§ 6350.24. Inhome therapy.
(a) This service should be available when the family member with an intellectual disability must receive therapy or a nonpublic school program in his own home. It insures the family that the family member with an intellectual disability will receive important treatment or therapy even in the event that he is ‘‘homebound.’’ This service is primarily directed to those individuals with an intellectual disability who have multiple disabilities or significant medical needs, or both. Except in unusual circumstances, it should not be utilized when the individual with an intellectual disability is capable of leaving his home to receive such needed therapy.
(1) Visiting nurses/related inhome medical therapy is an acceptable inhome therapy service. This service may include professional or paraprofessional personnel who perform such tasks as:
(i) Assisting the parents with special medically related problems and training these parents to perform these functions when possible.
(ii) Tube feeding, respiration control (oxygen), other special feeding techniques.
(iii) Administering medication.
(iv) Exercising.
(v) Dietetics.
(vi) Other medical treatment as directed by the physician.
(vii) General health care.
(viii) Caring for the convalescing individual with an intellectual disability after he has been hospitalized.
(2) Only a registered nurse or a licensed practical nurse may perform or direct inhome medical therapy.
(3) Inhome medical therapy will be paid for only if a physician has, in writing, prescribed the specific services required.
(4) The physician’s written prescription must be available to the Base Service Unit and the County Mental Health/Intellectual Disability (MH/ID) Office.
(b) Physical/occupational therapy services may be vital to the individual with an intellectual disability and a physical disability whose family, because of these disabilities, will need additional assistance in physical care and in basic self-care skills development. This service not only will help the individual with an intellectual disability to be self-sufficient but will also provide relief to other family members.
(1) The following eligible persons are listed in order of priority:
(i) Persons who are ‘‘homebound’’ and not able to go out of the home for therapy.
(ii) Persons who are attending a day program where no formal physical or occupational therapy is provided.
(iii) Persons who have had a minimal amount of physical and occupational therapy, but professional evaluation indicates that the person needs a more consistent program than has been available.
(2) A licensed physical therapist must perform or direct physical therapy. A registered occupational therapist must perform or direct occupational therapy.
(3) Physical therapy or occupational therapy will be paid for only if a physician has, in writing, either documented the need for or prescribed a specific therapy program.
(4) The written therapy prescription and program plan must be available to the Base Service Unit and the County MH/ID Office.
(5) Responsible family members must receive instruction and be a part of the therapy program.
(6) If an individual with an intellectual disability is of school age, the public school system should provide the therapy service when it is a part of the person’s individual prescriptive educational plan.
(c) Speech/language therapy/audiology services are acceptable Family Resource Service (FRS) Programs.
(1) The ‘‘eligible persons’’ listed in subsection (b)(1) apply equally to speech/language therapy/audiology.
(2) To be eligible, the individual with an intellectual disability must have been examined by a certified or certification-eligible audiologist for possible hearing deficiencies or a certified or certification-eligible speech therapist who have recommended a formal speech/language/audiology program. The ensuing program must be professionally prescribed and directed.
(3) A written program, including short- and long-range goals, must be available to both the Base Service Unit and the County MH/ID Office.
(4) There must be evidence of involvement of responsible family members in the speech/language/audiology program.
(5) If the individual with an intellectual disability is of school age, the public school system should provide this service.
(d) Visual/mobility therapy (training) service may be vital to the individual with an intellectual disability and a severe visual impairment, who because of these disabilities, is unable to navigate around his place of residence or in the community.
(1) The ‘‘eligible persons’’ listed in subsection (b)(1) apply equally to visual/mobility therapy (training).
(2) To be eligible, the individual with an intellectual disability must have been examined by a physician to determine the extent of visual impairment and to document the need for visual/mobility therapy (training).
(3) A trained mobility specialist/instructor must evaluate the individual with an intellectual disability and a visual impairment and develop a written visual/mobility training program plan specific to the service recipient.
(4) A trained mobility specialist/instructor must perform the visual/mobility therapy (training).
(5) The written therapy program plan, including short- and long-range goals, must be available to the Base Service Unit and the County MH/ID Office.
(6) There must be evidence of involvement by responsible family members in the visual/mobility training program.
(7) If an individual with an intellectual disability is of school age, the public school system should provide this service.
(e) Vocational therapy consists of the provision of vocationally oriented services in the home of an individual with an intellectual disability to help the individual with an intellectual disability become more self-sufficient, progress to an out-of-home setting, or maintain vocational skills previously acquired.
(1) The following are eligible persons for inhome vocational therapy:
(i) Persons who are engaged in community vocational programs but are temporarily ‘‘homebound’’ while convalescing from an illness, accident, or are receiving medical treatment related to a chronic handicapping condition.
(ii) Persons who are not currently engaged in a community vocational habilitation program and who are indefinitely ‘‘homebound’’ due to the severity of their mental or physical handicap. These persons could benefit from vocational services:
(A) To enhance their self-worth and self-sufficiency within the homebound situation.
(B) To assess their vocational potential and develop their social/vocational functioning to the point that they can enter an out-of-home vocationally-oriented setting.
(2) For eligible persons to participate inhome vocational therapy, the following procedures must be followed:
(i) There must be a written physician’s statement that the person’s medical condition permits him to participate in homebound employment and which includes an estimate of the time needed for convalescence.
(ii) There must be a written individual habilitation plan for the homebound work prepared and implemented by the community vocational program in which the person has been participating.
(iii) The written program must be available to the Base Service Unit and the County MH/ID Office.
(3) Homebound employment may be funded for an initial interval of 2 months. Extensions, in intervals of 2 months, or less, may also be funded, provided that a medical statement indicates the person may not yet return to the vocational program in the community. Homebound employment may not be utilized beyond the point when the individual with an intellectual disability is capable of leaving his home to participate in an out-of-home vocational program.
(4) There should be evidence that the family supports the homebound employment program in terms of available work space and time in the home but does not do the work for the individual with an intellectual disability.
(5) For eligible persons to participate in inhome vocational therapy:
(i) The individual with an intellectual disability must be evaluated initially by a qualified vocational evaluator who recommends an inhome vocational therapy program.
(ii) There must be evidence, preferably a physician’s statement, that the person cannot participate in a vocational program at an out-of-home setting due to the severity of his mental or physical handicap with an estimate of the duration of the homebound state.
(iii) There must be an individual inhome vocational therapy plan prepared and directed by a recognized community vocational habilitation program.
(iv) Except in unusual circumstances, as determined by the County MH/ID Office, there should be evidence within the individual’s program plan that the inhome program will result in the individual eventually entering an out-of-home vocationally oriented setting.
(v) This written program plan must be available to the Base Service Unit and the County MH/ID Office.
(vi) Quarterly status reports must be submitted to the Base Service Unit and County MH/ID Office as part of the program plan implementation.
(vii) Vocational therapy for eligible persons may be funded for an initial interval of 6 months.
(viii) The initial vocational evaluation in the home may also be funded through the FRS Program. Extensions, in intervals of 3 months or less, may also be funded, provided that the quarterly program status report indicates that extended service is an integral part of the individual’s vocational habilitation plan.
(f) Recreational therapy/therapeutic recreation is for individuals with an intellectual disability who, due to the severity of their mental or physical handicap, or both, may be deprived of having their minimal socio-recreative needs met because of their homebound state and, consequently, may be showing signs of psycho-social regression or physical atrophy, or both.
(1) Inhome recreational therapy services may only be made available to those individuals with an intellectual disability who are ‘‘homebound.’’
(2) Recreational therapy/therapeutic recreation services should be provided or directed by an individual with training in recreation or an allied human services field. Appropriate training may be obtained from a formal academic education as well as participation in seminars, workshops, inservice training programs, and the like.
(3) Inhome recreational therapy services may be paid for through the FRS Program provided that the services result from a goal-oriented recreational therapy plan for the individual service recipient with an intellectual disability. This program plan must include the following:
(i) A statement which defines the needs of the individual with an intellectual disability for inhome recreational therapy service.
(ii) A statement of short- and long-term goals which serve as the rationale for the recreational therapy program.
(iii) A general description of the program.
(4) The written plan for the recreational therapy program must be available to the Base Service Unit and the County MH/ID Office.
(5) Responsible family members must receive instruction in and be a part of the recreational therapy program.
(g) Professional inhome dental hygiene services may be made available to those individuals with an intellectual disability who because of the mental or physical disabilities, or both, are ‘‘homebound.’’
(1) Only those inhome dental hygiene services provided by a dentist or licensed dental hygienist are eligible for FRS funding.
(2) The dental hygiene program must be approved by the County MH/ID Office.
(3) A copy of the dental hygiene treatment plan/program must be available to the Base Service Unit and the County MH/ID Office.
(4) Responsible family members must receive instruction in and be a part of the approved dental hygiene program.
(h) Behavioral programming and other related services may be provided through the FRS Program with the provision that they are consistent with the general intent of the FRS Program and the specific inhome therapy guidelines.
Authority The provisions of this § 6350.24 amended under sections 201(2) and (8) and 202 of the Mental Health and Intellectual Disability Act of 1966 (50 P.S. § § 4201(2) and (8) and 4202).
Source The provisions of this § 6350.24 amended June 17, 2016, effective June 18, 2016, 46 Pa.B. 3177. Immediately preceding text appears at serial pages (247853) to (247857).
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