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Subject: Part One: The Policy up for comment

Author: Judy

[ Next Thread | Previous Thread | Next Message | Previous Message ] Date Posted: 09/11/05 Sun In reply to: Judy 's message, "Public Comment: WV Division of Rehab Services" on 09/11/05 Sun First Half: 4400 WEST VIRGINIA REHABILITATION CENTER. 4401 General. The West Virginia Rehabilitation Center (hereinafter referred to as the Center) is vocationally oriented and uses a team approach in providing comprehensive rehabilitation services to clients. Admission to the Center may be denied because of limitations in programming or expertise. The Center is committed to serving individuals with the most significant disabilities. However, the Division does reserve the right to serve those individuals having the potential to benefit from Center services in terms of planned rehabilitation objectives. To aid in accomplishing its mission, the Center is accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF) and the North Central Association of Colleges and Schools (NCA). 4402 Admission Guidelines. The following guidelines are offered to assist the Field Counselor or other referral source in selecting candidates for Center services. 4402.1 Referral. Referral for Center services may be appropriate when: A. The applicant may need multiple services which would be delivered most appropriately in a comprehensive rehabilitation center setting; and/or, B. Extenuating circumstances indicate, in the Field Counselor’s professional judgment, that Center services would substantially improve the likelihood of the candidate’s successful vocational rehabilitation. 4402.2 Ability to Participate. All candidates must meet admissions criteria to participate in the program of choice. Candidates should not constitute a significant hazard to themselves or a disruption to others. Their needs must lie within the capacity of the Center’s staff and resources. Their functional levels should be reasonably stabilized so that an assessment of rehabilitation potential will have long-range validity. Examples of inappropriate applicants or persons include those: A. In body casts; B. With pressure or bed sores (decubiti) so severe that they cannot participate in a program of evaluation or training; C. In need of a long-term period of medical convalescence prior to beginning a program of medical evaluation; D. Who are psychotic or at significant risk of suicide; E. Involved in substance abuse during the past 90 days; F. Involved in litigation of a nature which will interfere with his/her participation in a rehabilitation program; G. With either behavioral, intellectual, or emotional problems too severe to be supervised or treated appropriately in the Center’s open setting, considering current staffing levels (i.e., individuals exhibiting self-injurious behavior or those behaviors constituting a threat to the health, safety and welfare of other students or staff; and/or those individuals requiring one on one supervision); H. Requiring twenty-four hour supervision other than medical; I. Who cannot bathe or attend to personal toileting needs other than medical; or, J. Unable to direct an attendant in performing activities of daily living and other attendant care tasks. 4402.3 Priority. Priority will be given to Division clients, individuals with most significant disabilities, order of selection, and other fee for service clients. 4402.4 Waiting Lists. Waiting lists are maintained for each Center area of service. These waiting lists are reviewed quarterly. Clients who have been on the waiting lists for any length of time are contacted, as well as their Field Counselors, in order to inquire as to whether or not they still wish to receive services. Clients are placed on the waiting lists on a first come, first served basis. 4402.5 Evaluation. Students in vocational training programs are under an evaluation period for the first thirty days. Students who withdraw or transfer during this period are not counted in graduation completion rate statistics. Field Counselors are expected to use their professional judgment prior to referring a student to a training program. Their assessment will include an evaluation and consideration of client choice. 4402.6 Eligibility or Acceptability. All candidates referred to the Center by a Field Counselor will be either applicants for rehabilitation services (Status 02) or Division clients (Status 10 and above). 4402.7 Age. All candidates will be of an age such that they will be employable at the time rehabilitation services are expected to be completed. 4403 Referral of Division Clients. The Field Counselor will request the client’s admission to the Center by sending the required documentation (see Figure 4400-1) to the Coordinator, Center Admissions. If the client is accepted for admission, both the client and Field Counselor will be notified of the planned admission date and will receive other appropriate information or instructions. A. Medical Information. Required is complete medical information about the client’s disability(ies), including report of the general medical evaluation or Health Assessment Questionnaire (HAQ); report of medical specialist examination; radiology, pathology, or other laboratory reports; copies of any special diet(s); dosage and schedule of prescribed medication(s); pertinent hospital records (including discharge summaries); and, reports of psychiatric or behavioral evaluations or other records of diagnosis or treatment of a cognitive, emotional or behavioral disorder. It is not necessary to obtain an audiological evaluation for a blind client or a visual evaluation for a deaf client prior to requesting Center admission, since such evaluations can be performed after the client is admitted. 1. General Medical Evaluations or HAQ. General medical evaluations or HAQs completed during the 36 months prior to admission will be considered acceptable, provided the Field Counselor documents that the client’s disability is stable or slowly progressive. 2. Specialist Evaluations. All specialist evaluations (except psychiatric) completed during the 36 months prior to admission will be considered acceptable, provided the Field Counselor documents that the client’s disability is stable. If the client has been seen regularly by a specialist, the most recent report will be required. A six-month recency standard applies to psychiatric evaluations. 3. Completeness of Medical Information. Field Counselors may submit cases for review by the Center Admissions Counselor and the client may be admitted prior to receipt of all medical information requested by the Field Counselor. Information regarding any prescription medication(s) used by the client is required. To the extent deemed prudent by the medical staff, the Center will not delay admission of clients in need of services because nonessential medical records are absent from the case folder. The Field Counselor should document carefully what medical information has been requested and promptly forward such information to the Center upon receipt. B. Educational Information. The Field Counselor will submit school records, academic aptitude or achievement testing reports (e.g., IEPs, subtest scores, or other pertinent information). C. Psychological Information. The Field Counselor will submit psychological testing reports. D. Vocational/Social History. The Field Counselor will provide a complete vocational and social history. 4403.1 Counselor Comments. The more specific the information provided, the more relevant the actions of Center staff will be. If the client is to live at the Center, the Field Counselor may recommend that Center services include a structured recreational program; instruction in self care, hygiene, health, and room care; or participation in drug education and treatment programs. The last entry in Counselor Comments should include explanations/descriptions of the following (as appropriate): A. Need for the requested service(s); B. Anticipated rehabilitation goal(s) or range of goals, if submitted for a preliminary or thorough diagnostic study; C. Questions to be answered; D. Behaviors to be modified; E. Skills to be attained; F. Arrangements for residence and/or care of the client during Center holidays and at the end of the client’s program if client is to reside at the Center; G. Special instructions to Center staff; H. Transportation arrangements to and from the Center; I. Signed statements regarding payment arrangements by relatives or third parties and a current Economic Survey; and, J. Random drug screenings and AA/NA attendance during the Center program for individuals with alcohol/drug addiction. 4403.2 Readmission. The Field Counselor requesting readmission of a client to the Center is not required to resubmit a new case. Division casework standards for justification of requested services will apply in all cases. All narrative documentation and case service forms completed since the date of Center discharge, a narrative justification for the requested service, and an updated Economic Survey must be submitted to the Center Admissions Office. 4404 Policy for Minors and those under Guardianship. Since the WVRC is an open campus, clients are free to leave campus in the evenings and on weekends in accordance with curfews and guidelines unless they are minors or under guardianship. Although staff members are on duty 24 hours a day, the Center cannot provide one on one supervision to any client. 4404.1 Center Rules and Regulations. All minors and those under guardianship MUST adhere to all Center rules, regulations and Standards of Conduct found in the Center Student Handbook. These include but are not limited to: A. Dormitory clients are not allowed to visit in Hospital rooms. Visitation should take place in the Hospital Solarium. B. Sexual activity is not permitted on campus. C. No possession, use or distribution of alcohol or illegal drugs will be permitted. D. No dorm students are allowed in the hospital after visiting hours unless they are ill or scheduled to pick up medication. E. Possession of fireworks, knives, explosives, firearms or weapons of any kind will not be permitted. 4404.2 Special Considerations for Minors and Those Under Guardianship. Counselors must inform applicants or eligible individuals and the parent or guardian of the following special considerations for WVRC admission for those who are minors or under guardianship: A. Clients must be at least 16 years old to reside at the WVRC. B. Minors and those under guardianship residing in the dormitory will be on the first floor of the dormitory. C. If a designated room is not available, the minor/those under guardianship will need to wait to enter WVRC. D. Minors/those under guardianship will not be housed with adults in the hospital or in the dormitory rooms. E. All cases (Skeleton, Medical File and Center File) will be flagged with labels indicating minor and/or guardianship status. The I.D. badges for minors will be marked with red labels; the I.D. badges for those under guardianship will be marked with orange labels. F. The rehabilitation counselor will explain all required forms with the parent/guardian. The parent and/or guardian will acknowledge that he/she has read and understands the policy and limitations on supervision of a minor family member or individual under guardianship by signing ALL forms. G. An orientation will be provided to the parents/guardians of minors and those under guardianship. Guardians and/or parents MUST attend this orientation. If the parent/guardian cannot attend, the orientation may be rescheduled for another date. H. Staff on duty in the Hospital and Dorm will check the rooms of minors a minimum of twice per shift. I. If a hospital minor patient or patient who is under guardianship wants to visit in the first floor dorm lounge, he/she must inform a nurse and sign in with the dorm Resident Advisor. Visitation above the first floor is not permitted. J. Minors and those under guardianship residing in the hospital may not visit in dorm rooms. Any visitation in the hospital must take place in the Hospital Solarium, Recreation or first floor dorm lobby K. Minors and those under guardianship residing in the dormitory may not visit in another student’s dorm room unless permission is granted by the Shift Supervisor or Evening Counselor. L. WV Code 16-9A-3 says “No person under the age of 18 years shall have on or about his/her person or premises or use any cigarette, or cigarette paper or any other paper prepared, manufactured or made for the purpose of smoking any tobacco products, in any form; or, any pipe, snuff, chewing tobacco or tobacco product..” In accordance with this law, minors are not permitted to possess, use or distribute tobacco products. M. The parent/guardian will be contacted when an emergency occurs, the client is non-compliant with policy or discipline must be considered. N. If a complaint falls under mandatory reporting statutes (abuse, sexual assault, rape, neglect) WVDHHR Child Protective Services will be notified and the police department will be contacted immediately by the person receiving the complaint. The WVRC Administrator or designee will be notified immediately. If the complaint occurs during the work day, the WVRC Administrator or designee and the Patient Rights Representative or designee will be notified immediately. If the complaint occurs on a week-end or after 4:45 p.m. on a week day, the WVRC Administrator or designee and the Patient Rights Representative or designee, will be notified the following work day. O. Minors and those under guardianship will be restricted to Center grounds. However, minors and those under guardianship may participate in off campus Center supervised activities with written parental or guardian approval when possible. If it is not possible or practical to obtain written approval, verbal approval will be acceptable and documented as appropriate. P. Curfew for minors and those under guardianships is as follows: 1. By 10:15 p.m. Sunday through Thursday minors and/or those under guardianship must be in their own room or in the lobby of the first floor and must be in their room by 11:30. 2. Friday and Saturday nights minors and those under guardianship must be in their room or the lobby of the first floors by 11:00 p.m. and must be in their rooms by 2:00 a.m. 3. Minor Hospital patients and those under guardianships must be in their hospital room or the Hospital Solarium by 10:00 p.m. seven days per week unless otherwise instructed by the charge nurse. 4404.3 Counselor Responsibility: The counselor must submit a copy of the guardianship or power of attorney/legal documents at the time of referral to WVRC for services. In addition, the rehabilitation counselor will explain all required WVRC forms with the parent/guardian. The parents and/or guardians will acknowledge that they have read and understand the policy and limitations on supervision of a minor family member or individual under guardianship by signing ALL forms. The parent or guardian’s signature on these forms verifies that the individual has read and understands the policy and the limitations on supervision of his/her minor family member or individual under guardianship. Policy for minors/those under guardianship cannot be waived by parents/guardians. The counselor should emphasize that failure to comply with WVRC policy/regulations or Minor/Guardianship policy after admission to WVRC may result in disciplinary actions up to and including discharge. The following WVRC forms must be signed by the parent/legal guardian prior to submitting the case for Center services. A. Minor/Guardianship Policy, B. Assignment of Benefits/Insurance, C. Alcohol/Drug-Free Workplace, D. Consent to Photograph, E. Consent for Medical Treatment, F. Notice of Privacy Practices, G. Campus Security and Completion/Persistence Rate Document H. Release of Information, I. Statement of Parent and Legal guardian and J. Client Medication Policy. 4405 Application Procedures for Direct Referrals. The Field Counselor will submit: A. A statement specifying the Center services desired; B. A signed statement by a responsible party specifying to what degree the referral source and/or other sources will assume financial sponsorship of desired Center services, including ancillary and emergency services; C. All claim, identification, or other numbers or information needed by the Center to obtain payment for Center services rendered to the referral; D. A completed WVDRS-61, WVRC Application; E. Complete and current medical information about the referral’s disability(ies), including: general medical evaluations; medical specialist evaluations; radiology, pathology, or other laboratory reports; special diet(s); dosage and schedule of prescribed medication(s); pertinent hospital records (including discharge summaries); reports of psychiatric or behavioral evaluations; and, records of diagnosis or treatment of a cognitive, emotional, or behavioral disorder (36 months recency for medical; 6 months for psychiatric); F. School records, academic aptitude, or achievement testing reports (e.g., IEPs, subtest scores, or other pertinent information); G. Psychological testing reports; H. Complete vocational information and social history; I. A chronological narrative report maintained by the referral agency summarizing progress; and, J. Special instructions for working effectively with the referral. 4404.1 Non-Medical Direct Referrals. Direct referrals are requests for Center programs from a referral source who is willing and able to assume complete responsibility for financial sponsorship. Types of cases that may be served as direct referrals include: Veterans Administration; insurance or private pay for therapy services; Disability Determination Section; and, medical hospital referrals. If Division sponsorship of any portion of the program is desired, referral will be made through the Field Counselor. The referral source should be prepared to cover the cost of laboratory, medical, or other needed services required during the course of the referral’s stay at the Center which are not covered by the Center’s per diem charges or which must be purchased outside the Center. The case will be reviewed by the Admissions Counselor using the same criteria as for Division referrals. The referral source, referral, and Field Counselor will be notified of disposition of the application and, if accepted, will be notified when an admission date is established. For direct referrals, the referral source will request the referral’s admission by submitting information regarding the referral’s history to the Coordinator, Center Admissions. Direct referrals from the Veterans Administration become joint clients of the Division and Veterans Administration upon admission to the Center. A Center Counselor develops the case using Division criteria. The Center Counselor will provide the Field Counselor with copies of information developed with the client and will forward the original casework documentation to the Field Counselor. 4404.2 Direct Referrals of Non-Division Clients for Outpatient Services. A procedure or service needed for a client of another public agency sometimes can be provided in the geographic area only by specialized technical staff at the Center. Direct referrals for outpatient services from another agency will be directed to the Center’s Admissions Office. All of the following criteria must be met: A. The applicant is referred by and is a client of an agency of the government of the State of West Virginia; B. Division staff clearly have the expertise to provide the service; and, C. The requesting agency is willing to pay for the service at total direct and indirect costs to the Center. 4404.3 Priority to Division Clients. Direct referrals for Center services (whether inpatient or outpatient) will be admitted only when their admission would not delay or prevent provision of needed services to Division clients. 4405 Acceptance Procedure. Center Admissions Counselors have the authority and responsibility for reviewing each admission application and for deciding on the acceptability and timing of admission of each applicant. The Admissions Counselor reviews the case with respect to criteria regarding candidates for admission and adherence to application procedures. Applicants within each priority classification will be admitted in chronological order of acceptance and scheduled based on Division priorities, special projects, and Center staffing considerations. Special considerations for scheduling (school clients to be served in a group or during the summer months) should be stated by the Field Counselor in Counselor Comments. 4406 Medical Rehabilitation Comprehensive Inpatient Rehabilitation Program. 4406.1 General. Admission to the Medical Rehabilitation Unit is made upon the recommendation of licensed physicians who have staff privileges in this facility. Admission is based upon the need for a comprehensive interdisciplinary coordinated team approach for a client/patient with a significant neuromuscular skeletal impairment. Primary issues to be addressed in the Comprehensive Inpatient Rehabilitation Program are problems in self care, sphincter control, mobility, locomotion, communication, and social cognition. The severity of the problem can be measured by identifying whether or not the assistance of another person is required, and if so, to what extent. Ordinarily, those requiring comprehensive inpatient rehabilitation care need the assistance of others. Progress will be measured through use of the Functional Independence Measure prepared by the Data Management Service of the Uniform Data System for Medical Rehabilitation. The Medical Rehabilitation Unit does not accept involuntary admissions. Each individual who wishes to receive treatment at our facility must complete the application process with a Field Counselor. If a person is under 18 years of age, under a guardianship, or over 18 years old but not physically or mentally capable of giving his/her consent to receive services, the parent or guardian must sign the application. Center handbooks detailing client/patient rights and responsibilities are distributed to and discussed with prospective patients/clients and their families prior to facility entry. The medical chart will contain a signed statement of client/patient rights and responsibilities. 4406.2 Admission Criteria. The client/patient must be able or have the potential to comprehend verbal or gestural directions to the extent that s/he can actively participate in a rehabilitation program. Inpatient admission requires the need for: A. Medical supervision; B. Rehabilitation nursing; and, C. The potential to improve in identified problem areas. 4406.3 Medical Case Record/Direct Transfer Procedures. A. Therapy Cases in Status 10. In order to prepare the client’s IPE in a timely manner, the counseling supervisor (or designee) will determine at each Rehabilitation Clinic which referrals the Medical Director is recommending for therapy. This person immediately will contact the Field Counselor to advise him/her of this recommendation. The Field Counselor may, if appropriate at that time, develop an IPE. Therapy may be provided in Status 10 as a diagnostic service. B. Field Client Database Input. The Center Registrar enter direct referrals into the field client database. This procedure insures that authorizations and other critical transactions can be completed quickly. C. Direct Referral Medical Information. The admissions secretary will copy the Medical Director and Medical Counselor with medical information received on direct transfers. The Medical Counselor will staff the case with the Field Counselor to expedite case work up and management. D. Direct Transfer Procedure. 1. Admissions Counselor Actions. When a direct transfer is received, the Admissions Counselor will complete a direct transfer memorandum for review by the Medical Director. The Admissions Counselor will request the following information from the referring social worker: a. History and physical; b. X-ray reports; c. Operative reports; d. Consultant and physicians’ reports; e. Therapists’ reports; and, f. A comprehensive social summary that includes information concerning possible substance abuse, the support system, discharge plans, in addition to any other significant social issue(s). 2. Additional Center Actions. a. Center nursing staff will contact the hospital to discuss the patient with the referring hospital’s nursing staff. b. The Medical Director will review information from the hospital but will not make a decision until the comprehensive social summary is received. c. Upon receipt of the referral, the field office nearest the referring hospital will be contacted. The hospital liaison will be asked to visit the referral while hospitalized in order to determine eligibility and appropriateness of the applicant and to initiate the casework process. d. A copy of the medical information will be sent to the Director of Nursing for review and filing, with a copy of medical records forwarded to the Medical Counselors. e. A copy of the medical information received from the hospital will be mailed to the Field Counselor. If a field case is not available, the receiving Medical Counselor will develop the case record and will forward original casework with the medical information. The Medical Counselor will consult with the Field Counselor prior to determining eligibility and/or prior to IPE development. 4406.4 Intake Procedures. Intake occurs through a coordinated effort between the Field Counselor and Center Admissions Office. All admissions to the comprehensive Medical Rehabilitation Unit are made based upon the recommendation of the Medical Director (or designee). Referral sources include Rehabilitation Counselors; hospitals and physicians, clients/patients and their families; other state and/or federal agencies; and any other source not previously identified. The referral source will be directed to the appropriate personnel who will initiate the application process. The case, with all appropriate information, then will be submitted to the Center Admissions Office for review. A. Screening. With assistance from the Medical Director, the Admissions Office will screen the case based on available information. Except direct hospital referrals, all referrals for medical rehabilitation will be seen in the rehabilitation clinic for evaluation by the Medical Director. During the screening process an appraisal of the strengths and assets, deficits/disabilities, need for rehabilitative services, and the potential for functional improvement will be made. Based on the review, a decision will be made to accept or deny admission. One factor that will be considered will be the ability of Center staff to effectively serve the applicant. For example, the applicant who has minimal or no potential to improve in functional independence may be denied. After screening, the referral source will be notified of the admissions decision. B. Admissions Outcome. 1. Accepted. Clients/patients who are accepted for inpatient rehabilitation services will be categorized based on the severity of impairment and the degree of nursing care required. Categories include those who need admission to the nursing unit, dormitory residents, and commuters. Clients/patients who are accepted for services will be admitted in accordance with bed availability and the capacity of the staff to effectively serve the client. 2. Denied. Clients/patients who are denied services will be assisted by the referral source and Admissions with regard to alternative resources available in the community. 4406.5 Evaluation. Upon admission, the client/patient will receive a multidisciplinary evaluation consisting of one or more of the following evaluations: medical; physiatric; physical therapy; occupational therapy; rehabilitation nursing; speech and language therapy; hearing and audiology; optometric; psychological; and, counseling. Upon completion of the evaluation, an interdisciplinary team staffing will be conducted for those patients/clients receiving one week therapy or stroke evaluation or regular medical rehabilitation services. In addition to all service providers and the Medical Director, the client and family, as well as the referral source, will attend the staffing if possible. If, based upon evaluations using the functional independence measure, there is a reasonable expectation for significant functional improvement, the client/patient will be accepted for continued therapy services and an estimated completion date will be identified. 4406.6 West Virginia Rehabilitation Hospital Discharge. The client/patient will be discharged when: A. The client/patient achieves the goals identified at the completion of the initial evaluation (or as amended); B. S/he is unable to reach established objectives or progress is too slow (plateaus for a two-week period) to justify further inpatient rehabilitation; C. His/her medical/psychiatric condition deteriorates to the point of being medically unstable requiring acute medical care (transfer to an appropriate acute care facility will be arranged); D. S/he develops complications requiring medical/surgical care that cannot be provided at the Center (transfer to an appropriate acute care facility will be arranged); E. S/he does not meaningfully participate in therapy program (due to lack of motivation) and attempts on the part of the staff to positively influence the level of participation fail; or, F. His/her behavior becomes disruptive to the program or compromises quality of care for other patients/clients. 4406.7 Eligibility for Medicaid Disproportionate Share (DSH) Sponsorship of Inpatient Medical Rehabilitation Services. In order to qualify, the referral must have a valid Medicaid card, be 20 years or younger, and the medical necessity and appropriateness of the inpatient setting must be demonstrated. 4406.8 Inpatient Medical Rehabilitation. A. Requirements. Two basic requirements for inpatient hospital stays must be met for the rehabilitation care to be covered. They are: 1. The services must be reasonable and necessary (in terms of efficacy, duration, frequency and amount) for the treatment of the patient’s condition; and, 2. It must be reasonable and necessary to furnish the care on an inpatient hospital basis rather than in a less intensive setting such as a skilled nursing facility (SNF), an SNF level of care in a swing bed hospital, or on an outpatient basis. B. PRO Screening. The Professional Review Organization (PRO) utilizes the following screening criteria to determine that the patient requires a rehabilitative hospital level of care: 1. Close Medical Supervision by Physician With Specialized Training or Experience in Rehabilitation. A patient’s condition must require the 24-hour availability of a physician with specialized training or experience in the field of rehabilitation. 2. Twenty-Four Hour Nursing Care. The patient requires the 24-hour availability of a registered nurse with specialized training or experience in rehabilitation. 3. Relatively Intense Level of Rehabilitation Services. The general threshold for establishing the need for inpatient hospital rehabilitation services is that the patient must require and receive at least three hours a day of physical and/or occupational therapy. This may include other rehabilitation treatment modalities, such as speech-language pathology services or prosthetic-orthotic services. 4. Multidisciplinary Team Approach to Program Delivery. At a minimum, the team must include a physician, rehabilitation nurse, and a therapist. 5. Coordinated Program of Care. The patient’s needs must reflect evidence of a coordinated program (documentation that periodic team conferences were held at least every two weeks) to assess the individual’s progress or problems impeding progress; consider possible resolutions to such problems; and, reassess the validity of the rehabilitation goal(s) initially established. Decisions made during such conferences must be recorded in the clinical record. 6. Significant Practical Improvement. Hospitalization after the initial assessment is covered only in those cases where the initial assessment results in a conclusion by members of the rehabilitation team that a significant practical improvement can be expected within a reasonable time period. It is not necessary that there be reasonable expectation of complete independence in activities of daily living, but there must be a reasonable expectation of improvement that will be of practical value to the patient, measured against his/her condition when the rehabilitation program began. 7. Realistic Goals. The aim of treatment is to achieve the maximum level of function possible. 8. Rehabilitation Program Length. Coverage ends when further progress toward the established rehabilitation goal is unlikely or it can be achieved in a less intensive setting. In deciding if further care can be carried out in a less intensive setting, both the degree of improvement which has occurred and the type of program required to achieve further improvement must be considered. In some cases, an individual may be expected to improve under an outpatient program. There are other situations where further improvement in the individual’s ability to function relatively independently in activities of daily living can be expected only if a multidisciplinary team effort is continued. [ Next Thread | Previous Thread | Next Message | Previous Message ]

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Subject	Author	Date
Part Two: The Policy up for comment	No name	09/11/05 Sun
Part Three: The Policy up for comment -- No name, 09/11/05 Sun