N.J. Admin. Code § 10:54-5.35

Current through Register Vol. 56, No. 9, May 6, 2024

Section 10:54-5.35 - Rehabilitative services; general

(a) Rehabilitative services include physical therapy, occupational therapy, and speech-language pathology and audiology, including the use of such supplies and equipment as are necessary in the provision of such services. Rehabilitative services and other restorative services are provided for the purpose of attaining maximum reduction of physical or mental disability and restoration of a Medicaid/NJ FamilyCare beneficiary to his or her best functional level. Rehabilitative services shall be made available to Medicaid/NJ FamilyCare beneficiaries as an integral part of a comprehensive medical program.

(b) In a physician's office, rehabilitative services shall be provided by or under the direction of a physical therapist, occupational therapist, speech-language pathologist or audiologist employed by or under contract to the physician. Each of these therapy services are discussed at 10:54-5.36, 5.37 and 5.38, respectively.

1. Physical therapy, occupational therapy, speech-language pathology and audiology services shall be reimbursed directly to the physician only when provided in the physician's office.

2. Physical therapy and speech-language therapy treatments shall be individual and shall consist of a minimum of 30 minutes.

3. Audiology services shall be reimbursed only when services are provided in an office of an Ear, Nose and Throat Specialist.

(c) A plan of treatment shall be completed during the Medicaid/NJ FamilyCare beneficiary's initial evaluation visit and retained on file.

1. The plan of treatment shall be definitive as to the type, amount, frequency, and duration of the rehabilitative services that are to be furnished and shall include the beneficiary's diagnosis and the anticipated goal(s) of the treatment.

N.J. Admin. Code § 10:54-5.35

Amended by R.2001 d.51, effective 2/5/2001.
See: 32 New Jersey Register 3929(a), 33 New Jersey Register 555(a).
In (a) and (c), substituted references to beneficiaries for references to recipients throughout.
Amended by R.2003 d.69, effective 2/3/2003.
See: 34 New Jersey Register 3183(a), 35 New Jersey Register 888(a).
In (a), substituted "Medicaid/NJ FamilyCare" for "Medicaid" throughout; In (b), inserted "occupational therapy," following "Physical therapy," in 1, and deleted 4.