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March 30, 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 have to submit documentation to the Department in order for services beyond these limits. Providers must maintain all documentation as required. This documentation must be provided to the Department for inspection within two days of their request. Failure to provide documentation may result in claim denial or recoupment. Please, do not submit documentation unless requested. 

Required documentation:

  • Physician/midlevel practitioner & Therapist signed Plan of Care 
  • Evaluation 
  • Current progress 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. 


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