Wisconsin Legislature: DHS 107.17(1)(i)

Alert! This chapter may be affected by an emergency rule:

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4. Posture and body integration; and

5. Sensorimotor integration;

1. Orientation;

2. Attention span;

3. Problem-solving;

4. Conceptualization; and

5. Integration of learning;

(d) Activities of daily living skills, as follows:

1. Self-care;

2. Work skills; and

3. Avocational skills;

(e) Social interpersonal skills, as follows:

1. Dyadic interaction skills; and

2. Group interaction skills;

(f) Psychological intrapersonal skills, as follows:

1. Self-identity and self-concept;

2. Coping skills; and

3. Independent living skills;

(g) Preventive skills, as follows:

1. Energy conservation;

2. Joint protection;

3. Edema control; and

4. Positioning;

(h) Therapeutic adaptions, as follows:

1. Orthotics/splinting;

2. Prosthetics;

3. Assistive/adaptive equipment; and

4. Environmental adaptations;

(i) Environmental planning; and

(j) Evaluations or re-evaluations. Covered evaluations, the results of which shall be set out in a written report attached to the test chart or form in the recipient’s medical record, are the following:

1. Motor skills:

a. Range-of-motion;

b. Gross muscle test;

c. Manual muscle test;

d. Coordination evaluation;

e. Nine hole peg test;

f. Purdue pegboard test;

g. Strength evaluation;

h. Head-trunk balance evaluation;

i. Standing balance — endurance;

j. Sitting balance — endurance;

k. Prosthetic check-out;

L. Hemiplegic evaluation;

m. Arthritis evaluation; and

n. Hand evaluation — strength and range-of-motion;

2. Sensory integrative skills:

a. Beery test of visual motor integration;

b. Southern California kinesthesia and tactile perception test;

c. A. Milloni-Comparetti developmental scale;

d. Gesell developmental scale;

e. Southern California perceptual motor test battery;

f. Marianne Frostig developmental test of visual perception;

g. Reflex testing;

h. Ayres space test;

i. Sensory evaluation;

j. Denver developmental test;

k. Perceptual motor evaluation; and

L. Visual field evaluation;

3. Cognitive skills:

a. Reality orientation assessment; and

b. Level of cognition evaluation;

4. Activities of daily living skills:

a. Bennet hand tool evaluation;

b. Crawford small parts dexterity test;

c. Avocational interest and skill battery;

d. Minnesota rate of manipulation; and

e. ADL evaluation \ men and women;

5. Social interpersonal skills — evaluation of response in group;

6. Psychological intrapersonal skills:

a. Subjective assessment of current emotional status;

b. Azima diagnostic battery; and

c. Goodenough draw-a-man test;

7. Therapeutic adaptions; and

8. Environmental planning — environmental evaluation.

(2) Services requiring prior authorization.

(a) Definition. In this subsection, “spell of illness” means a condition characterized by a demonstrated loss of functional ability to perform daily living skills, caused by a new disease, injury or medical condition or by an increase in the severity of a pre-existing medical condition. For a condition to be classified as a new spell of illness, the recipient must display the potential to reachieve the skill level that he or she had previously.

(b) Requirement. Prior authorization is required under this subsection for occupational therapy services provided to an MA recipient in excess of 35 treatment days per spell of illness, except that occupational therapy services provided to an MA recipient who is a hospital inpatient or who is receiving occupational therapy services provided by a home health agency are not subject to prior authorization under this subsection.

Note: Occupational therapy services provided by a home health agency are subject to prior authorization under s. DHS 107.11 (3).

(c) Conditions justifying spell of illness designation. The following conditions may justify designation of a new spell of illness:

1. An acute onset of a new disease, injury or condition such as:

a. Neuromuscular dysfunction, including stroke-hemiparesis, multiple sclerosis, Parkinson’s disease and diabetic neuropathy;

b. Musculoskeletal dysfunction, including fracture, amputation, strains and sprains, and complications associated with surgical procedures;

c. Problems and complications associated with physiologic dysfunction, including severe pain, vascular conditions, and cardio-pulmonary conditions; or

d. Psychological dysfunction, including thought disorders, organic conditions and affective disorders;

2. An exacerbation of a pre-existing condition including but not limited to the following, which requires occupational therapy intervention on an intensive basis:

a. Multiple sclerosis;

b. Rheumatoid arthritis;

c. Parkinson’s disease; or