MedicaidCoverageHigh impact
Newsletter Vol. 4, No. 25
New Jersey Medicaid·NJ · Physical Therapy, Speech Therapy, Occupational Therapy +1 more·Provider Notice
We identified it
Jun 20, 2026
Summary
Medicaid will no longer reimburse home health agencies for special therapy services (physical therapy, speech-language pathology, occupational therapy) when provided outside the recipient's place of residence, such as at adult activity centers or day programs. Providers who have already submitted and received payment for out-of-home services must immediately submit forms to void those previously paid claims.
Action Required
Immediately: (1) Billing team must implement edit rules in billing system to prevent submission of claims for therapy services (physical therapy, speech-language pathology, occupational therapy) provided by home health agencies when the place of service is NOT the recipient's residence (private home, residential hotel, residential health care facility, rooming house, or boarding home). (2) Identify and audit all home health therapy claims paid in the past 12 months where services were delivered at day programs or adult activity centers. (3) Prepare and submit void/adjustment forms for all identified out-of-home claims to recover overpaid amounts. (4) Update provider documentation requirements and encounter forms to require explicit capture of place of service as recipient's residence. (5) Notify all home health agencies contracted with the practice that day program therapy services are no longer billable to Medicaid. Failure to comply will result in demand for repayment of claims paid for services rendered outside the home setting.