Rule 37.86.601 - THERAPY SERVICES, DEFINITIONS In ARM 37.86.601, 37.86.605, 37.86.606, and 37.86.610, the following definitions apply:
(1) "Assistant/aide" means an assistant, aide or other person authorized under and practicing in accordance with the applicable provisions of Title 37, MCA, who subject to supervision required by law, assists in the provision of a therapy service.(2) "Condition" means an illness, injury, disorder, or disability(3) "Habilitative care" means services provided when a member requires help to maintain, learn, or improve skills and functioning for daily living, or to prevent deterioration. These services include: physical therapy, occupational therapy, speech-language pathology, and behavioral health professional treatment. Applied behavior analysis (ABA) for adults is excluded. Habilitative services are reimbursable if a licensed therapist is needed and the service must be provided by a licensed therapist. Services may be provided in a variety of inpatient and outpatient settings as prescribed by a physician or mid-level practitioner.(4) "Licensed therapist" means a physical therapist, speech-language pathologist, or occupational therapist licensed under the applicable provisions of Title 37, MCA to practice the particular category of therapy services provided, but does not include an assistant, aide, or other person whose authority to perform services is restricted to working under the supervision of another.(5) "Maintenance therapy" means repetitive therapy services that are required to maintain functions, that are performed without reasonable expectation of significant progress and that do not involve complex and sophisticated therapy services requiring the judgment or skill of a licensed therapist.(6) "Mid-level practitioner" means an advanced practice registered nurse or a physician assistant as defined in ARM 37.86.202.(7) "Occupational therapy services" means occupational therapy services as defined in 37-24-103, MCA. For purposes of ARM 37.86.601, 37.86.605, 37.86.606, 37.86.610, 46.12.526, and 46.12.529, occupational therapy services do not include services provided by a hospital or home health agency.(8) "Physical therapy services" means physical therapy services as defined in 37-11-101, MCA. For purposes of ARM 37.86.601, 37.86.605, 37.86.606, 37.86.610, 46.12.526, and through 46.12.529, physical therapy services do not include services provided by a hospital or home health agency.(9) "Rehabilitative care" means services provided when a member needs help to keep, get back, or improve skills and functioning for daily living that have been lost or impaired because a member was sick, hurt, or disabled. Rehabilitative services include: physical therapy, occupational therapy, speech-language pathology, and behavioral health professional treatment. Applied behavioral analysis (ABA) for adults is excluded. Rehabilitative services are reimbursable if a licensed therapist is needed and the service must be provided by a licensed therapist. Services may be provided in a variety of inpatient and outpatient settings as prescribed by a physician or mid-level practitioner.(10) "Restorative therapy" means therapy services that are performed with a reasonable expectation that the recipient's function will improve significantly in a reasonable and predictable period of time, based upon an assessment of the recipient's restoration potential made by a physician or mid-level practitioner in consultation, with the licensed therapist. Therapy services are not restorative therapy if the recipient's expected restoration potential would be insignificant in relation to the extent and duration of services required. Therapy services are no longer restorative therapy if at any time after commencement of treatment it is determined that the reasonable expectation of significant improvement in function will not materialize.(11) "Speech therapy services" means the practice of speech-language pathology as defined in 37-15-102, MCA. For purposes of ARM 37.86.601, 37.86.605, 37.86.606, 37.86.610, and 46.12.529, speech therapy services do not include services provided by a hospital or home health agency.(12) "Therapy services" or "therapies" means speech therapy services, occupational therapy services and physical therapy services. Mont. Admin. r. 37.86.601
NEW, 1996 MAR p. 1687, Eff. 6/21/96; AMD, 1998 MAR p. 676, Eff. 3/13/98; TRANS, from SRS, 2000 MAR p. 481; AMD, 2016 MAY p. 829, Eff. 5/7/2016AUTH: 53-2-201, 53-6-113, MCA; IMP: 53-6-101, 53-6-113, MCA