Occupational, Physical and Speech Therapy Services
To ensure better outcomes for our members, CCHP has created a comprehensive Therapy Services Handbook (Physical, Occupational, and Speech Therapy) for your reference. Our objective is to communicate our policies, protocols, and criteria to help ensure that ordering providers, therapists, and therapy agencies are able to maintain their focus on providing quality treatment services to our members.
Cook Children’s Health Plan (CCHP) provides therapy services for Members of all ages. Therapy services include Occupational Therapy (OT), Speech Therapy (ST) and Physical Therapy (PT). It is CCHP’s policy to authorize therapy services that are medically necessary and appropriate for the Member’s needs as well as require the skills and judgment of a licensed Occupational Therapist, Speech-Language Pathologist or Physical Therapist.
Therapy services address a Member’s acute or chronic need(s). *Acute therapy services are a benefit for Members of all ages and are intended to improve, adapt, restore, or maintain function that have been lost or impaired due to a recent illness, injury, loss of a body part, congenital anomaly, or due to a developmental delay or chronic medical condition. *Therapy services for chronic conditions are a benefit for Members ages 20 years and younger to address behaviors or skills that allow the Member to achieve outcomes relevant to his/her health, safety, or independence in the context of everyday environments. Approvals for therapy service requests are contingent upon meeting CCHP’s therapy guidelines and criteria.
*Texas Medicaid Provider Procedures Manual, Physical Therapy, Occupational Therapy, and Speech Therapy Services Handbook, 5.1.1; 5.1.2; 6.1.1
Therapy Services Monitoring
HHSC Quality and Improvement Services for STAR and CHIP require all Managed Care Organizations to obtain accurate and comprehensive information regarding therapy services provided to Members. Therapy Providers that place clients who are birth through 20 years of age on waiting lists for services, for any reason, have the option of reporting this information to Cook Children’s Health Plan (CCHP) Network Development Department or Health and Human Services Commission (HHSC).
If a therapy provider is experiencing one or all of the following occurrences when treating a CCHP Member it must be reported:
- Not accepting new patients
- Cannot treat the patient at the frequency assessed
- Cannot provide appropriate services for the patient needs
- Maintaining a “wait list” for evaluation of services
- A client placed on a waiting list should stay on the list until he or she receives the necessary therapy service
If any of these situations occur, Providers must submit notification to CCHP Network Development Department or HHSC.
If you cannot meet the service needs of the patient(s), send a list of the Members affected by attaching the Therapy Notification to CCHP document by e-mail or to HHSC by email using the HHSC reporting template.
If you are no longer accepting new patients, send written confirmation of the change by e-mail. Questions? Call Cook Children’s Health Plan Provider Line at 888-243-3312 and ask to speak with a Network Development representative.
Therapy notifications from HHS and TMHP
- Provider Reporting of Therapy Waitlists Effective June 3, 2019 Posted June 3, 2019
- Writing Functional Therapy Goals Webinar and QA Now Available Posted March 8, 2019
- Upcoming Webinar on Writing Functional Therapy Goals, January 23, 2019 Posted December 10, 2018
- Benefit and Policy Language for Otology and
Audiometry Services Will Change Posted September 21, 2018
- Reimbursement Rate Changes for Texas Medicaid Therapy Assistant Services Posted July 11, 2018
- Clarification for Providers Regarding Therapy Guidance Posted June 22, 2018
- Clarification to Assist PT, OT and ST Posted March 15, 2018
- Therapy Treatment Procedure Codes Subject to NCCI Guidelines for Texas Medicaid Posted February 09, 2018
- Provider Type and Places of Service Changes for Physical, Occupational and Speech Therapy Posted August 24, 2017
- Reimbursement Rate Changes and Updates for Texas Medicaid Therapy Services Posted August 21, 2017
- New Definition of Individual Speech Therapy Encounter Posted August 18, 2017
Therapy Education and Helpful Resources
If you have additional questions please call Provider Services at 1-888-243-3312 Monday-Friday from 8 a.m. to 5 p.m. or
Contact us here