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May 26, 2017

Therapy Services

House Bill 260, passed by the 2011 Idaho Legislature, directs the Department to limit physical, occupational, and speech therapy services covered by Medicaid so they align with annual Medicare caps.  For dates of service on or after January 1, 2017, the Department will limit therapy services to:
  
• $1,960 per calendar year for a combination of speech therapy services and physical therapy services. 
• $1,960 per calendar year for occupational therapy services. 

Beginning November 1, 2016, providers no longer are required to submit documentation to the Department for services beyond the therapy limitation. Providers must maintain all documentation as required. This documentation must be provided to the Department for inspection within ten business days from the date on the letter. Failure to provide the supporting documentation within this timeframe may result in claim recoupment.

The required supporting documentation is outlined in the handbook and includes: 
• Completed Idaho Medicaid Therapy Service Documentation Coversheet 
• Physician order (signed and dated) 
• Current evaluation 
• Current Plan of Care signed and dated by the physician or mid-level 
• Current progress report 
• Last five sessions of treatment notes 

Services that are not medically necessary, that do not require the skills of a professional therapist, or that are not supported by appropriate documentation will be denied, and subject to recoupment. 

When requested by the department, please remember to fax documentation for each participant and each type of therapy service separately.

Information about how many therapy services a participant has used will be available in eligibility information at the Molina Health PAS portal, or by contacting Molina at (866) 686-4272. If you have questions about a denied claim contact a Molina Customer Service Representative to read the memo on the denial.

Contact

Attn: Therapy Services
Idaho Medicaid, Medical Care Unit
PO Box 83720
Boise, ID 83720-0009

 Phone: 1 (866) 205-7403
Fax: 1 (877) 314-8779
Email: MedicalCareUnit@DHW.idaho.gov