105 CMR 150.010 - Rehabilitation Services: Physical Therapy, Occupational Therapy, Speech, Hearing and Language Therapy (and Therapeutic Recreation in a SNCFC)

(A) Facilities providing Levels I, II or III care shall establish written policies and procedures governing the delivery of rehabilitation services.

(1) Facilities providing Level I care, shall have an organized, continuous, rehabilitation services program.

(2) Facilities providing Level II care shall provide meaningful availability of rehabilitation services beyond restorative and maintenance nursing care.

(3) Facilities providing Level III or IV care should make arrangements for rehabilitation services when needed by residents.

(4) A SNCFC shall have an organized continuous, restorative nursing care program including recreation/rehabilitation therapy.

(B)

(1) Direct rehabilitation services shall be provided to residents only upon written order of the resident's primary care provider who shall indicate anticipated goals and frequency of treatments. Such treatment shall be initiated within three days of the written order. In a SNCFC, direct rehabilitation services shall be provided as indicated in the resident's care plan, which has been approved and signed by the resident's primary care provider.

(2) The facility shall accept a patient for outpatient rehabilitation services only on the order of a referring physician who indicates diagnosis and anticipated goals, and who is responsible for the general medical direction of such services as part of the total care of the patient and for each patient there shall be a written plan of care approved by the referring physician. The plan of care must specify the type, amount, frequency and duration of services to be provided. The plan of care and results of treatment shall be reviewed by the referring physician at least every 60 days or more often if required.

(C) All rehabilitation services shall be provided or supervised by licensed therapists.

(1) Rehabilitation services may be provided either directly by therapists employed by the facility or through written agreements with hospitals, institutions, clinics, agencies or independently practicing therapists in accordance with the facility's policies and procedures for rehabilitation services.

(2) Rehabilitation services provided to residents shall be integrated with the medical nursing, dietary, social, activity and other services to promote restoration of the resident to his or her maximum potential, and reviewed in conjunction with other periodic reviews of the resident's condition.

(a) In a SNCFC, the rehabilitation services portion of the resident's care plan shall include a schedule for expected developmental goals. These goals shall be reviewed on a quarterly basis and amended as necessary.

(b) In a SNCFC, the rehabilitation services staff shall participate, when appropriate, in planning for continuing care of each resident after discharge. Appropriate consultations shall be provided by rehabilitation services staff, when indicated, to family members who will be involved in care of a resident after discharge.

(D) Staff.

(1) Facilities providing Level I care shall provide a physical therapist and an occupational therapist, each for a minimum of eight hours per month for each unit for indirect services (such as consultation). Speech, hearing and language therapists shall be provided as needed.

(2) Facilities providing Level II care shall provide a physical therapist and an occupational therapist, each for a minimum of four hours per month for each unit for indirect services (such as consultation). Speech, hearing and language therapists shall be provided as needed.

(a) A SNCFC shall provide a supervisor of physical therapy services, full time, who shall be a registered physical therapist with a minimum of one year of experience or training in pediatrics.

(b) A SNCFC shall provide a physical therapist assistant or physical therapy aide on duty, on each unit, during a 12 hour period that includes all meal times seven days a week.

(c) A SNCFC shall provide a supervisor of occupational therapy services, full time, who shall be a registered occupational therapist with one year of experience or training in pediatrics.

(d) A SNCFC shall provide a titled occupational therapy assistant or occupational therapy aide, on duty, on each unit, during a 12 hour period that includes all meal times, seven days a week.

(e) A SNCFC shall provide a speech therapist ten to 15 hours per week or as needed, who shall be certified in speech pathology or in the combined areas of speech pathology and audiology.

(3) In addition to indirect services, therapists and supportive rehabilitation services personnel shall be provided in sufficient numbers and with sufficient skills to provide direct services to meet residents' needs. Supportive personnel shall be appropriately supervised.

In a SNCFC, there shall be an ongoing program of in-service education for all rehabilitation services staff to enable them to keep pace with advanced technology in the area of rehabilitation therapy and habilitative services. There shall be an appropriate orientation training program approved by the Department to enable aides and assistants to work with the residents in the unit.

(4) A SNCFC shall provide a therapeutic recreation therapist, full time, who shall plan and supervise therapeutic recreational services.

A SNCFC, in addition, shall provide a therapeutic recreation assistant and sufficient therapeutic recreation program staff during high activity periods and on weekends to implement recreational programs in accordance with resident needs.

(5) A facility providing rehabilitation services to outpatients shall provide an adequate number of qualified therapists and the equipment necessary to carry out its program and fulfill its objectives.

(E) Records and Reports.

(1) Indirect services provided shall be documented by a written summary available for inspection in the facility.

(2) Direct services records shall be filed in the resident's clinical record.

(F) A SNCFC shall provide furniture and special rehabilitation equipment as needed, sized and scaled appropriately for children's use.

Notes

105 CMR 150.010

Amended by Mass Register Issue 1361, eff. 3/23/2018.