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personnel who are authorized by state law to provide that service and who are on the premises at the time service is rendered; technical or professional personnel include a registered nurse, a licensed practical nurse, a licensed physical therapist, a licensed physical therapy assistant, a licensed occupational therapist, a certified occupational therapy assistant, a licensed speech-language pathologist, a registered speech-language pathologist assistant, and an audiologist. (b) Skilled nursing services are the observation, assessment, and treatment of a recipient’s unstable condition requiring the care of licensed nursing personnel to identify and evaluate the recipient’s need for possible modification of treatment, the initiation of ordered medical procedures, or both, until the recipient’s condition stabilizes. (c) Structural rehabilitation services are the following services required by physician orders and provided at least five days a week until the recipient’s condition fails to show continued improvement through objective evidence:

(1) ongoing assessment of structured rehabilitation needs and potentials; services must be concurrent with the management of a recipient care plan, including tests and measurements of range of motion, strength, balance, coordination, endurance, functional ability, activities of daily living, perceptual deficiencies, and speech, language, or hearing disorders;

(2) therapeutic exercises or activities that, because of the type of exercises employed or the condition of the recipient, must be performed by or under the supervision of a qualified physical therapist or occupational therapist, to ensure the safety of the recipient and the effectiveness of the treatment;

(3) gait evaluation and treatment;

(4) range-of-motion exercises that are part of the active treatment of a specific disease that has resulted in a loss of or restriction of mobility;

(5) maintenance occupational or physical therapy if specialized knowledge and judgment of a qualified occupational or physical therapist are required to design and establish a maintenance therapy program based on an initial evaluation and periodic reassessment of the recipient’s needs and consistent with the recipient’s capacity and tolerance;

(6) ultrasound, short-wave, and microwave therapy treatments;

(7) hot pack, infrared treatments, and paraffin baths in particular cases where the recipient’s condition is complicated by circulatory deficiencies, areas of desensitization, open wounds, fractures, or other complications;

(8) services of a communications specialist, a speech-language pathologist, or an audiologist if necessary for the restoration of function in speech or hearing. (Eff. 2/1/2010, Register 193) Statutory Authority: