Current through Register Vol. 46, No. 39, September 25, 2024
(a)
Provision of care. Rehabilitation services, with the exception of services
provided under subparagraph (c)(1)(iv) of this section, are available only if a
physician provides a written order for the services to the medical assistance
recipient and the services are an integral part of a comprehensive medical care
program. Services provided under subparagraph (c)(1)(iv) of this section may be
made available only if a physician, registered nurse, nurse practitioner,
physical therapist, occupational therapist, or speech pathologist, who is
acting within the scope of his or her practice under New York State law,
recommends the medical assistance recipient for such services and the services
are part of an individualized education program or an interim or final
individualized family services plan. The health professional must be licensed,
registered, and/or certified in accordance with the New York State Education
Law and the rules of the Commissioner of Education. Such recommendation must be
reflected in the individualized education program or an interim or final
individualized family services plan. Rehabilitation services include not only
services to the recipient but also instructions to responsible members of the
family in follow-up procedures necessary for the care of the
recipient.
(b) Where care may be
provided. Rehabilitation services may be provided in the recipient's home, in a
hospital outpatient department, in an approved clinic or outpatient medical
facility not part of a hospital, in an approved medical institution or
facility, in an approved home health agency, in the office of a qualified
private practicing therapist or speech pathologist and, with respect to a child
receiving rehabilitation services pursuant to an individualized education
program or an interim or final individualized family services plan, in a
school, an approved pre- school or natural environment, including home and
community settings, where such child would otherwise be found.
(c) Who may provide care. Rehabilitation
services may be provided by:
(1) Qualified
professional personnel employed by or under contract to:
(i) an approved home health agency;
(ii) a hospital;
(iii) an approved clinic or outpatient
medical facility not part of a hospital; or
(iv) a school district; an approved
pre-school; a county in the State or the city of New York; an approved early
intervention program; or a municipality in the State. Such services will be
furnished as part of the development of or pursuant to an individualized
education program or an interim or final individualized family services plan.
Speech pathology services may be provided under
subparagraph (iv) of this paragraph by a teacher of the speech and hearing
impaired under the direction of a speech pathologist. Under the direction of a
speech pathologist means that a teacher of the speech and hearing impaired may
provide services as long as a speech pathologist meets with such teacher on a
regular basis and is available for consultation to assure that care is provided
in accordance with the individualized education program or an interim or final
individualized family services plan. Teachers of the speech or hearing impaired
or speech pathologists who provide services or in the case of a speech
pathologist under whose direction services are provided must be currently
registered and certified in accordance with the New York State Education Law
and the rules of the Commissioner of Education.
(2) A qualified private practicing therapist,
therapist assistant or speech pathologist.
(d) Definitions.
(1) Qualified professional shall mean:
(i) occupational therapist, occupational
therapy assistant, physical therapist, physical therapist assistant or speech
pathologist who is licensed and currently registered with the New York State
Education Department;
(ii)
occupational therapist, occupational therapy assistant, physical therapist or
physical therapist assistant who possesses a limited permit and practice(s)
under the supervision of the appropriate professional in accordance with
requirements of the State Education Law;
(iii) speech pathologist who is in the
process of obtaining a license and has on file a "Notification of approval of
the Supervisory Plan" in accordance with requirements of the State Education
Law; or
(iv) out-of-state
occupational therapist, occupational therapy assistant, physical therapist,
physical therapist assistant or speech pathologist meeting the certification
requirements of the appropriate agency of the state in which they
practice.
(e)
Physician's written order required.
(1)
Rehabilitation services must be supported by a written order of a qualified
physician and must be carried out under his or her medical direction. The
written order constitutes medical direction of the physician.
(2) Such written order must include a
diagnostic statement and purpose of treatment.
(3) Such written order is required prior to
treatment.
(4) In extraordinary
circumstances and for valid reasons which must be documented, rehabilitation
evaluation in the home may be initiated by a home health agency before the
physician examines the recipient. Reimbursement cannot be made for more than
one such rehabilitation evaluation visit to a recipient in the recipient's home
before a physician's specific written order is obtained.
(5) Payment is available for a rehabilitation
evaluation of a child who is suspected of having a handicapping condition or a
disability and for whom an individualized education program or an interim or
final individualized family services plan is being developed if the evaluation
is performed in a school, an approved pre-school or a natural environment,
including home and community settings, where such child would otherwise be
found and the evaluation is initiated by a speech pathologist, occupational
therapist, or a physical therapist.
(f) Reimbursement.
(1) Except as otherwise provided in this
subdivision, reimbursement for rehabilitation services must be in accordance
with the rates and fees established by the Department of Health and approved by
the Director of the Budget.
(2)
Payment is available for rehabilitation services which are part of the
development of, or furnished pursuant to, an individualized education program
and which are provided by qualified professional personnel employed by, or
under contract to, a school district, an approved pre-school, a county in the
State or the city of New York. Reimbursement for such services must be made in
accordance with the provider agreement.
(3) Payment is available for rehabilitative
services which are part of the development of, or furnished pursuant to, an
interim or final individualized family services plan and which are provided by
qualified professional personnel employed by, or under contract to, an approved
early intervention program or a municipality in the State. Reimbursement for
such services must be made in accordance with the provider agreement.
