Developmental Therapy: Coverage And Limitations

01. Coverage. Developmental therapy is delivered in a DDA center-based program, the community, or the participant’s home, and includes individual developmental therapy and group developmental therapy. Services must: (7-1-26) a. Be directed toward rehabilitation or habilitation of physical or DDs in the areas of self-care, receptive and expressive language, learning, mobility, self-direction, capacity for independent living, or economic self-sufficiency. (7-1-26) b. Include age-appropriate instruction in ADLs not gained by a participant during normal developmental stages or not likely to develop without training or therapy. (7-1-26) c. Not include tutorial activities or assistance with educational tasks associated with educational IDAHO ADMINISTRATIVE CODE IDAPA 16.03.26 Department of Health & Welfare Medicaid Plan Benefits Section 603 Page 143 needs resulting from a disability. (7-1-26) d. Both individual and group therapy must be available based on participant needs, interests, or choices. (7-1-26) e. Include a minimum of one (1) qualified staff member providing direct services for every twelve (12) participants when center based. (7-1-26) f. Occur in integrated, inclusive settings with no more than three (3) participants per qualified staff at each community-based session. Additional staff must be added when necessary to meet the needs of each individual served. (7-1-26) 02. Limitations. Developmental therapy may not exceed these limitations: (7-1-26) a. No more than twenty-two (22) hours per week. (7-1-26) b. No more than forty (40) hours per week in combination with ADH and supported employment. (7-1-26) c. Only one (1) type of Medicaid-reimbursable therapy during a single period. (7-1-26) d. Cannot be reimbursed when providing transportation to and from the agency. (7-1-26)