LD 1919
pg. 234
Page 233 of 267 PUBLIC Law Chapter 673 Page 235 of 267
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LR 2833
Item 1

 
(2)__Treatment after a surgical procedure performed for
the purpose of improving physical function; or

 
(3)__Treatment in those situations in which a physician
has documented that the patient has in the preceding 30
days required extensive assistance in the performance
of one or more of the following activities of daily
living: eating, toileting, locomotion, transfer or bed
mobility.

 
The department may limit occupational and physical therapy
services benefits under this paragraph for palliative care
and maintenance of function to one visit per year to design
a plan of care and train the member or caretaker of the
member to implement the plan or to reassess the plan of
care.

 
F.__A member is eligible for benefits for chiropractic
services provided by a chiropractor licensed under Title 32.__
Benefits under this paragraph may be limited by the
department by requiring a member to have that member's
rehabilitation potential documented by a physician.__
Benefits may be limited to treatment as follows:

 
(1) Treatment for acute neuromuscular skeletal
conditions affecting range of motion, muscle strength
and physical functional abilities; or

 
(2) Treatment after a surgical procedure performed for
the purpose of improving physical function.

 
G.__A member is eligible for benefits under the private duty
nursing and personal care program and waiver programs for
the physically disabled or elderly as long as those benefits
may be limited by reductions in units of service or by rate
reductions.

 
H.__A member who is eligible for benefits under section
3174-G, subsection 1, paragraph F is eligible for benefits
under this section subject to the provisions of paragraphs A
to G and to additional rules limiting benefits as specified
in this paragraph.

 
(1)__Benefits for inpatient hospital admissions are
limited to 2 per year, except that more admissions may
be approved through prior authorization by the
department.__This subparagraph does not limit inpatient
hospital benefits for laboratory services, x-ray
services, prenatal care and mental health diagnoses.


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