Question: Is the lack reasonable expectation of significant improvement due to a condition that would qualify this patient for a Maintenance Plan of Care?
To answer this question, consider the following:
Is therapy medically-indicated?
Is the care necessary to prevent or delay deterioration of functional status due to a qualifying condition? Answering this question requires your clinical judgement, but qualifying conditions are conditions that are progressive and unstable in nature, leading to functional impairments that we do not expect to improve, or that have already improved as much as we reasonably expect through a recent course of Restorative Therapy. Conditions commonly seen under Maintenance Therapy include Parkinson’s Disease, Multiple Sclerosis or someone with Cancer undergoing an extended course of treatment.
Is the patient’s condition unstable, progressive, or complicated enough to require the skills of a clinician to provide safe and effective treatment?
Is the therapy reasonable and necessary?
The therapy must be appropriate for the patient’s condition and not excessive.
There should be a reasonable expectation of maintaining the patient’s functional ability and/or preventing further secondary complications that may place them at imminent risk of further decline, disability or hospitalization.
The treatment should align with accepted standards of practice. Remember, accepted standards of practice can be found by referencing relevant Clinical Practice Guidelines (CPGs) or the Guide to Physical Therapy.
Do the interventions require the Skills of a Clinician?
As with restorative therapy, maintenance therapy must require the skills of a licensed therapist.
The services must be necessary to prevent deterioration that could not be avoided without skilled care, due to the need for monitoring and frequent reassessment, or given the need for skilled facilitation or cuing for safe and effective performance of the exercise program.
If you can answer YES to ALL THREE of these conditions, choose the YES block below. If the answer to ANY of these conditions is NO, choose the NO block below.