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Respiratory Therapy

Provider Requirements and Service Limitations

From The July 2007 Florida Medicaid Provider Handbook

Respiratory Therapy- Requirements To Receive

Description

Respiratory therapy is a service prescribed by a physician and relates to
impairment of respiratory function and other deficiencies of the
cardiopulmonary system. Treatment activities include ventilator support,
therapeutic and diagnostic use of medical gases, respiratory rehabilitation,
management of life support systems, bronchopulmonary drainage, breathing
exercises and chest physiotherapy. The provider determines and monitors
the appropriate respiratory regimen and maintains sufficient supplies to
implement the regimen. The provider may also provide training to direct care
staff to ensure adequate and consistent care is provided. Respiratory therapy
services may also include a respiratory assessment.

Limitations

Respiratory therapy and assessment services are available through the
Medicaid Therapy Services Program state plan services for recipients under
the age of 21. Services for these recipients may not be purchased under the
waiver. Children receiving this service through a school health program are
still eligible for medically-necessary services funded by the Medicaid State
Plan. When additional therapy is necessary, families must seek the Medicaid
State Plan services for funding. The Medicaid Durable Medical Equipment
(DME) and Medical Supplies Program state plan services covers respiratory
equipment and supplies for adults and children. The waiver cannot reimburse
for respiratory supplies and equipment. A recipient shall receive no more than
eight units of this service per day. A unit is defined as a 15-minute time period
or portion thereof. Two assessments per year are allowed.
Note: Refer to the Florida Medicaid Therapy Services Coverage and
Limitations Handbook and the Florida Medicaid Durable Medical Equipment
and Medical Supply Services Coverage and Limitations Handbook for
additional information on Medicaid state plan coverage. The handbooks are
available on the Medicaid fiscal agent’s Web Portal at http://mymedicaidflorida.
com. Click on Public Information for Providers, then on Provider
Support, and then on Provider Handbooks. The Florida Medicaid Therapy
Services Coverage and Limitations Handbook is incorporated by reference in
rule 59G-4.320, F.A.C.; and the Florida Medicaid Durable Medical Equipment
and Medical Supply Services is incorporated by reference in rule 59G-4.070,
F.A.C.

Documentation Requirements
Reimbursement* and monitoring documentation to be maintained by the
provider:
1. *Copy of claim(s) submitted for payment;
2. *Service log;
3. *Monthly summary note;
4. Assessment report, if a claim is submitted for an assessment; and
5. Original prescription for service.
Documentation to be submitted to the waiver support coordinator by the
provider:
1. Copy of service log prior to or at time of claim submission;
2. Copy of monthly summary note;
3. Copy of assessment prior to or at time of claim submission; and
4. Copy of original prescription for service.
: *Indicates reimbursement documentation.
Place of Service This service is usually provided in the recipient’s place of residence.

Special Considerations
Respiratory therapy services shall be medically necessary and provided
under a physician’s prescription.

Respiratory Therapy Provider Requirements

Respiratory Therapy Provider Requirements

Provider Qualifications
Providers of respiratory therapy and assessment services shall be
respiratory therapists licensed in accordance with Chapter 468, Part V, F.S.
Respiratory therapists may be either independent vendors or an employee
of an agency.

Training Requirements
The provider is responsible for all training requirements outlined in the Core
Assurances.

Note: Refer to the Core Assurances in Appendix A for the provider training
requirements.