In the past three years I have had an ongoing frustration- The medicaid system in Missouri will reimburse a school for the services of an Occupational Therapist and a Physical Therapist, but will not provide any reimbursement for the services of a Certified Occupational Therapy Assistant or a Physical Therapy Assistant. On the surface this sounds reasonable. Why would anyone pay for the services of an assistant when a fully credentialed therapist could do the same thing.
The root of my frustration is this: There is a state-wide shortage in Missouri of Occupational therapists and physical therapists that are willing to serve in the school setting. There is also a shortage of assistants as well, but not to the same degree. By not reimbursing the schools for the services of an assistant the medicaid program is placing an unfunded mandate upon the schools.
According to the Individuals with Disabilities Education Act (IDEA) the school system is responsible for providing the services that a child requires in order to an appropriate public education. For many students, this includes occupational and physical therapy services. When a school is required to provide a service, but are not given the resources to fund the service the money must come from the general education fund. Less money in the general education fund, means less money for all students and teachers.
This behavior appears equivalent to an insurance company refusing to pay for the administration of a vaccine because the shot was given by a nurse and not a doctor. This doesn't make sense. The shot was still given! In this case, the therapy was still provided.
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