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Habilitation and Rehabilitation Therapy (Occupational, Physical, and Speech) (for Ohio Only)
Act
by Oct 31, 2026
Effective date
Nov 1, 2026
Identified
Oct 3, 2026
Summary
UnitedHealthcare Community Plan of Ohio revised its Habilitation and Rehabilitation Therapy policy to remove InterQual® LOC criteria as the basis for medical necessity determinations. Effective November 1, 2026, medical necessity for occupational, physical, and speech therapy must now be determined solely using Ohio Administrative Code Rule 5160-8-35: Skilled Therapy Services. InterQual® criteria may still be used only for determining allowable frequency and number of therapy requests, not for medical necessity approval.
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What to do
by Oct 31, 2026 · 5 steps
01Billing team must update prior authorization workflow to reference Ohio Administrative Code Rule 5160-8-35 instead of InterQual® LOC criteria for medical necessity review of occupational, physical, and speech therapy claims for Ohio Medicaid members.
02Update authorization request templates and clinical review checklists to reflect the new standard.
03Brief clinical review staff and providers on the policy change to ensure medical necessity determinations align with OAC 5160-8-35 criteria.
04Communicate to therapy providers that prior authorization decisions will be based on OAC standards, not InterQual® criteria.
05Ensure billing system denies claims that lack documentation supporting medical necessity per OAC 5160-8-35.
If missed: Failure to implement may result in claim processing delays and denials for non-compliant authorization requests.
Original notice
Habilitation and Rehabilitation Therapy (Occupational, Physical, and Speech) (for Ohio Only)
uhcprovider.com · Always check the source before changing claims.