Idaho Medicaid Provider Handbook Therapy Services Table of Contents Therapy Services .............................................................. 1 1.Important Contacts ........................................................ 3 1.1. Gainwell Technologies..................................................................................... 3 1.2. Provider Relations Consultants ......................................................................... 4 1.3. Medicaid ....................................................................................................... 5 2.Provider Qualifications .................................................6 2.1. Home Health Agencies .................................................................................... 6 2.2. Hospitals ....................................................................................................... 7 2.3. Nursing Facilities ............................................................................................ 8 2.4. Occupational Therapists .................................................................................. 9 2.4.1. References: Occupational Therapists .......................................................... 9 2.5. Occupational Therapy Assistants .................................................................... 11 2.5.1. References: Occupational Therapy Assistants ............................................ 11 2.6. Physical Therapists ....................................................................................... 13 2.6.1. References: Physical Therapists ............................................................... 13 2.7. Physical Therapy Assistants ........................................................................... 15 2.7.1. References: Physical Therapy Assistants ................................................... 15 2.8. Physician and Non-Physician Practitioners ....................................................... 16 2.9. Rehabilitation Facilities ................................................................................. 17 2.10. School-based Services ............................................................................... 18 2.11. Speech-Language Pathologists.................................................................... 19 2.11.1. References: Speech-Language Pathologists ............................................ 19 2.12. Speech-Language Pathology Assistants ........................................................ 20 2.12.1. References: Speech-Language Pathology Assistants ................................ 20 2.13. Therapy Aides and Supportive Personnel ...................................................... 21 2.13.1. References: Therapy Aides and Supportive Personnel .............................. 21 2.14. Therapy Students ..................................................................................... 22 2.14.1. References: Therapy Students .............................................................. 22 3.Eligible Participants .................................................... 23 3.1. References: Eligible Participants..................................................................... 23 3.1.1. State Regulations ................................................................................... 23 3.2. Referrals ..................................................................................................... 24 3.2.1. References: Referrals ............................................................................. 24 3.3. Adults with Developmental Disabilities ............................................................ 25 3.3.1. References: Adults with Developmental Disabilities .................................... 25 3.4. Participants with Home Health ....................................................................... 26 3.4.1. References: Participants with Home Health ............................................... 26 4.Covered Services and Limitations: General ............... 27 4.1. References: Covered Services and Limitations: General .................................... 27 4.1.1. State Regulations ................................................................................... 27 March 30, 2021 i Idaho Medicaid Provider Handbook Therapy Services 4.2. Occupational Therapy ................................................................................... 29 4.2.1. References: Occupational Therapy ........................................................... 30 4.3. Physical Therapy .......................................................................................... 32 4.3.1. References: Physical Therapy .................................................................. 33 4.4. Speech-Language Pathology .......................................................................... 34 4.4.1. References: Speech-Language Pathology .................................................. 34 4.5. Home Health ............................................................................................... 36 4.5.1. References: Home Health........................................................................ 36 4.6. Telehealth ................................................................................................... 37 4.6.1. References: Telehealth ........................................................................... 37 4.7. Evaluations ................................................................................................. 38 4.7.1. References: Evaluations .......................................................................... 39 4.7.2. Speech-Language Pathology Evaluations ................................................... 40 4.8. Assessment ................................................................................................. 41 4.8.1. References: Assessment ......................................................................... 41 4.9. Duplicate Services ........................................................................................ 42 4.9.1. References: Duplicate Services ................................................................ 42 4.10. Facility and Institution-Based Therapists ...................................................... 43 4.10.1. References: Facility and Institution-Based Therapists .............................. 43 4.11. Group Therapy ......................................................................................... 44 4.11.1. References: Group Therapy .................................................................. 44 4.12. Habilitative Therapy .................................................................................. 45 4.13. Independent Therapists ............................................................................. 46 4.13.1. References: Independent Therapists ..................................................... 46 4.14. Maintenance Therapy ................................................................................ 47 4.14.1. References: Maintenance Therapy ......................................................... 47 4.15. Rehabilitative Therapy ............................................................................... 48 4.16. Skilled Services ........................................................................................ 49 4.16.1. References: Skilled Services ................................................................. 49 4.17. Substitute Therapy Professional .................................................................. 50 4.18. Treatment Modalities ................................................................................. 51 4.18.1. References: Treatment Modalities ......................................................... 51 4.19. Untimed Codes ......................................................................................... 52 5.Covered Services and Limitations: Criteria ................ 53 5.1. Active Wound Care Management (OT/PT) ........................................................ 54 5.1.1. References: Active Wound Care Management ............................................ 55 5.2. Acupuncture (Non-covered)........................................................................... 57 5.2.1. References: Acupuncture ........................................................................ 57 5.3. Animal-Assisted Therapy (Non-covered) ......................................................... 58 5.3.1. References: Animal-Assisted Therapy ....................................................... 58 5.4. Aquatic Therapy (OT/PT) ............................................................................... 59 5.4.1. References: Aquatic Therapy ................................................................... 59 5.4.2. Halliwick (Non-covered) .......................................................................... 60 5.4.3. Watsu (Non-covered) ............................................................................. 61 5.5. Art Therapy (Non-covered)............................................................................ 62 March 30, 2021 ii Idaho Medicaid Provider Handbook Therapy Services 5.5.1. References: Art Therapy ......................................................................... 62 5.6. Athletic Trainer Services (Non-covered) .......................................................... 63 5.6.1. References: Athletic Trainer Services ........................................................ 63 5.7. Audiology Services (SLP) .............................................................................