The purpose of the therapy services program is to provide medically necessary occupational therapy (OT), physical therapy (PT), respiratory therapy (RT) and speech-language pathology (SLP) services to Medicaid recipients from birth through age 20. Regardless of age, the therapy services program provides services to all Medicaid recipients for SLP services for the provision of augmentative and alternative communication systems and PT and OT services for wheelchair evaluations and fittings.
Please consult the Therapy Services Coverage and Limitations Handbook for more information on Therapy Services.
Therapy Services Provider Qualifications
Medicaid reimburses for physical therapy services provided by licensed, Medicaid-participating physical therapists and by supervised physical therapy assistants.
Medicaid reimburses for speech language-pathology services provided by licensed, Medicaid-participating speech-language pathologists and by supervised speech-language pathologist assistants.
Medicaid reimburses for occupational therapy services provided by licensed, Medicaid-participating occupational therapists and by supervised occupational therapy assistants.
Medicaid reimburses for respiratory therapy services that are rendered by a licensed registered respiratory therapist.
Please consult the Therapy Services Coverage and Limitations Handbook for more information on Therapy Services.
Utilization Management Program (Fee-for-Service)
Florida Medicaid has implemented a utilization management program for therapy services as mandated by the Florida Legislature in section 409.912(40), Florida Statutes, to ensure recipients receive appropriate care in line with the standards set forth in the Florida Medicaid Therapy Services Coverage and Limitations Handbook.
Utilization Management Legislation (Fee-for-Service)
The authorizing language for the Florida Medicaid Therapy Services Utilization Management Program can be found in section 409.912(40), Florida Statutes, on the official internet website of the Florida Legislature, Online Sunshine.
Prior Authorization Vendor (Fee-for-Service)
The Agency for Health Care Administration (Agency) has entered into a contract with eQHealth Solutions, Inc. for utilization management, including prior authorization of therapy services.
The primary purpose of the utilization management program is to safeguard against the provision of unnecessary medical services or inappropriate use of Medicaid services and to ensure appropriate care.
The Agency will provide periodic updates through the Florida Medicaid fiscal agent’s Web portal, provider bulletins, provider notification letters, and Medicaid Health Care Alerts. The links below are to give providers more information.
eQHealth training schedule for prior authorization
Prior Authorization (Managed Care)
Recipients enrolled in a managed care plan should seek service authorization through their plan.
Handbooks
Florida Medicaid handbooks furnish the Medicaid provider with the policies and procedures needed to receive reimbursement for covered services provided to eligible Florida Medicaid recipients.
The Medicaid Therapy Services Coverage and Limitations Handbook explains covered services and policies for the Therapy Services program.
Contact Us
Have questions about the Therapy Services program? Please contact your local Medicaid field office for assistance.
