5101:3-34-01.1 Physical therapy, occupational therapy and speech-language pathology/audiology services: definitions.

Definitions in this rule apply to Chapter 5101:3-34 of the Administrative Code.

(A) "Audiology," as defined in accordance with Chapter 4753. of the Revised Code, is the application of principles, methods, or procedures related to hearing and the disorders of hearing.

(B) "Department" is the Ohio department of job and family services (ODJFS).

(C) "Developmental" describes physical therapy, occupational therapy, and/or speech-language pathology/audiology services provided to individuals aged birth through six years for the purpose of attaining a level of functionality that the child has not yet achieved, but is expected to achieve, based on age, in accordance with developmental milestones established by the American academy of pediatrics. Such services are skilled therapy.

(D) "Developmental delay" means:

(1) For children aged birth to three years, a 1.5 standard deviation or twenty-five percent delay (based on the use of an evidence-based tool and/or through informed clinical opinion) in physical (development or maturation, including communication) or sensory development of individuals, with the expectation that the delay is:

(a) Not permanent;

(b) Not likely to continue indefinitely; and

(c) Expected to last for less than twelve months; or

(2) For children at least three years of age but under seven years of age, two deficits and 1.5 standard deviation from the norm or one deficit and 2.0 standard deviation from the norm (based on the use of an evidence-based tool and/or through informed clinical opinion) in physical (development or maturation, including communication) or sensory development, with the expectation that the delay is:

(a) Not permanent;

(b) Not likely to continue indefinitely; and

(c) Expected to last for less than twelve months.

(E) "Developmental disability" in accordance with section 5123.01 of the Revised Code, means a severe, chronic disability that is:

(1) Attributable to a mental or physical impairment or a combination of mental and physical impairments (other than a mental or physical impairment solely caused by mental illness);

(2) Manifested before age twenty-two;

(3) Likely to continue indefinitely; and

(4) Results in:

(a) In the case of a person under three years of age, at least one developmental delay or an established risk;

(b) In the case of a person at least three years of age but under six years of age, at least two developmental delays or an established risk;

(c) In the case of a person six years of age or older, a substantial functional limitation in at least three of the following areas of major life activity, as appropriate for the person's age:

(i) Self-care;

(ii) Receptive and expressive language;

(iii) Learning; and

(iv) Mobility.

(v) If the person is at least sixteen years of age, capacity for economic self sufficiency.

(5) Causes the person to need a combination and sequence of special, interdisciplinary, or other type of care, treatment, or provision of services for an extended period of time that is individually planned and coordinated for the person.

(F) "Developmental milestones" means the general developmental trends in patients aged birth through six years of age, as developed by the American academy of pediatrics

("Caring for Baby and Young Child: Birth to Age 5"; fourth edition American academy of oediatrics).

(G) "Direct supervision" is defined in accordance with rules 5101:3-4-02 , 5101:3-8-02 , and 5101:3-8-03 of the Administrative Code.

(H) "Disability," in accordance with rule 5101:1-39-03 of the Administrative Code, means:

(1) For an individual age eighteen or over, a medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than twelve months that results in the individual's inability to engage in any substantial gainful activity.

(2) For an individual under age eighteen, a medically determinable physical or mental impairment, which results in marked and severe functional limitations, and which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than twelve months.

(I) "Evidence-based" describes, for the purposes of this chapter, health care services that:

(1) Are based on a clearly articulated and empirically-supported theory;

(2) Have a detailed description of the intervention and measurement design (what outcomes were produced in what populations with what intervention);

(3) Have measurable outcomes that have been assessed with psychometrically strong measures, including long-term follow-up, where indicated;

(4) Have been tested in a scientifically-sound way with comparison conditions, optimally through randomized controlled studies;

(5) Uniformly apply the standards of evidence gained from the scientific method, to certain aspects of medical practice;

(6) Apply judgments about the inductive quality of evidence, to those aspects of medicine which depend on rational assessments of risks and benefits of treatments (including lack of treatment);

(7) Integrate individual clinical expertise with the best available external clinical evidence from systematic research;

(8) Integrate the best research evidence with clinical expertise and patient values; and

(9) Include conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.

(J) "Habilitation," as defined in section 5126.01 of the Revised Code, means the process by which the staff of a facility or agency assists an individual with mental retardation or other developmental disabilities in acquiring and maintaining those life skills that enable the individual to cope more effectively with the demands of the individual's own person and environment, and in raising the level of the individual's personal, physical, mental, social, and vocational efficiency. habilitation services, in accordance with rule 5101:1-34-01.2 of the Administrative Code, are covered only when provided to residents of an intermediate care facility for persons with mental retardation or under a federally approved home and community-based services waiver for individuals with mental retardation/developmental disability.

(K) "Licensed audiologist" means a person holding a valid license under Chapter 4753. of the Revised Code as an audiologist and who is eligible for or meets the educational requirements for a certificate of clinical competence in audiology granted by the "American speech-language-hearing association."

(L) "Licensed audiology aide" means a person holding a valid license under Chapter 4753. of the Revised Code as an audiology aide.

(M) "Licensed mechanotherapist" means a person holding a valid license under Chapter 4731. of the Revised Code as a mechanotherapist.

(N) "Licensed occupational therapist" means a person holding a valid license under Chapter 4755. of the Revised Code as an occupational therapist.

(O) "Licensed occupational therapy assistant" means a person holding a valid license under Chapter 4755. of the Revised Code as an occupational therapy assistant (OTA).

(P) "Licensed physical therapist" means a person holding a valid license under Chapter 4755. of the Revised Code as a physical therapist.

(Q) "Licensed physical therapist assistant" means a person holding a valid license under Chapter 4755. of the Revised Code as a physical therapist assistant (PTA).

(R) "Licensed speech-language pathologist" means a person holding a valid license under Chapter 4753. of the Revised Code as a speech-language pathologist and who is eligible for or meets the educational requirements for a certificate of clinical competence in speech-language pathology granted by the "American speech-language-hearing association."

(S) "Licensed speech-language pathology aide" means a person holding a valid license under Chapter 4753. of the Revised Code as a speech-language pathology aide.

(T) "Licensed therapist" means a licensed physical therapist, licensed mechanotherapist, licensed occupational therapist, licensed speech-language pathologist, or licensed audiologist.

(U) "Licensed therapy aide" means a licensed audiology aide or a licensed speech-language pathology aide.

(V) "Licensed therapist assistant" means a licensed physical therapist assistant, or a licensed occupational therapy assistant.

(W) "Maintenance," describes physical therapy, occupational therapy, and/or speech-language pathology/audiology services provided to individuals for the purpose of maintaining a level of functionality, not improvement of functionality. Although the development of a maintenance plan is considered part of developmental and rehabilitation services, the services furnished under a maintenance plan are not skilled therapy.

(X) "Medicaid authorized prescriber" means a physician (M.D. or D.O.), podiatrist, dentist, or advanced practice nurse working within his or her scope of practice as defined by state law.

(Y) "Medicaid eligible provider" is, in accordance with rule 5101:3-1-17 of the Administrative Code, any individual, group practice, corporation, or institution that:

(1) Meets the specific provider requirements and standards in division 5101:3 of the Administrative Code; and

(2) Is approved for participation in the medicaid program by the department, as evidenced by the issuance of both a signed provider agreement and an Ohio medicaid legacy number.

(Z) "Medically necessary services," are health care services that:

(1) Meet the requirements established in rule 5101:3-1-01 of the Administrative Code;

(2) Are evidence-based, in accordance with paragraph (I) of this rule; and

(3) Are provided with the expectation that:

(a) The patient's condition will improve within a sixty-day period of treatment for rehabilitative services or six-month period of treatment for developmental services; and

(b) The patient will attain or substantially progress toward the maximum possible expected milestones or be restored to or substantially progress toward the maximum possible level of functionality within twelve months of treatment, beginning with the evaluation.

(AA) "Natural environments" means settings that are natural or normal for the patients, and includes home and community settings in which patients without disabilities participate.

(BB) "Occupational therapy" is the evaluation and treatment of patients whose functioning is impaired by developmental deficiencies, physical injury or illness, through techniques specified in section 4755.04 of the Revised Code.

(CC) "Physical therapy" is the evaluation and treatment of patients by physical measures and the use of therapeutic exercises and rehabilitative procedures, with or without assistive devices, for the purpose of correcting, or alleviating any disability, as specified in section 4755.40 of the Revised Code.

(DD) "Rehabilitation" describes physical therapy, occupational therapy, and/or speech-language pathology/audiology services provided to individuals for the purpose of restoring the individual to the maximum possible level of functionality after a loss of functionality. Such services are considered skilled therapy. Although the development of a maintenance plan is considered part of rehabilitation services, the services furnished under a maintenance plan are not skilled therapy.

(EE) "Skilled therapy" means physical therapy, occupational therapy, and speech-language pathology/audiology services of such complexity and sophistication that the service can be safely and effectively performed only by or under the direct supervision of licensed therapists, licensed therapy aides, licensed therapist assistants, or licensed mechanotherapists practicing within the scope of their licensure. Skilled therapy does not include maintenance services, habilitative services, or services provided by non-licensed persons.

(FF) "Speech Language Pathology," as defined in accordance with Chapter 4753. of the Revised Code, is the application of principles, methods, or procedures related to the development and disorders of human communication.

Effective: 01/01/2008
R.C. 119.032 review dates: 01/01/2013
Promulgated Under: 119.03
Statutory Authority: 5111.02
Rule Amplifies: 5111.01 , 5111.02 , 5111.021 , 5111.029