Haw. Code R. § 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.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.