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Virginia Medicaid Outpatient Therapy Definitions 

Acute Conditions - Conditions that are expected to be of brief duration (less than 12 months) and in which progress toward established goals is likely to occur frequently.

DMAS - The Department of Medical Assistance Services.

Evaluation - A thorough assessment completed by a licensed therapist that is signed and fully dated and includes the following components: a medical diagnosis, clinical signs and symptoms, medical history, current functional status, summary of previous rehabilitative treatment and the result, and the therapist's recommendation for treatment.

Nonacute Conditions- Means conditions that are of long duration (greater than 12 months) and in which progress toward established goals is likely to occur slowly.

Physical Rehabilitation Services - Any medical or remedial services, as defined in 42 CFR 440.130, recommended by a physician or other licensed practitioner of the healing arts, within the scope of his practice under state law, for maximum reduction of physical or mental disability and restoration of an eligible individual to his best possible functional level.

Plan of Care - A treatment plan developed by a licensed therapist, which shall include medical diagnosis; current functional status; individualized, measurable, participant-oriented goals (long-term and short-term goals) that describe the anticipated level of functional improvement; achievement timeframes for all goals; therapeutic interventions or treatments to be utilized by the therapist; frequency and duration of the therapies; and a discharge plan and anticipated discharge date.

Reevaluation - An assessment that contains all of the same components as an evaluation and that shall be completed when an individual has a significant change in his condition or when an individual is readmitted to a rehabilitative service.

SLP - Speech-language pathology.

Reference

12 VAC 30-50-200

About Us

Zachary Edgar JD, LLM is the managing partner for Therapy Comply.  Zachary is a healthcare attorney that specializes in federal and state healthcare regulatory issues particularly for physical, occupational, and speech therapy practices.  

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