New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 52 - HOSPITAL SERVICES MANUAL › Subchapter 2 - POLICIES AND PROCEDURES RELATED TO SPECIFIC SERVICES › Section 10:52-2.11 - Rehabilitative services; hospital outpatient department

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The following words and terms, when used in this section, shall have the following meanings, unless the context clearly indicates otherwise.
1. "Rehabilitative services" means physical therapy, occupational therapy, speech pathology and audiology services, and the use of such supplies and equipment as are necessary in the provision of such services. Rehabilitative services and other restorative services shall be provided for the purpose of attaining maximum reduction in disability and restoration of a Medicaid beneficiary to his or her highest possible functional level. Rehabilitative services shall be made available to Medicaid/NJ FamilyCare beneficiaries as an integral part of a comprehensive medical program.
2. "Occupational therapy" means services prescribed by a physician or other licensed practitioner of the healing arts within the scope of his or her practice under State law and provided to a Medicaid/NJ FamilyCare fee-for-service beneficiary by or under the direction of a qualified occupational therapist. These services include necessary supplies and equipment.
3. "Qualified occupational therapist" means an individual who is:
i. Registered by the American Occupational Therapy Association (AOTA); or,
ii. A graduate of a program in occupational therapy approved by the Committee on Allied Health Education and Accreditation of the American Medical Association and engaged in the supplemental clinical experience required before registration by the American Occupational Therapy Association. If treatment and/or services are provided in a state other than New Jersey, the occupational therapist shall meet the requirements of that state, including licensure, if applicable, and shall also meet all applicable Federal requirements.
4. "Physical therapy" means services prescribed by a physician or other licensed practitioner of the healing arts within the scope of his or her practice under State law and provided to a Medicaid/NJ FamilyCare fee-for-service beneficiary by or under the direction of a qualified physical therapist. These services include necessary supplies and equipment.
5. "Qualified physical therapist" means an individual who is:
i. Licensed by the State of New Jersey as a physical therapist in accordance with N.J.A.C. 13:39A;
ii. A graduate of a program of physical therapy approved by both the Committee on Allied Health Education and Accreditation of the American Medical Association and the American Physical Therapy Association or its equivalent; and
iii. If treatment or services are provided in a state other than New Jersey, the physical therapist shall meet the requirements of that state, including licensure if applicable, and all applicable Federal requirements.
6. "Speech-language pathology" and "audiology services" mean diagnostic, screening, preventive, or corrective services provided by or under the direction of a speech-language pathologist or audiologist. The services include necessary supplies and equipment.
7. "Speech-language pathologist" or "audiologist" means an individual who is licensed by the State of New Jersey as a speech-language pathologist or audiologist, in accordance with N.J.A.C. 13:44C, and who meets all applicable Federal requirements including:
i. A certificate of clinical competence in Speech-Language Pathology (CCC-SLP) or Audiology (CCC-A) from the American Speech-Language-Hearing Association (American Speech-Language-Hearing Association, 2200 Research Blvd., Rockville, MD 20850-5650, or
www.asha.org
); or completion of the equivalent educational requirements and work experience necessary for the certificate; or completion of the academic program and is in the process of acquiring supervised work experience in order to qualify for the certificate;
ii. If treatment or services are provided in a state other than New Jersey, the speech-language pathologist or audiologist shall meet the requirements of that state, including licensure if applicable, and all applicable Federal requirements;
iii. If the attending physician orders an evaluation for speech-language therapy, the speech-language pathologist may make an initial visit for a screening examination. If, as a result of the screening examination, a comprehensive evaluation is necessary, the comprehensive evaluation shall be completed at the same time as the screening examination, or at the earliest mutual convenience of the patient and the provider;
iv. An initial comprehensive speech-language pathology evaluation should last approximately three hours, and shall include, as an integral part of the evaluation, a written report, as well as discussion and consultation with the patient or family, or both, regarding the findings; and
v. The Division shall reimburse for either a screening examination or a comprehensive speech-language evaluation rendered to a beneficiary, but not both. If the documentation reveals that the screening examination did not support the need for a comprehensive evaluation, the request for reimbursement will be downgraded to Speech-Language Therapy--Initial Visit Screening Examination, and reimbursed accordingly.