Occupational, Physical and Speech Therapy Services
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 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 have required all Managed Care Organizations to obtain accurate and comprehensive information regarding therapy services provided to Members. Therapy Providers must report to Cook Children’s Health Plan (CCHP) Network Development Department when a therapy provider is experiencing one or all of the following occurrences when treating a CCHP Member:
- 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
If any of these situations occur, Providers must submit notification to CCHP Network Development Department. If you are no longer accepting new patients, send written confirmation of the change by e-mail. 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.
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 Health and Human Services (HHS) and Texas Medicaid & Health Partnership (TMHP)
Helpful Therapy Resources for Therapists and Referring Providers