Until 21 years old, Occupational Therapy (OT), Physical Therapy (PT), and Speech & Language Pathology (SLP) are provided as part of Medicaid acute care. OT, PT, and SLP are also covered on many private insurance plans.
CLASS can provide these therapies:
- At any age if the request is to support a request for an Adaptive Aid or Minor Home Modification.
- After a client is 21 years old, if the request is for ongoing therapy.
- After private insurance has been exhausted or denied the service (if applicable)
A current physician’s order for each therapy is required before the delivery of occupational therapy, physical therapy and speech and language pathology. Physician’s orders are not necessary for an evaluation only.
The following activities may be billed under the CLASS program if included in the individual’s authorized Individual Plan of Care:
- direct contact with the individual;
- time spent by a therapist to train the individual/legally authorized representative, primary caregiver or service provider in the proper use of an adaptive aid;
- time spent teaching a service provider to reinforce therapy goals during activities of daily living (ADL);
- time spent by a therapist to perform face-to-face evaluations to determine an individual’s need for skilled therapy service, adaptive aids or minor home modifications; and
- participation on the SPT may be billed as a professional service, only:
- when the individual has an identified need for the service, and
- for actual time spent in the capacity of the respective discipline.
The therapist must provide justification for time required to develop an assessment of the individual’s need for an adaptive aid or minor home modification. The justification should include time necessary to conduct the assessment and research regarding the most appropriate and cost-effective manner to meet the individual’s needs.