Subsection 144-101-II-102.02 - DEFINITIONS102.02-1Authorized Agent is an organization authorized by the Department to perform functions under a valid contract or other approved signed agreement.102.02-2Brain Injury is an insult to the brain resulting directly or indirectly from trauma, infection, anoxia, or vascular lesions, and not of a degenerative or congenital nature, but which may produce a diminished or altered state of consciousness resulting in impairment of cognitive abilities and/or physical functioning. It can also result in the disturbance of behavioral or emotional functioning. These impairments may be either temporary or permanent and cause partial or total functional disability or psychosocial maladjustment. This does not include brain injuries that are induced by birth.102.02-3CARF is the Commission on Accreditation of Rehabilitation Facilities.102.02-4Collateral Contact is a direct (face-to-face) contact on behalf of the member by a provider to obtain information from, or discuss the member's case with, other professionals, caregivers, or others included in the treatment plan in order to achieve continuity of care, coordination of services, and the appropriate services for the member. Discussions or meetings among staff employed by a single provider on behalf of the member are not to be considered collateral contacts, and are not a billable service.102.02-5Family is a person with a demonstrated family relationship to a member with Brain Injury whose Brain Injury has led to challenging behaviors. For the purposes of this section, family may include only the following; parents, spouse, siblings, children, legal guardian, caregiver, significant other of the member with Brain Injury or the significant other's children. 102.02-6Functionally Significant Improvement is the demonstrable measurable increase in the member's ability to perform specific tasks or motions that contribute to independence outside the therapeutic environment.102.02-7Individualized Treatment or Service Plan is a person centered plan of rehabilitative care based on an individual assessment made by a professional or other qualified staff of a member's medical and social needs with specific functional and measurable goals and objectives , authorized by the Department, or the Department's Authorized Agent, at the discretion of the Department.102.02-8Intensive Rehabilitation Nursing Facility (NF) Services for Individuals with a Brain Injury means services that are delivered in a part of a NF and reimbursed a special rate pursuant to Chapter III, Section 67, Principles of Reimbursement for Nursing Facilities, Intensive Rehabilitation NF Services for Brain Injured Individuals.
102.02-9Rehabilitation Potential is the documented expectation of measurable, functionally significant improvement in the member's condition in a reasonable, predictable period of time as the result of the prescribed treatment plan, as determined by a qualified professional. The documentation of rehabilitation potential must include the clinical justification used for this expectation.102.02-10Rehabilitative Provider is a distinct organizational entity in a distinct physical setting, which provides coordinated and integrated services that include evaluation and treatment related to the member's functional limitations and the member's response to treatment. Members may require some services in the home and community away from the provider's physical setting in order to obtain optimal level of functioning. The services are designed to prevent and/or minimize chronic disabilities while restoring the member to the optimal level of physical, cognitive, and behavioral function within the context of the person, family, and the community. The services are highly specialized to address unique service needs of the individual, and designed to prevent deterioration and maintain an optimal level of function over time.102.02-11Rehabilitative Services are those covered services provided under the direction of a neuropsychologist or physician and delivered by a neuropsychologist, physician, occupational therapist, physical therapist, registered nurse, speech-language pathologist, or other qualified staff meeting the qualifications identified in Section 102.08-5.102.02-12Significant Change/Relapse is indicated when the member's score on the Department's authorized brain injury assessment tool increases from the most recent score to a score of at least three (3) on one (1) item, in two (2) or more domains. C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-102, subsec. 144-101-II-102.02