Chapter DHS 107

DHS 107.17 DHS 107.17 Occupational therapy.

DHS 107.17(1) (1) Covered services. Covered occupational therapy services are the following medically necessary services when prescribed by a physician and performed by a certified occupational therapist (OT) or by a certified occupational therapist assistant (COTA) under the direct, immediate, on-premises supervision of a certified occupational therapist or, for services under par. (d), by a certified occupational therapist assistant under the general supervision of a certified occupational therapist pursuant to the requirements of s. DHS 105.28 (2):

DHS 107.17(1)(a) (a) Motor skills, as follows:

DHS 107.17(1)(a)1. 1. Range-of-motion;

DHS 107.17(1)(a)2. 2. Gross/fine coordination;

DHS 107.17(1)(a)3. 3. Strengthening;

DHS 107.17(1)(a)4. 4. Endurance/tolerance; and

DHS 107.17(1)(a)5. 5. Balance;

DHS 107.17(1)(b) (b) Sensory integrative skills, as follows:

DHS 107.17(1)(b)1. 1. Reflex/sensory status;

DHS 107.17(1)(b)2. 2. Body concept;

DHS 107.17(1)(b)3. 3. Visual-spatial relationships;

DHS 107.17(1)(b)4. 4. Posture and body integration; and

DHS 107.17(1)(b)5. 5. Sensorimotor integration;

DHS 107.17(1)(c) (c) Cognitive skills, as follows:

DHS 107.17(1)(c)1. 1. Orientation;

DHS 107.17(1)(c)2. 2. Attention span;

DHS 107.17(1)(c)3. 3. Problem-solving;

DHS 107.17(1)(c)4. 4. Conceptualization; and

DHS 107.17(1)(c)5. 5. Integration of learning;

DHS 107.17(1)(d) (d) Activities of daily living skills, as follows:

DHS 107.17(1)(d)1. 1. Self-care;

DHS 107.17(1)(d)2. 2. Work skills; and

DHS 107.17(1)(d)3. 3. Avocational skills;

DHS 107.17(1)(e) (e) Social interpersonal skills, as follows:

DHS 107.17(1)(e)1. 1. Dyadic interaction skills; and

DHS 107.17(1)(e)2. 2. Group interaction skills;

DHS 107.17(1)(f) (f) Psychological intrapersonal skills, as follows:

DHS 107.17(1)(f)1. 1. Self-identity and self-concept;

DHS 107.17(1)(f)2. 2. Coping skills; and

DHS 107.17(1)(f)3. 3. Independent living skills;

DHS 107.17(1)(g) (g) Preventive skills, as follows:

DHS 107.17(1)(g)1. 1. Energy conservation;

DHS 107.17(1)(g)2. 2. Joint protection;

DHS 107.17(1)(g)3. 3. Edema control; and

DHS 107.17(1)(g)4. 4. Positioning;

DHS 107.17(1)(h) (h) Therapeutic adaptions, as follows:

DHS 107.17(1)(h)1. 1. Orthotics/splinting;

DHS 107.17(1)(h)2. 2. Prosthetics;

DHS 107.17(1)(h)3. 3. Assistive/adaptive equipment; and

DHS 107.17(1)(h)4. 4. Environmental adaptations;

DHS 107.17(1)(i) (i) Environmental planning; and

DHS 107.17(1)(j) (j) Evaluations or re-evaluations. Covered evaluations, the results of which shall be set out in a written report attached to the test chart or form in the recipient’s medical record, are the following:

DHS 107.17(1)(j)1. 1. Motor skills:

DHS 107.17(1)(j)1.a. a. Range-of-motion;

DHS 107.17(1)(j)1.b. b. Gross muscle test;

DHS 107.17(1)(j)1.c. c. Manual muscle test;

DHS 107.17(1)(j)1.d. d. Coordination evaluation;

DHS 107.17(1)(j)1.e. e. Nine hole peg test;

DHS 107.17(1)(j)1.f. f. Purdue pegboard test;

DHS 107.17(1)(j)1.g. g. Strength evaluation;

DHS 107.17(1)(j)1.h. h. Head-trunk balance evaluation;

DHS 107.17(1)(j)1.i. i. Standing balance — endurance;

DHS 107.17(1)(j)1.j. j. Sitting balance — endurance;

DHS 107.17(1)(j)1.k. k. Prosthetic check-out;

DHS 107.17(1)(j)1.L. L. Hemiplegic evaluation;

DHS 107.17(1)(j)1.m. m. Arthritis evaluation; and

DHS 107.17(1)(j)1.n. n. Hand evaluation — strength and range-of-motion;

DHS 107.17(1)(j)2. 2. Sensory integrative skills:

DHS 107.17(1)(j)2.a. a. Beery test of visual motor integration;

DHS 107.17(1)(j)2.b. b. Southern California kinesthesia and tactile perception test;

DHS 107.17(1)(j)2.c. c. A. Milloni-Comparetti developmental scale;

DHS 107.17(1)(j)2.d. d. Gesell developmental scale;

DHS 107.17(1)(j)2.e. e. Southern California perceptual motor test battery;

DHS 107.17(1)(j)2.f. f. Marianne Frostig developmental test of visual perception;

DHS 107.17(1)(j)2.g. g. Reflex testing;

DHS 107.17(1)(j)2.h. h. Ayres space test;

DHS 107.17(1)(j)2.i. i. Sensory evaluation;

DHS 107.17(1)(j)2.j. j. Denver developmental test;

DHS 107.17(1)(j)2.k. k. Perceptual motor evaluation; and

DHS 107.17(1)(j)2.L. L. Visual field evaluation;

DHS 107.17(1)(j)3. 3. Cognitive skills:

DHS 107.17(1)(j)3.a. a. Reality orientation assessment; and

DHS 107.17(1)(j)3.b. b. Level of cognition evaluation;

DHS 107.17(1)(j)4. 4. Activities of daily living skills:

DHS 107.17(1)(j)4.a. a. Bennet hand tool evaluation;

DHS 107.17(1)(j)4.b. b. Crawford small parts dexterity test;

DHS 107.17(1)(j)4.c. c. Avocational interest and skill battery;

DHS 107.17(1)(j)4.d. d. Minnesota rate of manipulation; and

DHS 107.17(1)(j)4.e. e. ADL evaluation \ men and women;

DHS 107.17(1)(j)5. 5. Social interpersonal skills — evaluation of response in group;

DHS 107.17(1)(j)6. 6. Psychological intrapersonal skills:

DHS 107.17(1)(j)6.a. a. Subjective assessment of current emotional status;

DHS 107.17(1)(j)6.b. b. Azima diagnostic battery; and

DHS 107.17(1)(j)6.c. c. Goodenough draw-a-man test;

DHS 107.17(1)(j)7. 7. Therapeutic adaptions; and

DHS 107.17(1)(j)8. 8. Environmental planning — environmental evaluation.

DHS 107.17(2) (2) Services requiring prior authorization.

DHS 107.17(2)(a) (a) Definition. In this subsection, “spell of illness” means a condition characterized by a demonstrated loss of functional ability to perform daily living skills, caused by a new disease, injury or medical condition or by an increase in the severity of a pre-existing medical condition. For a condition to be classified as a new spell of illness, the recipient must display the potential to reachieve the skill level that he or she had previously.