Does a doctor have to "prescribe" rehabilitation for an elder?


Q: How do I get rehabilitation for an elderly parent? Can I sign them up, or do I need a note from their doctor?

A: The answer to this question is a bit tricky due to state regulations and legal issues as well as health insurance and reimbursement issues.

If your dad is in need of occupational therapy or speech-language pathology services, a referral from a physician is required. Generally, occupational therapists and speech therapists are legally not allowed to perform an evaluation or provide treatment without a physician referral. Additionally, insurance companies will not pay for the services unless there is a referral.

If your dad is in need of physical therapy services, the regulations vary state-to-state. In most states, you are able to go directly to a physical therapist for an evaluation without a referral from a physician. Some states even allow you to proceed with treatment without a referral. However, from a health insurance and reimbursement standpoint, generally regardless of the state regulations and legal issues, a referral from a physician is needed for physical therapy evaluation and treatment in order to be reimbursed.

State regulations vary widely and change frequently, so I encourage you to ask the rehabilitation providers in your area the specific regulations and reimbursement policies so that you are covered appropriately. You may also want to review your dad's health insurance policies or call the insurance provider to make sure rehabilitation services are covered before beginning treatment. I also encourage you to speak with your dad's physician to ensure good communication about the services that would help him most as well as effective and efficient use of all the rehabilitation services available.

Melanie Sponholz is a Physical Therapist with a Board Certification in Geriatrics (GCS). Melanie is the Director of Quality Assurance and Professional Development at Fox Rehabilitation. She is an alumnus of Columbia University where she received a Master of Science Degree in Physical Therapy.

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