Also see the PDF print version of all recommended service arrays

Traumatic Brain Injury (TBI) Inpatient Comprehensive Medical Rehabilitation Services (maximum 90 days)

Key

LP = Licensed Professional
CP = Certified Professional
PP = Paraprofessional

Core Services Service Delivery Modality Provider Qualifications
Aquatic Therapy Individual and Group LP
Art Therapy Individual and Group LP
Behavior Management Individual LP or CP
Case Management Individual CP
Chemical Dependency Individual and Group LP
Cognitive Rehabilitation Therapy (CRT) Individual and Group LP
Dietary Nutritional Services Individual and Group LP
Massage Therapy Individual LP
Medical Services Individual LP
Mental Restoration Individual and Group LP
Music Therapy Individual and Group CP
Neuropsychiatric Services Individual and Group LP
Neuropsychological Services Individual and Group LP
Occupational Therapy Individual and Group LP or CP
Physical Therapy Individual and Group LP or CP
Recreational Therapy Individual and Group CP
Room and Board Individual Qualifications not stipulated
Speech/Language Pathology Individual and Group LP or CP
Ancillary Services Service Delivery Modality Provider Qualifications
Audiology Individual LP
DME/Supplies Individual Qualifications not stipulated
Family Therapy Individual and Group LP
Family/Caregiver Education & Training Individual and Group LP or CP
Orthosis/Prosthesis Individual LP
Over the Counter Medications Individual Qualifications not stipulated
Physical Restoration Individual LP
Prescription Medications Individual LP
Rehabilitation Technology Individual LP, other professionals
Transportation Individual Qualifications not stipulated
Vision Services Individual LP

Traumatic Brain Injury (TBI) Outpatient Services (maximum 120 hours)

Key

LP = Licensed Professional
CP = Certified Professional
PP = Paraprofessional

Core Services Service Delivery Modality Provider Qualifications
Aquatic Therapy Individual and Group LP
Art Therapy Individual and Group LP
Chemical Dependency Individual and Group LP
Cognitive Rehabilitation Therapy (CRT) Individual and Group LP
Massage Therapy Individual LP
Mental Restoration Individual and Group LP
Music Therapy Individual and Group CP
Neuropsychiatric Services Individual and Group LP
Neuropsychological Services Individual and Group LP
Occupational Therapy Individual and Group LP or CP
Physical Therapy Individual and Group LP or CP
Recreational Therapy Individual and Group CP
Speech/Language Pathology Individual and Group LP or CP
Ancillary Services Service Delivery Modality Provider Qualifications
Audiology Individual LP
Dietary Nutritional Services Individual and Group LP
DME/Supplies Individual Qualifications not stipulated
Family Therapy Individual and Group LP
Family/Caregiver Education & Training Individual and Group LP or CP
Home Modification Individual LP
Orthosis/Prosthesis Individual LP
Personal Attendant Care Individual PP
Physical Restoration Individual LP
Prescription Medications Individual LP
Rehabilitation Technology Individual LP, other professionals
Transportation Individual Qualifications not stipulated
Vision Services Individual LP

Post-Acute Brain Injury (PABI) Residential Services (maximum 180 days total PABI)

Key

LP = Licensed Professional
CP = Certified Professional
PP = Paraprofessional

Core Services Service Delivery Modality Provider Qualifications
Aquatic Therapy Individual and Group LP
Art Therapy Individual and Group LP
Behavior Management Individual LP or CP
Case Management Individual CP
Chemical Dependency Individual and Group LP
Cognitive Rehabilitation Therapy (CRT) Individual and Group LP
Dietary Nutritional Services Individual and Group LP
Massage Therapy Individual LP
Medical Services Individual LP
Mental Restoration Individual and Group LP
Music Therapy Individual and Group CP
Neuropsychiatric Services Individual and Group LP
Neuropsychological Services Individual and Group LP
Occupational Therapy Individual and Group LP or CP
Personal Assistance Individual and Group PP
Physical Therapy Individual and Group LP or CP
Recreational Therapy Individual and Group CP
Room and Board Individual Qualifications not stipulated
Speech/Language Pathology Individual and Group LP or CP
Ancillary Services Service Delivery Modality Provider Qualifications
Audiology Individual LP
DME/Supplies Individual Qualifications not stipulated
Family Therapy Individual and Group LP
Family/Caregiver Education & Training Individual and Group LP or CP
Home Modification Individual LP
Limited Skilled Nursing Individual LP
Orthosis/Prosthesis Individual LP
Over the Counter Medications Individual Qualifications not stipulated
Physical Restoration Individual LP
Prescription Medications Individual LP
Rehabilitation Technology Individual LP, other professionals
Transportation Individual Qualifications not stipulated
Vision Services Individual LP

Post-Acute Brain Injury (PABI) Non-Residential Services (maximum 180 days total PABI)

Key

LP = Licensed Professional
CP = Certified Professional
PP = Paraprofessional

Core Services Service Delivery Modality Provider Qualifications
Aquatic Therapy Individual and Group LP
Art Therapy Individual and Group LP
Behavior Management Individual LP or CP
Case Management Individual CP
Chemical Dependency Individual and Group LP
Cognitive Rehabilitation Therapy (CRT) Individual and Group LP
Dietary Nutritional Services Individual and Group LP
Massage Therapy Individual LP
Mental Restoration Individual and Group LP
Music Therapy Individual and Group CP
Neuropsychiatric Services Individual and Group LP
Neuropsychological Services Individual and Group LP
Occupational Therapy Individual and Group LP or CP
Physical Therapy Individual and Group LP or CP
Recreational Therapy Individual and Group CP
Speech/Language Pathology Individual and Group LP or CP
Ancillary Services Service Delivery Modality Provider Qualifications
Audiology Individual LP
DME/Supplies Individual Qualifications not stipulated
Family Therapy Individual and Group LP
Family/Caregiver Education & Training Individual and Group LP or CP
Home Modification Individual LP
Limited Skilled Nursing Individual LP
Orthosis/Prosthesis Individual LP
Over the Counter Medications Individual Qualifications not stipulated
Personal Attendant Care Individual PP
Physical Restoration Individual LP
Prescription Medications Individual LP
Rehabilitation Technology Individual LP, other professionals
Transportation Individual Qualifications not stipulated
Vision Services Individual LP

Spinal Cord Injury (SCI) Inpatient Comprehensive Medical Rehabilitation Services (maximum 90 days)

Key

LP = Licensed Professional
CP = Certified Professional
PP = Paraprofessional

Core Services Service Delivery Modality Provider Qualifications
Aquatic Therapy Individual and Group LP
Art Therapy Individual and Group LP
Case Management Individual CP
Dietary Nutritional Services Individual and Group LP
Massage Therapy Individual LP
Medical Services Individual LP
Music Therapy Individual and Group CP
Occupational Therapy Individual and Group LP or CP
Physical Therapy Individual and Group LP or CP
Recreational Therapy Individual and Group CP
Room and Board Individual Qualifications not stipulated
Speech/Language Pathology Individual and Group LP or CP
Ancillary Services Service Delivery Modality Provider Qualifications
DME/Supplies Individual Qualifications not stipulated
Family Therapy Individual and Group LP
Family/Caregiver Education & Training Individual and Group LP or CP
Home Modification Individual LP
Limited Skilled Nursing Individual LP
Mental Restoration Individual and Group LP
Orthosis/Prosthesis Individual LP
Over the Counter Medications Individual Qualifications not stipulated
Physical Restoration Individual LP
Prescription Medications Individual LP
Rehabilitation Technology Individual LP, other professionals
Transportation Individual Qualifications not stipulated

Spinal Cord Injury (SCI) Outpatient Services (maximum 120 hours)

Key

LP = Licensed Professional
CP = Certified Professional
PP = Paraprofessional

Core Services Service Delivery Modality Provider Qualifications
Aquatic Therapy Individual and Group LP
Art Therapy Individual and Group LP
Massage Therapy Individual LP
Music Therapy Individual and Group CP
Occupational Therapy Individual and Group LP or CP
Physical Therapy Individual and Group LP or CP
Recreational Therapy Individual and Group CP
Speech/Language Pathology Individual and Group LP or CP
Ancillary Services Service Delivery Modality Provider Qualifications
Dietary Nutritional Services Individual and Group LP
DME/Supplies Individual Qualifications not stipulated
Family Therapy Individual and Group LP
Family/Caregiver Education & Training Individual and Group LP or CP
Home Modification Individual LP
Mental Restoration Individual and Group LP
Orthosis/Prosthesis Individual LP
Personal Attendant Care Individual PP
Physical Restoration Individual LP
Prescription Medications Individual LP
Rehabilitation Technology Individual LP, other professionals
Transportation Individual Qualifications not stipulated

Post Acute Spinal Cord Injury Non-Residential (maximum 180 days)

Key

LP = Licensed Professional
CP = Certified Professional
PP = Paraprofessional

Core Services Service Delivery Modality Provider Qualifications
Aquatic Therapy Individual and Group LP
Art Therapy Individual and Group LP
Case Management Individual CP
Dietary Nutritional Services Individual and Group LP
Massage Therapy Individual LP
Music Therapy Individual and Group CP
Occupational Therapy Individual and Group LP
Physical Therapy Individual and Group LP
Recreational Therapy Individual and Group CP
Speech/Language Pathology Individual and Group LP
Ancillary Services Service Delivery Modality Provider Qualifications
DME/Supplies Individual Qualifications not stipulated
Family Therapy Individual and Group LP
Family/Caregiver Education & Training Individual and Group LP or CP
Home Modification Individual Qualifications not stipulated
Limited Skilled Nursing Individual LP
Mental Restoration Individual and Group LP
Orthosis/Prosthesis Individual Qualifications not stipulated
Over the Counter Medications Individual Qualifications not stipulated
Personal Attendant Care Individual PP
Physical Restoration Individual LP
Prescription Medications Individual Qualifications not stipulated
Rehabilitation Technology Individual Qualifications not stipulated
Transportation Individual Qualifications not stipulated
Vision Therapy Individual LP