AHCA: Medicaid Child Health Services: Therapy Services

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Medicaid Child Health Services
Therapy Services

The purpose of the therapy services program is to provide medically necessary occupational therapy (OT), physical therapy (PT), respiratory therapy (RT) and speech-language pathology (SLP) services to Medicaid recipients from birth through age 20. Regardless of age, the therapy services program provides services to all Medicaid recipients for SLP services for the provision of augmentative and alternative communication systems and PT and OT services for wheelchair evaluations and fittings.

Please consult the Therapy Services Coverage and Limitations Handbook for more information on Therapy Services.

Therapy Services Policy Webinars

A recorded version of the webinar is posted on the Medicaid Provider Training e-Library at: http://ahca.myflorida.com/Medicaid/e-library/index.shtml. The link will take you to the Provider Training e-Library main page. From there, click on the Previous Training Materials tab at the top and the video is at the bottom of the page. The PowerPoint used at the webinar is available below for downloading.

Medicaid Therapy Services Policy, November 2011 [629KB]

Therapy Services Provider Qualifications

Medicaid reimburses for physical therapy services provided by licensed, Medicaid-participating physical therapists and by supervised physical therapy assistants.

Medicaid reimburses for speech language-pathology services provided by licensed, Medicaid-participating speech-language pathologists and by supervised speech-language pathologist assistants.

Medicaid reimburses for occupational therapy services provided by licensed, Medicaid-participating occupational therapists and by supervised occupational therapy assistants.

Medicaid reimburses for respiratory therapy services that are rendered by a licensed registered respiratory therapist.

Please consult the Therapy Services Coverage and Limitations Handbook for more information on Therapy Services.

Utilization Management Program

Florida Medicaid has implemented a utilization management program for therapy services as mandated by the Florida Legislature in section 409.912(40), Florida Statutes, to ensure recipients receive appropriate care in line with the standards set forth in the Florida Medicaid Therapy Services Coverage and Limitations Handbook.

This program utilizes a retrospective records review of a small claims sample. The review is performed by a contracted therapist in the discipline corresponding to the type of therapy provided.

Click here to view the Therapy Utilization Management Program FAQ. [219KB]

The Agency for Health Care Administration has compiled a Therapy Utilization Management Provider Self Training to assist providers. The training gives a high-level overview of what providers can expect from the Utilization Management Program.

Click here to access the Therapy Utilization Management Provider Self Training. [312KB]

Utilization Management Legislation

The authorizing language for the Florida Medicaid Therapy Services Utilization Management Program can be found in section 409.912(40), Florida Statutes. The language may be accessed on the official internet Web site of the Florida Legislature, Online Sunshine.

Click here to access the authorizing language on the official internet Web site of the Florida Legislature, Online Sunshine.

Prior Authorization Vendor

The Agency for Health Care Administration (Agency) has entered into a contract with eQHealth Solutions, Inc. for utilization management, including prior authorization of therapy services.

The primary purpose of the utilization management program is to safeguard against the provision of unnecessary medical services or inappropriate use of Medicaid services and to ensure appropriate care.

The Agency will provide periodic updates through the Florida Medicaid fiscal agent’s Web portal, provider bulletins, provider notification letters, and Medicaid Health Care Alerts.

Click here to access the eQHealth Solutions Web site.

Click here to access eQHealth tips for preparing for prior authorization. [269KB]

Click here to access eQHealth training schedule for prior authorization.

Click here to access eQHealth Therapy Transition plan.

Therapy Provider Checklist

In order to assist with proper service documentation, Medicaid has drafted a Therapy Provider Checklist. The checklist is a tool to assist providers and is not a required form.

Click here to access the Therapy Provider Checklist. [274KB]

Therapy Services Provider Tools

In an effort to assist providers to provide therapy services in a manner consistent with Florida Medicaid requirements, Medicaid has drafted the following forms. The forms are tools to assist providers and are not required.

Click here to access the Therapy Services Referral/Evaluation/Prescription Form. [267KB]

Click here to access the Therapy Services Plan of Care Form. [336KB]

Click here to access the Therapy Services Treatment Form. [196KB]

Durable Medical Equipment Evaluation Training

In order to assist Therapy Providers with the Durable Medical Equipment (DME) Program’s wheelchair and augmentative and alternative communication (AAC) device evaluation procedures, the DME program put together presentations that illustrate key components of these processes.

Click here to access the DME Medicaid Prior Approval Process Wheelchair Evaluation Presentation. [745KB]

Click here to access the DME Augmentative and Alternative Communication Systems Evaluation Training. [368KB]

Therapy Provider Forum Agenda Items

Florida Medicaid is setting up the agenda for the next Therapy Provider Public Forum and would like your input! Please send your suggestions for agenda items to the Therapy Services mailbox at: Therapy_Services@ahca.myflorida.com.

E-mails sent to the Therapy Services mailbox will be used to identify agenda topics for the next Therapy Provider Public Forum and will not be responded to directly. Questions about therapy policy should be directed to your local Medicaid area office.

Click here to find contact information for your local Medicaid area office.

Future Therapy Forums

Florida Medicaid has tentatively scheduled future public forums for the following dates in 2012:

March 15
June 28
September 20
December 6

Past Therapy Forum Summaries

Click below to view the Meeting Summary for the Therapy Services Forum from the following dates:

December 9, 2011 [164KB]

Provider Eligibility Resource [2.16MB]
What’s New in the Therapy Prior Authorization Review Process, December 2011 [1.04MB]

Rule Development

Activities on the Administrative Code of the State of Florida can be tracked on the state’s e-rulemaking Web site. To track rule development that affects the Medicaid Therapy Services program, please follow the link below.

Click here to track rule development that affects the Therapy Services program.

Handbooks

Florida Medicaid handbooks furnish the Medicaid provider with the policies and procedures needed to receive reimbursement for covered services provided to eligible Florida Medicaid recipients.

The Medicaid Therapy Services Coverage and Limitations Handbook explains covered services and policies for the Therapy Services program.

Click here to access the Therapy Services Coverage and Limitations Handbook.

The Medicaid Provider General Handbook contains requirements of the Florida Medicaid Program that apply to all providers. Providers must follow the provisions of this handbook in addition to their services specific handbook.

Click here to access the Medicaid Provider General Handbook.

The Provider Reimbursement Handbook, CMS 1500 contains generic eligibility information, general Medicaid information, and claim instructions.

Click here to access the Provider Reimbursement, CMS 1500 Handbook.

Florida Medicaid Health Care Alerts

Would you like Florida Medicaid Health Care Alerts sent directly to your e-mail account? The Florida Medicaid program has an e-mail alert system to supplement the present method of receiving Provider Alerts and to notify registered providers or interested parties of "late-breaking" information. An e-mail will be delivered to your mailbox when Medicaid policy clarifications or other health care information is available that is appropriate for your selected provider type.

Click here to sign up to receive Florida Medicaid Health Care Alerts.