Code of Massachusetts Regulations
130 CMR - DIVISION OF MEDICAL ASSISTANCE
Title 130 CMR 630.000 - Home- and Community-Based Services Waiver services
Section 630.434 - Occupational Therapy, Physical Therapy, and Speech Therapy
Universal Citation: 130 MA Code of Regs 130.630
Current through Register 1531, September 27, 2024
(A) Occupational Therapy .
(1)
Conditions of Payment . Occupational therapy is
covered when:
(a) authorized and included in
the participant's service plan;
(b)
appropriate and necessary for the participant to improve, develop, correct,
rehabilitate, or prevent the worsening of physical functions that have been
lost, impaired or reduced as a result of acute or chronic medical conditions,
congenital anomalies or injuries; or required to maintain or prevent the
worsening of function;
(c) the
participant's needs are of such a level of complexity and sophistication that
the judgment, knowledge, and skills of a licensed occupational therapist are
required;
(d) performed by a
licensed occupational therapist, or by a licensed occupational therapy
assistant under the supervision of a licensed occupational therapist;
and
(e) when the service is not
covered under 130 CMR 403.000: Home Health Agency, 130 CMR
432.000: Therapist Services, 130 CMR 430.600:
Rehabilitation Center Services, 130 CMR 435.000:
Chronic Disease and Rehabilitation Inpatient Hospital
Services, or 130 CMR 410.000: Outpatient Hospital
Services.
(2)
Nonpayable Services . Services that are not of direct
medical or remedial benefit to a participant are not covered by
MassHealth.
(B) Physical Therapy .
(1)
Conditions of
Payment . To be covered, physical therapy must
(a) be authorized and included in the
participant's service plan;
(b) be
appropriate and necessary for the participant to improve, develop, correct,
rehabilitate, or prevent the worsening of physical functions that have been
lost, impaired, or reduced as a result of acute or chronic medical conditions,
congenital anomalies, or injuries; or required to maintain or prevent the
worsening of function;
(c) the
participant's needs are of such a level of complexity and sophistication that
the judgment, knowledge, and skills of a licensed physical therapist are
required;
(d) be performed by a
licensed physical therapist, or by a licensed physical therapy assistant under
the supervision of a licensed physical therapist; and
(e) when the service is not covered under 130
CMR 403.000: Home Health Agency, 130 CMR 432.000:
Therapist Services, 130 CMR 430.600: Rehabilitation
Center Services, 130 CMR 435.000: Chronic Disease and
Rehabilitation Inpatient Hospital Services, or 130 CMR 410.000:
Outpatient Hospital Services.
(2)
Nonpayable
Services . Services that are not of direct medical or remedial
benefit to a participant are not covered by MassHealth.
(C) Speech Therapy .
(1)
Conditions of
Payment . Speech therapy is covered when:
(a) authorized and included in the
participant's service plan;
(b)
appropriate and necessary for the participant to improve, develop, correct,
rehabilitate, or prevent the worsening of physical functions that have been
lost, impaired, or reduced as a result of acute or chronic medical conditions,
congenital anomalies, or injuries; or required to maintain or prevent the
worsening of function;
(c) the
participant's needs are of such a level of complexity and sophistication that
the judgment, knowledge, and skills of a licensed speech/language therapist are
required;
(d) be performed by a
licensed speech/language therapist; and
(e) when the service is not covered under 130
CMR 403.000: Home Health Agency, 130 CMR 410.000:
Outpatient Hospital Services, 130 CMR 413.000: Speech
and Hearing Center Services, 130 CMR 430.600: Rehabilitation
Center Services, 130 CMR 432.000: Therapist Services,
or 130 CMR 435.000: Chronic Disease and Rehabilitation Inpatient
Hospital Services.
(2)
Nonpayable
Services . Services that are not of direct medical or remedial
benefit to a participant are not covered by MassHealth.
(D) Maintenance Program .
(1) The MassHealth
agency pays for the establishment of a maintenance program and for the training
of the participant, the participant's family, or other persons to carry it out,
as part of a regular treatment visit, not as a separate service.
(2) In certain instances, the specialized
knowledge and judgment of a licensed therapist may be required to perform
services that are part of a maintenance program, to ensure safety or
effectiveness that may otherwise be compromised due to the participant's
medical condition. At the time the decision is made that the services must be
performed by a licensed therapist, all information that supports the
appropriateness and necessity for performance of such services by a licensed
therapist, rather than a non-therapist, must be documented in the manner and
format designated by the MassHealth agency or its designee.
Disclaimer: These regulations may not be the most recent version. Massachusetts may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google
Privacy Policy and
Terms of Service apply.
