Common use of Rehabilitative and habilitative services Clause in Contracts

Rehabilitative and habilitative services. Benefits are available for outpatient rehabilitative and habilitative services. Rehabilitative services help to restore the skills and functional ability you need to perform Activities of Daily Living when you are disabled by injury or illness. Habilitative services are therapies that help you learn, keep, or improve the skills or functioning you need for Activities of Daily Living. These services include physical therapy, occupational therapy, and speech therapy. Your Physician or Health Care Provider must prepare a treatment plan. Treatment must be provided by an appropriately-licensed or certified Health Care Provider. You can continue to receive rehabilitative or habilitative services as long as your treatment is Medically Necessary. Blue Shield may periodically review the provider’s treatment plan and records for Medical Necessity. See the Hospital services section for information about inpatient rehabilitative Benefits. See the Home health services and Hospice program services sections for information about coverage for rehabilitative and habilitative services provided in the home. Physical therapy Physical therapy uses physical agents and therapeutic treatment to develop, improve, and maintain your musculoskeletal, neuromuscular, and respiratory systems. Physical agents and therapeutic treatments include but are not limited to: • Ultrasound; • Heat; • Range of motion testing; • Targeted exercise; and • Massage as a component of a multimodality rehabilitative treatment plan or physical therapy treatment plan. Occupational therapy Occupational therapy is treatment to develop, improve, and maintain the skills you need for Activities of Daily Living, such as dressing, eating, and drinking. Speech therapy Speech therapy is used to develop, improve, and maintain vocal or swallowing skills that have not developed according to established norms or have been impaired by a diagnosed illness or injury. Benefits are available for outpatient speech therapy for the treatment of: • A communication impairment; • A swallowing disorder; • An expressive or receptive language disorder; and • An abnormal delay in speech development. Skilled Nursing Facility (SNF) services Benefits are available for treatment in the Skilled Nursing unit of a Hospital or in a free- standing Skilled Nursing Facility (SNF) when you are receiving Skilled Nursing or rehabilitative services. This Benefit also includes care at the Subacute Care level. Benefits must be prior authorized and are limited to a day maximum per benefit period, as shown in the Summary of Benefits section. A benefit period begins on the date you are admitted to the facility. A benefit period ends 60 days after you are discharged from the facility or you stop receiving Skilled Nursing services. A new benefit period can only begin after an existing benefit period ends.

Rehabilitative and habilitative services. Benefits are available for outpatient rehabilitative and habilitative services. Rehabilitative services help to restore the skills and functional ability you need to perform Activities of Daily Living when you are disabled by injury or illness. Habilitative services are therapies that help you learn, keep, or improve the skills or functioning you need for Activities of Daily Living. These services include physical therapy, occupational therapy, and speech therapy. Your Physician or Health Care Provider must prepare a treatment plan. Treatment must be provided by an appropriately-licensed or certified Health Care Provider. You can continue to receive rehabilitative or habilitative services as long as your treatment is Medically Necessary. Blue Shield may periodically review the provider’s treatment plan and records for Medical Necessity. See the Hospital services section for information about inpatient rehabilitative Benefits. See the Home health services and Hospice program services sections for information about coverage for rehabilitative and habilitative services provided in the home. Physical therapy Physical therapy uses physical agents and therapeutic treatment to develop, improve, and maintain your musculoskeletal, neuromuscular, and respiratory systems. Physical agents and therapeutic treatments include but are not limited to: •  Ultrasound; •  Heat; •  Range of motion testing; •  Targeted exercise; and •  Massage as a component of a multimodality rehabilitative treatment plan or physical therapy treatment plan. Occupational therapy Occupational therapy is treatment to develop, improve, and maintain the skills you need for Activities of Daily Living, such as dressing, eating, and drinking. Speech therapy Speech therapy is used to develop, improve, and maintain vocal or swallowing skills that have not developed according to established norms or have been impaired by a diagnosed illness or injury. Benefits are available for outpatient speech therapy for the treatment of: •  A communication impairment; •  A swallowing disorder; •  An expressive or receptive language disorder; and •  An abnormal delay in speech development. Skilled Nursing Facility (SNF) services Benefits are available for treatment in the Skilled Nursing unit of a Hospital or in a free- standing Skilled Nursing Facility (SNF) when you are receiving Skilled Nursing or rehabilitative services. This Benefit also includes care at the Subacute Care level. Benefits must be prior authorized and are limited to a day maximum per benefit period, as shown in the Summary of Benefits section. A benefit period begins on the date you are admitted to the facility. A benefit period ends 60 days after you are discharged from the facility or you stop receiving Skilled Nursing services. A new benefit period can only begin after an existing benefit period ends.