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Elizabeth M. Whitehorn, Director

Provider Notice issued 02/04/14

Occupational Therapy Referral Requirement

To:​ Local Education Agencies​
​Date: ​February 4, 2014
​Re: Occupational Therapy Referral Requirement​

The purpose of this notice is to provide clarification of the requirements of the School-Based Health Services Program related to occupational therapy services provided to recipients at local education agencies.

 

Public Act 98-0264 (pdf) amends the Illinois Occupational Therapy Practice Act and provides that a referral from a physician or other health care provider is not required for evaluations or interventions if an occupational therapist or occupational therapy assistant provides services in a school-based or educational environment. This change does not apply to Medicaid billed services for occupational therapy.

Federal regulations (42 CFR 440.110(b) (pdf)) require that occupational therapy services be prescribed by a physician. As a result, local education agencies enrolled with the department to provide Medicaid covered medical services are still required to obtain a referral from a physician.

Questions regarding this notice may be directed to the Bureau of Program and Policy Coordination at 217-782-3953.

Theresa A. Eagleson, Administrator

Division of Medical Programs