Clinical Practice Guidelines for the Determination of Medical Necessity: Distribution of Statewide Therapy Services for Children with Special Health Care Needs

Abstract 743 Poster Session IV, Tuesday, 5/4 (poster 39)

BACKGROUND: In December 1997, Arkansas Medicaid in cooperation with Title V and Children's Medical Services implemented guidelines for the preauthorization of therapy services for Children with Special Health Care Needs (CSHCN).

OBJECTIVE: To describe the distribution of services requested by Physical Therapy (PT), Occupational therapy (OT), and Speech/Language Therapy (SLP) in Arkansas (AR) for 12/97 - 10/98 and to evaluate geographic distribution of requests for therapy to determine if urban areas had higher requests for therapy services than rural areas.

METHODS: An encrypted online Internet transaction log was developed to track all requests for therapy services for CSHCN in Arkansas which were preauthorized by Children's Medical Services (CMS). The transaction log was updated in real-time as each request was processed by statewide CMS personnel. Cumulative requests by therapy type and distribution were analyzed. Requests were normalized by population base to evaluate the distribution of services for each of the seventy-five counties in the state.

RESULTS: The results of the overall percent of therapy distribution requests for the state during this specified time period were PT (22.22%), OT (25.57%), and SLP (52.20%). Normalization of the number of requests by county population base and therapy type were PT, range (9.29-127.75), average (48.94 ± 27.02), OT, range (3.10-143.2), average (62.15 ± 38.06), and SLP, range (31.52-801.95), average (290.93 ± 147.95). (Table)

Table 1 PREAUTHORIZATION REQUESTS BY THERAPY TYPE

CONCLUSIONS: Almost twice the number of SLP was requested as PT and OT. After normalization, Little Rock, as well as the next three largest urban areas of the state were average in the number of requests for each of the therapies by normalized population base. Children throughout the state appeared to be requesting therapy regardless of the geographic proximity or access to therapy services. Children in urban areas accounted for an average number of therapy requests with respect to their rural counterparts. This demonstrated that the counties with high and low number of requests for therapy services in the state were not necessarily localized in the urban areas.

Funded by Health Care Finance Administration and Arkansas Medicaid

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(Spon by: Shultz G. Eldon)

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Mooney, D., Nancy, C., Eldon, S. et al. Clinical Practice Guidelines for the Determination of Medical Necessity: Distribution of Statewide Therapy Services for Children with Special Health Care Needs. Pediatr Res 45, 128 (1999). https://doi.org/10.1203/00006450-199904020-00760

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