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Special Rehabilitative Services

Description of Federal Requirements
Comparison of State Requirements
Table Comparing States
Complete Transcript of State Requirements on Special Rehabilitative Services (PDF)

Federal Regulations & Related F-tags for 483.45 Applicable Federal Regulation
(a)Provision of services | F406
(b) Qualifications | F407
 
  • 483.45 Special Rehabilitative Services
  • Description of Federal Requirements    (TOP)    (NEXT)

    The federal regulation specifically relating to specialized rehabilitation services (483.45) defines specialized rehabilitative services to include, but not be limited to, physical therapy, speech/language therapy, occupational therapy, and mental health rehabilitative services for residents with mental illness and mental retardation.  The federal rule holds that if such specialized rehabilitative services are required in the resident’s comprehensive plan of care, the facility must provide the services or obtain them from an outside provider.  Further, the federal rule requires that specialized rehabilitative services must be provided under a written order from a physician..  Under Administration, 483.75 (g) (2) on staff qualifications, professional staff must be licensed, certified, or registered in accordance with applicable State laws; this stipulation would apply to the various rehabilitation specialists the facility might employ as staff or consultants.  No other specific allusions to rehabilitative services or to disciplines such as physical therapy, speech/language pathology, occupational therapy, or mental health professionals can be found in federal regulations.

    The regulation on Resident Assessment (483.20) (i0 (2) (iii) states that the comprehensive care plan must be prepared by an interdisciplinary team, that includes the attending physician, a registered nurse with responsibility for the resident “and other appropriate staff in disciplines as determined by the resident’s needs.” By extension, therapist could be part of “other appropriate staff,” but the requirement is vague. 

    Most of the inferences one could draw about requirements for rehabilitative services are derived from the Quality Care Regulation (483.25), which states that a resident must receive “the necessary care and services to attain or maintain the highest, practicable physical, mental, and psychosocial wellbeing.”   The various services and professions grouped under special rehabilitative services could be deemed necessary to some care planning teams.  Under 483.25 (b) (2), the facility must arrange for transportation to and from the office of a practitioner specializing in the treatment of vision or hearing impairment or the office of a professional specializing in the provision of vision or hearing assistive devices.  Under 483.25 (e) (2), a resident with a limited range of motion must receive appropriate treatment and services to increase that range or prevent further deterioration, under 483.25 (f), a resident with mental or psychosocial adjustment difficulty must “receive appropriate treatment and services to correct the assessed problem,“ and under 483.25 (k), the facility must ensure that residents with special needs receive “proper treatment and care” for a list of special services that includes respiratory care, foot care, and prostheses.  By inference, meeting quality of care standards may require physical therapy, occupational therapy, speech therapy, and/or mental health services, though the vision and hearing professionals are the only ones mentioned specifically.

    Comparison of State Requirements    (TOP)    (NEXT)

    NOTE:  The examples below may not list all States with similar language; always check your state for specifics

    Eleven (11) States (Alabama, Connecticut, Florida, Indiana, Nevada, New Hampshire, North Dakota, Ohio, Pennsylvania, South Dakota and Vermont) have no State-specific nursing home regulations on Rehabilitative Services, though they may well have occupational licensure rules for the related disciplines that would apply to the work of those professionals in nursing home or they reassert the Federal rules.

    The remaining 37 States have one or more provisions on special rehabilitative services.  Most state-specific provisions can be grouped into general categories. Seventeen (17) States have added requirements for the Credentials of the therapists; these vary from brief general comments to articulation of separate credentials for many rehabilitative disciplines.  Fourteen (14) have requirements regarding the therapy record, progress notes, or integration with the medical record.  Twelve (12) States have requirements that we have group together as Services, including those that establish goals for services or quality criteria.   Closely related to this category on Services are the nine (9) States that have specific requirements around Inter-disciplinary Collaboration or some team effort involving Special Rehabilitative services.   Eleven (11) states have requirements that we grouped under the general category of Timelines; most often these establish the time periods for the therapists to complete an evaluation after referral and/or the time periods for showing progress, but occasionally the State merely requires that the services be “timely.”  In this category we also include any mandates for the frequency or amount of service.   Ten (10) States have added stipulations around referral to Rehabilitative Services, 5 of which stipulate that people other than a physician may make the referral, and 10 have specified something about Space, Equipment, and/or Supplies for a rehabilitative services program.  Nine (9) States have a requirement for written policies on the Rehabilitative Services Program.  Five (5) States specify that potential residents or current residents whose care needs require services must not be admitted or retained if the facility cannot provide the therapies. The table at the end of this narrative organizes the content into these major categories.  We note that sometimes the assignment to the category is somewhat arbitrary because a provision could simultaneously relate to several areas.

    The remaining elements of State regulations in this category, which we grouped as Other include a wide range of stipulations, including organizational stipulations on leadership of the rehabilitative services program, the manner in which the rehabilitative specialists relate to nursing and other facility staff, in-service education roles of the therapists, continuity from the hospital, maintenance rehabilitation, outpatient services from nursing homes, notification of families, and reimbursement under Medicaid.  In the State of Washington, for example, the nursing home may provide specialized rehabilitative and habilitative services to outpatients on the facility premises, only if the nursing home continues to also meet the needs of current residents. 

    Below we provide illustrations from these various categories.  For complete information, the actual State regulations should be consulted.

    Credentials    (TOP)    (NEXT)

    Reference to credentials is usually general and brief, typically invoking state licensing criteria.  For instance, in Louisiana special rehabilitation services are provided by “appropriately credentialed individuals;” in Tennessee they, are provided “by individuals who meet the qualifications specified by nursing home policy, consistent with state law,” and IdahoNew York and Wyoming call just for ““qualified personnel” (with Idaho also stating that other supportive personnel for special rehabilitative services must work under the supervision of qualified therapists).  California specifies that the rehabilitation program shall be under the direction of a physical therapist who meets the State practice requirements.  Pennsylvania requires the facility to insure that personnel and services provided by outside resources meet all necessary licensure and certification requirements, including those of the Bureau of Professional and Occupational Affairs in the Pennsylvania Department of State.  Similarly Minnesota requires professional staff that are licensed, certified, or registered in accordance with applicable state laws and rules, and are “educated to perform the particular service safely and competently.” Virginia requires the services to meet standards of practice by qualified therapists, or by trained assistants under the supervision of a licensed or certified professional, and West Virginiarequires that specialized rehabilitative services be provided by qualified personnel as determined by licensing boards of those personnel.  In Maryland, the facility shall maintain a file that includes proof of current licensure of all the rehabilitative services’ personnel.  In Iowa besides requiring licensure for all types of rehabilitation personnel, the rules add that occupational therapy services shall be under the direction of a qualified occupational therapist currently registered by the American Occupational Therapy Association.  Similarly, Washington requires that that occupational therapy shall be given or supervised only by a therapist who meets the standards for registration as an occupational therapist of the American Occu­pational Therapy Association, and that speech and hearing therapy shall be given or supervised only by a therapist who meets the standards for a certificate of clinical competence granted by the American Speech and Hearing Association, or who meets the educational standards, and is in the process of acquiring the supervised experience required for the certification.

    ColoradoNew JerseyNew Mexico, and Texas provide the most detail on credentials for each of the main professional groups providing specialized rehabilitation services.  Texas includes requirements for physical therapy assistants and occupational therapy assistants. [NH Regs Plus Comment:  We did not find any specific credentials related to mental health or mental retardation specialists, even among States that laid out credentials for physical therapists, occupational therapists, speech therapists, and audiologists.]

    Records/Reporting Requirements    (TOP)    (NEXT)

    Commonly, state-added reporting requirements are that the therapist report to the physician within two weeks of his referral, which de facto requires an assessment within 2 weeks of referral.  Commonly, too, States specify regular periods for updates, and/or require that the therapy notes be part of the general record.  ColoradoGeorgiaIllinois,IowaMississippiOregon, and Rhode Island all specify reporting without required time frames. Interesting variation is found in the content of what those states state shall be reported.  Colorado includes special tests and measurements, Georgia includes precautions and progress or lack of progress, and Iowa includes long-term and short-term goals and requires a summary for nursing home staff and family upon discharge from active therapy.  Examples of the more detailed specifications are below:

    - In Georgia, a therapy record will be kept as a part of the medical record on each patient receiving physical therapy. Information in the medical record shall include referral, diagnosis, precautions, initial physical therapy evaluation treatment plan and objectives, frequency and dates of medical reevaluations.  . . The physical therapist shall keep progress notes on each patient including progress or lack of progress, symptoms noted, and changes in treatment plans.

    - In Iowa, treatment records in the resident’s medical chart shall include: (1) The physician’s prescription for treatment; (2) An initial evaluation note by the physical therapist; (3) The physical therapy care plan defining clearly the long-term and short-term goals and outlin­ing the current treatment program; (4) Notes of the treatments given and changes in the resident’s condition; (5) A complete discharge summary to include recommendations for nursing staff and family. 

    -  In Oregon, all rehabilitative services provided and results of those services shall be clearly documented in the resident's clinical record.  Progress notes relevant to the plan shall be documented in the resident's clinical record as frequently as the resident's condition or ability changes, but no less often than quarterly.

    AlaskaIdahoNew MexicoMarylandUtah, and Wisconsin require reports to the attending physician within 2 weeks of the initiation of therapy.  Hawaii requires such a report 14 days after initiating services.  AlaskaIdahoHawaii, and Utah require reports every 30 days for residents receiving active services (though the physician can recommend an alternative schedule in Utah and document it in the medical record)  In Maryland, progress notes must be written every two weeks, a team evaluation of progress must occur every 30 days, and the physician must document his reevaluation on the medical record at least every 60 days.  In Massachusetts, the physician must review the treatment plan every 60 days as well.

    Massachusetts recognizes direct and indirect therapy services.  The direct services must be recorded in the medical record, and the indirect services (that is, consultative services to facility staff regarding residents) must be documented by a written summary available for inspection in the facility.

    Written Policies    (TOP)    (NEXT)

    Some States merely require written policies to govern the therapeutic services programs, and other States specify some of the elements of that written program to greater or lesser detail.  In Arkansas if a facility offers specialized rehabilitative services, written administrative and patient care policies and procedure for rehabilitative services shall be developed for appropriate therapists and representatives of the medical, administrative, and nursing staffs. In Colorado, the facility shall have written policies approved by the governing body identifying the organization, administration, performance standards, direction, and supervision of resident care. In New York, the facility shall designate an occupational therapist, physical therapist and speech-pathologist to assist the facility in the development and implementation, in cooperation with nursing and medical services, of written policies and procedures for rehabilitative services within the facility.  In Rhode Island, written administrative and resident care policies and procedures shall be developed for rehabilitative services by appropriate therapists and representatives of the medical, administrative and professional staff. In Oregon, the facility shall have written policies governing the provision and documentation of rehabilitative services.  Also, Oregon invests the Director of Nursing with overall responsibility for the program; the Director of Nursing Services or his/her designee shall ensure the development and implementation of an effective rehabilitation services program when applicable. In Maryland, written administrative and patient care policies and procedures shall be developed for rehabilitative services by appropriate rehabilitation team members and representatives of the medical, administrative, and nursing staff, and policies shall provide for the coordination of rehabilitative services and the rehabilitative aspects of nursing.   Maryland also required written job descriptions for all rehabilitative services personnel.  Idaho has detailed requirements for written policies, as excerpted below:

    In Idaho, written policies and procedures shall be developed which include, but are not limited to: a. Types of services offered; b. Responsibilities of attending physicians; c. Responsibilities of therapists; d. Care and maintenance of equipment; e. Provision that no patient shall be admitted or retained in the facility who needs a rehabilitative service if the facility cannot offer the service or arrange for the service;

    -  In Massachusettsfacilities that provide Levels I, II or III care shall establish written policies and procedures governing the delivery of restorative services.  Restorative Services Units shall ordinarily be permitted only in facilities that provide Level I care (i.e., skilled: NHRegsPlus).  Units may be permitted in facilities that provide Level II care with the written approval of the Department. Facilities that provide Level I care, shall have an organized, continuous, restorative services program.

    Five States (ArkansasIdahoNorth CarolinaRhode Island, and Wyoming) have explicit policy statements that if the resident requires specialized rehabilitation services and the facility cannot provide them, the resident must not be admitted, or (in the case of current residents) the resident must be discharged. 

    Timelines    (TOP)    (NEXT)

    Timelines for reporting back to the referring individual or making progress notes have been included in the section above.  Additionally, some States have established timelines for the therapy itself or for a proactive communication with the nursing home. For example, in Kansas, the nursing home must ensure the timeliness of the services, and in Kentucky and Maryland, the written order includes the frequency of the services.   In Colorado, the therapist must take all necessary steps to communicate to the facility the resident's condition and response to treatment within two weeks of initiation of treatment and every thirty days thereafter while treatment continues.  In Massachusetts, the therapy is initiated within three days of the referral, and in New Jersey, audiology and occupational therapy services specifically are initiated in 72 hours of referral.  Texas rules specify the lengths of various therapies authorized under the Medicaid State Plan for those residents funded through Medicaid.  Other States stipulate periods for review, such as monthly, quarterly, or annually, but usually also notwithstanding require review as needed.

    Referrals    (TOP)    (NEXT)

    Several States amplify the federal policy that referrals shall be only from physicians with additional information governing the referral.   In contrast, five (5) states explicitly envisage that someone other than a physician may make a referral to special rehabilitative services.  In Massachusetts direct restorative therapy services shall be provided to inpatients only upon written order of a physician, physician assistant, or nurse practitioner who shall indicate anticipated goals and frequency of treatments.  In Minnesota, services are under the written order of a physician or other health care practitioner authorized to prescribe.  In Mississippi, rehabilitative services are provide as needed upon the written orders upon the written orders of an attending physician or nurse practitioner.  In New Jersey, orders are from physicians or from advanced practice nurses, to the extent allowable by applicable laws.  In Kentucky, where more detail is given, rehabilitative services shall be provided upon written order of the physician; or an advanced registered nurse practitioner as authorized in KRS 314.011(8) and 314.042(8); a therapeutically-certified optometrist in the practice of optometry as defined in KRS 320.210(2); or a physician assistant as authorized in KRS 311.560(3).  These referring individuals may write an order for rehabilitative services limited to their scope of practice.  In Maryland, as in most States specialized rehabilitative services shall be provided only upon written orders of the attending physician. But Maryland rules go on to say that orders shall include modalities to be used, frequency, and anticipated goals, and shall be made a part of the patient care plan. Notably, unless medically contraindicated, the physician shall discuss with the patient or his family or sponsor the goals and the treatment program. 

    Space/Equipment    (TOP)    (NEXT)

    Most references to space, equipment, and supplies are brief.  For example, New Mexico states that equipment necessary for the provision of therapies required by the residents shall be available and used as needed; Mississippi states that appropriate equipment and supplies shall be provided; Rhode Island states that safe and adequate space and equipment shall be available commensurate with the scope of services provided; Utah requires the  facility to provide space and equipment for specialized rehabilitative services in accordance with the needs of the residents, andSouth Carolina merely says that if rehabilitative services are offered, space and equipment shall be provided. Louisiana says that rehabilitative services, when provided in the nursing home, shall be delivered in a safe and accessible area.Washington calls for equipment necessary for the provision of ther­apies required by the residents to be available and used as needed. Iowa rules call for adequate facilities, space, appropriate equipment, and storage areas as are es­sential to the treatment or examinations of residents.  Colorado requires the facility to provide space, appropriate equipment, and storage areas adequate for physical therapy on all referred residents.  Further, in Colorado services shall be provided in an area readily accessible to residents and equipment shall be properly maintained to ensure safety of residents and staff.  Summarizing these, the characteristics usually emphasized are safety and accessibility.  Requirements such as “adequate” and “commensurate with need” are hard to measure. [NH Regs Plus Comment: Although sufficient space is often called for, dedicated space does not seem to be specified.]

    The most detailed provision on space and equipment is in Kentucky, which requires that commonly used ambulation and therapeutic equipment necessary for services offered shall be available for use in the facility such as parallel bars, hand rails, wheelchairs, walkers, walkerettes, crutches and canes. The therapists in Kentucky shall advise the administrator concerning the purchase, rental, storage and maintenance of equipment and supplies.

    Hawaii is noteworthy in that it calls for facilities to provide for the procurement, and maintenance of aids as needed by the patient to adapt and function within the patient's environment. [NH Regs Plus Comment: This provision seems closely linked to each resident’s quality of life.]

    Services (Goals and Activities)    (TOP)    (NEXT)

    State regulatory language about rehabilitative services is more likely to deal with time intervals for services and recording of services than the nature of the services themselves. Some States do refer to the goals or activities of the therapy, however. [NH Regs Plus Comment: References to the goals of therapy and the process of establishing such goals provide a glimpse into various visions of what a facility might do to restore or promote maximum functioning and are, thus, of interest with reference to resident autonomy and quality of life.  It is particularly noteworthy if the facility is expected to develop a highly individualized approach of goal setting tied to individual preferences and routines.  Also noteworthy is whether the facility is expected to develop goals for maintenance of physical and/or mental functioning after a period of active restorative services is over, and how, if at all, nursing staff and other facility staff are expected to be engaged in the effort.]

    For example, in North Carolina, services shall be designed to maintain and improve the patient's ability to function independently, prevent as much as possible the advancement of progressive disabilities, and restore maximum function; in Idaho, rehabilitative services shall be provided to maintain function or improve the resident’s ability to carry out the activities of daily living.  In Maryland, the minimal acceptable restorative service shall be the restorative nursing care plan designed to maintain function or improve the patient's ability to carry out the activities of daily living.  In New Mexico, the  facility shall either provide or arrange for, under written agreement, specialized rehabilitative services as needed by residents to improve and maintain functioning.  In Oregon, each resident shall have a rehabilitation plan based on an assessment of resident's needs and delivered in accordance with the resident care plan.

    - In Nebraska, the goal language specifically mentions independence and self-determination as goals of the special therapy, and in New York that emphasis is even more explicit, as the extracts below show.

    - In Nebraska, the specialized rehabilitative services must be designed to maintain and improve the resident's ability to function independently, to prevent, as much as possible, advancement of progressive disabilities, and to restore maximum function, independence and self-determination.

    - In New York, the facility must establish a system of determining rehabilitative goals for each resident based on the resident's need relative to his or her physical and mental level of functioning, the overall plan of care for the resident and the resident preferences. These treatment goals shall range on a continuum, progressing from all specialized restorative rehabilitative services to routine maintenance rehabilitation.  Also the facility shall establish a system to monitor the maintenance of optimum levels of functioning for those residents who have been discharged from a formal rehabilitative program and who are on a maintenance program primarily provided by nursing staff on the floor.

    Several States have provided more details on the therapy functions, including the activities they will engage in, the disciplines included, and/or the relationship with nursing home staff.  Some of the more detailed provisions are illustrated below; Kentucky and Oklahoma are particularly detailed.

    -  In Hawaiithe facility shall provide specialized and supportive rehabilitation services, including occupational therapy, physical therapy, and speech therapy, according to the needs of each patient, either directly by qualified staff or through arrangements with qualified outside resources. Services shall be programmed to: (1) Preserve and improve the patient's maximal abilities for independent function; (2) Prevent, insofar as possible, irreversible or progressive disabilities; (3) Provide for the procurement, and maintenance of aids as needed by the patient to adapt and function within the patient's environment; (4) Instruct facility staff or person responsible in therapy goals to meet the continuity of patient care.

    -  In Iowathe licensed physical therapist shall: (1) evaluate the resident and prepare a physical therapy treatment plan conforming to the medical orders and goals; (III)

    (2) consult with other personnel in the facility who are providing resident care and plan with them for the integration of a physical therapy treatment program into the overall health care plan; (III) (3) instruct the nursing personnel responsible for administering selected restorative procedures between treatments; (III) (4) present programs in the facility’s in-service education programs. 

    - In Kentuckyphysical therapy may includes: a. Assisting the physician in his evaluation of patients by applying muscle, nerve, joint, and functional ability tests; and b. Treating patients to relieve pain, develop or restore functions, and maintain maximum performance, using physical means such as exercise, massage, heat, water, light, and electricity.  Speech therapy may include: a. Services in speech pathology or audiology; b. Cooperation in the evaluation of patients with speech, hearing, or language disorders; and c. Determination and recommendation of appropriate speech and hearing services. 3. Occupational therapy services may includes: a. Assisting the physician in his evaluation of the patient's level of function by applying diagnostic and prognostic tests; and b. Guiding the patient in his use of therapeutic creative and self-care activities for improving function. 

    -  Oklahoma provides the most extensive list of services we have seen to be included within special rehabilitative services that promote restoration of the resident's maximum potential.  These are: Physical therapy; Speech therapy; Audiology; Occupational therapy; Psychological or psychiatric counseling/therapy; (6)  Nutritional counseling;  Restorative nursing  provided by the nursing staff according to the care plan (including but not limited to Range of motion to prevent contractures; Bowel and bladder training to restore continence; Self-help skill training;  Behavioral modification under the direction of a qualified consultant;  Ambulation.; Remotivation; Reality orientation; and Reminiscence therapy).

    Texas includes a lengthy section on psychoactive medications, and Washington includes a lengthy section on mental health and mental retardation therapies.

    Interdisciplinary Collaboration/Teamwork    (TOP)    (NEXT)

    Some States are explicit about special therapies as part of an interdisciplinary or facility-wide collaborative or team effort.  Without providing all examples, below we illustrate that focus that makes rehabilitation an integral part of the program.   These vary from brief statements of philosophy as in Alaska and Utah, to more elaborate specifications, such as New York.  The New York provisions (summarized below) are exemplary for their attention to resident preferences.

    -  In Alaska, a nursing facility must provide a program of rehabilitative nursing care that assists each resident to achieve and maintain an optimal level of self-care and independence, as an integral part of the nursing service. 

    - In Massachusetts, restorative therapy services provided to inpatients shall be integrated with the medical nursing, dietary, social, activity and other services to promote restoration to the patient to his maximum potential, and reviewed in conjunction with other periodic reviews of the patient’s condition

    - In New York,  the facility shall designate an occupational therapist, physical therapist and speech-pathologist to assist the facility in the development and implementation, in cooperation with nursing and medical services, of written policies and procedures for rehabilitative services within the facility which will : (1) establish restorative and maintenance rehabilitation as components of inter-disciplinary resident care planning and treatment; and (2) establish a system of determining rehabilitative goals for each resident based on the resident's need relative to his or her physical and mental level of functioning, the overall plan of care for the resident and the resident preferences. These treatment goals shall range on a continuum, progressing from all specialized restorative rehabilitative services to routine maintenance rehabilitation; and (3) establish a system to monitor the maintenance of optimum levels of functioning for those residents who have been discharged from a formal rehabilitative program and who are on a maintenance program primarily provided by nursing staff on the floor.

    - In Utah, the plan of treatment must be initiated by an attending physician and developed by the therapist in consultation with the nursing staff.

    - In Washington,  (1) If specialized habilitative and rehabilitative services such as, but not limited to, physical therapy, speech-language pathology, occupational therapy, and mental health rehabilitative services for mental illness and mental retardation, are required in the resident's comprehensive plan of care, the nursing facility must:  (a) ensure that residents who display mental or psychosocial adjustment difficulties receive appropriate treatment and services to correct the assessed problem; and  (b) provide or arrange for the mental health or mental retardation services needed by residents that are of a lesser intensity than the specialized services defined at WAC 388-97-251.

    Table Comparing States    (TOP)

    Note: If the States in this table are not hyper-linked, their provisions do not appear to address the topic, and therefore, do not alter the Federal Regulatory scope.  The Table summarizes content onSpecial Rehabilitative Services by State (with a link to each State's specific language).  Link to a downloadable PDF document containing all State requirements on Special Rehabilitative Services.

    483.45 Specialized Rehabilitation Services

    State Goes beyond Federal Regulations? Subjects Addressed: How State Differs From or Expands On Federal Regulations
    Alabama No Requirements echo federal regulations in this area
    Alaska Yes Interdisciplinary Collaboration; records; physical therapy service; occupational therapy service
    Arizona Yes Medical director to ensure that resident is assisted in obtaining, at resident’s expense physical therapy; speech therapy and occupational therapy.
    Arkansas Yes Written Policies Required. No admission/retention If needed rehab not available; rehab services based on resident needs, review of resident progress.
    California Yes Credentials; services (sufficient hours); optional service units; physical therapy service unit; equipment and size of space; occupational therapy services and space; speech pathology and audiology service, equipment and space.
    Colorado Yes Written Policies; Credentials; Records; Timelines; Space, Equipment/Space
    Connecticut No State requirements do not address this subject.
    Delaware Yes Family/Guardian Notification of Services Ordered and coordination of services.
    District of Columbia Yes Records; Timelines; Reporting
    Florida No State requirements do not address this subject.
    Georgia Yes Records; Timelines; Reporting
    Hawaii Yes Records,  Sufficient staff, Space/Equipment; In-Services Education; Services
    Idaho Yes Records; Written Policies; Timelines; Credentials; No admission/retention if needed rehab not available.
    Illinois Yes Written Polices; Records; Timelines; consultation services for specific restorative services.
    Indiana No Requirements echo federal requirements.
    Iowa Yes Credentials; Services; In-service education
    Kansas Yes Timelines and provision of services.
    Kentucky Yes Services; Timelines, Referrals (non-physicians may write an order), Space/Equipment
    Louisiana Yes Credentials; Space/Equipment
    Maine Yes Specialized therapy services including space and equipment and therapists’ responsibilities.
    Maryland Yes Referrals; Credential; Timelines; Written Policies (including Job Descriptions) Records, Services; Interdisciplinary Collaboration; NHs without restorative programs; proof of licensure and job descriptions.
    Massachusetts Yes Written Policies; Referral (non-physicians may order services); Services (Goals included); Interdisciplinary approach; Timelines; Records
    Michigan Yes If named rehabilitation center must provide rehab services.
    Minnesota Yes Credentials; Referral (non-physicians may order services)
    Mississippi Yes Referrals (non-physicians may order services); Space/Equipment; Records
    Missouri Yes In addition to rehab or restorative nursing, all facilities to provide or make arrangements for providing rehab services according to their needs.
    Montana Yes Specialized rehab services, separately billable items, services furnished
    Nebraska Yes Service (Goals)
    Nevada No Requirements echo federal regulations in this area.
    New Hampshire No State requirements do not address this subject.
    New Jersey Yes Referrals (non-physicians can make referrals); written policies; credentials; timelines; mandatory rehab supplies and equipment and advisory rehab space and supplies.
    New Mexico Yes Records; Credentials; Services (rehab plan); Space/Equipment
    New York Yes Interdisciplinary Collaboration; Written Policies; Services (Goals); Maintenance Rehabilitation
    North Carolina Yes Services (quality); Interdisciplinary collaboration; Training and roles of NH staff.  No admission/retention if needed rehabilitation not available.
    North Dakota No Requirements echo federal regulations in this area.
    Ohio No State requirements do not address this subject.
    Oklahoma Yes Services; Restorative Nursing; In-service education
    Oregon Yes Written policies; Records; Services (Rehab plans for each resident); leadership of Director of Nursing; rehab services of physical therapy, speech therapy and occupational therapy provide at least 5 days every week.
    Pennsylvania Yes Regulations do not contain specific content for specialized rehab services.
    Rhode Island Yes Written Policies; (no admission/retention if needed rehab services not available); Interdisciplinary collaboration; Records; Space/ Equipment.
    South Carolina Yes Services
    South Dakota No Requirements echo federal regulations in this area.
    Tennessee Yes Interdisciplinary Collaboration; Direct Contact Between Therapists and Residents; Sufficient Staff.
    Texas Yes Credentials (including PT and OT aides); Timelines; Psychoactive Medications in Mental Health Services; Reimbursement under Medicaid.
    Utah Yes Space and Equipment; Credentials; Timelines; Interdisciplinary Collaboration; Records
    Vermont No Requirements echo federal regulations in this area.
    Virginia Yes Credentials; Written Policies
    Washington Yes Credentials; Delegation by therapists; Mental Health Specified; Outpatient Services on Premises.
    West Virginia Yes Credentials
    Wisconsin Yes Credentials; Equipment
    Wyoming Yes Equipment and Space; Continuity from Hospital; No admission/retention if needed rehabilitation not available.

    Complete Transcript of Special Rehabilitative Services    (TOP)