Cal. Code Regs. Tit. 22, § 51215.10 - Pediatric Subacute Care Unit -Rehabilitation Therapy Services
(a) Each pediatric
subacute care unit shall define, implement and maintain a system for assessing
and meeting patient needs for all appropriate physical, occupational and speech
therapy services including supportive and maintenance programs. The appropriate
therapist shall develop a plan of treatment, as specified in (g) or (j) of this
section, which shall be integrated into an individualized comprehensive plan of
care consistent with an interdisciplinary team approach in meeting each child's
needs.
(b) The following
definitions shall apply only to this section:
(1) "Physician" shall mean a licensed medical
doctor who is a pediatric physiatrist or a physician with knowledge and
experience in the rehabilitation of infants, children and
adolescents.
(2) "Therapist" shall
mean a licensed or registered physical therapist, occupational therapist or
speech pathologist with experience in pediatric rehabilitation
services.
(c) Each
pediatric subacute care patient shall receive, not more than 14 calendar days
prior to, or within seven calendar days after admission to a pediatric subacute
care unit, a complete rehabilitation assessment performed by a physician. Such
assessment shall reflect the actual status of the child at the time of
admission to the pediatric subacute care unit and shall be repeated as
clinically indicated by change in functional or cognitive status of the
child.
(d) In addition to the
complete rehabilitation assessment specified in (c) of this section, the
physician shall, based on functional potential and maintenance needs of the
pediatric subacute care patient, develop and recommend a program of therapy to
be provided after admission to the pediatric subacute care unit.
(e) Each pediatric subacute care patient
shall receive a physical therapy and occupational therapy assessment and have a
plan of treatment developed by the appropriate therapist reflective of the
medical recommendations specified in (d) of this section, within 14 days of
admission to the pediatric subacute care unit, unless medically contraindicated
and documented as such in the medical record. Subsequent physical therapy and
occupational therapy assessments shall be performed quarterly or more often as
clinically indicated.
(f) A speech
therapy assessment shall be provided to pediatric subacute care patients as
medically indicated and a plan of treatment developed that identifies
measurable functional goals within specific time frames.
(g) For each pediatric subacute care patient,
in developing the plan of treatment specified in (e) of this section, the
therapist shall:
(1) Develop, periodically
review and revise a time limited, goal oriented plan of supportive or
maintenance interventions;
(2)
Instruct appropriate pediatric subacute care unit staff on the provision of the
interventions.
(h) The
therapy services specified in (e) through (g) of this section shall be
considered a part of the pediatric subacute care services authorized in
accordance with Section
51335.6(c).
(i) In addition to the therapy services as
specified in (e), (f) and (g) of this section, supplemental rehabilitation
therapy services provided in a pediatric subacute care unit may be covered
separately for pediatric subacute care patients who, as determined by the
physician who performs the assessment specified in (c) of this section:
(1) Can tolerate a minimum of four hours per
week of any combination of direct therapy provided by or under the direct
supervision of a therapist as specified in (b) of this section.
(2) Demonstrate the potential to achieve, or
continue to achieve, measurable functional goals within specific time frames in
such areas as mobility, activities of daily living or the reduction of nursing
care.
(i) For each
pediatric subacute care patient for whom supplemental rehabilitation therapy
services are requested, the physician shall participate in the continuing
rehabilitation plan of treatment by providing ongoing rehabilitation
consultation and direction to the rehabilitation therapy staff in addition to
the review and approval of the rehabilitation plan of treatment.
(k) For each pediatric subacute care patient
for whom supplemental rehabilitation therapy services are requested, in
addition to the requirements to (e), (f) and (g), the therapist shall document
in the supplemental rehabilitation therapy plan of treatment:
(1) The specific type, number and frequency
of direct therapy services to be performed by or under the direct supervision
of the appropriate therapist;
(2)
Therapeutic goals of the services provided by each discipline and anticipated
duration of treatment.
(l) Supplemental rehabilitation therapy
services shall be covered separately from the pediatric subacute care services
authorized in accordance with Section
51335.6(c).
(m) Supplemental rehabilitation therapy
services shall be subject to the standards of medical necessity as set forth in
Sections 51303(a) and
51340(e).
Authorization requests shall be initiated by the facility.
(1) For the initial requests for supplemental
rehabilitation therapy services, a treatment authorization request (TAR) shall
be submitted within 10 working days of the development of the patient's plan of
treatment accompanied by the documentation as required by the
Department.
(2) For reauthorization
or requests for continuation of supplemental rehabilitation therapy services, a
TAR shall be accompanied by a statement describing the pediatric subacute care
patient's progress and documentation demonstrating the continued medical
necessity of these services.
Notes
2. Certificate of Compliance as to 6-30-97 order transmitted to OAL 10-22-97 and filed 11-26-97 (Register 97, No. 48).
Note: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions Code. Reference: Section 14132.25, Welfare and Institutions Code.
2. Certificate of Compliance as to 6-30-97 order transmitted to OAL 10-22-97 and filed 11-26-97 (Register 97, No. 48).
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.