Missouri manual section 6.22
Occupational therapy
Official service name: Occupational Therapy
Occupational therapy can evaluate and address skills, positioning, adaptive-equipment use, and daily-function needs through a treatment plan, direct therapy, consultation, and training for caregivers or other people who support the person.
What the manual describes
What this service can help with
- Evaluating occupational-therapy needs and developing a treatment plan
- Direct therapy to improve or maintain daily functioning
- Using adaptive equipment, positioning, and therapeutic exercises
- Training and consultation for caregivers and other people who work with the person
- Therapeutic activities directed by an occupational therapist or appropriately supervised assistant
Source-backed working pathway
To establish you'll probably need:
These steps translate the cited manual section into a practical review sequence. Confirm the current local process before acting.
Describe the functional need and intended outcome.
Identify the daily activity, positioning, adaptive-equipment, self-care, or participation problem and connect it to a person-centered outcome.
Confirm the age and state-plan pathway.
Verify that the person is age 21 or older. For someone under 21, access medically necessary occupational therapy through the Healthy Children and Youth state-plan benefit rather than waiver occupational therapy.
Obtain a physician prescription and occupational-therapy evaluation.
Secure the physician's prescription and a certified occupational therapist's evaluation identifying the need, recommended approach, and treatment goals.
Identify a licensed and contracted provider.
Confirm the therapist or agency's Missouri occupational-therapy license and Department contract. If a certified assistant will participate, confirm the required occupational-therapist supervision.
Confirm authorization and the treatment plan.
Verify the authorized activities and units, the eight-unit daily maximum, caregiver-training needs, any virtual-delivery plan, progress-note expectations, and the schedule for at least annual reevaluation.
Important boundaries
Limits that may affect fit or authorization
- A physician prescription and an occupational-therapy evaluation are required.
- Waiver occupational therapy is available only for people age 21 and older. Services for people under 21 must first be accessed through the Medicaid state-plan Healthy Children and Youth benefit.
- The waiver service must be additional to, and cannot duplicate, Medicaid state-plan occupational therapy.
- A certified occupational therapy assistant may provide direct therapy only under the required occupational-therapist supervision.
- Virtual delivery must meet the additional requirements in Manual Section 7.
- The manual lists fifteen-minute units and a maximum of eight units per day.
- A written evaluation must be completed at least annually, and the prescription and evaluation must remain on file.
- Comprehensive and Community Support waivers remain under a temporary renewal extension through December 27, 2026, or until CMS grants final approval. Confirm the currently approved rules with the support coordinator; proposed renewal changes are not automatically active.
Do not assume this part
Questions to confirm locally
- Is the person age 21 or older?
- Has the Medicaid state-plan pathway been used or ruled out as applicable?
- Is the physician prescription current and on file?
- What need and treatment goals are documented in the occupational-therapy evaluation?
- Is the provider licensed, contracted, and able to provide the required supervision?
- Will any service be virtual, and which Section 7 requirements apply?
- How many units are authorized, and when is the annual reevaluation due?