Refer Texas children for therapy services when they need them

Texas Medicaid provides benefits for medically necessary physical, occupational, and speech therapy services for children. These therapies may be crucial to improving the child’s health, development, and function.

As a primary care provider, you are in a position to identify a functional need, refer children for therapy, help the patient and family understand realistic goals of therapy, advocate for adequate frequency and duration of therapy while setting appropriate limits, and provide ongoing care in the medical home. Some children may require therapy for an acute condition, such as a sports injury, or for a chronic condition, such as cerebral palsy. Others may have a developmental deficit that is identified through screening during a Texas Health Steps preventive medical checkup or is suspected by a parent, caregiver, or teacher.

This course focuses on Texas Medicaid services for children birth through 20 years who have a need for physical, occupational, or speech therapy. Though children birth through 35 months may be eligible for additional therapy through Texas Medicaid, they must be referred to Early Childhood Intervention (ECI) Services within 7 days after a health-care provider suspects or identifies a developmental delay. Patients ages 21 years and older have different therapy referral rules and are beyond the scope of this course.

Early Childhood Intervention Services

ECI is a statewide program within the Texas Health and Human Services Commission for families with children from birth through 35 months who have developmental delays, disabilities, or certain medical diagnoses that may impact development. ECI services support families as they learn how to help their children grow and learn. ECI provides family-centered services in settings familiar to the child and family, with a multi-disciplinary team that may include OT, PT, or ST.

Health-care providers are required by federal and state regulations to refer children birth through 35 months with a suspected or confirmed developmental delay to the local ECI program. Refer to the Resources at the end of this course for a link to the ECI Provider Referral and Feedback form to refer a child for services.