Therapeutic Consultation

THERAPEUTIC CONSULTATION – A PRESCRIPTION IS NOT REQUIRED

Therapeutic consultation is designed to assist the individual’s staff and/or the individual’s family/caregiver, as appropriate, with assessments, plan design, and teaching for the purpose of assisting the individual enrolled in the waiver.

Types of training and skill practice: Range of motion (passive and active), splint or brace assistance, bed mobility, transfer, walking, dressing or grooming, eating or swallowing, amputation/prosthetic care, and communication.

The specialty areas provided by Making Strides are:

  • Physical Therapy
  • Occupational Therapy
  • Speech-Language Pathology

The need for any of these services shall be based on the Individual Support Plan and shall be provided to those individuals for whom specialized consultation is clinically necessary and who have additional challenges restricting their abilities to function in the community.

Therapeutic consultation services may be provided in individuals’ homes and in appropriate community settings (such as licensed or approved homes or day support programs) as long as they are intended to advance individuals’ desired outcomes as identified in their Individual Support Plans.

Therapeutic consultation service providers are reimbursed according to the amount and type of service authorized in the plan of care based on an hourly fee for service.

Applicable Waivers

  • Family and Individual – which includes supports for children and adults living with their families, friends, or in their own homes.
  • Community Living – which includes up to 24/7 residential services and additional supports for adults and children with exceptional medical and/or behavioral support needs.  This is the only waiver that provides the sponsored residential and group home residential services options.

Unit – 1 Hour Increments

Detailed information about the program can be found at:

https://thearcofva.org/resources-services/medicaid-waivers/edcd/

https://thearcofva.org/resources-services/the-new-dd-waiver-program-idd-waiver-redesign/

https://thearcofva.org/wp-content/uploads/2017/10/00Navigating-the-DD-Waivers-Oct-2017-final.pdf

Process:

  • Making Strides of Virginia provides environmental modification through the DD Waiver
    • Case Manager goes into WAMS and launches a blank Service Authorization (SA)
    • Case Manager contacts Making Strides to alert them that there is a SA open
      • Phone Number (804) 203-1991
    • SA is completed by therapist and sent back to case manager with request for hours need & required documents (treatment plan).
    • Case manager reviews the SA and sends for approval
    • Approval is seen in WAMS and service can be provided

Insurances Accepted: (Please check back frequently as we are continuously adding insurance companies)

  • United Healthcare (UHC)
  • Anthem
  • Cigna
  •  VA Community Care
        • Patient Centered Community Care (PCCC)
        • Veterans Choice Program (VCP)
  • CCC Plus Managed Care Program – Basic Concept of CCC Plus: CCC Plus is managed care, which means that instead of medical and other service providers contracting with Medicaid directly and billing Medicaid directly, each provider will have to go through one of six managed care organizations (MCOs) to enroll, get service authorization, and bill. These MCOs are usually for-profit insurance companies. The move toward managed care is part of a large and growing national trend to contain costs for Medicaid.
    • The 6 MCO’s administering the CCC Plus Waiver are:
      • United Healthcare
      • Anthem Health Keepers Plus
      • Optima Health (Pending in next month)
      • Magellan Complete Care of VA (Pending in next month)
      • AETNA Better Health of VA (Pending in next month)
      • Virginia Premier (OUT OF NETWORK)

Detailed information about the program can be found at: https://thearcofnova.org/content/uploads/sites/6/2018/08/Commonwealth-Coordinated-Care-Handout-8.7.18.pdf