<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".07" citation="COMAR 10.14.02.07" title_num="10" subtitle_num="14" chapter_num="02" heading="Physical Therapy Services.">
  <paragraph num="A.">
    <text>To be considered a participating physical therapist in the Program, the provider shall:</text>
    <paragraph num="(1)">
      <text>Be a physical therapist licensed to practice physical therapy in Maryland or a jurisdiction bordering Maryland;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Agree to abide by the provisions set forth in this regulation by signing and sending to the Department the designated Departmental form;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Follow standard health and safety procedures to protect an eligible patient from potential hazards;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Agree to the medical and reporting requirements of the Program pursuant to Regulation .04A(5), (9), and (10) of this chapter;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Agree to accept, as payment in full, the amount paid by the Program pursuant to §E of this regulation plus the amount paid by the eligible patient’s health insurer, if applicable; and</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Agree not to bill an eligible patient an additional charge for the covered service.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>The Program shall reimburse a participating physical therapist for a medically necessary physical therapy service ordered in writing by a participating physician when the service is:</text>
    <paragraph num="(1)">
      <text>Provided by a physical therapist or by a physical therapist assistant under the direct supervision of a physical therapist;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Provided in a physical therapy office or the patient's home;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Considered one or more of the following:</text>
      <paragraph num="(a)">
        <text>Diagnostic;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Rehabilitative; or</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Therapeutic;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(4)">
      <text>Directly related to the written treatment order;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Of sufficient complexity and sophistication, or the condition of the patient is such that the service of a physical therapist is required;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Rendered pursuant to a written treatment order which:</text>
      <paragraph num="(a)">
        <text>Is signed and dated by the prescribing physician;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Specifies the following:</text>
        <paragraph num="(i)">
          <text>Body part to be treated;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Type of modality or treatment to be rendered;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Expected result of physical therapy treatment; and</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Frequency and duration of treatment;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(c)">
        <text>Is kept on file by the physical therapist as a part of the permanent patient record subject to review by the Department or its designee;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Is not altered by the physical therapist unless medically indicated, whereby the physical therapist shall make a necessary change and sign the treatment order, advising the prescribing physician of the change and noting it in the patient record;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(7)">
      <text>Recorded in the permanent record to include the following:</text>
      <paragraph num="(a)">
        <text>The treatment order;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The initial evaluation by the physical therapist;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Significant past history;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Pertinent diagnoses and prognoses;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Contraindications, if applicable; and</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Progress notes, at least once every 2 weeks;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(8)">
      <text>For a written treatment order for treatment exceeding 30 days and the participating physician:</text>
      <paragraph num="(a)">
        <text>Reviews and rewrites the order monthly; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Initials and dates a copy of the original order monthly; and</text>
      </paragraph>
    </paragraph>
    <paragraph num="(9)">
      <text>For an initial physical therapy evaluation, on a one-time basis, per condition, when the requirements of this regulation are met.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>The Program does not reimburse for services:</text>
    <paragraph num="(1)">
      <text>Performed by a physical therapy assistant when not under the direct supervision of the physical therapist;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Performed by a physical therapy aide; or</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Not directly related to the treatment of breast and cervical cancer.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>The participating physical therapist is responsible for the following:</text>
    <paragraph num="(1)">
      <text>Submitting to the Department, within 12 months of the date of service, a request for payment on the designated form;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Certifying on the invoice that the treatment order is on file and was in effect at the time that services were rendered; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Specifying on the invoice the type of treatment provided.</text>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>Reimbursement Principles.</text>
    <paragraph num="(1)">
      <text>The Department shall reimburse the participating physical therapist:</text>
      <paragraph num="(a)">
        <text>The current Medical Assistance approved rate in the State for a covered service performed in the provider’s office for an eligible patient who is uninsured or has insurance that does not provide coverage for the reimbursed procedure or service;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The outstanding deductible and patient contribution for a covered service performed in the provider’s office for an eligible patient who has Medicare or other insurance that provides reimbursement for a covered procedure or service; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>For covered services performed in the home of an eligible patient pursuant to Regulation .11F of this chapter.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>The Department may not reimburse the participating physical therapist for:</text>
      <paragraph num="(a)">
        <text>Services rendered by mail or telephone;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Completion of a form or report;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>A broken or missed appointment; or</text>
      </paragraph>
      <paragraph num="(d)">
        <text>A service which is provided at no charge to the general public.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="F.">
    <text>The participating physical therapist shall obtain recovery pursuant to Regulation .17 of this chapter.</text>
  </paragraph>
  <paragraph num="G.">
    <text>The Program shall reimburse for claims submitted pursuant to this regulation as set forth in Regulation .21 of this chapter.</text>
  </paragraph>
</regulation>