2019 Connecticut General Statutes
Title 38a - Insurance
Chapter 700c - Health Insurance
Section 38a-496 - (Formerly Sec. 38-174q). Coverage for occupational therapy.
(a) For the purposes of this section:
(1) “Occupational therapy” means services provided by a licensed occupational therapist in accordance with a plan of care established and approved in writing by a physician licensed in accordance with the provisions of chapter 370 or an advanced practice registered nurse licensed in accordance with the provisions of chapter 378, who has certified that the prescribed care and treatment are not available from sources other than a licensed occupational therapist and which are provided in private practice or in a licensed health care facility. Such plan shall be reviewed and certified at least every two months by such physician or advanced practice registered nurse.
(2) “Health care facility” means an institution which provides occupational therapy, including, but not limited to, an outpatient clinic, a rehabilitative agency and a skilled or intermediate nursing facility.
(3) “Rehabilitative agency” means an agency which provides an integrated multitreatment program designed to upgrade the function of persons with physical disabilities by bringing together, as a team, specialized personnel from various allied health fields.
(4) “Partial hospitalization” means a formal program of care provided in a hospital or facility for periods of less than twenty-four hours a day.
(b) Each individual health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (6), (10), (11) and (12) of section 38a-469 delivered, issued for delivery, renewed, amended or continued in this state that provides coverage for expenses incurred for physical therapy shall provide coverage for occupational therapy provided in private practice or in a health care facility or in a partial hospitalization program on an exchange basis.
(P.A. 82-148; P.A. 90-243, S. 86; P.A. 11-19, S. 45; P.A. 16-39, S. 61; P.A. 17-202, S. 89.)
History: P.A. 90-243 substituted reference to health insurance policies for reference to hospital and medical expense policies or contracts in Subsec. (b) and specified applicability solely to individual policies; Sec. 38-174q transferred to Sec. 38a-496 in 1991; P.A. 11-19 inserted “amended or continued” and made technical changes in Subsec. (b), effective January 1, 2012; P.A. 16-39 amended Subsec. (a)(1) by adding references to advanced practice registered nurse; P.A. 17-202 amended Subsec. (a)(3) by replacing “handicapped disabled individuals” with “persons with physical disabilities”.
