Occupational Therapy

Provider Requirements and Service Limitations

From The July 2007 Florida Medicaid Provider Handbook

Occupational Therapy- Requirements To Receive


Occupational therapy services are services prescribed by a physician that are
necessary to produce specific functional outcomes in self-help, adaptive, and
sensory motor skill areas, and assist the recipient to control and maneuver within
the environment. The services also include an occupational therapy assessment,
which does not require a physician's prescription. In addition, this service
includes training direct care staff and caregivers and monitoring those individuals
to ensure they are carrying out therapy goals correctly.


Occupational therapy and assessment services are available through the
Medicaid Therapy Services Program state plan services to recipients under the
age of 21. Services for these recipients may not be purchased under the waiver.
Refer to the Florida Medicaid Therapy Services Coverage and Limitations
Handbook for additional information on Medicaid state plan coverage.
Children who receive this service through a school health program may still be
eligible for additional Medicaid state plan occupational therapy services.
A recipient shall receive no more than eight units of these services per day. A
unit is defined as a 15 minute time period or portion thereof. The occupational
therapy assessment is limited to one per year.

Note: The Florida Medicaid Therapy Services Coverage and Limitations
Handbook are available on the Medicaid fiscal agent’s Web Portal at
http://mymedicaid-florida.com. Click on Public Information for Providers, then on
Provider Support, and then on Provider Handbooks. The handbook is
incorporated by reference in 59G-4.320, F.A.C.

Documentation Requirements
Reimbursement* and monitoring documentation to be maintained by the provider:
1. *Copy of claim(s) submitted for payment;
2. *Copy of service log;
3. *Monthly summary note;
4. *Assessment report (if requesting reimbursement for assessment);
5. Annual report; and
6. The original prescription for the service.

Documentation to be submitted to the waiver support coordinator by the
1. Copy of the assessment report;
2. Copy of annual report prior to the annual support plan update;
3. Copy of original prescription for the service; and
4. Copy of service log, monthly.
*Indicates reimbursement documentation.

Place of Service

These services may be provided in the therapist's office, in the recipient’s
residence, or anywhere in the community.

Occupational Therapy Provider Requirements

Occupational Therapy Provider Requirements
Provider Qualifications Providers of occupational therapy and assessment services shall be
licensed as occupational therapists, occupational therapy aides, or
occupational therapy assistants, in accordance with Chapter 468, part III,
F.S. They may also provide and bill for the services of a licensed
occupational therapy assistant. The licensed occupational therapy assistant
is not qualified to perform occupational therapy assessments. Assessments
can only be performed by a licensed physical therapist.
Occupational therapists, aides and assistants may provide services as
independent vendors or an employee of an agency.
Occupational therapy aides and assistants must be supervised by an
occupational therapist in accordance with the requirements of their
professional licenses.

Training Requirements The provider is responsible for all training requirements outlined in the Core
Note: Refer to the Core Assurances in Appendix A for the provider training