Cook Children's Health Plan Therapy Services Handbook
To ensure better outcomes for our Members, we have created a comprehensive Therapy Services Handbook 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 (twenty) 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 twenty (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:
- 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 Member 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 notify Cook Children's Health Plan or contact Health and Human Services Commission (HHSC).
If you cannot meet the service needs of the patient(s), via the Secure Provider Portal by submitting a customer service request by selecting the topic Therapy Notification - Closing practice to new patient and/or Therapy Notification - Patients on waitlist or to HHSC by email using the HHSC reporting template. Providers pending access approval to the Secure Provider Portal can email the Therapy Notification form to Network Development at CCHPNetworkDevelopment@cookchildrens.org.
- Consensus statement from AOTA, APTA, and ASHA on clinical judgment in health care settings
- Choosing wisely: five things patients and providers should question - american occupational therapy association
- American occupational therapy association code of ethics
- American physical therapy association code of ethics
- American speech language hearing association code of ethics