Medicaid Benefits: Home Health Services – Physical Therapy, Occupational Therapy, and/or Speech Pathology/Audiology

2018

Location	Benefit Covered	Copayment Required?	Limits on Services
United States	Yes - 44 No - 2 NR - 5	Yes - 4	Yes - 25
Alabama	No
Alaska	Yes	No	Prior authorization Required
Arizona	Yes	No	15 visits for habilitation, 15 visits for rehabilitation
Arkansas	Yes	NR	NR
California	Yes	No	No
Colorado	Yes	No	Services subject to prior authorization and daily maximum reimbursement limits
Connecticut	Yes	No	Evaluation limited to one per day per calendar year per provider per member. Treatment in excess of 2 services per calendar week per client, per provider must have prior authorization. Treatment services in excess of 9 per calendar year per provider per member must have prior authorization.
Delaware	Yes	No	No
District of Columbia	Yes	No	Requires PA for service to be reimbursable
Florida	Yes	No	One wheelchair evaluation and follow-ups once per five years. Other therapy services can be received as part of a recipient's annual $1,500 outpatient services cap.
Georgia	Yes	$3 copay	More than 50 visits per year per specialty must be prior authorized.
Hawaii	Yes	No	No
Idaho	Yes	No	No
Illinois	NR	NR	NR
Indiana	Yes	No	Prior authorization. 120 hours of care within 30 days of hospital discharge if ordered by physician.
Iowa	NR	NR	NR
Kansas	Yes	No	Therapy is limited to 6 months per injury; all therapy services limited to one unit per day
Kentucky	Yes	NR	NR
Louisiana	Yes	No	NR
Maine	Yes	$.50 to $2/day depending on payment amount, up to $20/month	No
Maryland	Yes	No	No
Massachusetts	Yes	No	No
Michigan	Yes	No	Medically Necessary
Minnesota	Yes	No	No
Mississippi	Yes	No	Services are prior authorized for medical necessity for waiver participants once the allowable State Plan benefit has been exhausted.
Missouri	Yes	No	Limited to pregnant women or persons who are blind
Montana	Yes	$4 per visit	180 combined skilled nursing, aide and therapy visits per year
Nebraska	Yes	No	HH-PT/OT/ST; For clients age 21 and older, Medicaid does not cover therapy sessions in excess of 60 session per fiscal year (July 1-June 30) for any combination of physical therapy, occupational therapy and speech therapy (471 NAC 14-004, 17-004, 23-004). 244.65/day- Daily payment limit on skilled nursing services for persons age 21 and older in a home health setting 796.32/day – Daily payment limit on skilled nursing services for persons age 21 and older who are ventilator dependent in a home health setting.
Nevada	Yes	No	Prior authorization required
New Hampshire	NR	NR	NR
New Jersey	Yes	No	No
New Mexico	Yes	No	No
New York	NR	NR	NR
North Carolina	Yes	No	NR
North Dakota	Yes	No	50 visits per year
Ohio	Yes	No	Four hours or less per visit, no more than eight hours a day combined, up to 14 hours a week.
Oklahoma	No
Oregon	Yes	No	Day limits, PA to go over limits. All coverage is based upon the prioritized list of health services.
Pennsylvania	Yes	No	Unlimited for first 28 days; the limited to 15 days every month thereafter, in combination with nursing and home health aide visits.
Rhode Island	Yes	No	No
South Carolina	NR	NR	NR
South Dakota	Yes	No	NR
Tennessee	Yes	No	No
Texas	Yes	No	Requires prior authorization for PT/OT. Speech Therapy is not a benefit for adults through home health.
Utah	Yes	No	Occupational therapy and speech language pathology services to adults are not allowed in home health
Vermont	Yes	No	4-month limit without prior authorization to exceed
Virginia	Yes	$3 per visit	NR
Washington	Yes	No	No
West Virginia	Yes	No	PA required for services that exceed 60 visits in a calendar year
Wisconsin	Yes	No	Therapy visits limited to one per day; prior approval required after 30 visits in a calendar year, regardless of home health service or provider
Wyoming	Yes	No	Prior authorization required

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Medicaid Benefits: Home Health Services – Physical Therapy, Occupational Therapy, and/or Speech Pathology/Audiology

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Medicaid Benefits: Home Health Services – Physical Therapy, Occupational Therapy, and/or Speech Pathology/Audiology

2018

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