OT/PT Service Billing Impacted by Change to California Children’s Services Program

California’s 2017-18 state budget, which went into effect on July 1, 2017, included $1.6 million for nonmedically necessary OT and PT services to the California Children’s Services (CCS) Medical Therapy program.

While CCS was previously required to provide OT and PT services that the agency determined were medically necessary for CCS-eligible children, these sometimes only included a fraction of the total OT and PT services listed on a child’s Individualized Education Plan (IEP). The new budgetary language makes clear that CCS will now be required to provide any OT or PT service listed in a CCS-eligible child’s IEP:

The budget summary states, “The Budget includes $1.6 million General Fund for nonmedically necessary occupational therapy and physical therapy services. Recent court decisions have required the provision of these services if included in a child’s written Individualized Education Program, even when they are not deemed medically necessary. These services are not eligible for federal financial participation.” 

With CCS on the hook for providing all OT and PT services in a CCS-eligible child’s IEP, regardless of the agency’s determination of medical necessity, this change will require LEAs to ensure they are not billing any OT or PT service through the LEA Medi-Cal Billing Option Program if that service is provided to a CCS-eligible child.

Read the complete summary: 2017-18 California Budget summary, CCS Medical Therapy Program (page 2)