Section 140.457  Therapy Services

a)         For purposes of enrollment as a provider in the Medical Assistance Program, a physical, speech/language or occupational therapist must be licensed by the Illinois Department of Financial and Professional Regulation or equivalent licensing body in the therapist's state of practice.

b)         Payment for therapy services shall be made to providers enrolled in the Illinois Medical Assistance Program as a physical therapist, an occupational therapist, a speech/language therapist, or a Community Health Agency.

c)         Payment shall be made for physical, occupational, and speech/language therapy evaluation and treatment services that are:

1)         Rendered by a licensed physical, occupational, or speech/language therapist or by a licensed therapy assistant operating under the licensed therapist's supervision in line with an established plan of care;

2)         Ordered by a physician or other licensed practitioner of the healing arts (LPHA) operating within their scope of practice.  For the purposes of this Section, an LPHA may include a licensed physical, occupational, or speech/language therapist as permitted pursuant to the therapist's respective practice act.

3)         Medically necessary in accordance with a plan of care established by the rendering therapist or clinical fellow for the purpose of attaining maximum reduction of a disability and/or restoration of the individual to an acceptable functional level; and

4)         Provided to children and adults with prior authorization, except prior authorization is not required for speech/language therapy services for children under age 21.

d)         Effective with dates of services February 1, 2022 and after, payment shall be made for Adaptive Behavior Support (ABS) services for treatment of autism spectrum disorders when provided pursuant to 89 Ill. Adm. Code 140.465.

(Source:  Amended at 48 Ill. Reg. 864, effective December 27, 2023)