10 Colo. Code Regs. § 2505-10-8.017
Current through Register Vol. 47, No. 16, August 25, 2024
Section 10 CCR 2505-10-8.017 - HABILITATIVE SERVICES8.017.ADEFINITIONHabilitative services means services that help a person retain, learn, or improve skills and functioning for daily living that are offered in parity with, and in addition to, any rehabilitative services offered in the Alternative Benefit Plan. Parity in this context means of like type and substantially equivalent in scope, amount, and duration.
8.017.BCOVERED SERVICESHabilitative therapy services shall have parity in amount, scope, and duration to rehabilitative therapies and will only consist of physical, occupational, and speech-language pathology services.
8.017.CELIGIBLE CLIENTSHabilitative services shall only be available to the eligibility categories described in § 8.016.A.
8.017.DELIGIBLE PROVIDERS8.017.D.1 Habilitative Physical Therapy services shall only be provided by a licensed physical therapist who is an approved Medicaid provider or a physical therapist assistant under the general supervision of a licensed physical therapist who is an approved Medicaid provider.8.017.D.2 Habilitative Occupational Therapy services shall be provided by a licensed occupational therapist who is an approved Medicaid provider or an occupational therapy assistant under the general supervision of a licensed occupational therapist.8.017.D.3 Habilitative Speech Language Pathology services shall be provided by any of the following: a. A certified speech language pathologist with a current certification issued by the Department of Regulatory Affairs;b. A clinical fellow under the general supervision of an American Speech-Language-Hearing Association (ASHA) certified speech language pathologist; orc. A speech language pathology assistant with an associate degree from a program in which the individual received technical training in the scope of work recommended by ASHA for speech language pathology assistants.8.017.EPRIOR AUTHORIZATION OF SERVICESA medical prescription is required for covered services. The provider shall be responsible for submitting a prior authorization request that includes the medical prescription to the Department's designee for all covered services in 8.017.B. Following the receipt of a complete request, the Department's designee shall approve or deny all requests for prior authorization and shall determine the length of time that the service is medically necessary. A prior authorization request shall be effective for a length of time not to exceed 12 months.
8.017.FLIMITATIONS8.017.F.1. Clients accessing Habilitative Physical or Habilitative Occupational Therapy are limited to 5 units per date of service and 48 units per state fiscal year (July 1 to June 30). A unit is defined by the current procedural terminology (CPT) code. 8.017.F.2 For Habilitative Speech Language Pathology: a. Services are limited to 5 units per date of service. A unit is defined by the current procedural terminology (CPT) code.b. Diagnostic procedures provided by an audiologist for the purpose of determining general hearing levels or for the distribution of a hearing device are not a covered benefit except for individuals eligible for the Early and Periodic Screening, Diagnosis and Treatment Program (EPSDT).8.017.F.3 All services described in §8.017.B Covered Services shall be provided in accordance with 42 CFR § 440.110 (2000) which is hereby incorporated by reference. The incorporation by reference of this regulation excludes later amendments to, or editions of, the reference material. The regulation is available from the U.S. Government Printing Office at http://www.gpo.gov/fdsys/pkg/CFR-2010-title42-vol4/pdf/CFR-2010-title42-vol4-sec440-110.pdf. Pursuant to § 24-4-103 (12.5), C.R.S., the Department maintains copies of this incorporated text in its entirety, available for public inspection during regular business hours at: Colorado Department of Health Care Policy and Financing, 1570 Grant Street, Denver, CO 80203. Certified copies of incorporated materials are provided at cost upon request.47 CR 01, January 10, 2024, effective 12/9/2023, exp. 4/6/2024 (Emergency)