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Physical, Speech & Occupational Therapy Limits Lifted for 2021

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Posted: 22 Aug, 2011
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Updated: 13 Oct, 2021
by Valerie Bogart (New York Legal Assistance Group)

The 2011-12 NY State budget, ] limited  access to compression stockings, prescription footwear, and enteral nutritional formula, as well as physical therapy, occupational therapy, and speech therapy.

Some of these limits have been repealed or made less harsh.

Physical, Speech, and Occupational Therapy -

  •  In 2011, the state budget limited Occupational Therapy, Physical Therapy and Speech Therapy/Pathology to 20 visits per year. This was a flat limit on services, with no override allowed.  The  limits did not apply to people with developmental disabilities or traumatic brain injury, but to all other Medicaid recipients, including those who access these therapies through Managed Long Term Care and managed care plans.  

  • In April 2018  --The annual cap on Physical Therapy (PT) visits was increased from 20 to 40 visits per year. Unfortunately, the budget left unchanged the cap on Speech and Occupational Therapy visits at 20 per year for each type of therapy.

  •  Jan. 1, 2021- The  CAPS on all of the therapy services was REMOVED.  See NYS Medicaid Update.   April 2021.  

Compression Stockings and Orthopedic Footwear - Court Strikes Down Restrictions in Medicaid Coverage 

The full article can be found here.

"Ensure" and Enteral Nutritional Supplements - 

In 2011, the state budget law limited these "enteral supplements" to only those adults who can only be tube-fed.  This change was Medicaid Redesign Team   MRT 5901 Bowing to pressure to reinstate broader access to these supplements, in 2012, the state amended Social Services Law § 365-a(2)(g) to direct the State Department of Health to develop standards so that adults diagnosed with an HIV-related condition and other illness and conditions may qualify for Medicaid to pay for these supplements, including those who do not have to be tube-fed.  The State Department of Health delayed in issuing the new standards for adults until finally issuing them in June 2013.

See the changes in eligibility for these supplements in this article.

This article was authored by the Empire Justice Center and updated by NYLAG.

Empire Justice Center

Also read
item Court Orders Lifting Restrictions in Medicaid Coverage for Compression Stockings and Orthopedic Footwear
item "Ensure" and Enteral Nutritional Supplements - When does Medicaid Pay for it? 2013 Changes for Adults

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Fundamental Changes to NY Medicaid in the 2011 State Budget       Medicaid Managed Care

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