1. Program Definition and Services

Therapy Services in Tennessee provide clinical occupational, physical, and speech therapies designed to improve everyday functioning, enhance communication, and foster independent living. The program aims to help maintain individuals with severe chronic or developmental conditions in the community, averting long-term institutional stays. Services include:

• Habilitative & Rehabilitative Therapy: Individualized Physical Therapy (PT) for mobility/gait, Occupational Therapy (OT) for fine motor and ADL adjustments, and Speech-Language Pathology (SLP) for expressive verbal communication
• Specialized Clinical Support: Clinically monitored feeding and swallowing therapy, sensory processing integration plans, and Alternative and Augmentative Communication (AAC) device setups

2. Regulations

The program is governed by the following regulations:

• Rules of the Tennessee Department of Health, Division of Health Related Boards (Chapters governing PT, OT, and SLP practices)
• TennCare Rules and Regulations, Chapter 1200-13-01 (Medicaid Habilitative Therapy Benefits)
• Tennessee Medical Practice Act and Allied Health Professional Statutes
• HIPAA Standards and Rules for Electronic Medical Record Compliance

3. Licensing or Certification

Practitioners must hold individual licenses from their respective Tennessee Professional Licensing Boards, and the business entity must be credentialed as an active therapy provider group by TennCare and DIDD.

4. Responsible State Agency

The Tennessee Department of Health (TDH) Professional Boards and the Bureau of TennCare are responsible for reviewing group applications and certifying therapy service providers.

5. Application Process

The application process is conducted through the electronic TennCare MCO Portals and the Council for Affordable Quality Healthcare (CAQH) credentialing platform. Providers must submit clinical data forms online to initiate enrollment.

6. Required Documentation

While specific documentation requirements vary based on the target waiver, providers typically need to submit:

• Proof of compliance with state clinical practice safety acts and health board certifications
• Therapy Services Policy & Procedure Manual (covering session tracking and evaluation logs)
• Therapist staff license records, resumes, and CAQH system profile numbers
• Proof of extensive professional malpractice and general liability insurance

7. Timeline for Approval

The exact timeline for approval fluctuates based on agency capacity. Providers should contact individual MCO network management offices for detailed information on current credentialing processing timeframes.

8. Pre-Application Process

Prospective providers must complete specific foundation tasks before applying. They must establish their clinical business entity with the TN Secretary of State, secure an EIN, and obtain a Type 2 Group NPI.

9. Pre-Application Training

The state hosts mandatory administrative and compliance training sessions online. Access details regarding TennCare authorization criteria and ISP goal integration are sent to qualified applicants once preliminary paperwork is reviewed.

10. Additional Notes

• Providers must ensure that outpatient clinical environments meet all state healthcare accessibility and emergency safety protocols
• Habilitative care must be authorized via physician orders and linked directly to individual service plan outcomes
• All professional and administrative staff must conduct mandatory state background clearances and child/adult registry screenings
• Providers must maintain detailed records of face-to-face evaluations, daily progress notes, and billing records for Medicaid compliance

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