Medicaid Places Cap On Therapy Prescriptions

(KFSM) -- Medicaid and the Department of Development Services are making changes to the amount of time allowed for children who require therapy every week.

A new funding cap starts on Saturday (July 1) that will only allow children 90 minutes per week of therapy.

Fort Smith mother, Kathryn Mattox said her daughter, Lilly, was born with Agensis of the Corpus Callosum, a condition in which her daughter was born without a connection to the right and left hemispheres of her brain.

Many things like eating, drinking, coordination and motor skills are difficult for her daughter Lilly, but Mattox said without at least 120 minutes of weekly therapy, her daughter would not have made the strides she has so far in her life.

"She relies on therapy," Mattox said. "Her first three years of life were so critical so that she can develop new pathways in her brain so she can do things like walk, play and talk, hopefully someday. She wasn't expected to walk until she was seven years old, but because of therapy, she started walking when she was two."

Mattox first heard about the Medicaid changes from a Facebook post and like many mothers in our area, she said she didn't know any details.

That is when Mattox scheduled a public informational meeting with therapy providers for parents of children who require therapy to provide all the correct information and guidance for the new changes.

Parents whose child receives more than 90 minutes of therapy can apply for prior approval so their child can continue receiving the needed amount of therapy each week, but parents at the informational meeting said they are unsure how long that third party approval may take.

The prior approval requirements include: (source: Melissa Stone with Department of Development Services)

  • The prescription
  • A comprehensive, age appropriate evaluation was conducted using an approved standardized testing instrument in the manual.
  • The therapy is conductive due to a valid diagnosis.
  • The therapy administered effectively treats the beneficiary's condition.
  • There is a reasonable expectation that therapy will result in meaningful improvement or that the therapy will prevent worsening of the condition.
  • The frequency, intensity and duration of therapy is realistic for the age of the child

If a child already receives 90 minutes or less of therapy per week, the cap will not change anything.

The next informational meeting with be help in Fort Smith on Tuesday (July 25) at 5:30 p.m. at Bost Inc. Admin Offices at 5812 Remington Circle. The Department of Development Services will be at this meeting to provide a better understanding and more information about the therapy cap and other changes expected for Medicaid recipients over the next 18 months.

For more information about Arkansas Medicaid, visit the AR Medicaid website. 

For more information from local parents and how Medicaid therapy has helped their child, visit the Medicaid Saves Lives website.