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    Maryland Register

    Issue Date:  April 13, 2018

    Volume 45 • Issue 8 • Pages 429—430


    Title 10


    10.09.17 Physical Therapy Services

    Authority: Health-General Article, §§2-104(b), 15-103, and 15-105, Annotated Code of Maryland

    Notice of Proposed Action


                    The Secretary of Health proposes to amend Regulations .01—.04 and .06 under COMAR 10.09.17 Physical Therapy Services.

    Statement of Purpose

    The purpose of this action is to include doctors of dental surgery or dental medicine, physician assistants and nurse practitioners as health professionals who may prescribe physical therapy services for adults.

    Comparison to Federal Standards

    There is a corresponding federal standard to this proposed action, but the proposed action is not more restrictive or stringent.

    Estimate of Economic Impact

    The proposed action has no economic impact.

    Economic Impact on Small Businesses

    The proposed action has minimal or no economic impact on small businesses.

    Impact on Individuals with Disabilities

    The proposed action has no impact on individuals with disabilities.

    Opportunity for Public Comment

    Comments may be sent to Michele Phinney, Director, Office of Regulation and Policy Coordination, Maryland Department of Health, 201 West Preston Street, Room 512, Baltimore, MD 21201, or call 410-767-6499 (TTY 800-735-2258), or email to mdh.regs@maryland.gov, or fax to 410-767-6483. Comments will be accepted through May 14, 2018. A public hearing has not been scheduled.

    .01 Definitions.

    A. (text unchanged)

    B. Terms Defined.

    (1)—(2) (text unchanged)

    (3) 'Initial evaluation' means the determination of the [recipient's] participant's condition by taking a case history and the administration of appropriate tests on the first visit. Treatment provided at this visit is considered to be part of the initial evaluation.

    (4) “Medical Assistance Program” means the program of comprehensive medical and other health related care for indigent and medically indigent [persons] individuals, jointly financed by the federal and state governments and administered by states under Title XIX of the Social Security Act, 42 U.S.C. §1396 et seq., as amended.

    [(5) 'Medical Care Programs' means the unit of the Department responsible for the administration of the Medical Assistance Program.]

    [(6)] (5) 'Medically necessary' means that the service or benefit is:

    (a)—(c) (text unchanged)

    (d) Not primarily for the convenience of the [consumer] participant, family, or provider.

    [(7)] (6) (text unchanged)

    (7) 'Participant' means an individual who is certified as eligible for, and is receiving, Medical Assistance benefits.

    (8)—(13) (text unchanged)

    (14) 'Prescriber' means a physician, [dentist,] doctor of dental surgery or of dental medicine, physician assistant, nurse practitioner, or podiatrist licensed to prescribe physical therapy.

    (15)—(16) (text unchanged)

    (17) 'Provider' means an individual, association, partnership, corporation, or unincorporated group licensed or similarly licensed or certified to provide health care services for [recipients] participants and who, through appropriate agreement with the Department, has been identified as a Program provider by the issuance of an individual account number.

    [(18) 'Recipient' means an individual who is certified as eligible for, and is receiving, Medical Assistance benefits.]

    [(19)] (18) 'Treatment order' means a written prescription for physical therapy signed by a physician, [dentist,] doctor of dental surgery or of dental medicine, physician assistant, nurse practitioner, or podiatrist.

    .02 Licensure and Certification Requirements.

    A. To provide services as a physical therapist under this chapter, a physical therapist shall be[:

    (1) Licensed] licensed by the State Board of Physical Therapy Examiners of Maryland to practice physical therapy, as defined in Health Occupations Article, Title 13, Annotated Code of Maryland, or by the appropriate licensing body in the jurisdiction where the physical therapy services are performed[; and

    (2) If providing services in a jurisdiction without licensure, shall be licensed, certified, or approved by the jurisdiction's appropriate credentialing agency or department].

    B. To provide services as a physical therapist assistant under this chapter, a physical therapist assistant shall[:

    (1) Be] be licensed by the State Board of Physical Therapy Examiners of Maryland to practice as a physical therapist assistant as defined:

    [(a)] (1) (text unchanged)

    [(b)] (2) By the appropriate licensing body in the jurisdiction where the physical therapy assistant services are performed[; or

    (2) If providing services in a jurisdiction without licensure, have graduated from an accredited curriculum for physical therapist assistants that is recognized and approved by the jurisdiction where the services are provided].

    .03 Conditions for Participation.

    To participate in the Program, the provider shall:

    A. Comply with the conditions for participation as set forth in COMAR 10.09.36; and

    B. Maintain the office and medical equipment so that they are free of hazards to the health and safety of [recipients] participants.

    .04 Covered Services.

    A. The Physical Therapy Program covers medically necessary physical therapy services ordered in writing by a physician, [dentist,] doctor of dental surgery or of dental medicine, physician assistant, nurse practitioner, or podiatrist when the services are:

    (1) Provided by a licensed physical therapist or by a licensed physical therapist assistant under a licensed physical therapist's direct supervision[.];

    (2) Provided in the provider's office, the patient's home, or a domiciliary level facility[.];

    (3) Diagnostic, rehabilitative, or therapeutic, and directly related to the written treatment order[.];

    (4) Of sufficient complexity and sophistication, or the condition of the patient is such, that the services of a physical therapist are required[.];

    (5) Rendered pursuant to a written treatment order which:

    (a) Is signed and dated by the [prescribing physician, dentist, or podiatrist] prescriber;

    (b) Specifies the following:

    (i) Part or parts to be treated; and

    [(ii) Type of modalities or treatments to be rendered;]

    [(iii)] (ii) (text unchanged)

    [(iv) Frequency and duration of treatment;]

    (c) Is kept on file by the therapist as a part of the patient's permanent record, subject to review by the Department or its designee; and

    (d) Is not altered [in type, amount, frequency, or duration] by the therapist unless [medically indicated. The physical therapist shall make necessary changes and sign the treatment order, advising the prescriber of the change and noting it in the patient's record.]:

    (i) Medically indicated;

    (ii) Signed by the therapist;

    (iii) Necessary changes are made;

    (iv) The prescriber is notified of the change; and

    (v) The change is noted in the patient's record; and

    (6) Recorded in the patient's permanent record which includes:

    (a)—(c) (text unchanged)

    (d) Contraindications, if any; and

    (e) Progress notes[, at least once every two weeks.] documented in accordance with the requirements listed in COMAR, C, and D.

    [(7) If pursuant to a written treatment order for treatment exceeding 30 days, reviewed monthly, thereafter, by the prescriber, in communication with the therapist and that order is either rewritten or a copy of the original order initialed and dated by the prescriber monthly.]

    B. (text unchanged)

    C. If the prescribing order exceeds 30 days, the therapist shall request a new order from the prescriber for continued therapy.

    .06 Payment Procedures.

    A.—G. (text unchanged)

    H. Payments on Medicare claims are authorized if:

    (1)(3) (text unchanged)

    (4) Services are covered by the Program; and

    (5) (text unchanged)

    I.K. (text unchanged)

    Secretary of Health