THERAPY SERVICES PROVIDER IN TENNESSEE

Fatumata Kaba
3 days ago
3 min read

EMPOWERING INDIVIDUALS THROUGH OCCUPATIONAL, PHYSICAL, AND SPEECH THERAPIES DESIGNED TO PROMOTE FUNCTION, COMMUNICATION, AND INDEPENDENT LIVING

Therapy Services in Tennessee are critical components of care plans for individuals with developmental disabilities, chronic health conditions, or functional limitations. These services are covered under TennCare’s State Plan, Employment and Community First (ECF) CHOICES, 1915(c) Waivers, and the Katie Beckett Program, and must be provided by licensed professionals within their scope of practice.

1. GOVERNING AGENCIES

Agency: TennCare (Tennessee Medicaid)

Role: Manages therapy coverage through State Plan and waiver programs, including authorization and reimbursement.

Agency: Tennessee Department of Health (DOH)

Role: Licenses Physical Therapists (PT), Occupational Therapists (OT), and Speech-Language Pathologists (SLP) through its health licensure boards.

Agency: Department of Intellectual and Developmental Disabilities (DIDD)

Role: Coordinates provider certification and participant ISP implementation under 1915(c) and ECF CHOICES Waivers.

Agency: Centers for Medicare & Medicaid Services (CMS)**

Role: Establishes federal Medicaid coverage standards for therapy services.

2. THERAPY SERVICES OVERVIEW

Therapy services may be delivered in-home, in-clinic, or in community settings, depending on the individual’s need and plan of care.

Covered therapies include:

Occupational Therapy (OT)
- Daily living skill training (e.g., dressing, grooming, toileting)
- Fine motor development, sensory processing, adaptive equipment use
Physical Therapy (PT)
- Mobility, balance, muscle strength, and postural control
- Adaptive movement and gait training
Speech-Language Pathology (SLP)
- Verbal communication, feeding and swallowing, AAC device use
- Social pragmatics and articulation development
Feeding & Swallowing Therapy
- Often provided by SLPs with specific training
- Supports safety, nutrition, and mealtime function

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register business with the TN Secretary of State (if billing as an agency)
Obtain EIN and Type 2 NPI
Ensure all therapists are individually licensed through the Tennessee Board of Health Licensure
Apply to TennCare as a Medicaid Therapy Services provider
Register with DIDD if delivering therapy under waiver programs
Maintain liability and malpractice insurance
Develop a Therapy Services Policy & Procedure Manual

4. TENNESSEE PROVIDER ENROLLMENT PROCESS

Step 1: Business registration and NPI acquisition (individual and group, if applicable)

Step 2: Apply to TennCare or MCOs as an OT, PT, or SLP provider

Step 3: Submit licensure verification and credentialing documents

Step 4: If serving waiver participants, enroll with DIDD and participate in ISP planning

Step 5: Begin delivering therapy upon authorization

5. REQUIRED DOCUMENTATION

Business entity documents, EIN, NPI
Licensure verification for each therapist
Proof of liability/malpractice insurance
Therapy Services Policy Manual, including:
- Documentation standards and progress notes
- Session tracking and Medicaid billing logs
- Treatment plan development and ISP coordination
- Participant rights and confidentiality policies
- Infection control and emergency procedures
- Discharge planning and re-evaluation protocols

6. STAFFING REQUIREMENTS

Role: Occupational Therapist (OT)

Requirements: TN OT license, relevant experience, CPR/First Aid certification

Role: Physical Therapist (PT)

Requirements: TN PT license, experience with waiver populations, safety training

Role: Speech-Language Pathologist (SLP)

Requirements: TN SLP license, ASHA certification preferred

All therapists must complete:

TennCare/DIDD orientation if applicable
HIPAA and abuse prevention training
Documentation and goal tracking procedures
Plan of care implementation training
Emergency and safety protocols for home/community settings

7. MEDICAID WAIVER PROGRAMS

Therapy Services are authorized through:

TennCare State Plan – With physician orders, therapy may be provided for rehabilitation or habilitation
ECF CHOICES – Therapy can be built into an ISP to promote independence and skill development
1915(c) Waivers – Used for habilitative therapy for individuals with I/DD
Katie Beckett Program – Offers therapy for medically complex children
EPSDT (under 21) – Provides medically necessary therapy to children and adolescents with documented needs

8. TIMELINE TO LAUNCH

Phase: Business Registration & License Verification

Timeline: 1–2 months

Phase: TennCare Enrollment & Credentialing

Timeline: 2–3 months

Phase: DIDD Enrollment & Staff Orientation

Timeline: 30–60 days

Phase: Service Authorization & Start

Timeline: Upon plan approval and service referral

9. CONTACT INFORMATION

TennCare (Tennessee Medicaid Program)

Website: https://www.tn.gov/tenncare

Tennessee Department of Health – Health Professional Boards

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

Tennessee Department of Intellectual and Developmental Disabilities (DIDD)

Website: https://www.tn.gov/didd

Centers for Medicare & Medicaid Services (CMS)

Website: https://www.cms.gov

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

WCG helps therapy agencies, solo practitioners, and multidisciplinary clinics enter Tennessee’s Medicaid ecosystem to provide high-impact rehabilitative and habilitative care.

Scope of Work: