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December 2016 Texas Medicaid Provider Procedures Manual

Physical Therapy, Occupational Therapy, and Speech Therapy Services Handbook : 6 Adult Services : 6.2 Authorization Requirements for Outpatient and Home Health —PT, OT, and ST Services : 6.2.1 Initial Evaluation and Considerations for Prior Authorization for Treatment : 6.2.1.1 * Documentation

6.2.1.1
All of the following documentation is required when submitting an initial request for therapy services initiated after the completion of the evaluation:
A completed Texas Medicaid Physical, Occupational, or Speech Therapy (PT, OT, ST) Prior Authorization Form signed and dated by the therapist and signed and dated by the prescribing provider is required). When the request form is unsigned by the prescribing provider, it must be accompanied by a signed and dated written order, or prescription, or a documented verbal order delineating the prescribed therapy services.
Documentation of the acute or acute exacerbation of the medical condition requiring therapy. Evaluation and Treatment Plan or Plan of Care (POC) with all of the following required elements:
When a client also receives PPECC services, indicate if therapy services will be delivered in a PPECC setting, the amount, frequency, and duration of the therapy services to be delivered in a PPECC setting in contrast with other locations (e.g., the home)
Additional requirements for speech therapy include one or more of the following:
Language evaluations—oral-peripheral speech mechanism examination and formal or informal assessment of hearing, articulation, voice and fluency skills.
Oral Motor/Swallowing/Feeding—If swallowing problems and/or signs of aspiration are noted, then include a statement indicating that a referral for a video fluoroscopic swallow study has been made; formal screening of language skills, formal or informal assessment of hearing, voice and fluency skills.

Texas Medicaid & Healthcare Partnership
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