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Update: Physical medicine and therapy policy bulletin


Many of you are aware that South Carolina Medicaid sent a Bulletin on Feb. 6, 2014 entitled Physical Medicine and Therapy Policy Update (Bulletin #14-001). It was not clear in the Bulletin if the expansion of the Medicaid benefit for outpatient therapy for beneficiaries over 21 applied to therapy providers classified as Private Rehabilitative and Audiological Services Providers. This is the Medicaid manual that therapists in private practice must utilize. We have reached out to Medicaid and have received clarification that this expansion does include Private Rehabilitative and Audiological Services Providers. Medicaid communicated to us that they intend to update the manual for private providers “in the next few days”.

Some important points to remember if you plan to offer services to adults with Medicaid:
  • Prior authorization through KEPRO will be required. This is a very specific Medicaid system and retro authorization is not given. Taking steps to learn how to authorize through KEPRO will be critical to successful reimbursement.
  • Medicaid eligibility is month to month.
  • A person must not only meet the income requirements to be Medicaid eligible, but must also meet the program requirements offered by the state (i.e. Aged, Blind and Disabled, Pregnant Women, Qualified Medicare Beneficiary).
What is not clear is how this will affect Medicaid Managed Care Programs. Checking with specific managed care programs to see if they have also expanded their coverage to persons over 21 is highly recommended. Managed Care Programs may have separate and unique authorization processes.

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