12.2 Required Documentation

Assessments for outpatient therapy services must be completed by a qualified, licensed professional, as defined in Appendix B: Post-Acute Rehabilitation Core Services – Modality and Staff Qualifications.
Before providing outpatient therapy services, the provider must recommend to the CRS program the specific type of service, frequency, and duration necessary for the participant to reach the outcomes noted in the treatment plan. The assessment and treatment plan can be contained in the same document, if all the essential elements of both are included.

The treatment plan must be developed with the participant or the participant’s family, guardian or representative and licensed professional before outpatient therapy services are provided. The treatment plan must contain clearly defined, measurable objectives and be sent by the provider to a CRS program staff member.

To justify continuing outpatient therapy services, the licensed professional must provide data at least monthly. The data provided must support the need to provide services to the participant. If the participant’s progress is inadequate or the participant regresses, additional documentation is necessary to revise the treatment plan and continue the outpatient therapy services. Providers must keep on file documentation showing that the services were preauthorized by the CRS program. The provider must respond to CRS program staff member inquiries pertaining to billing within two business days after receiving the request. The provider must submit documentation within five business days after receiving the request. See Chapter 4: General Provider Responsibilities for additional documentation requirements.