Adult Habilitative Services - Speech Therapy Stakeholder Engagement Questions and Answers
This website summarizes:
- Unanswered stakeholder questions received during HCPF's stakeholder engagement on June 25, 2024 regarding adult habilitative services for speech therapy.
Below each item, HCPF has provided and interim response.
Important Notice: There are several stages of policy development and implementation. Any responses on this website represent a snap-shot of HCPF's position as of April 3, 2025 and should not be read as final policy determination.
Where can I find policy changes and updates shared in the stakeholder meeting, held on Tuesday, June 25, 2024?
The June 25, 2024 meeting presentation and recording are posted on the Adult Habilitative Services Stakeholder Meeting webpage.
What is the timeline for the policy change?
The proposed rule will begin the Medical Services Board rulemaking process in April 2025. The implementation date will be announced through the Provider Bulletin and the billing manual will reflect the changes after approval.
Who is eligible for adult habilitative speech therapy services?
Any adult Health First Colorado member who is 21 years of age and older may be eligible to receive habilitative speech therapy services when the services are deemed medically necessary.
Can denials prior to the policy effective date be approved?
No, the implemented policy will not be approved retroactively. Any denials prior to the policy effective date will remain.
What is the difference between habilitative and rehabilitative speech therapy?
Rehabilitative means therapy that treats acute injuries and illnesses which are non-chronic conditions. Rehabilitative therapy is short-term in nature.
Habilitative speech therapy services help a person retain, learn, or improve skills and functioning for daily living and may be long-term in nature.
Will this include Augmentative and Alternative Communication (AAC)?
Yes, the speech therapy benefit currently covers Augmentative and Alternative Communication (AAC) and Speech Generating Devices (SGD) when medically necessary and will continue to do so after the new policy implementation.
Will this include outpatient habilitative speech therapy services?
Yes, this policy change is specifically for the outpatient speech therapy benefit and should not be confused with the Home Health Speech Therapy Benefit.
Can habilitative speech therapy services be provided in the home?
Please reference the Outpatient Speech Therapy Billing Manual for allowed place of service codes.
How can stakeholders engage with HCPF regarding reimbursement rates?
Providers may attend the Medicaid Provider Rate Review Advisory Committee (MPRRAC) meetings to provide feedback on HCPF’s data-driven and evidence-based analyses, conclusions, and recommendations. The meeting schedule and information may be accessed on the MPRRAC webpage.
Is a prior authorization request (PAR) required for adult habilitative speech therapy services?
12 sessions of speech therapy in each rolling calendar year are available to all members before a PAR is required. Providers are highly encouraged to submit a PAR if the member is reaching the 12 sessions mark, to avoid a lapse in services.
One date of service is equivalent to one session, regardless of the number of units billed on one date of service. Providers are still required to reference and follow National Correct Coding Initiative (NCCI) and Medically Unlikely Edits (MUE) guidance to avoid claims denials.
Will a new PAR be needed after policy implementation if they currently have an approved PAR?
No, an existing approved PAR will be sufficient.
Which modifiers can be used for adult habilitative speech therapy services?
Please reference the Outpatient Speech Therapy Billing Manual for appropriate modifiers.
What PAR criteria must be met to demonstrate medical necessity for adult habilitative speech therapy services, including for augmentative alternative communication devices?
A nationally recognized proprietary evidence-based criteria set is used for all outpatient speech therapy services. Adult habilitative services will be reviewed using this criteria.
Can HCPF provide coding and billing guidance for adult habilitative speech therapy services?
Please reference the Outpatient Speech Therapy Billing Manual for coding and billing guidance.
For more information, contact HCPF_Stakeholders@state.co.us.