Medicaid School Program update for physical therapist, occupational therapist, speech language therapist, and audiologist services

April 25, 2017

 

House Bill (HB) 89, signed on December 19, 2016, enacts a new section of the Ohio Revised Code that authorizes physical therapist, occupational therapists, speech-language pathologist, and audiologists to make referrals, within their specific discipline, for medically necessary physical therapy, occupational therapy, speech language therapy, and audiology services when the services are provided to Medicaid eligible children who receive such services in a school environment under the Ohio Medicaid School Program and in accordance with each child’s Individualized Education Plan (IEP).

 

The new provision of the Revised Code as described in HB 89 permits physical therapists, occupational therapists, speech language therapists, and audiologists to make referrals for medically necessary services within their specific discipline that will be provided to children eligible under the Medicaid school program.

 

For physical therapy, occupational therapy, speech language therapy, and audiology services provided on and after 7/1/2017, a referral must be obtained from a physical therapy, occupational therapy, speech language therapy, and audiology provider in accordance with the child’s IEP. The therapist’s National Provider Identifier (NPI) must be recorded in the “referring provider” field on the claims submitted for reimbursement to the Ohio Department of Medicaid.

Physical therapy, occupational therapy, speech language therapy, and audiology providers who have not enrolled with Ohio Medicaid should do so before referring Medicaid School Program children to treatment.

 

For help with enrolling and billing for MSP therapy services school program providers, billers, or EDI trading partners should contact the Ohio Department of Medicaid Provider Hotline at 1-800-686-1516.

 

For schools and billing agents, the ability to bill for the services rendered in MSP by physical therapist, occupational therapists, speech pathologists and audiologists who are registered as an ORP provider will be operational as of April 1st 2017.

 

The requirement to come into compliance on the ORP provisions of the Medicaid Schools Program were formally expected by August 1, 2016. ODM has had clarity from CMS that there has been an extension for compliance to June 30, 2017 to have an ORP provider listed on the MSP claim.

 

 

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