1. GOVERNING AGENCIES

Agency: Alabama Department of Mental Health (ADMH)
Role: Regulates provider approval, defines service standards, and ensures compliance with therapeutic service delivery under HCBS waivers

Agency: Alabama Medicaid Agency
Role: Oversees Medicaid enrollment, reimbursement, and service codes for Occupational Therapy Services

Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Provides federal oversight and ensures therapeutic services meet HCBS Medicaid guidelines

2. OCCUPATIONAL THERAPY SERVICE OVERVIEW

Occupational Therapy Services focus on the evaluation and treatment of individuals with functional limitations that interfere with independence in areas such as self-care, work, play, and social participation. Services must be person-centered and included in the individual’s service plan. Approved providers may deliver:

• Comprehensive functional evaluations
• Development and implementation of individualized therapeutic interventions
• Training in activities of daily living (ADLs) and instrumental ADLs
• Sensory integration and motor skill development
• Adaptation of environments and use of assistive devices
• Caregiver education and support strategies

All services must be medically necessary, provided by a licensed occupational therapist, and documented in alignment with ADMH and Medicaid requirements.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

• Register business with the Alabama Secretary of State
• Obtain EIN from the IRS and NPI (Type 2)
• Employ or contract with a Licensed Occupational Therapist (OT) and/or Certified Occupational Therapy Assistant (COTA)
• Maintain a HIPAA-compliant clinical environment for service delivery
• Develop clinical documentation systems aligned with Medicaid billing and therapy protocols
• Demonstrate the ability to perform evaluations, maintain client records, and track therapeutic progress

4. ADMH PROVIDER ENROLLMENT PROCESS

Initial Interest and Application:

• Request the Occupational Therapy Services Provider Application Packet from ADMH
• Submit a clinical service model including therapist qualifications, treatment procedures, and outcome tracking
• Include copies of licensure, supervisory structures, and documentation templates

Background & Credentialing:

• Background checks for all therapy and support staff
• Proof of active Alabama licensure for occupational therapists and assistants
• Verification of continuing education, liability insurance, and professional certification

Program Readiness Review:

• Evaluation of assessment tools, service plans, and therapy documentation forms
• Review of clinical documentation, HIPAA compliance, and service delivery models
• Demonstration of measurable outcome tracking and quality assurance practices

Approval & Medicaid Enrollment:

• Once approved by ADMH, complete enrollment with Alabama Medicaid as a provider of Occupational Therapy Services
• Add appropriate CPT/HCPCS billing codes to your service profile

5. REQUIRED DOCUMENTATION

• Articles of Incorporation or LLC Certificate
• IRS EIN Letter
• NPI confirmation
• Facility lease or service location documentation
• Licensure and certification for all clinical staff

ADMH-Compliant Policy & Procedure Manual including:

• Eligibility, referral, and evaluation processes
• Service planning and treatment documentation protocols
• Clinical supervision and reassessment policies
• Confidentiality, HIPAA compliance, and informed consent
• Emergency, grievance, and fraud prevention procedures
• Progress notes, goal tracking forms, and therapy logs
• Signed individual service plans and therapy consent forms

6. STAFFING REQUIREMENTS

Role: Licensed Occupational Therapist (OT)
Requirements: Master's degree or higher in Occupational Therapy, Alabama state license, experience in IDD services preferred

Role: Certified Occupational Therapy Assistant (COTA) (optional)
Requirements: Associate’s degree in OTA, Alabama state certification, supervision by licensed OT

All staff must complete:

• ADMH orientation and HCBS Waiver training
• Annual training in documentation standards, safety protocols, and therapeutic best practices
• Ongoing education in therapy techniques, disability support, and ethics

7. MEDICAID WAIVER SERVICES

The following Alabama Medicaid Waivers authorize Occupational Therapy Services:

• ID Waiver (Intellectual Disabilities Waiver)
• LAH Waiver (Living at Home Waiver)
• State of Alabama Community Waiver Program

Approved providers may deliver:

• Functional assessments and individualized therapy planning
• Direct therapeutic interventions and environmental adaptations
• Caregiver and staff training on functional strategies
• Documentation of progress and reassessment of needs

8. TIMELINE TO LAUNCH

Phase: Business Formation
Timeline: 0–1 week

Phase: ADMH Application Review
Timeline: 60–90 days

Phase: Clinical Readiness and Licensing Verification
Timeline: 30–60 days

Phase: Medicaid Enrollment
Timeline: 60–90 days

9. CONTACT INFORMATION

Alabama Department of Mental Health (ADMH) – Division of Developmental Disabilities
Email: ddprovider@mh.alabama.gov
Phone: (334) 242-3702
Website: https://mh.alabama.gov

Alabama Medicaid Agency – Waiver Services
Website: https://medicaid.alabama.gov

10. SCOPE OF WORK

• Business formation (LLC, EIN, NPI)
• ADMH provider application and therapy service model development
• Occupational Therapy Policy & Procedure Manual
• Staff credentialing and licensure verification
• Medicaid enrollment and billing support
• Therapy evaluation forms, progress notes, and consent templates
• WEBSITE, DOMAIN, AND EMAIL SETUP
• CLIENT ADMISSION PACKET
• MARKETING AND ADVERTISING MATERIALS
• OPERATIONAL TRAINING
• COMPLIANCE AND REGULATORY SUPPORT
• QUALITY ASSURANCE PROGRAMS
• MARKETING AND CLIENT ACQUISITION STRATEGIES