1. (a) One visit in a six-month period, for evaluation of the patient and preparation of an extended treatment plan, is covered without prior authorization. Additional services in a six-month period require prior authorization. The request for prior authorization shall be accompanied by an extended treatment plan signed by a physician. The extended treatment plan shall include all of the following:

   1. (1) The principal and significant associated diagnosis.
   2. (2) Prognosis.
   3. (3) Date of onset of illness or injury.
   4. (4) Specific type, number, and frequency of services to be rendered by each discipline.
   5. (5) Therapeutic goals to be achieved by each discipline and the anticipated time required for achievement of these goals.
   6. (6) The extent to which physical therapy, occupational therapy, speech therapy or audiology services have been previously provided, and benefits or improvements demonstrated by such prior care.

2. (b) Authorization may be granted for rehabilitation center outpatient services when such services are medically necessary as set forth in Section 51303(a) and are reasonably expected to develop or restore functions related to basic activities of daily living. Therapeutic goals may seek to:

   1. (1) Develop or restore intelligible speech,
   2. (2) Provide necessary training in the use of prosthetic or orthotic devices,
   3. (3) Provide capability for self care to include feeding, toilet activities, and ambulation.
3. (c) A maximum of 30 visits may be authorized at any one time. Authorizations shall be valid for up to 120 days. A request for reauthorization shall include a statement describing the patient's progress toward achieving the therapeutic goals included in the extended treatment plan.

Outpatient physical therapy, occupational therapy, speech therapy and audiology services provided in a rehabilitation center approved as meeting the standards set forth in Section 51213 are covered as specified below:

Note: Authority cited: Sections 14105 and 14124.5, Welfare and Institutions Code; and Section 57(c), Chapter 328, Statutes of 1982. Reference: Sections 14132, 14133 and 14133.3, Welfare and Institutions Code.

History

1. New section filed 12-24-71, as an emergency; effective upon filing (Register 71, No. 52).

2. Certificate of Compliance filed 4-19-72 (Register 72, No. 18).

3. Repealer of subsection (d) filed 8-8-78; effective thirtieth day thereafter (Register 78, No. 32).

4. Amendment of subsection (b) filed 9-1-82 as an emergency; effective upon filing (Register 82, No. 37). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 12-30-82.

5. Certificate of Compliance transmitted to OAL 12-30-82 and withdrawn 1-28-83 (Register 83, No. 7).

6. Amendment of subsection (b) refiled 1-28-83 as an emergency; effective upon filing (Register 83, No. 7). (Corrected copy of 1-28-83 emergency order refiled 2-16-83.) A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 5-28-83 (Register 83, No. 7).

7. Editorial correction of History No. 6 (Register 83, No. 11).

8. Emergency language repealed by operation of Government Code Section 11346.1(f) (Register 83, No. 27).

9. Amendment of subsection (b) filed 6-29-83 as an emergency; effective upon filing (Register 83, No. 27). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 10-27-83.

10. Certificate of Compliance as to 6-29-83 order filed 8-11-83 (Register 83, No. 33).