01/10/2026
This information release has caused significant panic. I have held off on posting and have made an attempt to clarify the accuracy of it and it is really hard to determine. It is not posted on the state PAS website anywhere. If one really digs, you can find the release on an alternate state website. I have read many posts and comments and am not completely sure this has actually passed. The state has nothing about this posted anywhere that I can find except this letter. Reading comments on posts, it also appears that this may not affect all pediatric clients and that some diagnosis’ may be exempt. I can not find any information from the state to verify or clarify anything about therapy limits or if any clients will be exempt from this if it is policy. Most pediatric clients will be protected under the EPSDT rules which are federal and trump state rules.
With that said, for some of us providers that have been around for a long time, (I hate dating myself…) Medicaid had us under 100% review for client therapy services from 2008 until 2010; meaning all of our pediatric clients had to have medical necessity established and prior authorizations for ongoing services after 25 visits. It is doable, it is time consuming and troublesome. Most clinics have Electronic Record systems that can track this and help to notify when reauthorizations are due. The release does not provide what form is needed to comply with making requests and according to the provider manuals, these requests would go through Telligen. In reviewing the Telligen website it appears that the request would be electronically submitted online and processed within 5 days. I am hopeful that in the event it is happening we will be able to make it work and keep our kids in services without interruptions to services.
Will this be a problem if it in fact goes into effect and inhibits timely access to ongoing services? ABSOLUTELY. Please contact state officials with your concerns as soon as possible. All of the links are provided. Many of the remarkable therapists and parents that have already posted in various groups have said everything that I could add about how devastating this would and will be should it affect service coverage.
Office of Governor Brad Little- 208-334-2100
Idaho Legislature Information Center- 208-332-1000 -idleginfo@lso.idaho.gov
General DHW Contact (Medicaid & Benefits): 877-456-1233
Medicaid Division (Policy/Administration): 208-334-5747
