(1)
Extended skilled therapy for eligible recipients 21 years and
older: Extended skilled therapy for adults may include physical therapy,
occupational therapy or speech language therapy when skilled therapy services
under the medicaid state plan are exhausted or are not a covered benefit.
Eligible recipients 21 years and older in the mi via program access therapy
services under the state medicaid plan for acute and temporary conditions that
are expected to improve significantly in a reasonable and generally predictable
period of time. Therapy services provided to eligible recipients 21 years and
older in the mi via program focus on improving functional independence, health
maintenance, community integration, socialization, and exercise, or enhance
support and normalization of family relationships.
(a)
Physical therapy: Diagnosis
and management of movement dysfunction and the enhancement of physical and
functional abilities. Physical therapy addresses the restoration, maintenance
and promotion of optimal physical function, wellness and quality of life
related to movement and health. Physical therapy activities do the following:
(i) increase, maintain or reduce the loss of
functional skills;
(ii) treat a
specific condition clinically related to the eligible recipient's
disability;
(iii) support the
eligible recipient's health and safety needs; or
(iv) identify, implement, and train on
therapeutic strategies to support the eligible recipient and his or her family
or support staff consistent with the eligible recipient's SSP desired outcomes
and goals.
(b)
Occupational therapy: Diagnosis, assessment, and management of
functional limitations intended to assist the eligible recipient to regain,
maintain, develop, and build skills that are important for independence,
functioning, and health. Occupational therapy services typically include:
(i) customized treatment programs to improve
the eligible recipient's ability to perform daily activities;
(ii) comprehensive home and job site
evaluations with adaptation recommendations;
(iii) skills assessments and
treatment;
(iv) assistive
technology recommendations and usage training;
(v) guidance to family members and
caregivers;
(vi) increasing or
maintaining functional skills or reducing the loss of functional
skills;
(vii) treating specific
conditions clinically related to the eligible recipient's developmental
disability;
(viii) support for the
eligible recipient's health and safety needs; and
(ix) identifying, implementing, and training
therapeutic strategies to support the eligible recipient and his or her family
or support staff consistent with the eligible recipient's SSP desired outcomes
and goals.
(c)
Speech and language pathology: Diagnosis, counseling and
instruction related to the development and disorders of communication including
speech fluency, voice, verbal and written language, auditory comprehension,
cognition, swallowing dysfunction, oral pharyngeal or laryngeal, and sensor
motor competencies. Speech language pathology is also used when an eligible
recipient requires the use of an augmentative communication device. Based upon
therapy goals, services may be delivered in an integrated natural setting,
clinical setting or in a group. Services are intended to:
(i) improve or maintain the eligible
recipient's capacity for successful communication or to lessen the effects of
the loss of communication skills; or
(ii) improve or maintain the eligible
recipient's ability to eat foods, drink liquids, and manage oral secretions
with minimal risk of aspiration or other potential injuries or illness related
to swallowing disorders;
(iii)
provide consultation on usage and training for augmentative communication
devices;
(iv) identify, implement
and train therapeutic strategies to support the eligible recipient and his or
her family or support staff consistent with the eligible recipient's SSP
desired outcomes and goals.
(d)
Behavior support
consultation: Behavior support consultation services consist of
functional support assessments, positive behavior support plan that is part of
the eligible recipient's treatment plan development, and training and support
coordination for the eligible recipient's related to behaviors that compromise
the eligible recipient's quality of life. Based on the eligible recipient's
SSP, services are delivered in an integrated, natural setting, or in a clinical
setting. Behavior support consultation:
(i)
informs and guides the eligible recipient's service and support employees or
vendors toward understanding the contributing factors to the eligible
recipient's behavior;
(ii)
identifies support strategies to ameliorate contributing factors with the
intention of enhancing functional capacities, adding to the provider's
competency to predict, prevent and respond to interfering behavior and
potentially reducing interfering behavior(s);
(iii) supports effective implementation based
on a functional assessment and support plans;
(iv) collaborates with medical and ancillary
therapies to promote coherent and coordinated services addressing behavioral
issues, and to limit the need for psychotherapeutic medications; and
(v) monitors and adapts support strategies
based on the response of the eligible recipient and his or her service and
support providers in order for services to be provided in the least restrictive
manner; HSD does not allow the use of any restraints, restrictive
interventions, or seclusion to an eligible recipient.
(e)
Nutritional counseling:
Nutritional counseling services include assessment of the eligible recipient's
nutritional needs, development or revision of the eligible recipient's
nutritional plan, counseling and nutritional intervention and observation and
technical assistance related to implementation of the nutritional
plan.
(f)
Private duty
nursing for adults: Private duty nursing for eligible recipients 21
years or older includes activities, procedures, and treatment for the eligible
recipient's physical condition, physical illness or chronic disability.
Services include medication management, administration and teaching, aspiration
precautions, feeding tube management, gastrostomy and jejunostomy care, skin
care, weight management, urinary catheter management, bowel and bladder care,
wound care, health education, health screening, infection control,
environmental management for safety, nutrition management, oxygen management,
seizure management and precautions, anxiety reduction, staff supervision,
behavior and self-care assistance.
(2)
Specialized therapies:
Specialized therapies are non-experimental therapies or techniques that have
been proven effective for certain conditions. Experimental or investigational
procedures, technologies or therapies and those services covered as a medicaid
state plan benefit are excluded. Services in this category include the
following therapies:
(a)
Acupuncture: Acupuncture is a distinct system of primary health
care with the goal of prevention, cure, or correction of any disease, illness,
injury, pain or other physical or behavioral health condition by controlling
and regulating the flow and balance of energy, form and function to restore and
maintain physical health and increased mental clarity. Acupuncture may provide
effective pain control, decreased symptoms of stress, improved circulation and
a stronger immune system, as well as other benefits. See 16.2.1 NMAC.
(b)
Biofeedback: Biofeedback
uses visual, auditory or other monitors to provide eligible recipients with
physiological information of which they are normally unaware. This technique
enables an eligible recipient to learn how to change physiological,
psychological and behavioral responses for the purposes of improving emotional,
behavioral, and cognitive health performance. The use of biofeedback may assist
in strengthening or gaining conscious control over the above processes in order
to self-regulate. Biofeedback therapy is also useful for muscle re-education of
specific muscle groups or for treating pathological muscle abnormalities of
spasticity, incapacitating muscle spasm, or weakness.
(c)
Chiropractic: Chiropractic
care is designed to locate and remove interference with the transmissions or
expression of nerve forces in the human body by the correction of misalignments
or subluxations of the vertebral column and pelvis, for the purpose of
restoring and maintaining health for treatment of human disease primarily by,
but not limited to, adjustment and manipulation of the human structure.
Chiropractic therapy may positively affect neurological function, improve
certain reflexes and sensations, increase range of motion, and lead to improved
general health. See 16.4.1 NMAC.
(d)
Cognitive rehabilitation
therapy: Cognitive rehabilitation therapy services are designed to
improve cognitive functioning by reinforcing, strengthening, or reestablishing
previously learned patterns of behavior, or establishing new patterns of
cognitive activity or compensatory mechanisms for impaired neurological
systems. Treatments may be focused on improving a particular cognitive domain
such as attention, memory, language, or executive functions. Alternatively,
treatments may be skill-based, aimed at improving performance of activities of
daily living. The overall goal is to restore function in a cognitive domain or
set of domains or to teach compensatory strategies to overcome an eligible
recipient's specific cognitive problems.
(e)
Hippotherapy: Hippotherapy
is a physical, occupational, and speech-language therapy treatment strategy
that utilizes equine movement as part of an integrated intervention program to
achieve functional outcomes. Hippotherapy applies multidimensional movement of
a horse for an eligible recipient with movement dysfunction and may increase
mobility and range of motion, decrease contractures and aid in normalizing
muscle tone. Hippotherapy requires that the eligible recipient use cognitive
functioning, especially for sequencing and memory. An eligible recipient with
attention deficits and behavior problems are redirecting attention and
behaviors by focusing on the activity. Hippotherapy involves therapeutic
exercise, neuromuscular education, kinetic activities, therapeutic activities,
sensory integration activities, and individual speech therapy. The activities
may also help improve respiratory function and assist with improved breathing
and speech production. Hippotherapy must be performed by a RLD licensed
physical therapist, occupational therapist, or speech therapist.
(f)
Massage therapy: Massage
therapy is the assessment and treatment of soft tissues and their dysfunctions
for therapeutic purposes primarily for comfort and relief of pain. It includes
gliding, kneading, percussion, compression, vibration, friction, nerve strokes,
stretching the tissue and exercising the range of motion, and may include the
use of oils, salt glows, hot or cold packs or hydrotherapy. Massage increases
the circulation, helps loosen contracted, shortened muscles and can stimulate
weak muscles to improve posture and movement, improves range of motion and
reduces spasticity. Massage therapy may increase, or help sustain, an eligible
recipient's ability to be more independent in the performance of activities of
daily living; thereby, decreasing dependency upon others to perform or assist
with basic daily activities. See 16.7.1 NMAC.
(g)
Naprapathy: Naprapathy
focuses on the evaluation and treatment of neuro-musculoskeletal conditions,
and is a system for restoring functionality and reducing pain in muscles and
joints. The therapy uses manipulation and mobilization of the spine and other
joints, and muscle treatments such as stretching and massage. Based on the
concept that constricted connective tissue (ligaments, muscles, and tendons)
interfere with nerve, blood, and lymph flow, naprapathy uses manipulation of
connective tissue to open these channels of body function. See 16.6.1
NMAC.
(h)
Native American
healers: Native American healing therapies encompass a wide variety of
culturally-appropriate therapies that support eligible recipients in their
communities by addressing their physical, emotional and spiritual health.
Treatments may include prayer, dance, ceremony, song, plant medicines, foods,
participation in sweat lodges, and the use of meaningful symbols of healing,
such as the medicine wheel or other sacred objects.
(i)
Play therapy: Play therapy
is a variety of play and creative arts techniques utilized to alleviate
chronic, mild and moderate psychological and emotional conditions for an
eligible recipient that are causing behavioral problems or are preventing the
eligible recipient from realizing his or her potential. The play therapist
works integratively using a wide range of play and creative arts techniques,
mostly responding to the eligible recipient's direction.