THERAPY SERVICES PROVIDER IN NEW YORK

Fatumata Kaba
Sep 4, 2025
4 min read

DELIVERING HOLISTIC AND PERSON-CENTERED THERAPEUTIC SUPPORT TO ENHANCE FUNCTIONAL ABILITIES AND WELL-BEING

Therapy Services in New York support individuals with physical, developmental, or mental health challenges through rehabilitative and therapeutic interventions. These services are delivered in home, community, or clinical settings to promote independence, mobility, and emotional well-being. Therapy Services are authorized under New York Medicaid Home and Community-Based Services (HCBS) Waiver programs.

1. GOVERNING AGENCIES

Agency: New York State Department of Health (NYSDOH)

Role: Administers Medicaid waiver funding for Therapy Services and oversees provider enrollment, service authorization, and reimbursement.

Agency: Office for People With Developmental Disabilities (OPWDD)

Role: Provides oversight for therapy services targeting individuals with developmental disabilities.

Agency: New York State Office of Mental Health (OMH)

Role: Ensures compliance for therapy programs serving individuals with mental and behavioral health needs.

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Provides federal oversight to ensure Medicaid-funded Therapy Services meet quality, safety, and person-centered care standards.

2. THERAPY SERVICES OVERVIEW

Therapy Services are designed to support individuals in achieving functional improvement and maintaining well-being through physical, occupational, speech, and behavioral therapies.

Approved providers may deliver:

Physical Therapy (PT): Improving mobility, strength, and coordination through therapeutic exercises.
Occupational Therapy (OT): Enhancing daily living skills and fine motor functions for greater independence.
Speech and Language Therapy (SLT): Addressing communication disorders and swallowing difficulties.
Behavioral Therapy: Implementing strategies to manage challenging behaviors and improve social skills.
Mental Health Counseling: Supporting emotional well-being and coping mechanisms.
Rehabilitation Therapy: Assisting in recovery post-injury or illness.
Music and Art Therapy: Encouraging self-expression and emotional processing.
Sensory Integration Therapy: Addressing sensory processing issues to improve functioning.
Documentation: Maintaining accurate records of therapy sessions, progress tracking, and treatment outcomes.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register the business entity with the New York Department of State.
Obtain EIN from the IRS and NPI (Type 2).
Enroll as a Medicaid Waiver Therapy Services provider via the New York Medicaid Provider Enrollment Portal (eMedNY).
Maintain general liability and professional liability insurance.
Develop policies for therapy planning, client safety, and professional practice standards.
Ensure therapists hold valid state licenses and complete required background checks.

4. NEW YORK PROVIDER ENROLLMENT PROCESS

Initial Interest and Application:

Complete the Provider Enrollment Application via the eMedNY Portal for Therapy Services under HCBS waivers.

Application and Documentation Submission:

Submit Articles of Incorporation, proof of EIN/NPI, insurance certificates, therapy policies, and staff licensure documentation.

Program Readiness Review:

NYSDOH, OPWDD, and OMH evaluate provider readiness, including therapy protocols, safety measures, and staff qualifications.

Approval & Medicaid Enrollment:

Upon approval, providers are authorized to bill Medicaid for Therapy Services using designated billing codes.

5. REQUIRED DOCUMENTATION

Articles of Incorporation or Business License (New York Department of State)
IRS EIN confirmation
NPI confirmation
Proof of general and professional liability insurance
Therapy Services Policy & Procedure Manual including:
- Therapy assessment, treatment planning, and intervention protocols
- Documentation standards for progress tracking and Medicaid billing
- Staff credentialing, background checks, and ongoing training records
- HIPAA compliance, participant rights, and grievance handling
- Safety protocols for in-home and community-based therapy
- Quality assurance and compliance monitoring

6. STAFFING REQUIREMENTS

Role: Therapy Program Director

Requirements: Licensed therapist (PT, OT, SLP, or behavioral therapist) with a Master's or Doctorate in a relevant field; experience in program management and clinical supervision.

Role: Physical Therapists (PT)

Requirements: Doctorate in Physical Therapy (DPT); New York State license; CPR certification; experience in rehabilitative care.

Role: Occupational Therapists (OT)

Requirements: Master’s degree in Occupational Therapy; state licensure; experience in ADL training and rehabilitation.

Role: Speech-Language Pathologists (SLP)

Requirements: Master’s degree in Speech-Language Pathology; ASHA certification; state licensure.

Role: Behavioral TherapistsRequirements: Certification as a Board Certified Behavior Analyst (BCBA) or similar; experience in behavioral interventions.

All staff must complete:

Training in therapy techniques, safety protocols, and client interaction
HIPAA compliance and participant rights education
Annual competency evaluations and ongoing professional development
Safety, crisis management, and client care training
Documentation and record-keeping best practices

7. MEDICAID WAIVER PROGRAMS

Therapy Services are available under the following New York Medicaid Waivers:

OPWDD Comprehensive Waiver
Home and Community-Based Services (HCBS) Waiver
Nursing Home Transition and Diversion (NHTD) Waiver
Traumatic Brain Injury (TBI) Waiver
Children’s Waiver

8. TIMELINE TO LAUNCH

Phase: Business Formation and Compliance Preparation

Timeline: 1–2 months

Phase: Staff Hiring, Credentialing, and Program Development

Timeline: 2–3 months

Phase: New York Medicaid Provider Enrollment and Readiness Review

Timeline: 60–90 days

Phase: Medicaid Billing Setup and Therapy Service Launch

Timeline: 30–45 days

9. CONTACT INFORMATION

New York State Department of Health (NYSDOH)

Website: https://www.health.ny.gov/

Office for People With Developmental Disabilities (OPWDD)

Website: https://opwdd.ny.gov/

New York State Office of Mental Health (OMH)

Website: https://omh.ny.gov/

eMedNY Provider Enrollment Portal

Website: https://www.emedny.org/

Centers for Medicare & Medicaid Services (CMS)

Website: https://www.cms.gov/

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — NEW YORK THERAPY SERVICES PROVIDER

WCG supports agencies in launching Medicaid-compliant Therapy Services in New York, offering:

Scope of Work:

Business registration, Medicaid enrollment, and licensing assistance
Policy manual development for therapy protocols and client safety
Staff credentialing, training program templates, and compliance documentation
Medicaid billing setup and audit-prepared financial management
Branding, website development, and community outreach strategies
Quality assurance systems for therapeutic interventions and compliance monitoring
Collaboration with healthcare providers, therapy specialists, and community organizations