{"component": "clause", "props": {"groups": [{"snippet": "The following Services are covered when rendered by a Network Provider [upon prior written Referral by a [Member]'s Primary Care Provider [or the Care Manager]]. Subject to the stated limits, We cover the Therapy Services listed below. We cover other types of Therapy Services provided they are performed by a licensed Provider, are Medically Necessary and Appropriate and are not Experimental or Investigational.", "size": 75, "samples": [{"hash": "aAxblCQlMDn", "uri": "/contracts/aAxblCQlMDn#therapy-services", "label": "Hmo Plan Contract", "score": 36.2775551171, "published": true}, {"hash": "f4L4w1Kajmy", "uri": "/contracts/f4L4w1Kajmy#therapy-services", "label": "Hmo Plan Contract", "score": 35.8346633911, "published": true}, {"hash": "6fxILvya06K", "uri": "/contracts/6fxILvya06K#therapy-services", "label": "Hmo Plan Contract", "score": 35.6349258423, "published": true}], "snippet_links": [{"key": "network-provider", "type": "definition", "offset": [54, 70]}, {"key": "written-referral", "type": "clause", "offset": [83, 99]}, {"key": "primary-care-provider", "type": "definition", "offset": [116, 137]}, {"key": "care-manager", "type": "definition", "offset": [146, 158]}, {"key": "subject-to-the", "type": "clause", "offset": [162, 176]}, {"key": "we-cover", "type": "clause", "offset": [192, 200]}, {"key": "listed-below", "type": "clause", "offset": [222, 234]}, {"key": "types-of", "type": "clause", "offset": [251, 259]}, {"key": "services-provided", "type": "clause", "offset": [268, 285]}, {"key": "performed-by", "type": "clause", "offset": [295, 307]}, {"key": "licensed-provider", "type": "definition", "offset": [310, 327]}, {"key": "medically-necessary-and-appropriate", "type": "clause", "offset": [333, 368]}, {"key": "experimental-or-investigational", "type": "definition", "offset": [381, 412]}], "hash": "66741e25c2c4e50b81a7b6e6983f83b8", "id": 1}, {"snippet": "If therapy services are provided, they shall be provided in accordance with the plan of care for the patient and by individuals who meet qualification requirements for therapy service delivery such as evidence of current licensure or registration and academic training. Therapy services shall con- sist of:\n1. Physical, occupational, speech and language pathology or respiratory therapy;\n2. The provision of a patient assessment as directed by the plan of care under the supervision of the care coordinator; and\n3. The development of a therapy plan of intervention based on consultation with the care coordinator which shall state spe- cific patient needs and goals and outline interventions and approaches to meet patient needs.", "size": 10, "samples": [{"hash": "l7faPVUtBzh", "uri": "/contracts/l7faPVUtBzh#therapy-services", "label": "HFS 131   Hospices Regulations", "score": 29.3828353882, "published": true}, {"hash": "7Q5MYMrUFjR", "uri": "/contracts/7Q5MYMrUFjR#therapy-services", "label": "HFS 131   Hospices Regulations", "score": 29.3828353882, "published": true}, {"hash": "4yv47JGTLbL", "uri": "/contracts/4yv47JGTLbL#therapy-services", "label": "Hospice Regulations", "score": 29.3828353882, "published": true}], "snippet_links": [{"key": "services-are-provided", "type": "clause", "offset": [11, 32]}, {"key": "in-accordance-with", "type": "definition", "offset": [57, 75]}, {"key": "plan-of-care", "type": "definition", "offset": [80, 92]}, {"key": "requirements-for", "type": "clause", "offset": [151, 167]}, {"key": "service-delivery", "type": "definition", "offset": [176, 192]}, {"key": "evidence-of-current", "type": "clause", "offset": [201, 220]}, {"key": "licensure-or-registration", "type": "clause", "offset": [221, 246]}, {"key": "academic-training", "type": "clause", "offset": [251, 268]}, {"key": "respiratory-therapy", "type": "clause", "offset": [367, 386]}, {"key": "provision-of-a", "type": "clause", "offset": [395, 409]}, {"key": "patient-assessment", "type": "definition", "offset": [410, 428]}, {"key": "as-directed", "type": "clause", "offset": [429, 440]}, {"key": "supervision-of-the", "type": "clause", "offset": [471, 489]}, {"key": "care-coordinator", "type": "definition", "offset": [490, 506]}, {"key": "development-of-a", "type": "clause", "offset": [519, 535]}, {"key": "based-on", "type": "definition", "offset": [565, 573]}], "hash": "8e719c69c986cf860de70e5d512416d3", "id": 2}, {"snippet": "Benefits will be provided for the following Covered Services only when such Services are ordered by a Physician.", "size": 9, "samples": [{"hash": "kXraLW0wLwd", "uri": "/contracts/kXraLW0wLwd#therapy-services", "label": "Individual Comprehensive Major Medical Preferred Provider Subscription Agreement", "score": 22.4113616943, "published": true}, {"hash": "j4repMMkUG", "uri": "/contracts/j4repMMkUG#therapy-services", "label": "Individual Comprehensive Major Medical Preferred Provider Qualified High Deductible Health Plan Subscription Agreement", "score": 22.4113616943, "published": true}, {"hash": "iqkRZ7ORFV7", "uri": "/contracts/iqkRZ7ORFV7#therapy-services", "label": "Individual Comprehensive Major Medical Exclusive Provider Subscription Agreement", "score": 22.4113616943, "published": true}], "snippet_links": [{"key": "benefits-will", "type": "clause", "offset": [0, 13]}, {"key": "services-only", "type": "clause", "offset": [52, 65]}, {"key": "ordered-by", "type": "definition", "offset": [89, 99]}], "hash": "efd612bb2d001c105d6cd33afeeffcfb", "id": 3}, {"snippet": "Physical, occupational and/or speech pathology treatment provided by or under the supervision of a qualified therapist as prescribed by your physician. Respiratory therapy, as prescribed by the primary care physician. Rehab services for a mental disorder and intellectual disability, or services of a lesser intensity, as prescribed by the primary care physician.", "size": 4, "samples": [{"hash": "b2Xp07X41jg", "uri": "/contracts/b2Xp07X41jg#therapy-services", "label": "Admission Agreement", "score": 30.7788925171, "published": true}, {"hash": "21NevQlTJOb", "uri": "/contracts/21NevQlTJOb#therapy-services", "label": "Admission Agreement", "score": 30.7788925171, "published": true}, {"hash": "9ZPw5n5K69O", "uri": "/contracts/9ZPw5n5K69O#therapy-services", "label": "Admission Agreement", "score": 29.412946701, "published": true}], "snippet_links": [{"key": "speech-pathology", "type": "definition", "offset": [30, 46]}, {"key": "under-the-supervision-of", "type": "definition", "offset": [72, 96]}, {"key": "qualified-therapist", "type": "definition", "offset": [99, 118]}, {"key": "as-prescribed", "type": "definition", "offset": [119, 132]}, {"key": "your-physician", "type": "clause", "offset": [136, 150]}, {"key": "respiratory-therapy", "type": "clause", "offset": [152, 171]}, {"key": "the-primary-care-physician", "type": "clause", "offset": [190, 216]}, {"key": "services-for", "type": "clause", "offset": [224, 236]}, {"key": "mental-disorder", "type": "clause", "offset": [239, 254]}, {"key": "intellectual-disability", "type": "clause", "offset": [259, 282]}], "hash": "98bb3ce9fd1ceb6a50ac705078da3fad", "id": 4}, {"snippet": "Psychological Services \u2013 Psychotherapy has both benefits and risks. Risks may include experiencing uncomfortable feelings, such as sadness, guilt, anxiety, anger, frustration or loneliness because the process of psychotherapy often requires discussing the unpleasant aspects of your life. However, psychotherapy has been shown to have benefits. Therapy often leads to a significant reduction of feeling distressed, increased skill for managing stress, and resolution to specific problems. There are no guarantees about what will happen. Psychotherapy requires a very active effort on the part of the patient.", "size": 3, "samples": [{"hash": "kuP8XUwkOjl", "uri": "/contracts/kuP8XUwkOjl#therapy-services", "label": "Patient Contract for Behavioral Health Services", "score": 26.2047519684, "published": true}, {"hash": "biVUrBWhqPO", "uri": "/contracts/biVUrBWhqPO#therapy-services", "label": "Patient Contract for Behavioral Health Services", "score": 26.1992759705, "published": true}, {"hash": "93P4TFkPDrG", "uri": "/contracts/93P4TFkPDrG#therapy-services", "label": "Patient Contract for Behavioral Health Services", "score": 26.0815696716, "published": true}], "snippet_links": [{"key": "psychological-services", "type": "definition", "offset": [0, 22]}, {"key": "benefits-and-risks", "type": "clause", "offset": [48, 66]}, {"key": "the-process", "type": "clause", "offset": [197, 208]}, {"key": "reduction-of", "type": "clause", "offset": [382, 394]}, {"key": "for-managing", "type": "clause", "offset": [431, 443]}, {"key": "no-guarantees", "type": "clause", "offset": [499, 512]}], "hash": "ac95065ccb06115a8f163b5b6f8b18d0", "id": 5}, {"snippet": "a. Medicaid therapy services are physical, speech-language (including augmentative and alternative communication systems), occupational and respiratory therapies. The Health Plan shall cover therapy services consistent with handbook requirements. Medicaid pays only for therapy services that are Medically Necessary for the provision of therapy evaluations and individual therapy treatment. Therapy services are limited to Children/Adolescents under the age of twenty-one (21). Adults are covered for physical and respiratory therapy services under the outpatient Hospital services program. The Agency shall reimburse schools participating in the certified school match program for school-based therapy services rendered to Enrollees. The provision of school-based therapy services to an Enrollee does not replace, substitute or fulfill a service prescription or doctors' orders for therapy services external to the Health Plan. The Health Plan shall:\n(1) Refer Enrollees to appropriate Providers for further assessment and treatment of conditions;\n(2) Offer Enrollees scheduling assistance in making treatment appointments and obtaining transportation; and\n(3) Provide for care management in order to follow the Enrollee\u2019s progress from screening through his/her course of treatment.", "size": 3, "samples": [{"hash": "bNLWtTj3On5", "uri": "/contracts/bNLWtTj3On5#therapy-services", "label": "Health Care Services Contract (Wellcare Health Plans, Inc.)", "score": 21.0, "published": true}, {"hash": "8J2mQVlUckt", "uri": "/contracts/8J2mQVlUckt#therapy-services", "label": "Health Care Services Contract (Wellcare Health Plans, Inc.)", "score": 21.0, "published": true}, {"hash": "3tB1XoN16Qt", "uri": "/contracts/3tB1XoN16Qt#therapy-services", "label": "Health Care Services Agreement", "score": 21.0, "published": true}], "snippet_links": [{"key": "communication-systems", "type": "definition", "offset": [99, 120]}, {"key": "health-plan", "type": "definition", "offset": [167, 178]}, {"key": "consistent-with", "type": "definition", "offset": [208, 223]}, {"key": "necessary-for", "type": "definition", "offset": [306, 319]}, {"key": "provision-of", "type": "clause", "offset": [324, 336]}, {"key": "individual-therapy", "type": "clause", "offset": [361, 379]}, {"key": "respiratory-therapy-services", "type": "definition", "offset": [514, 542]}, {"key": "services-program", "type": "definition", "offset": [573, 589]}, {"key": "the-agency-shall", "type": "clause", "offset": [591, 607]}, {"key": "participating-in", "type": "definition", "offset": [626, 642]}, {"key": "certified-school", "type": "definition", "offset": [647, 663]}, {"key": "for-school", "type": "clause", "offset": [678, 688]}, {"key": "services-rendered", "type": "definition", "offset": [703, 720]}, {"key": "external-to-the", "type": "definition", "offset": [900, 915]}, {"key": "to-appropriate", "type": "clause", "offset": [972, 986]}, {"key": "treatment-of", "type": "definition", "offset": [1024, 1036]}, {"key": "assistance-in", "type": "definition", "offset": [1080, 1093]}, {"key": "provide-for", "type": "clause", "offset": [1162, 1173]}, {"key": "care-management", "type": "definition", "offset": [1174, 1189]}, {"key": "in-order-to", "type": "clause", "offset": [1190, 1201]}, {"key": "course-of-treatment", "type": "clause", "offset": [1264, 1283]}], "hash": "b18d8b82f035f9cde6b8b2cfb1bcf788", "id": 6}, {"snippet": "Physical, occupational and/or speech pathology treatment provided by or under the supervision of a qualified therapist as prescribed by Resident\u2019s physician. The federal government may require a cap on the amount of funds Medicare will pay for these services in one year. This amount may be changed from time to time. Resident agrees to pay for any services not covered by Medicare or any other third party payor.", "size": 3, "samples": [{"hash": "4HIKoKBzojt", "uri": "/contracts/4HIKoKBzojt#therapy-services", "label": "Admission Agreement", "score": 30.1821460724, "published": true}, {"hash": "b1rxGJhsmee", "uri": "/contracts/b1rxGJhsmee#therapy-services", "label": "Admission Agreement", "score": 29.1255226135, "published": true}], "snippet_links": [{"key": "speech-pathology", "type": "definition", "offset": [30, 46]}, {"key": "under-the-supervision-of", "type": "definition", "offset": [72, 96]}, {"key": "qualified-therapist", "type": "definition", "offset": [99, 118]}, {"key": "as-prescribed", "type": "definition", "offset": [119, 132]}, {"key": "by-resident", "type": "definition", "offset": [133, 144]}, {"key": "the-federal-government", "type": "clause", "offset": [158, 180]}, {"key": "amount-of-funds", "type": "clause", "offset": [206, 221]}, {"key": "pay-for", "type": "clause", "offset": [236, 243]}, {"key": "one-year", "type": "clause", "offset": [262, 270]}, {"key": "from-time-to-time", "type": "clause", "offset": [299, 316]}, {"key": "to-pay", "type": "clause", "offset": [334, 340]}, {"key": "covered-by", "type": "definition", "offset": [362, 372]}, {"key": "third-party-payor", "type": "clause", "offset": [395, 412]}], "hash": "77792ec89945696f905dfebc8a2b9d99", "id": 7}, {"snippet": "Medicaid therapy services are physical, speech-language (including augmentative and alternative communication systems), occupational and respiratory therapies. The Health Plan shall cover therapy services consistent with the Medicaid Therapy Services Coverage and Limitations Handbook requirements. Therapy services are limited to children/adolescents under age 21. Adults are covered for physical and respiratory therapy services under the outpatient hospital services program. The Agency shall reimburse schools participating in the certified school match program for school-based therapy services rendered to enrollees. The provision of school-based therapy services to an enrollee does not replace, substitute or fulfill a service prescription or doctors\u2019 orders for therapy services covered by the Health Plan. The Health Plan shall:\na. Refer enrollees to appropriate providers for further assessment and treatment of conditions;\nb. Offer enrollees scheduling assistance in making treatment appointments and arranging transportation; and\nc. Provide for care management in order to follow the enrollee\u2019s progress from screening through the course of treatment. WellCare of Florida, Inc. d/b/a Staywell Health Plan of Florida Medicaid HMO Non-Reform Contract", "size": 3, "samples": [{"hash": "6Tlbge1DqQt", "uri": "/contracts/6Tlbge1DqQt#therapy-services", "label": "Standard Contract (Wellcare Health Plans, Inc.)", "score": 21.0, "published": true}], "snippet_links": [{"key": "communication-systems", "type": "definition", "offset": [96, 117]}, {"key": "health-plan", "type": "definition", "offset": [164, 175]}, {"key": "consistent-with-the", "type": "clause", "offset": [205, 224]}, {"key": "coverage-and-limitations-handbook", "type": "clause", "offset": [251, 284]}, {"key": "age-21", "type": "definition", "offset": [358, 364]}, {"key": "respiratory-therapy-services", "type": "definition", "offset": [402, 430]}, {"key": "services-program", "type": "definition", "offset": [461, 477]}, {"key": "the-agency-shall", "type": "clause", "offset": [479, 495]}, {"key": "participating-in", "type": "definition", "offset": [514, 530]}, {"key": "certified-school", "type": "definition", "offset": [535, 551]}, {"key": "for-school", "type": "clause", "offset": [566, 576]}, {"key": "services-rendered", "type": "definition", "offset": [591, 608]}, {"key": "provision-of", "type": "clause", "offset": [627, 639]}, {"key": "covered-by", "type": "definition", "offset": [788, 798]}, {"key": "to-appropriate", "type": "clause", "offset": [858, 872]}, {"key": "treatment-of", "type": "definition", "offset": [910, 922]}, {"key": "assistance-in", "type": "definition", "offset": [965, 978]}, {"key": "provide-for", "type": "clause", "offset": [1046, 1057]}, {"key": "care-management", "type": "definition", "offset": [1058, 1073]}, {"key": "in-order-to", "type": "clause", "offset": [1074, 1085]}, {"key": "course-of-treatment", "type": "clause", "offset": [1144, 1163]}, {"key": "plan-of", "type": "definition", "offset": [1213, 1220]}], "hash": "ff511e747840e5ed167abb4b4cb8946d", "id": 8}, {"snippet": "a. These services include individual or group therapy, which may include psychotherapy or supportive counseling focused on assisting recipients with the problems or symptoms identified in an assessment. The focus should be on identifying and utilizing the strengths of the recipient, family, and other natural support systems. Therapy services should be geared to the individual needs of the recipient and should be sensitive to the age, developmental level, and functional level of the recipient.\nb. Family or marital therapy is also included in this category. Examples of interventions include those that focus on resolution of a life crisis or an adjustment reaction to an external stressor or developmental challenge. The provider shall offer recipients a choice of direct service providers, as well as location, to the extent feasible and appropriate.", "size": 2, "samples": [{"hash": "irnE7Rb76vz", "uri": "/contracts/irnE7Rb76vz#therapy-services", "label": "Medicaid Hmo Contract (Wellcare Health Plans, Inc.)", "score": 19.0, "published": true}, {"hash": "9TtwY3t5U8u", "uri": "/contracts/9TtwY3t5U8u#therapy-services", "label": "Medicaid Hmo Contract (Wellcare Health Plans, Inc.)", "score": 19.0, "published": true}], "snippet_links": [{"key": "these-services-include", "type": "clause", "offset": [3, 25]}, {"key": "group-therapy", "type": "clause", "offset": [40, 53]}, {"key": "supportive-counseling", "type": "definition", "offset": [90, 111]}, {"key": "the-recipient", "type": "clause", "offset": [269, 282]}, {"key": "support-systems", "type": "definition", "offset": [310, 325]}, {"key": "the-individual", "type": "clause", "offset": [364, 378]}, {"key": "also-included", "type": "clause", "offset": [530, 543]}, {"key": "examples-of", "type": "clause", "offset": [562, 573]}, {"key": "an-external", "type": "clause", "offset": [673, 684]}, {"key": "the-provider-shall", "type": "clause", "offset": [722, 740]}, {"key": "offer-recipients", "type": "definition", "offset": [741, 757]}, {"key": "service-providers", "type": "definition", "offset": [777, 794]}, {"key": "to-the-extent", "type": "clause", "offset": [817, 830]}], "hash": "dc3a131c6acd52962abe356da44f5363", "id": 9}, {"snippet": "Medicaid therapy services are physical, speech-language (including augmentative and alternative communication systems), occupational and respiratory therapies. The Health Plan shall cover therapy services consistent with the Medicaid Therapy Services Coverage and Limitations Handbook requirements. Therapy services are limited to children/adolescents under age 21. Adults are covered for physical and respiratory therapy services under the outpatient hospital services program. The Agency shall reimburse schools participating in the certified school match program for school-based therapy services rendered to enrollees. The provision of school-based therapy services to an enrollee does not replace, substitute or fulfill a service prescription or doctors\u2019 orders for therapy services covered by the Health Plan. The Health Plan shall:", "size": 2, "samples": [{"hash": "gTJokMrrcyw", "uri": "/contracts/gTJokMrrcyw#therapy-services", "label": "Standard Contract (Wellcare Health Plans, Inc.)", "score": 23.729637146, "published": true}, {"hash": "HdDtIRAXoE", "uri": "/contracts/HdDtIRAXoE#therapy-services", "label": "Standard Contract (Wellcare Health Plans, Inc.)", "score": 23.729637146, "published": true}], "snippet_links": [{"key": "communication-systems", "type": "definition", "offset": [96, 117]}, {"key": "health-plan", "type": "definition", "offset": [164, 175]}, {"key": "consistent-with-the", "type": "clause", "offset": [205, 224]}, {"key": "coverage-and-limitations-handbook", "type": "clause", "offset": [251, 284]}, {"key": "age-21", "type": "definition", "offset": [358, 364]}, {"key": "respiratory-therapy-services", "type": "definition", "offset": [402, 430]}, {"key": "services-program", "type": "definition", "offset": [461, 477]}, {"key": "the-agency-shall", "type": "clause", "offset": [479, 495]}, {"key": "participating-in", "type": "definition", "offset": [514, 530]}, {"key": "certified-school", "type": "definition", "offset": [535, 551]}, {"key": "for-school", "type": "clause", "offset": [566, 576]}, {"key": "services-rendered", "type": "definition", "offset": [591, 608]}, {"key": "provision-of", "type": "clause", "offset": [627, 639]}, {"key": "covered-by", "type": "definition", "offset": [788, 798]}], "hash": "abbd93fb2b5792a7caa0e935cfb563a4", "id": 10}], "next_curs": "ClkSU2oVc35sYXdpbnNpZGVyY29udHJhY3RzcjULEhZDbGF1c2VTbmlwcGV0R3JvdXBfdjU2Ihl0aGVyYXB5LXNlcnZpY2VzIzAwMDAwMDBhDKIBAmVuGAAgAA==", "clause": {"size": 149, "children": [["cognitive-rehabilitation-therapy", "Cognitive Rehabilitation Therapy"], ["dialysis-treatment", "Dialysis Treatment"], ["radiation-therapy", "Radiation Therapy"], ["public-health-emergencies", "Public Health Emergencies"]], "parents": [["bereavement-services", "Bereavement services"], ["coverage-provisions", "Coverage Provisions"], ["the-vendor-and-agency-hereby-mutually-agree", "THE VENDOR AND AGENCY HEREBY MUTUALLY AGREE"], ["services-provided-by-fh", "Services Provided by Fh"], ["additional-services", "Additional Services"]], "title": "THERAPY SERVICES", "id": "therapy-services", "related": [["radiation-therapy-chemotherapy-services", "Radiation Therapy/Chemotherapy Services", "Radiation Therapy/Chemotherapy Services"], ["surgery-services", "Surgery Services", "Surgery Services"], ["pharmacy-services", "Pharmacy Services", "Pharmacy Services"], ["mastectomy-services", "Mastectomy Services", "Mastectomy Services"], ["telemedicine-services", "Telemedicine Services", "Telemedicine Services"]], "related_snippets": [], "updated": "2025-07-10T04:27:38+00:00"}, "json": true, "cursor": ""}}