1. (a) Therapy service described in He-W 568.05 above shall be documented, including:

   1. (1) The date of each therapy service provided;
   2. (2) The amount of time spent rendering each therapy service;
   3. (3) A description of the therapeutic modality used during the therapy service;
   4. (4) Measurable short-term and long-term goals;
   5. (5) Objectives of the therapy service provided;
   6. (6) Modalities to be utilized during the therapy service;
   7. (7) Frequency of therapy services prescribed;
   8. (8) An estimation of the duration of treatment;
   9. (9) Ongoing progress notes evaluating the recipient’s progress in relation to the established goals and estimated duration of treatment; and
   10. (10) An indication as to whether the services provided were for individual or group therapy.
2. (b) The provider shall maintain records to support claims submitted for reimbursement for a period of at least 6 years from the date of service, or until the resolution of any legal action(s) commenced in the 6-year period, whichever is longer.

Source. (See Revision Note at chapter heading He-W 500); ss by #4995, eff 11-30-90, EXPIRED: 11-30-96 New. #7909, eff 6-24-03; ss by #9929, INTERIM, eff 6-19-11, EXPIRES: 12-16-11; ss by #10042, eff 12-16-11; ss by #13355, eff 3-19-22