The Therapy Services Webpage is designed to provide physical therapists, occupational therapists, and speech-language pathologists with helpful resources and other pertinent information regarding Medicaid rules and policies.
Therapists should also access this site to obtain current Information Releases, notifications, and updates associated with Medicaid therapy services.
ANNOUNCEMENT: OCT 2008
Medicaid has been receiving questions about where an independent therapist is able to provide services. The Healing Arts Provider Handbook for independent therapists states “Medicaid services are reimbursed when provided in the participant’s home or in the therapist’s office”.
To better define “therapist’s office”, Medicaid follows Medicare’s definition which states:
“Services should be furnished in the therapist’s or group’s office or in the patient’s home. The office is defined as the location(s) where the practice is operated, in the state(s) where the therapist (and practice, if applicable) is legally authorized to furnish services, during the hours that the therapist engages in the practice at that location. If services are furnished in a private practice office space, that space shall be owned, leased, or rented by the practice and used for the exclusive purpose of operating the practice”.
ATTENTION: THERAPY GROUPS
It has come to the department’s attention that providers enrolling to become OT and SLP Medicaid providers may have joined an existing Physical Therapy group. This needs to be corrected.
Therapists may only join a group with their specialty:
- OT can only join an OT group
- SLP can only join a SLP group
- PT can only join a PT group
If you are an OT and joined an existing PT group, the visits will be counted towards PT since the same CPT codes are used. A SLP enrolled in a PT group will receive a denial. A separate group number has to be assigned for each specialty.
To correct this issue:
- Fill out a new Healing Arts Group application found to the right of this page under “Resources/Links”. If there are multiple therapists under the same specialty, all names should be included under this new group name. You will not have an Idaho Medicaid Group Provider Number, so leave that space blank.
- A new Individual Affiliation Roster, found in the Healing Arts Individual application, will need to be resubmitted as well. Again, put the therapy group name but leave the Idaho Medicaid Group Provider Number blank.
- Submit the Group application along with the Individual Affiliation Roster to EDS (It is NOT necessary to fill out an entire individual application again).
- EDS will assign the correct group number, and the provider will need to submit new claims using that number. Existing claims will need to be voided.
To void the already billed claims:
- If billing using PES software, the PES manual will explain the claim voiding process.
- If not using PES software, the provider must complete an Adjustment Request Form, found in the Provider Handbook under Appendix D: Forms. A separate form must be submitted per claim ICN.
THERAPY RULE - 2008
Beginning June 1, 2008, the Department of Health and Welfare (DHW) will reimburse independent occupational therapists and speech-language pathologists directly. DHW will also begin reimbursing home health agencies for speech-language pathology services. A new rule passed during the 2008 legislature gives DHW the authority to implement these changes.
LIMITATIONS FOR THERAPY SERVICES
Under the new therapy rule, occupational therapy now requires prior authorization for therapy exceeding 25 visits per calendar year, and speech-language pathology requires prior authorization for therapy exceeding 40 visits per calendar year. This limitation applies to outpatient hospitals, outpatient rehabilitation facilities, comprehensive outpatient rehabilitation facilities, nursing facilities, developmental disability agencies, and independent practitioners. School-based services and home health are excluded from these limitations.
Physical therapists, occupational therapists, and speech-language pathologists should refer to the new rule and provider handbook for a complete description of services that are billable by independent therapists, the prior authorization (PA) process, therapist qualifications, supervision requirements, etc.
PRIOR AUTHORIZATION
To request a prior authorization, providers will contact:
Idaho Medicaid
Medical Care Management
P.O. Box 83720
Boise, ID 83720-0036
Phone: (208) 364-1904
Fax: (208) 332-7280