The services must be at a level of complexity that requires the judgment, knowledge and skills of a licensed physical, speech or occupational therapist, be based on a treatment plan and be provided by such therapist or under the therapist's direct supervision. Such services are not covered when medical documentation does not support the medical necessity due to the member's inability to progress toward the treatment plan goals or when a member has already met the treatment goals.

The functional assessment of the member as related to the continuation of rehabilitation services is performed by one or more rehabilitation professionals.

Institutional and professional services provided for inpatient and outpatient rehabilitation are covered. The therapy must promote and maintain movement-related health and wellness. Refer to the Health Net Provider Participation Agreement (PPA) for financial responsibility information.