DDRS Waiver Manual

Service Standards
The following service standards apply to Occupational Therapy services:
Individual Occupational Therapy services must be reflected in the ISP regardless of the funding
source.
The need for such services must be documented by an appropriate assessment and authorized in the
ISP.
Documentation of this service being requested on Medicaid State Plan shall be included in the ISP.
Documentation Standards
Documentation standards for Occupational Therapy services include the following:
Documentation by appropriate assessment by a qualified therapist
Services provided both under the Medicaid State Plan and the waiver must be outlined in the ISP
Appropriate credentials for service provider
Attendance record, therapist logs, and/or chart detailing services provided, dates, and times
Documentation in compliance with 460 IAC 6 Supported Living Services and Supports requirements
As applicable, monthly/quarterly reports must be uploaded to Advocare by the chosen service provider on
or before the fifteenth day of the following month
Limitations
The following limitations apply to Occupational Therapy services:
One hour of billed therapy service must include a minimum of 45 minutes of direct patient
care/therapy with the balance of the hour spent in related patient services.
Activities Not Allowed
The following activities are not allowed under Occupational Therapy services:
Therapy services furnished to the participant within the educational/school setting or as a
component of the participant’s school day
Activities delivered in a nursing facility
Services that are available through the Medicaid State Plan (a Medicaid State Plan prior
authorization denial is required before reimbursement is available through the Medicaid waiver for
this service).
Section 10.19: Participant Assistance and Care (PAC) (currently under FSW only)
Service Definition
Participant Assistance and Care (PAC) services are provided in order to allow participants (consumers) with
intellectual/developmental disabilities to remain and live successfully in their own homes, function and
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