Overview
Under Chapter 118E of the Massachusetts General Laws, the Executive Office of Health and Human Services, through the Division of Medical Assistance, administers the state’s Medicaid program, known as MassHealth. MassHealth provides access to healthcare services for approximately 1.9 million low- and moderate-income children, families, seniors, and people with disabilities annually. In fiscal year 2018, MassHealth paid healthcare providers more than $15 billion, of which approximately 50% was funded by the Commonwealth. Medicaid expenditures represent approximately 39% of the Commonwealth’s total annual budget.
According to Section 432 of Title 130 of the Code of Massachusetts Regulations, MassHealth pays for physical therapy provided to eligible MassHealth members. Dr. Joseph O’Connor is a therapist and the owner of Advance Physical Therapy & Sports Rehabilitation (APTSR). He has been certified with MassHealth since 1991, and APTSR has been providing physical therapy since 1997. Dr. O’Connor received a total of $568,988 for therapy provided to MassHealth members during the audit period:
|
Calendar Year |
Number of Members Served |
Number of Claims |
MassHealth Payments |
|---|---|---|---|
|
2015 |
341 |
8,190 |
$140,942 |
|
2016 |
323 |
6,405 |
111,182 |
|
2017 |
307 |
8,100 |
136,040 |
|
2018 |
413 |
10,688 |
180,824 |
|
Total |
1,384* |
33,383 |
$568,988 |
* The total unduplicated number is 1,129.
Physical Therapy
The therapy provided by physical therapists to eligible MassHealth members includes diagnostic evaluation and therapeutic treatments. Physical therapy provides rehabilitation for patients suffering from physical pain in order to help restore functionality to the greatest extent possible. It includes the following:
- physical therapy evaluations for one member or in a group setting for multiple members
- application of modalities such as hot and cold packs
- therapeutic procedures to develop range of motion, flexibility, strength, and endurance
- gait training
- massage treatments
MassHealth pays for physical therapy only when there is complete documentation in the member’s medical record, and therapists are required to retain documentation for each member for four years after the last date of service. According to MassHealth regulations, the following must be documented in the member’s medical record:
- a licensed physician’s or licensed nurse practitioner’s written referral for evaluation, referral for treatment, and renewal of referral (if applicable) every 60 days
- a written comprehensive evaluation report
- the name, address, and telephone number of the member’s primary physician
- at least weekly documentation of the following:
- the date or dates when therapy was provided
- the specific therapeutic procedures and methods used
- the member’s response to treatment
- any changes in the member’s condition
- the problems encountered or changes in the treatment plan or goals, if any
- the location where the service was provided, if different from that in the evaluation report
- the amount of time spent in treatment
- the therapist’s signature
Physical therapy providers use this information to determine and update treatment plans for patients.
| Date published: | January 13, 2020 |
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