VNS Health MLTC: Rehabilitation Therapy

Rehabilitation services may be provided at outpatient locations, based on needs. These services include Physical Therapy (PT), Occupational Therapy (OT), and Speech Therapy (ST), which are rehabilitation services provided for the purpose of maximum reduction of physical or mental disability and restoration to best functional level.

Physical therapy focuses on strength, mobility, balance, and pain. Occupational therapy focuses on function and performing activities necessary for daily living, including the use of assistive devices. Speech therapy focuses on muscles that assist with breathing, talking, chewing, and swallowing, as well as cognitive processes (thinking).

Physical Therapy is limited to forty (40) visits per calendar year. Occupational therapy is limited to twenty (20) visits per calendar year. Speech therapy is limited to twenty (20) visits per calendar year.

If receiving benefits from both Medicare and Medicaid, PT, OT, or ST visits that are paid for as part of Medicare benefits, do not count as part of the limits described above. These Medicaid limits apply to rehabilitation therapy visits that are received in a private practitioner’s office, as well as visits received in a certified hospital outpatient department or a diagnostic and treatment center (free-standing clinic).

These service limits do not apply to visits that take place in a hospital inpatient setting, in a skilled nursing facility (SNF), or by a Medicare-certified home health agency (CHHA).

Additionally, these service limits do not apply if additional services are authorized by the health plan, in the presence of a traumatic brain injury, or if determined to be developmentally disabled by the appropriate authorities (such as an Office for the Developmentally Disabled).