On July 1, 2017, a federal mandate with influence from Ohio law added a referral requirement for occupational, physical, and speech therapy and nursing services within the Medicaid School Program (MSP).
House Bill 89, enacted in 2016, authorized PTs, OTs, SLPs, and Audiologists to make referrals for specific services under MSP. Referring providers must have a provider agreement in order for services under their referral to be reimbursed.
In 2017, provisions of the Affordable Care Act (ACA) began requiring providers who order, refer, or prescribe (ORP) to have a provider agreement. Nursing services have required ORP approval since the start of Ohio’s MSP, and with the new ACA requirement, the provider that made the ORP for the service will have their Medicaid provider agreement number sent with the claim.
Referrals are good for up to one year or to the end date specified, whichever is less.
Referrals can be made at any time, but the following are recommended:
- First Referral – Add when a disability is suspected or the first date of testing/assessment
- Second Referral – Start Date of Plan (IEP or any plan accompanied by a School Services POC).
- Annual Referral – Yearly Start Date of Plan, as long as student is eligible.
Additional resources:
ORC 5162.366 Referrals for certain services under the Medicaid School Program
ODE Educating Children with Disabilities Presentation 1.28.16