Sec. 10.14.02.14. Occupational Therapy Services

A. To be considered a participating occupational therapist in the Program, the provider shall:

(1) Be an occupational therapist licensed to practice occupational therapy in Maryland or a jurisdiction bordering Maryland;

(2) Agree to abide by the provisions set forth in this regulation by signing and sending to the Department the designated departmental form;

(3) Follow standard health and safety procedures to protect an eligible patient from potential hazards;

(4) Agree to requirements of the Program set forth in Regulation .04A(5), (9), and (10) of this chapter;

(5) Agree to accept as payment in full the amount paid by the Program under §E of this regulation, plus the amount paid by the eligible patient's health insurer, if applicable; and

(6) Agree not to bill an eligible patient an additional charge for the service.

B. The cost of an occupational therapist’s services are covered as set forth in COMAR 10.09.04.04B(4).

C. The Program does not reimburse for services:

(1) Performed by an occupational therapy assistant if not under the direct supervision of a licensed occupational therapist;

(2) Performed by an occupational therapy aide; or

(3) Not directly related to the treatment of breast or cervical cancer.

D. The participating occupational therapist is responsible for the following:

(1) Submitting to the Department, within 12 months of the date of service, a request for payment on the designated form;

(2) Certifying on the invoice that a treatment order is on file and was in effect at the time services were rendered; and

(3) Specifying on the invoice the type of treatment provided.

E. Reimbursement Principles.

(1) The Department shall reimburse the participating occupational therapist:

(a) For a covered service performed in the provider’s office the amount of:

(i) The current Medical Assistance approved rate for the State for an eligible patient who is uninsured or has insurance that does not provide coverage for the reimbursed procedure or service; or

(ii) The outstanding deductible and patient contribution for an eligible patient who is covered by Medicare or other insurance; and

(b) For covered services performed in the home of an eligible patient under Regulation .11F of this chapter.

(2) The Department may not reimburse the participating occupational therapist for:

(a) Services rendered by mail or telephone;

(b) Completion of a form or report;

(c) A broken or missed appointment; or

(d) A service which is provided at no charge to the general public.

F. The participating occupational therapist shall obtain recovery under Regulation .17 of this chapter.

G. The Program shall reimburse for claims submitted pursuant to this regulation as set forth in Regulation .21 of this chapter.