Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES › Subchapter 37.86.6 - Therapy Services › Rule 37.86.601 - THERAPY SERVICES, DEFINITIONS

Current through Register Vol. 13, July 5, 2024
In ARM
				  37.86.601,
				  37.86.605,
				  37.86.606, and
				  37.86.610, the following
				  definitions apply:
(1)
				"Assistant/aide" means an assistant, aide or other person authorized under and
				practicing in accordance with the applicable provisions of Title 37, MCA, who
				subject to supervision required by law, assists in the provision of a therapy
				service.
(2) "Condition" means an
				illness, injury, disorder, or disability
(3) "Habilitative care" means services
				provided when a member requires help to maintain, learn, or improve skills and
				functioning for daily living, or to prevent deterioration. These services
				include: physical therapy, occupational therapy, speech-language pathology, and
				behavioral health professional treatment. Applied behavior analysis (ABA) for
				adults is excluded. Habilitative services are reimbursable if a licensed
				therapist is needed and the service must be provided by a licensed therapist.
				Services may be provided in a variety of inpatient and outpatient settings as
				prescribed by a physician or mid-level practitioner.
(4) "Licensed therapist" means a physical
				therapist, speech-language pathologist, or occupational therapist licensed
				under the applicable provisions of Title 37, MCA to practice the particular
				category of therapy services provided, but does not include an assistant, aide,
				or other person whose authority to perform services is restricted to working
				under the supervision of another.
(5) "Maintenance therapy" means repetitive
				therapy services that are required to maintain functions, that are performed
				without reasonable expectation of significant progress and that do not involve
				complex and sophisticated therapy services requiring the judgment or skill of a
				licensed therapist.
(6) "Mid-level
				practitioner" means an advanced practice registered nurse or a physician
				assistant as defined in ARM
				37.86.202.
(7) "Occupational therapy services" means
				occupational therapy services as defined in
				37-24-103,
				MCA. For purposes of ARM 37.86.601, 37.86.605, 37.86.606, 37.86.610, 46.12.526,
				and 46.12.529, occupational therapy services do not include services provided
				by a hospital or home health agency.
(8) "Physical therapy services" means
				physical therapy services as defined in
				37-11-101,
				MCA. For purposes of ARM 37.86.601, 37.86.605, 37.86.606, 37.86.610, 46.12.526,
				and through 46.12.529, physical therapy services do not include services
				provided by a hospital or home health agency.
(9) "Rehabilitative care" means services
				provided when a member needs help to keep, get back, or improve skills and
				functioning for daily living that have been lost or impaired because a member
				was sick, hurt, or disabled. Rehabilitative services include: physical therapy,
				occupational therapy, speech-language pathology, and behavioral health
				professional treatment. Applied behavioral analysis (ABA) for adults is
				excluded. Rehabilitative services are reimbursable if a licensed therapist is
				needed and the service must be provided by a licensed therapist. Services may
				be provided in a variety of inpatient and outpatient settings as prescribed by
				a physician or mid-level practitioner.
(10) "Restorative therapy" means therapy
				services that are performed with a reasonable expectation that the recipient's
				function will improve significantly in a reasonable and predictable period of
				time, based upon an assessment of the recipient's restoration potential made by
				a physician or mid-level practitioner in consultation, with the licensed
				therapist. Therapy services are not restorative therapy if the recipient's
				expected restoration potential would be insignificant in relation to the extent
				and duration of services required. Therapy services are no longer restorative
				therapy if at any time after commencement of treatment it is determined that
				the reasonable expectation of significant improvement in function will not
				materialize.
(11) "Speech therapy
				services" means the practice of speech-language pathology as defined in
				37-15-102,
				MCA. For purposes of ARM 37.86.601, 37.86.605, 37.86.606, 37.86.610, and
				46.12.529, speech therapy services do not include services provided by a
				hospital or home health agency.
(12) "Therapy services" or "therapies" means
				speech therapy services, occupational therapy services and physical therapy
				services.
AUTH:
					 53-2-201,
					 53-6-113,
					 MCA; IMP:
					 53-6-101,
					 53-6-113,
					 MCA