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Andrew M. Ball, MS, PT -> Re: Doctor's RX for School Therapy (July 27, 2000 11:39:00 PM)
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Excellent question JFR welcome to the forum,
I hate to give this kind of answer, because it always pisses me off when people say this to me . . . you'll have to check with you state board of physical therapy examiners for specifics in your state.
That said, when I practiced for United Cerebral Palsy and BOCES when in New York, this was the drill:
In the direct access state, MD's order was not required to treat, but if anything (e.g. orthotics, equipment, etc. was going to be billed to insurance or medicaid, then the whole sha-bang had to be docummented and authorized by an MD). That meant that in truth, authorization was required for everything, but not for legal reasons . . . rather for reimbursement reasons. Authorization requests were filled out by the evaluating therapist and forwarded by the director of rehab to the medical director for authorization.
Standard practice there therefore, was that examination and evaluation could be preformed by a PT prior to that authroization because the IFSP (e.g. part C) needs to be written 45 days from referral and the IEP (part B) within 90 days. After the eval is completed, then authorization was requested prior to Rx starting, and they lasted for 6 months upon which time they needed to be renewed, with new goals. If you didn't reach your goals, then IEP's were often accompanied by a note that let you know that goals must be accomplished next time, or don't expect re-authorization. That helped to keep goals functional and prevented kids getting PT on the basis of Dx alone, to keep PT that didn't help, for years and years and years.
As far as units are concerned, that's tricky. In North Carolina, for example, PT's being paid through Medicaid have the option to write frequency in terms of units (e.g. instead of twice a week, 52 units per 6 months). That allows a little flexability if the kid is doing particularly well one week, and crappy the next, but in truth, no PT has that kind of flexabilty in their schedule, so very few PT's actually write goals and treat that way . . . but they could if they wanted to. I'm not sure how NJ works, you'll have to ask your supervisor.
Drew
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