who is intoxicated or may have a substance abuse problem (AAC R9-10-101).
