Policies & Guidelines
- Compliance
- Definitions
- Ambulatory Surgical Services
- Billing Policy
- Children's Services
- Chiropractic Services
- Clinic Services
- Dental
- HCBS Elderly Waiver
- Home Care
- Hospice
- Hospital Services
- Inpatient Hospital Notification and Authorization
- Laboratory/Pathology, Radiology and Diagnostic Services
- Long-Term Care
- Mental Health Services
- Optical Services
- Pharmacy Services
- Physician and Professional Services
- Rehabilitative Services
- Requirements for Providers
- Service Authorization
- Substance Use Disorder Services
- Transportation
- Tribal and Indian Health Services
- Legal References
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- Ambulatory Surgical Services
- Billing Policy
- CFSS
- Children's Services
- Chiropractic Services
- Clinic Services
- Dental
- Equipment and Supplies
- HCBS Elderly Waiver
- Home Care
- Hospice
- Hospital Services
- Housing Stabilization Services
- Immunizations and Vaccinations
- Inpatient Hospital Notification and Authorization
- Laboratory/Pathology, Radiology and Diagnostic Services
- Long-Term Care
- Member Eligibility
- Mental Health Services
- Optical Services
- Pharmacy Services
- Physician and Professional Services
- Recuperative Care
- Rehabilitative Services
- Requirements for Providers
- Service Authorization
- Substance Use Disorder Services
- Transportation
- Tribal and Indian Health Services
- Quality: HEDIS
- Policies & Procedures
Rehabilitative Services
Definitions
Audiologist: A health care professional who engages in the practice of audiology, meets the qualifications required by MN Stat. secs. 148.511 – 148.5196, and is licensed by the Minnesota Department of Health (MDH), or where applicable, licensed or registered by the state in which he/she practices. If the state does not license providers of audiology services, the applicant for enrollment with Minnesota Health Care Programs (MHCP) must demonstrate that he/she meets the Certificate of Clinical Compliance (CCC) and practicum requirement listed below:
- Holds a CCC from the American Speech-Language-Hearing Association (ASHA); or
- Meets the following clinical practicum (practicum requirement) standards:
- Has demonstrated a successful completion of a minimum of 350 clock-hours of supervised clinical practicum (or is in the process of accumulating such experience);
- Has performed not less than nine months of supervised full-time audiology services after obtaining a master’s or doctoral degree; and
- Has successfully completed a national exam in audiology approved by the Secretary.
Audiologic Evaluation: An assessment administered by an audiologist or otolaryngologist to evaluate communication problems caused by hearing loss.
Comprehensive Outpatient Rehabilitation Facility (CORF): A non-residential facility that is established and operated exclusively to provide diagnostic, therapeutic, and restorative services to outpatients for the rehabilitation of injured, disabled, or sick people, at a single fixed location, by or under the direction of a physician and that meets the conditions of participation. Additionally, a facility that qualifies as a CORF may be enrolled to provide mental health services.
Direction: The actions of a physical therapist (PT) or occupational therapist (OT) who instructs the physical or occupational therapist assistant (PTA/OTA), monitors the assistant’s provision of services, and provides on-site observation of the treatment and documentation of its appropriateness at least every sixth treatment session for each member when treatment is provided by an assistant and meets the other supervisory requirements of MN Rules Chap. 5601 and MN Stat. sec. 148.6432 and the therapy disciplines’ respective licensure requirements.
Functional Status: The ability to carry out the tasks associated with daily living.
Hearing Aid: A monaural hearing aid, set of binaural hearing aids, or other device worn by the member to improve access to and use of auditory information.
Hearing Aid Accessory: Chest harnesses, tone and ear hooks, carrying cases, and other accessories necessary to use the hearing aid, but not included in the cost of the hearing aid.
Hearing Aid Services: Services to dispense hearing aids and provide hearing aid accessories and repairs.
Hearing Aid Service Provider: A person who has been certified by the MDH as a hearing instrument dispenser (or his/her trainee).
Long-Term Care Facility (LTCF): A nursing facility, Skilled Nursing Facility (SNF), or Intermediate Care Facility for the Developmentally Disabled (ICF/DD).
Occupational Therapist (OT): A person who is certified by the National Board for Certification in Occupational Therapy, Inc. (NBCOT) and maintains State licensure as an OT (MN Stat. sec. 148.6408).
Occupational Therapist Assistant (OTA): A person who has successfully completed all academic and fieldwork requirements of an OTA program approved or accredited by the Accreditation Council for Occupational Therapy Education (ACOTE) and is currently certified by NBCOT as an OTA and, where applicable, is licensed by the state in which he/she practices.
Otolaryngologist: A physician specializing in diseases of the ear and larynx who is certified by the American Board of Otolaryngology (ABOto) or eligible for board certification.
Physical Therapist (PT): A person who is a graduate of a physical therapy program approved by both the Committee on Allied Health Education and Accreditation of the American Medical Association (AMA) and the American Physical Therapy Association (APTA) or its equivalent, is licensed by the State, and meets the requirements in MN Stat. sec. 148.70 – 148.78 and MN Rules part 5601.
Physical Therapist Assistant (PTA): A person who is a graduate of a PTA education program accredited by the APTA or a comparable accrediting agency. A PTA performs selected physical therapy treatments and related duties as delegated by the PT (MN Rules part 5601.0100).
Practitioner of the Healing Arts: Any person who engages in, or holds out to the public as being engaged in, the practice of medicine or surgery, the practice of osteopathy, or any other practitioner of the healing arts whose scope of practice under State law includes diagnosis of disease or health condition and prescribing treatment; for example: a physician, physician assistant, nurse practitioner, podiatrist, dentist, clinical nurse specialist, or certified nurse midwife.
Rehabilitative Agency: A provider certified by Medicare to provide restorative, specialized maintenance therapy, and social or vocational adjustment services.
Rehabilitative and Therapeutic Services: Restorative therapy, specialized maintenance therapy, and rehabilitative nursing services.
Rehabilitative Nursing Services: Rehabilitation nursing care as specified in MN Rules part 4658.0525.
Restorative Therapy: A health service specified in the member’s plan of care, ordered by a physician or other licensed practitioner of the healing arts within the practitioner’s scope of practice under state law, and that is designed to restore the member’s functional status to a level consistent with the member’s physical or mental limitations.
Specialized Maintenance Therapy: A health service specified in the member’s plan of care by a physician, or other licensed practitioner of the healing arts within the practitioner’s scope of practice under state law, that is necessary for maintaining a member’s functional status at a level consistent with the member’s physical or mental limitations, and that may include treatments in addition to rehabilitative nursing services, as defined in MN Rules part 4658.0525.
Speech-Language Pathologist (SLP): A person who has a certificate of clinical competence in speech-language pathology from ASHA and meets the state registration requirements. Speech-language providers are required by PrimeWest Health to hold current registration with MDH.
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