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December 16, 2011 Medicaid Banner Page

Change in Implementation of Earlier Oversight for Outpatient

Pediatric Rehabilitative Therapies

Effective December 9, 2011, the requirement for earlier oversight (greater than 8 visits) for outpatient pediatric

rehabilitative therapies per Emergency Rule AHS Bulletin 11‐11/Secretary of State ID# 11‐E09 will be suspended

pending formal approval of regular rule change by the legislature. Refer to current Rule 7317 for Rehabilitation

Therapy Services. Providers are encouraged to consider continuing to submit requests for medical necessity review

sooner than the 4 month requirement date on a voluntary basis. Earlier review by DVHA will help providers to:

Receive earlier guidance regarding medically necessary evidence based practice

Receive earlier assistance regarding Medicaid regulation and procedures

Avoid recoupments that would otherwise be generated through the retroactive utilization review process

DVHA will continue to work through the rulemaking process, with the anticipated approval of the rule change within

the next several months. For clinical assistance and support, please contact Susan Mason at 802 879‐6396 or