Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 50 - AMOUNT, DURATION, AND SCOPE OF MEDICAL AND REMEDIAL CARE SERVICES › Part III - Amount, Duration, and Scope of Services › Section 12VAC30-50-225 - Rehabilitative services; intensive physical rehabilitation and CORF services

Current through Register Vol. 40, No. 24, July 15, 2024
A. Definitions. The
				  following words and terms when used in this section shall have the following
				  meanings unless the context clearly indicates otherwise:
"Actively participate" means the individual regularly, as
					 may be ordered by the physician, attends planned therapeutic activities and
					 demonstrates progress towards goals established in the plan of care.
"Admission certification statement" means that the
					 physician signs and dates an initial written statement in the individual's
					 medical record of the need for intensive rehabilitation services. This
					 statement shall be documented at the time of the rehabilitation
					 admission.
"Comprehensive outpatient rehabilitation facility" or
					 "CORF" means a facility that offers a coordinated intensive rehabilitation day
					 program that uses an interdisciplinary team approach and includes, at a
					 minimum, physicians' services and rehabilitation nursing in addition to at
					 least two of the following four therapy services:
(i) physical therapy,
(ii) occupational therapy,
(iii) cognitive rehabilitation therapy, or
(iv) speech-language pathology.
"Licensed practitioner of the healing arts" means either a
					 nurse practitioner, a physician assistant, or other practitioner as licensed by
					 the Commonwealth to render covered services.
"Physical rehabilitation services" means medically
					 prescribed treatments for improving or restoring functions that have been
					 impaired by illness or injury, or where function has been permanently lost or
					 reduced by illness or injury, for improving the individual's ability to perform
					 those tasks required for independent functioning.
"Plan of care" means a written order signed and dated by a
					 physician or other licensed practitioner that is specific to the individual
					 that includes orders for rehabilitation therapies, including the frequency and
					 duration of services; required medications; treatments; diet; and other
					 services as needed, for example, psychological services, social work services,
					 or therapeutic recreation services.
"Recertification" means that the physician or other
					 licensed practitioner shall sign and date at least every 60 days a written
					 statement in the individual's medical record of the continuing need for
					 intensive rehabilitation services.
"Therapist plan of care" means a written treatment plan,
					 developed by each licensed therapist involved with the individual's care, to
					 include measurable long-term and short-term goals, interventions or modalities,
					 frequency and duration, and a discharge disposition. These therapist plans of
					 care shall be written, signed, and dated by either a licensed physical or
					 occupational therapist, speech-language pathologist, cognitive rehabilitative
					 therapist, psychologist, social worker, or certified therapeutic recreational
					 specialist.