Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.17 - Physical Therapy Services › Section 10.09.17.01 - Definitions

Current through Register Vol. 51, No. 14, July 12, 2024
A. In this chapter,
				  the following terms have the meanings indicated.
B. Terms Defined.
(1) "Department" means the Department of
				  Health and Mental Hygiene, which is the single State agency designated to
				  administer the Maryland Medical Assistance Program pursuant to Title XIX of the
				  Social Security Act, 42
				  U.S.C. §
												1396 et seq.
(2) "Direct supervision" means that a
				  licensed physical therapist is personally present and immediately available
				  within the same treatment area as the physical therapy assistant to give aid,
				  direction, and instruction when physical therapy procedures or activities are
				  performed.
(3) "Initial evaluation"
				  means the determination of the participant's condition by taking a case history
				  and the administration of appropriate tests on the first visit. Treatment
				  provided at this visit is considered to be part of the initial
				  evaluation.
(4) "Medical Assistance
				  Program" means the program of comprehensive medical and other health related
				  care for indigent and medically indigent individuals, jointly financed by the
				  federal and state governments and administered by states under Title XIX of the
				  Social Security Act, 42
				  U.S.C. §
												1396 et seq., as amended.
(5) "Medically
				  necessary" means that the service or benefit is:
(a) Directly related to diagnostic,
				  preventive, curative, palliative, rehabilitative, or ameliorative treatment of
				  an illness, injury, disability, or health condition;
(b) Consistent with current accepted
				  standards of good medical practice;
(c) The most cost efficient service that can
				  be provided without sacrificing effectiveness or access to care; and
(d) Not primarily for the convenience of the
				  participant, family, or provider.
(6) "Medicare" means the insurance program
				  administered by the federal government under Title XVIII of the Social Security
				  Act, 42 U.S.C. §§
												1395-
				  1395ccc.
(7) "Participant" means an individual who is
				  certified as eligible for, and is receiving, Medical Assistance
				  benefits.
(8) "Patient" means a
				  person awaiting or undergoing health care or treatment.
(9) "Physical therapist" means an individual
				  licensed by the Maryland Board of Physical Therapy Examiners or similarly
				  licensed or certified by the appropriate licensing body in the state or
				  jurisdiction in which the service is provided and within the scope of Health
				  Occupations Article, Title 13, Annotated Code of Maryland, or within the scope
				  established by the jurisdiction of the provided service.
(10) "Physical therapist assistant" means an
				  individual licensed as a physical therapy assistant, working under the direct
				  supervision of a licensed physical therapist, and performing limited physical
				  therapy procedures that are assigned by a licensed physical therapist within
				  the scope of Health Occupations Article, Title 13, Annotated Code of Maryland,
				  or who is otherwise similarly licensed or certified by the appropriate
				  licensing body in the state or jurisdiction where the service is provided and
				  performing therapy procedures within the scope established by the state or
				  jurisdiction of license or certification.
(11) "Physical therapy aide" means a
				  nonlicensed person in the employ of a physical therapist.
(12) "Physician" means an individual licensed
				  to practice medicine by the state in which the physician's practice is
				  located.
(13) "Plan of care" means
				  the plan of treatment aimed at achieving the anticipated functional
				  goals.
(14) "Prescriber" means a
				  physician, doctor of dental surgery or of dental medicine, physician assistant,
				  nurse practitioner, nurse midwife, or podiatrist licensed to prescribe physical
				  therapy.
(15) "Program" means the
				  Medical Assistance Program.
(16)
				  "Progress" means the measurable improvement as related to goals.
(17) "Provider" means an individual,
				  association, partnership, corporation, or unincorporated group licensed or
				  similarly licensed or certified to provide health care services for
				  participants and who, through appropriate agreement with the Department, has
				  been identified as a Program provider by the issuance of an individual account
				  number.
(18) "Treatment order" means a written prescription
				  for physical therapy signed by a physician, doctor of dental surgery or of
				  dental medicine, physician assistant, nurse practitioner, nurse midwife, or
				  podiatrist.