General Definitions

As used in 101 CMR 339.00, unless the context requires otherwise, terms have the meanings in 101 CMR 339.02. Center. The Center for Health Information and Analysis established under M.G.L. c. 12C. Comprehensive Restorative and Rehabilitation Center Evaluation. An all-inclusive, in-depth assessment of medical condition and level of functioning and limitations, to determine the need for treatment and, if necessary, to develop a plan of treatment. The comprehensive evaluation includes a written report. Eligible Provider of Rehabilitation Center Services. Freestanding centers providing rehabilitation services that are licensed by the Massachusetts Department of Public Health, that are accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF), and that meet such conditions of participation as may be required by a governmental unit purchasing rehabilitation services, or by a purchaser under M.G.L. c. 152 (the Workers’ Compensation Act). Eligible Provider of Restorative Services. A provider who meets the conditions of participation adopted by a governmental unit purchasing restorative services or by purchasers under M.G.L. c. 152 (the Workers' Compensation Act), and who is (a) a physical therapist — a person who is currently licensed by and in good standing with the Massachusetts Division of Professional Licensure, Board of Allied Health Professionals; (b) a physical therapy assistant — a person who is currently licensed by and in good standing with the Massachusetts Division of Professional Licensure, Board of Allied Health Professional and works under the supervision of a physical therapist; (c) an occupational therapist — a person who is currently licensed by and in good standing with the Massachusetts Division of Professional Licensure, Board of Allied Health Professionals; (d) an occupational therapy assistant — a person who is licensed by and in good standing with the Massachusetts Division of Professional Licensure, Board of Allied Health Professionals and works under the supervision of an occupational therapist; (e) a speech/language therapist (speech/language pathologist) — a person who is currently licensed by and in good standing with the Massachusetts Board of Registration in Speech- Language Pathology and Audiology; (f) a speech/language therapist assistant (speech/language pathologist assistant) — a person who is currently licensed by and in good standing with the Massachusetts Board of Registration in Speech-Language Pathology and Audiology and works under the supervision of a speech/language therapist; or (g) any speech and hearing center (proprietorship, partnership, or corporation) that provides authorized speech or language services rendered by a qualified speech pathologist who does not bill separately from such facility for professional services rendered. EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A. Governmental Unit. The Commonwealth, any department, agency, board, division, or commission of the Commonwealth, or any political subdivision of the Commonwealth. Group Therapy. Simultaneous therapy services provided to two to six patients who may or may not be doing the same activities. HCPCS. The Healthcare Common Procedure Coding System. Individual Consideration (IC). A designation indicating that there is no specified rate for a given service. Payment amounts for services designated “IC” are determined by the governmental unit purchasing such services. The governmental unit determines the appropriate payment based on the provider’s report of services provided, and documentation as requested by the governmental unit. The report must include a pertinent history and diagnosis, a description of the service rendered, and the length of time spent with the patient. In making the determination of the appropriate payment amount, the governmental unit uses the following criteria: (a) the policies, procedures, and practices of other third-party purchasers of care, both governmental and private; (b) the severity and complexity of the patient's disorder or disability; (c) prevailing provider ethics and accepted practice; and (d) the time, degree of skill, and cost including equipment cost required to perform the procedure(s). Occupational Therapy. Therapy services, including diagnostic evaluation and therapeutic intervention, designed to improve, develop, correct, rehabilitate, or prevent the worsening of functions that affect the activities of daily living that have been lost, impaired, or reduced because of acute or chronic medical conditions, congenital anomalies, or injuries. Occupational therapy programs are designed to improve quality of life by recovering competence, preventing further injury or disability, and to improve the individual’s ability to perform tasks required for independent functioning, so that the individual can engage in activities of daily living. Office Visit. Patient treatments rendered in a speech and hearing center, a licensed clinic or center, or in a practitioner's office (whether an individual practice, a group practice, or an association of practitioners). If a practitioner has an office in their home that is used for patient treatment, then services rendered there must be billed as office visits. Out-of-Office Visit. Patient treatments rendered in a nursing home, school, a patient's home, or in any other setting where the practitioner travels from their usual place of business to render patient treatment. Physical Therapy. Therapy services, including diagnostic evaluation and therapeutic intervention, designed to improve, develop, correct, rehabilitate, or prevent the worsening of physical functions that have been lost, impaired, or reduced because of acute or chronic medical conditions, congenital anomalies, or injuries. Physical therapy emphasizes a form of rehabilitation focused on treatment of dysfunctions involving neuromuscular, musculoskeletal, cardiovascular/pulmonary, or integumentary systems through the use of therapeutic interventions to optimize functioning levels. Physician's Comprehensive Rehabilitation Evaluation. A cardiopulmonary, neuromuscular, orthopedic, and functional assessment performed at a rehabilitation center by a physician. Publicly Aided Individual. A person who receives health care and services for which a governmental unit is in whole or part liable under a statutory program of public assistance. Rehabilitation. The process of providing, in a coordinated manner, those comprehensive services deemed appropriate to the needs of the physically disabled individual, in a program designed to achieve objectives of improved health and welfare with realization of their maximum physical, social, psychological, and vocational potential. Restorative Services. Services provided by a physical therapist, an occupational therapist, or a speech pathologist at the referral of a prescribing provider as defined by the governmental entity for the purpose of maximum reduction of physical and speech disability and restoration of the patient to a maximum functional level. Speech/Language Therapy. Therapy services, including diagnostic evaluation and therapeutic intervention, that are designed to improve, develop, correct, rehabilitate, or prevent the worsening of speech/language communication and swallowing disorders that have been lost, impaired, or reduced as a result of acute or chronic medical conditions, congenital anomalies, or injuries. Speech and language disorders are those that affect articulation of speech, sounds, fluency, voice, swallowing (regardless of presence of a communication disability), and those that impair comprehension, spoken, written, or other symbol systems used for communication.