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Assembly Bill A7772- Provide extended therapy coverage under Medicaid

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What is Bill A7772?

In the bill text, Bill A7772 aims to amend Paragraph (h) of subdivision 2 of  section 365-a of the social services law, as amended by section 27 of part H of chapter 59 of the laws of 2011. The current legislation limits Medicaid coverage for speech therapy, physical therapy, and occupational therapy to twenty visits each per year, unless the recipient is diagnosed with a traumatic brain injury and/or developmental disabilities. In this case, the individual receives endless coverage for therapy services.  The proposed legislation aims to provide additional coverage for therapy services to those who receive Medicaid at the extent of provider justification. This Bill was introduced in the Assembly in May of 2017, however has not moved far through the legal process so will have to be reintroduced next year. This bill is a New York State bill and remains specific to New York.

What is the importance of this bill?

The implementation of this bill could provide therapy recipients with the services they need to fully heal from a sustained injury and/or disability. If therapy services are cut-off too soon, the individual may not be fully independent or strong enough to return to their daily life. In addition, if the individual is not fully ready to terminate services when they are cut-off, it may cost more money in the end.

For example, if a patient with a stroke is receiving occupational therapy and physical therapy 3 times a week and speech therapy 2 times a week, they will quickly reach their Medicaid therapy cap. If this patient is still not safe with independent ambulation at their therapy cap, the patient may endure a fall at home due to lack of balance, strength, endurance, etc. If this patient breaks a bone as a result of their fall, they will not be able to receive anymore therapy services for the year because they already used their twenty visits during their recovery from their stroke. In this case, either the patient has to pay out of pocket increasing the burden on them and their family or they have to forego services developing risk for further injury.

If Bill A7772 is passed, these risks will be limited or nonexistent. If the therapist or medical provider make the educated decision that the patient needs more services, they would be required to write an in-depth medical justification requesting more services for the patient to Medicaid. If Medicaid doesn't agree with the therapist/medical provider, they simply deny the request.

How does the implementation of this bill affect therapists/medical providers?

Therapists and medical providers may have more job duties, however, the providers should be honored to perform these duties because they are helping their patients. Depending on the demand for therapy justification, jobs and/or increased hours might open up for therapists/medical providers.

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