What is rehabilitative therapy?
Rehabilitative therapy includes services designed to address recovery or improvement in function and, when possible, restoration to a previous level of health and well-being. Therefore, evaluation, re-evaluation and assessment documented in the Progress Report should describe objective measurements which, when compared, show improvements in function, decrease in severity or rationalization for an optimistic outlook to justify continued treatment. Improvement is evidenced by successive objective measurements whenever possible (see objective measurement and other instruments for evaluation in the §220.3.C of the Medicare Benefit Policy Manual, Chapter 15). If an individual’s expected rehabilitation potential is insignificant in relation to the extent and duration of therapy services required to achieve such potential, rehabilitative therapy is not reasonable and necessary.
What is a member's residence?
member’s residence is wherever the member makes his/her home. This may be his/her own dwelling, an apartment, a relative’s home, home for the aged, or some other type of institution. Refer to the Medicare Benefit Policy Manual, Chapter 7,
What is maintenance program?
Maintenance program is a program established by a therapist that consists of activities and/or mechanisms that will assist a beneficiary in maximizing or maintaining the progress he or she has made during therapy or to prevent or slow further deterioration due to a disease or illness.
What are the services of a CORF?
When a CORF provides occupational therapy, speech-language pathology and/or respiratory therapy services in addition to the required physical therapy services, the physical therapy services shall represent the predominate rehabilitation service provided
What is occupational therapy?
Occupational Therapy: Services provided within the scope of practice of occupational therapists and necessary for the diagnosis and treatment of impairments, functional disabilities or changes in physical function and health status. Medicare
What are not payable services for Medicare?
Services that do not meet the requirements for covered therapy services in Medicare manuals are not payable using codes and descriptions as therapy services. For example, services related to activities for the general good and welfare of patients, e.g., general exercises to promote overall fitness and flexibility and activities to provide diversion or general motivation, do not constitute therapy services for Medicare purposes. Also, services not provided under a therapy plan of care, or provided by staff who are not qualified or appropriately supervised, are not payable therapy services.
What is habilitative care?
Habilitative services are Medically Necessary, Skilled Care services that are part of a prescribed treatment plan or maintenance program* to help a person with a disabling condition to keep, learn or improve skills and functioning for daily living. (Large group plans that include coverage for habilitative services do not include coverage for maintenance programs, or services to keep skills and functioning for daily living.)
Is a service that does not help the covered person to meet or maintain functional goals in a treatment plan within
A service that does not help the covered person to meet or maintain functional goals in a treatment plan within a prescribed time frame is not a habilitative service
What is behavioral health?
Behavioral health care includes mental health care with a focus on a person’s behaviors and habits as well as treatment for substance use.
What is the number to call for substance abuse?
Substance Use Helpline — 1-855-780-5955. If you feel that you or a loved one are experiencing signs of addiction, call the confidential helpline to get support, guidance on treatment options, help finding a network provider and answers to your questions.
What is the Sanvello app?
An on-demand emotional support mobile app called Sanvello® is available to anyone to help you cope with stress, anxiety and depression.
