To ensure better outcomes for our Members, we have 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 provides therapy services for Members of all ages. Therapy services include Occupational Therapy (OT), Speech Therapy (ST) and Physical Therapy (PT). It is our 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 Cook Children's Health Plan 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
The Health and Human Services Commission (HHSC) Quality and Improvement Services for STAR and CHIP require all Managed Care Organizations (MCOs) to obtain accurate and comprehensive information regarding therapy services provided to Members. Therapy Providers that place clients who are ages 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 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 Cook Children's Health Plan Member it must be reported:
If any of these situations occur, providers must submit notification to Cook Children's Health Plan network development department (email@example.com) 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 Cook Children's Health Plan 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 services at 888-243-3312 and ask to speak with a network development representative.