(a) The department
will pay a skilled nursing facility for providing skilled nursing described in
(b) of this section or structural rehabilitation services described in (c) of
this section if those services are
(1) needed
to treat an unstable condition;
(2)
ordered by and under the direction of a physician; and
(3) provided directly by or under supervision
of qualified technical or professional personnel who are authorized by state
law to provide that service and who are on the premises at the time service is
rendered; technical or professional personnel include a registered nurse, a
licensed practical nurse, a licensed physical therapist, a licensed physical
therapy assistant, a licensed occupational therapist, a certified occupational
therapy assistant, a licensed speech-language pathologist, a registered
speech-language pathologist assistant, and an audiologist.
(b) Skilled nursing services are the
observation, assessment, and treatment of a recipient's unstable condition
requiring the care of licensed nursing personnel to identify and evaluate the
recipient's need for possible modification of treatment, the initiation of
ordered medical procedures, or both, until the recipient's condition
stabilizes.
(c) Structural
rehabilitation services are the following services required by physician orders
and provided at least five days a week until the recipient's condition fails to
show continued improvement through objective evidence:
(1) ongoing assessment of structured
rehabilitation needs and potentials; services must be concurrent with the
management of a recipient care plan, including tests and measurements of range
of motion, strength, balance, coordination, endurance, functional ability,
activities of daily living, perceptual deficiencies, and speech, language, or
hearing disorders;
(2) therapeutic
exercises or activities that, because of the type of exercises employed or the
condition of the recipient, must be performed by or under the supervision of a
qualified physical therapist or occupational therapist, to ensure the safety of
the recipient and the effectiveness of the treatment;
(3) gait evaluation and treatment;
(4) range-of-motion exercises that are part
of the active treatment of a specific disease that has resulted in a loss of or
restriction of mobility;
(5)
maintenance occupational or physical therapy if specialized knowledge and
judgment of a qualified occupational or physical therapist are required to
design and establish a maintenance therapy program based on an initial
evaluation and periodic reassessment of the recipient's needs and consistent
with the recipient's capacity and tolerance;
(6) ultrasound, short-wave, and microwave
therapy treatments;
(7) hot pack,
infrared treatments, and paraffin baths in particular cases where the
recipient's condition is complicated by circulatory deficiencies, areas of
desensitization, open wounds, fractures, or other complications;
(8) services of a communications specialist,
a speech-language pathologist, or an audiologist if necessary for the
restoration of function in speech or hearing.