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. 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.

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.

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, on the official internet website 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. The links below are to give providers more information.

eQHealth Solutions Web site

eQHealth tips for preparing for prior authorization [269KB]

eQHealth training schedule for prior authorization

eQHealth Therapy Transition plan

Therapy Provider Checklist

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

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 below are tools to assist providers and are not required.

Therapy Services Referral/Evaluation/Prescription Form. [267KB]

Therapy Services Plan of Care Form. [336KB]

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.

DME Medicaid Prior Approval Process Wheelchair Evaluation Presentation [745KB]

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.

Emails 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.

Future Therapy Forums

We are currently reviewing available dates for future forums. Please check this site frequently for updates and sign up for Health Care alerts to be notified of meeting dates and important developments in Medicaid policy.

Past Therapy Forum Summaries

Meeting Summarys for the Therapy Services Forum from the past meetings are list below,

December 9, 2011 [164KB]
- Provider Eligibility Resource [2.16MB]
- What’s New in the Therapy Prior Authorization Review Process, December 2011 [1.04MB]
September 16, 2011 [196KB]
June 24, 2011 [110KB]
March 25, 2011 [65KB]
January 7, 2011 [103KB]
September 1, 2010 [62KB]

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 visit the Florida Administrative Weekly website.

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.

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.

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

Florida Medicaid Health Care Alerts

Would you like Florida Medicaid Health Care Alerts sent directly to your email account? The Florida Medicaid program has an email alert system to supplement the present method of receiving Provider Alerts and to notify registered providers or interested parties of "late-breaking" information. An email 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. Visit the Florida Medicaid Health Care Alerts website to subscribe.