Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 339.00 - Rates for Restorative Services › Section 339.02 - General Definitions

Current through Register 1525, July 5, 2024
As used in
				101 CMR 339.00, unless the
				context requires otherwise, terms have the meanings ascribed in 101 CMR
				339.02.
Center
. The Center for Health
				Information and Analysis established under M.G.L. c. 12C.
Comprehensive Restorative and Rehabilitation Center
				Evaluation
. An all-inclusive, in-depth assessment of medical
				condition and level of functioning and limitations, to determine the need for
				treatment and, if necessary, to develop a plan of treatment. The comprehensive
				evaluation includes a written report.
Eligible Provider of Rehabilitation Center
				Services
. Freestanding centers providing rehabilitation services
				that are licensed by the Massachusetts Department of Public Health, that are
				accredited by the Commission on Accreditation of Rehabilitation Facilities
				(CARF), and that meet such conditions of participation as may be required by a
				governmental unit purchasing rehabilitation services, or by a purchaser under
				M.G.L. c. 152 (the Workers' Compensation Act).
Eligible Provider of Restorative
				Services
. A provider who meets the conditions of participation
				adopted by a governmental unit purchasing restorative services or by purchasers
				under M.G.L. c. 152 (the Workers' Compensation Act), and who is
(a) a physical therapist - a person who is currently licensed
				by and in good standing with the Massachusetts Division of Professional
				Licensure, Board of Allied Health Professionals; (b) a physical therapy
				assistant - a person who is currently licensed by and in good standing with the
				Massachusetts Division of Professional Licensure, Board of Allied Health
				Professional and works under the supervision of a Physical Therapist;
(c) an occupational therapist - a person who is currently
				licensed by and in good standing with the Massachusetts Division of
				Professional Licensure, Board of Allied Health Professionals;
(d) an occupational therapy assistant - a person who is
				licensed by and in good standing with the Massachusetts Division of
				Professional Licensure, Board of Allied Health Professionals and works under
				the supervision of an Occupational Therapist;
(e) a speech/language therapist (speech/language pathologist) -
				a person who is currently licensed by and in good standing with the
				Massachusetts Board of Registration in Speech-language Pathology and
				Audiology;
(f) a speech/language therapist assistant (speech/language
				pathologist assistant) - a person who is currently licensed by and in good
				standing with the Massachusetts Board of Registration in Speech Language
				Pathology and Audiology and works under the supervision of a Speech/Language
				Therapist; or
(g) any speech and hearing center (proprietorship, partnership,
				or corporation) that provides authorized speech or language services rendered
				by a qualified speech pathologist who does not bill separately from such
				facility for professional services rendered.
EOHHS
. The Executive Office of Health
				and Human Services established under M.G.L. c. 6A.
Governmental Unit
. The Commonwealth,
				any department, agency, board, division, or commission of the Commonwealth, or
				any political subdivision of the Commonwealth.
Group Therapy
. Simultaneous therapy
				services provided to two to six patients who may or may not be doing the same
				activities.
HCPCS
. The Healthcare Common Procedure
				Coding System.
Individual Consideration (I.C.)
. A
				designation indicating that there is no specified rate for a given service.
				Payment amounts for services designated "I.C." are determined by the
				governmental unit purchasing such services. The governmental unit determines
				the appropriate payment based on the provider's report of services provided,
				and documentation as requested by the governmental unit. The report must
				include a pertinent history and diagnosis, a description of the service
				rendered, and the length of time spent with the patient. In making the
				determination of the appropriate payment amount, the governmental unit uses the
				following criteria:
(a) the policies, procedures, and practices of other
				third-party purchasers of care, both governmental and private;
(b) the severity and complexity of the patient's disorder or
				disability;
(c) prevailing provider ethics and accepted practice;
				and
(d) the time, degree of skill, and cost including equipment
				cost required to perform the procedure(s).
Occupational Therapy
. Therapy
				services, including diagnostic evaluation and therapeutic intervention,
				designed to improve, develop, correct, rehabilitate, or prevent the worsening
				of functions that affect the activities of daily living that have been lost,
				impaired, or reduced as a result of acute or chronic medical conditions,
				congenital anomalies, or injuries. Occupational therapy programs are designed
				to improve quality of life by recovering competence, preventing further injury
				or disability, and to improve the individual's ability to perform tasks
				required for independent functioning, so that the individual can engage in
				activities of daily living.
Office Visit
. Patient treatments
				rendered in a speech and hearing center, a licensed clinic or center, or in a
				practitioner's office (whether an individual practice, a group practice, or an
				association of practitioners). If a practitioner has an office in his or her
				home that is used for patient treatment, then services rendered there must be
				billed as office visits.
Out-of-office Visit
. Patient
				treatments rendered in a nursing home, school, a patient's home, or in any
				other setting where the practitioner travels from his or her usual place of
				business to render patient treatment.
Physical Therapy
. Therapy services,
				including diagnostic evaluation and therapeutic intervention, designed 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. Physical therapy
				emphasizes a form of rehabilitation focused on treatment of dysfunctions
				involving neuromuscular, musculoskeletal, cardiovascular/pulmonary, or
				integumentary systems through the use of therapeutic interventions to optimize
				functioning levels.
Physician's Comprehensive Rehabilitation
				Evaluation
. A cardiopulmonary, neuromuscular, orthopedic, and
				functional assessment performed at a rehabilitation center by a
				physician.
Publicly-aided Individual
. A person
				who receives health care and services for which a governmental unit is in whole
				or part liable under a statutory program of public assistance.
Rehabilitation
. The process of
				providing, in a coordinated manner, those comprehensive services deemed
				appropriate to the needs of the physically disabled individual, in a program
				designed to achieve objectives of improved health and welfare with realization
				of his or her maximum physical, social, psychological, and vocational
				potential.
Restorative Services
. Services
				provided by a physical therapist, an occupational therapist, or a speech
				pathologist at the referral of a prescribing provider as defined by the
				governmental entity for the purpose of maximum reduction of physical and speech
				disability and restoration of the patient to a maximum functional level.
Speech/Language Therapy
. Therapy
				services, including diagnostic evaluation and therapeutic intervention, that
				are designed to improve, develop, correct, rehabilitate, or prevent the
				worsening of speech/language communication and swallowing disorders that have
				been lost, impaired, or reduced as a result of acute or chronic medical
				conditions, congenital anomalies, or injuries. Speech and language disorders
				are those that affect articulation of speech, sounds, fluency, voice,
				swallowing (regardless of presence of a communication disability), and those
				that impair comprehension, spoken, written, or other symbol systems used for
				communication.