Medicaid Rehabilitative Therapy

Overview of Medicaid Rehabilitative Therapy

Rehabilitative Services are medical or remedial services that have been recommended by a Physician or other Licensed Practitioner of the Healing Arts (LPHA) within the scope of their practice under South Carolina State Law and as further determined by the South Carolina Department of Health and Human Services (SCDHHS) for maximum reduction of physical or mental disability and restoration of a beneficiary to their best possible functional level.

LEAs must adhere to the applicable IDEA requirements when Medicaid-reimbursed school-based services are included in the IEP or IFSP.

Medicaid reimbursement is available for school-based rehabilitative therapy services when provided by or under the direction of the qualified rehabilitative therapy provider for which the beneficiary has been referred. Referrals must be made by a physician or other licensed practitioner of the healing arts (LPHA) within the scope of his or her practice under state law.

Reimbursement is available for services that conform to accepted methods of diagnosis and treatment. Reimbursement is not available for services determined to be unproven, experimental or research-oriented, in excess of those deemed medically necessary to treat the beneficiary’s condition, or not directly related to the beneficiary’s diagnosis, symptoms or medical history. Reimbursement is not available for time spent documenting services or traveling to or from services, or for canceled visits and missed appointments.

Medicaid Rehabilitative Therapy

Overview of Medicaid Rehabilitative Therapy

Current Updates

Medicaid Therapy Services

Medicaid Therapy Documentation

Staff Qualifications

Medicaid Therapy Training

Current Updates

Click the link above for current information.

Medicaid Therapy Services

Speech-Language Therapy
Occupational Therapy
Physical Therapy

Medicaid Therapy Documentation

All providers shall maintain a clinical record for each Medicaid-eligible beneficiary that fully describes the extent of the treatment services provided.

The clinical record must contain documentation sufficient to justify Medicaid participation and should allow an individual not familiar with the beneficiary to evaluate the course of treatment.

Medicaid File must contain the following documents:

Student Medicaid Eligibility Form from DHHS - example
Medicaid General Consent
Annual Notification Letter
Referral Form - Who can refer for services?
Evaluation and other assessments
Treatment Plan (IEP, or IFSP) (when services are recommended)
Clinical Service Notes (CSN) (document services)
Progress Service Notes (summarize therapy services at least every 90 days)
Other documents relevant to the care and treatment of the student (Lab reports, medical reports, additional assessments, and court orders)
Staff Credentials (Staff SCLLR license and Office of Inspector General Report

Other forms and information:

Staff Qualifications

Staff must meet all applicable Medicaid provider qualifications, as well as the applicable state licensure regulations, in addition to any specified requirements by the South Carolina Department of Education for the provision of Medicaid school-based services. The contracted LEA is responsible for ensuring the individuals rendering Medicaid school-based services are approved, credentialed, or licensed.

All subcontracts (e.g., billing contracts, contracted providers, etc.) are subject to the terms of the LEA’s contracts with SCDHHS, and the LEA provider is held solely responsible for the performance of the subcontractor.

All supervisory staff licensed by Labor, Licensing and Regulation (LLR) must adhere to any provisions as required by LLR.

In addition