Frequently Asked Questions for Maintenance Therapy1 Can we admit some - PDF document

Frequently Asked Questions for Maintenance Therapy1. Can we admit someone directly to maintenance therapy?Yes, but there must be evidence that the services are reasonable and necessary that the specialized skills, knowledge, and judgment of a qualifiedtherapist are 6. What if I have a patient that I know will decline after my restorative plan is completed because they are not compliant with the education and training I have provided nor do they have a caregiver, and I have a planned discharged for the patient?Services are not covered or considered skilled maintenance therapy just because a competent, skilled caregiver is not available to furnish the services and so a therapist must performthem.This would not be a covered maintenance therapy benefit unless:1) the patient requires complex and sophisticated treatment techniques that must be performed by a therapist, 2) the patient has a complex medical condition requiring a therapist to provide the intervention because of the complexities of the medical condition,3) ongoing training /modification of caregivers or a home exercise program is required in order to maintain, prevent or slow patient decline.7. What is an appropriate frequency for maintenance therapy?Just as the policy guidance does notmandate frequencies fora restorative POC, there is nomandate for a maintenance POC. Your frequency will depend on the goals you have to maintain, prevent, or slow decline and the patient characteristics.And your documentation will support

the need for all visits. We always need to be mindful of why our particular skills/services are needed and demonstrate how(via an appropriate selection of objective tests) our interventions are effective at preventing/slowing decline.Simply stating a patient has not had any falls lately ist evidence of effectiveness 8. My patient needs assistance walking or with his exercise program because he will not do it when his therapist is not there. Without these consistent treatments, I know my patient will decline. Is this a covered service under the maintenance therapyplan of care?In the example given, there does not appear to beevidence of a skilled need that requires complexor sophisticated interventions orthat the patient suffers from a medically complex issue requiring a therapist(“criteria 3”) Under “criteria 2,” there does not appear to beevidence that the therapist is evaluating the need for HEP modificationor care plan oversight. Section 40.2 of the Medicare Benefit Policy Manual specifically states that, “services are not covered or considered skilled maintenance therapy just because a competent, skilled caregiver is not available to furnish the services and so a therapist performs them.”One principle to keep in mind is that Medicare doest cover therapy merely for motivational purposes.As you know, most human beings benefit from a buddyto improve their motivation to perform their exercise regimen. This is good and is a widely accepted pra

ctice to improve exercise consistency.However, most healthy human beings do not require the skills ofa physical therapist to be that buddy to motivate them, count their reps, or keep track of times.10. Can a PTA/COTAperform both criteria 2 and criteria 3 maintenance therapy? The 2020 final rule (494.44) states that a therapist assistant can performa safe and effective maintenance program to maintain function or to prevent or slow further deterioration of function. Criteria 2 specifically outlines a process involving the establishment of a maintenance program by a therapist in order to ensure goalsare achieved. This also will require periodic reevaluation of the maintenance program. These elements of criteria 2 should be performed by a PT or OT.If, afterdesigning or establishing a maintenance program, the qualified therapist must teach the patient or the patient's family or caregiver’s necessary techniques, exercises or precautions as necessaryto treat the illness or injury, the education and teaching may be performed by a PT, PTA, OT or OTA. It is the reevaluation component that must only be conducted by a PT/OT. Criteria 3 states that maintenance therapy can be provided when the complex skills of a qualified therapist and/or therapy assistant are needed to performmaintenance therapy. ThereforePTA/COTAs can perform maintenance therapy under criteria 3. This criteria includes sophisticated, complex treatment techniques that cannot be performed by a nonskilled caregiver.