Outpatient Rehabilitative Therapy Services Limitations  Physical therapy, massage therapy (soft tissue mobilization), and occupational therapy Services are covered as Medically Necessary to restore or improve functional abilities when physical and/or sensory perceptual impairment exists due to injury, illness, stroke, or surgery.  Speech therapy Services are covered as Medically Necessary for speech impairments of specific organic origin such as cleft palate, or when speech, language, or the swallowing function is lost due to injury, illness, stroke, or surgery.  Therapy Services do not include maintenance therapy for chronic conditions except for neurodevelopmental conditions. Inpatient Rehabilitative Therapy Services Inpatient rehabilitative therapy Services are covered, subject to the inpatient hospital Cost Share, for the treatment of conditions which, in the judgment of a Participating Provider will show sustainable, objective, measurable improvement as a result of the prescribed therapy and must receive prior authorization as described under the “Prior and Concurrent Authorization and Utilization Review” in the “How to Obtain Services” section. Rehabilitative Therapy Services Exclusions  Services designed to maintain optimal health in the absence of symptoms. 33. Skilled Nursing Facility Services We cover skilled inpatient Services in a licensed Participating Skilled Nursing Facility, including drugs that are prescribed as part of your plan of care and administered to you by medical personnel in the facility. The skilled inpatient Services must be those customarily provided by Participating Skilled Nursing Facilities. These Services are subject to Utilization Review by Kaiser using criteria developed by Medical Group and approved by Kaiser. When your benefit has a day maximum, the “Benefit Summary” shows a day maximum for skilled nursing facility Services. That day maximum will be exhausted (used up) for a Year when the number of days that we covered during the Year under this EOC, plus any days we covered during the Year under any other evidence of coverage with the same group number printed on this EOC, add up to the day maximum. After you reach the day maximum, we will not cover any more days for the remainder of the Year. We cover the following:  Blood, blood products, blood storage, and their administration, including the Services and supplies of a blood bank.  Dialysis Services.  Medical and biological supplies.  Medical social Services.  Nursing Services.  Rehabilitative therapy Services.  Room and board. 34. Spinal and Extremity Manipulation Therapy Services We cover outpatient visits for Spinal and Extremity Manipulation therapy Services when provided by a Participating Provider in the Participating Provider’s office. Covered Services include: EWCLGHDHP1983ACT0124 67 WAPEBB-CD-ACT