• Therapy is not required to effect improvement or restoration of function where a patient/client suffers a transient or easily reversible loss of function (such as temporary weakness following surgery) which could reasonably be expected to improve spontaneously as the patient/client gradually resumes normal activities. Therapy in such cases is not considered reasonable and necessary to treat the patient’s/client’s illness or injury, under this condition. However, if the criteria for maintenance therapy is met, therapy could be covered under that condition. Initial therapy assessment requirements must be met. • For therapy only orders, the qualified therapist will perform the patient’s/client’s evaluation within 48 hours of the order or referral, and four days if skilled nursing establishes the initial contact with the patient/client. A qualified therapist (not an assistant) will assess the patient’s/client’s function using a method which objectively measures activities of daily living such as, but not limited to, eating, swallowing, bathing, dressing, toileting, walking, climbing stairs, using assistive devices, and mental and cognitive factors. The measurement results will be documented in the clinical record. • Where more than one discipline of therapy is being provided, a qualified therapist from each of the disciplines will functionally assess the patient/client. The therapist will document the measurement results which correspond to the therapist’s discipline and care plan goals in the clinical record. Reassessment at least every 30 days. Reassessment clock is not measured by episode but by the patient’s/client’s full course of treatment. • At least every 30 days, a qualified therapist (not an assistant) must provide the ordered therapy service and functionally reassess the patient/client using objective measurements to allow comparison to prior measurements. The therapist will document in the clinical record the measurement results along with the therapist’s determination of the effectiveness of therapy or lack thereof. The 30 day clock begins with the first therapy service (of that discipline) and the clock resets with each therapist’s visit/assessment/measurement/documentation (of that discipline). • Where more than one discipline of therapy is being provided, at least every 30 days, a qualified therapist from each of the disciplines must provide the ordered therapy service and functionally reassess the patient/client using objective measurements to allow comparison prior measurements. The therapist must document in the clinical record the measurement results along with the therapist’s determination of the effectiveness of therapy or lack thereof. In multi- discipline therapy cases, the qualified therapist would reassess functional items (and measure and document) those which correspond to the therapist’s discipline and care plan goals. In cases where more than one discipline of therapy is being provided, the 30 day clock begins with the first therapy service (of that discipline) and the clock resets with each therapist’s visit/assessment/measurement/documentation (of that discipline).
