TMPPM 2011 > Children's Services Handbook > Medicaid Children's Services Comprehensive Care Program (CCP) > Therapy Services (CCP)

2.10 Therapy Services (CCP)

Occupational (OT), physical (PT), and speech therapy (ST) services beyond the limitations of Texas Medicaid and Title XIX Home Health Services are benefits of the CCP for clients who are birth through 20 years of age and who are CCP eligible when:

•Therapy is prescribed by a licensed therapist.

•Documentation of medical necessity supports a condition that requires ongoing therapy or rehabilitation in the usual course, treatment, and management of the client's condition.

•Therapy services are provided by a licensed therapist.

•Therapy is provided in one of the following places of service:

•CORF and ORF

•Freestanding rehabilitation facility

•Home

•Licensed hospital

•Medicaid-enrolled private therapist office

•Physician office

This section does not apply to CORFs and ORFs.

Refer to: Subsection 2.4, "Comprehensive Outpatient Rehabilitation Facilities (CORFs)/Outpatient Rehabilitation Facilities (ORFs)" in this handbook.

Subsection 2.12, "Inpatient Rehabilitation Hospital (Freestanding) (CCP)" in this handbook.

Therapy may be performed by auxiliary personnel (occupational therapist, physical therapist, speech-language pathologist assistants) under the supervision of the physician or the licensed independently practicing therapist.

OT, PT, and ST may be performed in the office or home setting and may be authorized to be provided in the following locations: home of the client, home of the caregiver/guardian, client's daycare facility, or the client's school.

Services provided to a client on school premises are only permitted when delivered before or after school hours. The only CCP therapy that can be delivered in the client's school during regular school hours are those delivered by school districts as School Health and Related Services (SHARS) in POS 9.

Refer to: Section 3, "School Health and Related Services (SHARS)" in this handbook for more information regarding SHARS.

PT provided in the nursing home setting is limited to the nursing facility because it must be available to nursing home residents on an "as needed" basis and must be provided directly by the staff of the facility or furnished by the facility through arrangements with outside-qualified resources. Nursing home facilities must refrain from admitting clients who need goal directed therapy if the facility is unable to provide these services.

Home health agencies that perform therapy services under CCP are allowed one visit per day per therapy type and paid at the statewide visit rate.

Services That Are Not a Benefit

The following services are not a benefit of CCP.

•Procedure code 97010 (application of a modality to one or more areas; hot or cold packs).

•Services that are not medically necessary. Examples include, but are not limited to:

•Massage therapy that is the sole therapy or is not part of a therapeutic plan of care (POC) to address an acute condition.

•Hippotherapy.

•Separate reimbursement for VitalStim® therapy for dysphagia.

•Treatment solely for the instruction of other agency or professional personnel in the client's physical, occupational, or speech therapy program.

•Training in nonessential tasks (e.g., homemaking, gardening, recreational activities, cooking, driving, assistance with finances, scheduling).

•Emotional support, adjustment to extended hospitalization or disability, and behavioral readjustment.

•Therapy prescribed primarily as an adjunct to psychotherapy.