Code of Massachusetts Regulations
105 CMR - DEPARTMENT OF PUBLIC HEALTH
Title 105 CMR 150.000 - Standards for Long-Term Care Facilities
Section 150.010 - Rehabilitation Services: Physical Therapy, Occupational Therapy, Speech, Hearing and Language Therapy (and Therapeutic Recreation in a SNCFC)
Universal Citation: 105 MA Code of Regs 105.150
Current through Register 1531, September 27, 2024
(A) Facilities providing Levels I, II or III care shall establish written policies and procedures governing the delivery of rehabilitation services.
(1) Facilities
providing Level I care, shall have an organized, continuous, rehabilitation
services program.
(2) Facilities
providing Level II care shall provide meaningful availability of rehabilitation
services beyond restorative and maintenance nursing care.
(3) Facilities providing Level III or IV care
should make arrangements for rehabilitation services when needed by
residents.
(4) A SNCFC shall have
an organized continuous, restorative nursing care program including
recreation/rehabilitation therapy.
(B)
(1)
Direct rehabilitation services shall be provided to residents only upon written
order of the resident's primary care provider who shall indicate anticipated
goals and frequency of treatments. Such treatment shall be initiated within
three days of the written order. In a SNCFC, direct rehabilitation services
shall be provided as indicated in the resident's care plan, which has been
approved and signed by the resident's primary care provider.
(2) The facility shall accept a patient for
outpatient rehabilitation services only on the order of a referring physician
who indicates diagnosis and anticipated goals, and who is responsible for the
general medical direction of such services as part of the total care of the
patient and for each patient there shall be a written plan of care approved by
the referring physician. The plan of care must specify the type, amount,
frequency and duration of services to be provided. The plan of care and results
of treatment shall be reviewed by the referring physician at least every 60
days or more often if required.
(C) All rehabilitation services shall be provided or supervised by licensed therapists.
(1) Rehabilitation services may be provided
either directly by therapists employed by the facility or through written
agreements with hospitals, institutions, clinics, agencies or independently
practicing therapists in accordance with the facility's policies and procedures
for rehabilitation services.
(2)
Rehabilitation services provided to residents shall be integrated with the
medical nursing, dietary, social, activity and other services to promote
restoration of the resident to his or her maximum potential, and reviewed in
conjunction with other periodic reviews of the resident's condition.
(a) In a SNCFC, the rehabilitation services
portion of the resident's care plan shall include a schedule for expected
developmental goals. These goals shall be reviewed on a quarterly basis and
amended as necessary.
(b) In a
SNCFC, the rehabilitation services staff shall participate, when appropriate,
in planning for continuing care of each resident after discharge. Appropriate
consultations shall be provided by rehabilitation services staff, when
indicated, to family members who will be involved in care of a resident after
discharge.
(D) Staff.
(1) Facilities providing Level I care shall
provide a physical therapist and an occupational therapist, each for a minimum
of eight hours per month for each unit for indirect services (such as
consultation). Speech, hearing and language therapists shall be provided as
needed.
(2) Facilities providing Level II
care shall provide a physical therapist and an occupational therapist, each for
a minimum of four hours per month for each unit for indirect services (such as
consultation). Speech, hearing and language therapists shall be provided as
needed.
(a) A SNCFC shall provide a
supervisor of physical therapy services, full time, who shall be a registered
physical therapist with a minimum of one year of experience or training in
pediatrics.
(b) A SNCFC shall
provide a physical therapist assistant or physical therapy aide on duty, on
each unit, during a 12 hour period that includes all meal times seven days a
week.
(c) A SNCFC shall provide a
supervisor of occupational therapy services, full time, who shall be a
registered occupational therapist with one year of experience or training in
pediatrics.
(d) A SNCFC shall
provide a titled occupational therapy assistant or occupational therapy aide,
on duty, on each unit, during a 12 hour period that includes all meal times,
seven days a week.
(e) A SNCFC
shall provide a speech therapist ten to 15 hours per week or as needed, who
shall be certified in speech pathology or in the combined areas of speech
pathology and audiology.
(3) In addition to indirect services,
therapists and supportive rehabilitation services personnel shall be provided
in sufficient numbers and with sufficient skills to provide direct services to
meet residents' needs. Supportive personnel shall be appropriately supervised.
In a SNCFC, there shall be an ongoing program of in-service education for all rehabilitation services staff to enable them to keep pace with advanced technology in the area of rehabilitation therapy and habilitative services. There shall be an appropriate orientation training program approved by the Department to enable aides and assistants to work with the residents in the unit.
(4) A SNCFC shall
provide a therapeutic recreation therapist, full time, who shall plan and
supervise therapeutic recreational services.
A SNCFC, in addition, shall provide a therapeutic recreation assistant and sufficient therapeutic recreation program staff during high activity periods and on weekends to implement recreational programs in accordance with resident needs.
(5) A facility providing rehabilitation
services to outpatients shall provide an adequate number of qualified
therapists and the equipment necessary to carry out its program and fulfill its
objectives.
(E) Records and Reports.
(1) Indirect services provided shall be
documented by a written summary available for inspection in the
facility.
(2) Direct services
records shall be filed in the resident's clinical record.
(F) A SNCFC shall provide furniture and special rehabilitation equipment as needed, sized and scaled appropriately for children's use.
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