Section 85.34 - Rehabilitation services

85.34 Rehabilitation services.

(a) Provision of care. Rehabilitation services shall be made available, only at the direction of a physician, to eligible persons as medically needed and as an integral part of a comprehensive medical care program. Such services include not only service to the patient but also instructions to responsible members of the family in follow-up procedures necessary for the care of the patient.

(b) Where care may be provided. Rehabilitation services may be provided in the patient's own 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, or in the office of a qualified private practicing therapist or speech pathologist.

(c) Who may provide care. Rehabilitation services shall be provided by:

(1) qualified professional personnel employed by:

(i) an approved home health agency;

(ii) a hospital; or

(iii) an approved clinic or outpatient medical facility not part of a hospital;

(2) a qualified private practicing therapist or speech pathologist.

(d) Definitions. (1) Qualified professional shall mean:

(i) an occupational therapist, physical therapist or speech pathologist who is licensed and currently registered with the New York State Education Department;

(ii) an occupational therapist or physical therapist who possesses a limited permit and practices under the supervision of the appropriate professional in accordance with requirements of section 7905 and section 6735, respectively, of the State Education Law, book 16, McKinney's Consolidated Laws of New York. Copies are available from West Publishing Co., St. Paul, MN, and copies of both sections are available for inspection and copying at the offices of the records access officer of the Department of Health, Corning Tower, Empire State Plaza, Albany, NY;

(iii) a 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) an out-of-state occupational therapist, physical therapist or speech pathologist meeting the certification requirements of the appropriate agency of the state in which they practice.

(e) Use of rehabilitation resources. (1) In the provision of necessary occupational therapy, physical therapy and speech pathology, full and primary use shall be made of qualified rehabilitation therapists employed on the staff of an approved home health agency or approved rehabilitation clinic as part of a rehabilitation team under the overall direction of a qualified physician.

(2) Service of a qualified occupational therapist, physical therapist or speech pathologist, provided on a private practitioner basis, may be rendered to a patient in his or her own home, in an approved medical facility or in the office of the therapist or speech pathologist, only under the following conditions:

(i) when there is no approved home health agency available to provide the service needed by the patient; or

(ii) when the patient is in need of individual rehabilitation service beyond, or in addition to, that which is available from an approved home health agency.

(f) Prior approval and prior authorization. (1) Prior approval by the local professional director and prior authorization of the local social services official shall be required for the following:

(i) rehabilitation services provided by a private practicing occupational therapist, physical therapist or speech pathologist; and

(ii) all out-of-state rehabilitation services.

(2) Authorization to a private practicing occupational therapist, physical therapist and speech pathologist shall not exceed three months.

(g) Physicians, written order required. (1) All rehabilitation services shall be supported by a written order of a qualified physician and shall be carried out under his or her medical direction. The written order shall constitute medical direction of the physician.

(2) Such written order shall 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, a rehabilitation evaluation in the home may be initiated by a home health agency without a written order of a physician. Reimbursement shall not be made for more than one such rehabilitation evaluation visit to a patient in his own home before a physician's specific written order for treatment is obtained.

(h) Reimbursement. Reimbursement for rehabilitation services shall be made in accordance with rates and fees developed by the New York State Department of Health and approved by the New York State Division of the Budget.

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