Haw. Code R. § 17-1737-44

Current through November, 2024

Section 17-1737-44 - Rehabilitative services

(a) Rehabilitative services means those medical and remedial items or services which are prescribed by a licensed physician for the purpose of maximum reduction of a patient's physical or mental disability and restoration of the patient to the patient's best possible functional level.

(b) Rehabilitative services shall be directed to restoring a disabled person toward the following goals:

(1) Self-care and possible independent living; or

(2) Substantial gainful employment.

(c) Children through six years of age shall meet the following conditions to show rehabilitative services are reasonable and necessary:

(1) The services shall be considered under accepted standards of medical practice to be a specific and effective treatment for the patient's condition. Experimental therapies are excluded from coverage;

(2) An expectation that the condition will improve significantly in a reasonable and generally predictable period of time based on the assessment made by the physician of the patient's rehabilitative potential after any needed consultation with the qualified therapist or, services are necessary to establish a safe and effective maintenance program required in connection with a specific developmental or disease state;

(3) The services required can be safely and effectively performed only by a qualified therapist/pathologist or under the immediate supervision of a therapist because the services are complex or because of the child's medical or physical condition;

(4) The amount, frequency, and duration of the services shall be reasonable and subject to authorization by the department. Additionally, the provisions and limitations pertaining to the specific rehabilitation service such as physical therapy, speech therapy, etc. addressed in this chapter and chapter 17-173 9 shall apply;

(5) Referrals for therapeutic services shall be made by a physician. The physician is expected to employ clinical judgment, the history and physical, testing, etc. in determining the medical necessity of rehabilitative services; and

(6) Evaluation of the patient's developmental or therapeutic status shall be measured and expressed in objective, unambiguous concise language. The results of tests as well as goals, and therapeutic results shall be recorded on appropriate forms and may be reviewed by the department.

(d) Medical vendor payments may be made for the following types of services whether provided on an inpatient or an outpatient basis:

(1) Corrective surgery;

(2) Physical therapy;

(3) Speech therapy;

(4) Occupational therapy;

(5) Drugs, prosthetics, and durable medical equipment and supplies; and

(6) Other related restorative services.

Haw. Code R. § 17-1737-44

[Eff 08/01/94; am 02/10/97] (Auth: HRS § 346-14) (Imp: 42 C.F.R. §440.130 )