Reminder: Non-categorical Adult Benefit and Physical, Occupational and Speech Therapy Services

June 29, 2012

The Non-categorical Adults Benefit is a limited benefit. MaineCare members with this benefit are only covered for therapy services that are provided in the hospital setting or at Federally Qualified Health Centers (FQHC). These therapy services include: Physical Therapy (PT), Occupational Therapy (OT), and Speech Therapy. Members with the Non-categorical Adults benefit are not covered for PT, OT, or speech services delivered in a free standing clinic or office setting (with the exception of FQHCs).

Hospitals and FQHCs must provide the therapy services in accordance with Section 68, Occupational Therapy Services, Section 85 Physical Therapy Services, and Section 109, Speech and Hearing Services, including any limitations or requirements for rehabilitation, etc., specified in those Sections of the MaineCare Benefits Manual (MBM). [See MBM, Section 45, Hospital Services, sec. 45.05-10; Section 31, Federally Qualified Health Center Services, sec. 31.04-2(A); and Chapter X, Non categorical Adults, sec. 2.02, (1) & (7)].