NORTHPOINTE BEHAVIORAL HEALTHCARE SYSTEMS
POLICY TITLE: Use of Occupational Therapy
MANUAL: Clinical
ORIGINAL EFFECTIVE DATE: 9/21/98
REVIEWED/REVISED ON DATE: 4/16/15
REVISIONS TO POLICY STATEMENT:
YES
NO
PAGE: 1 of 2
SECTION: Miscellaneous
BOARD APPROVAL DATE: 9/26/13
CURRENT EFFECTIVE DATE: 11/14/14
OTHER REVISIONS:
YES
NO
APPLIES TO:
This policy applies to an individual receiving services at Northpointe.
POLICY:
It is the policy of NBHS to assure clinically appropriate, timely and cost effective use of Occupational Therapy (OT)
services. The use of these services shall be determined based on individual need; the person centered planned process,
and medical necessity.
PURPOSE:
To assist in ensuring the appropriate use of occupational therapy resources.
PROCEDURES:
1.
Occupational therapy shall be provided by those professionals who have been granted privileges to do so,
through NBHS Credentialing and Privileging procedures. Occupational Therapy must be prescribed by a
physician, licensed physician assistant or family nurse practitioner.
2.
An Occupational therapy referral will be triggered if an individual has identified needs (or desired outcomes)
that meet one or more of the following criteria, all community services available to the individual have been
utilized, and the physician’s order form is completed indicating medical necessity:
a)
Individual has desire/potential/ability to develop new skills in areas of self-care, home management,
community living skills, play/leisure skills, and psychosocial skills.
b)
Is anticipating a move to a less restrictive level of service or living arrangement.
c)
Has experienced a recent decline (or at risk for decline) in level of function in areas of activities of
daily living, play/leisure because of physical, cognitive, or psycho-social deficits, particularly involving
a progressive degenerative condition.
d)
Is at risk for moving to more restrictive setting because of sensory-motor (ex: loss of mobility, or motor
skills to meet ADL needs), cognitive, or social skill deficits.
e)
Possesses a physical or sensory impairment requiring adaptive aids for ADLs or mobility (wheelchair)
or instruction on compensatory techniques to meet ADL, vocational, play/leisure, and mobility needs.
3.
Prior to a referral for a child, CM will obtain information required to complete the Children’s Sensory
Checklist for Occupational Therapy (cl.210). The form will assist in establishing medical necessity for a formal
referral and also in addressing areas of need for treatment planning. The form must be presented to the assigned
Occupational Therapist. OT Sensory Checklist directions are found in the “How To” folder.
4.
Evaluations and ongoing treatment require a physician’s order, must be addressed in the IPOS, Preliminary
IPOS or IPOS Amendment and receive authorizations.
Levels of O.T. care include the following:
a)
Informal consultation only without formal written OT evaluation and recommendations (may not
require a doctor’s order/referral). May have some form of documentation where needed and
appropriate. After consultation, OT may suggest a physician’s order for an OT evaluation.
b)
OT evaluation with recommendations only. Evaluation may be comprehensive or targeted to
specific area of function. Recommendations to be followed up on by others, to include amount,
frequency, length of face to face contacts in minutes and units, and duration of OT services as specified
in the IPOS documents and each authorization. A physician’s order with the ELMER Specialty
Discipline Referral Form routed to the supervisor.
NORTHPOINTE BEHAVIORAL HEALTHCARE SYSTEMS
POLICY TITLE: Use of Occupational Therapy
MANUAL: Clinical
ORIGINAL EFFECTIVE DATE: 9/21/98
REVIEWED/REVISED ON DATE: 4/16/15
PAGE: 2 of 2
SECTION: Miscellaneous
BOARD APPROVAL DATE: 9/26/13
CURRENT EFFECTIVE DATE: 11/14/14
c)
Evaluation with written guidelines, procedure, or treatment suggestions. This type of
programming does not require ongoing staff training or ongoing treatment monitoring in order to be
implemented effectively, but should be mentioned in the IPOS. A physician’s order with the ELMER
Specialty Discipline Referral Form routed to the supervisor.
d)
Evaluation with formal treatment goals and objectives. May include staff training and treatment
monitoring (at regular intervals ranging from monthly to annually). May also involve direct OT
services. Monitoring may be completed, when appropriate, by care manager, after training by OT. A
physician’s order with the ELMER Specialty Discipline Referral Form routed to the supervisor.
e)
Care manager will review Occupational Therapy Services Treatment Guidelines with parent/guardian
for proper education and implementation of expected involvement during the service. Parent/Guardian
will need to sign the guideline to indicate understanding and consent. Care Manager will provide the
parents with a copy of the signed guidelines. Commitment to the service guarantees efficiency and
effectiveness of OT and CLS services. Services may undergo adjustment or termination if required
involvement is not met.
5.
This service would be included in the individual’s IPOS (including Preliminary IPOS or IPOS Amendment),
specifying amount, frequency, length of face-to-face contacts (duration), scope and an authorization for each
service.
6.
A new referral for OT evaluation will be sought a minimum of 30 days prior to annual IPOS. Care
manager/support coordinator will review with the assigned occupational therapist the individual’s level of
progress, review of current needs and concerns, and if continuation of OT services is recommended. Care
manager/support coordinator will document in the case record that a review with the occupational therapist took
place, and the outcome of this review. Care manager/support coordinator will also document that all community
resources available to the individual for occupational therapy services have been utilized. If continued
occupational therapy services are justified the new specialty referral will be entered into ELMER, and sent to
their supervisor.
7.
The case will be reviewed annually by a physician to verify ongoing medical necessity.
8.
If a referral or request for continuing the service is denied by the physician, an Action Notice is given to the
individual.
CROSS REFERENCE:
Service Recipient Grievance and Appeal Policy & Procedure
NBHS Occupational Therapy Assessment Template
ELMER Specialty Discipline Referral Form
Occupational Therapy Services Treatment Guidelines (How To folder)
Use of OT Sensory Checklist (How To folder)
NBHS form Cl.210 Children’s Sensory Checklist for Occupational Therapy
Michigan Medicaid Manual, October 1, 2014