42 CFR §410.61

1. (a)Basic requirement. Outpatient rehabilitation services (including services furnished by a qualified physical or occupational therapist in private practice), must be furnished under a written plan of treatment that meets the requirements of paragraphs (b) through (e) of this section.
2. (b)Establishment of the plan. The plan is established before treatment is begun by one of the following:
   1. (1)A physician.
   2. (2)A physical therapist who furnishes the physical therapy services.
   3. (3)A speech-language pathologist who furnishes the speech-language pathology services.
   4. (4)An occupational therapist who furnishes the occupational therapy services.
   5. (5)A nurse practitioner, a clinical nurse specialist, or a physician assistant.
3. (c)Content of the plan. The plan prescribes the type, amount, frequency, and duration of the physical therapy, occupational therapy, or speech-language pathology services to be furnished to the individual, and indicates the diagnosis and anticipated goals.
4. (d)Changes in the plan. Any changes in the plan—
   1. (1)Are made in writing and signed by one of the following:
      1. (i)The physician.
      2. (ii)The physical therapist who furnishes the physical therapy services.
      3. (iii)The occupational therapist that furnishes the occupational therapy services.
      4. (iv)The speech-language pathologist who furnishes the speech-language pathology services.
      5. (v)A registered professional nurse or a staff physician, in accordance with oral orders from the physician, physical therapist, occupational therapist, or speech-language pathologist who furnishes the services.
      6. (vi)A nurse practitioner, a clinical nurse specialist, or a physician assistant.
   2. (2)The changes are incorporated in the plan immediately.