AOTA want­ed to make you aware that start­ing August 1, 2021 AIM Spe­cial­ty Care — on behalf of Anthem — will be con­duct­ing Site of Care ser­vice reviews for com­mer­cial plans based on Anthem’s Site of Care pol­i­cy, CPG-REHAB-10 (attached). Anthem will be send­ing out notice to affect­ed providers with their May Provider Bul­letin, giv­ing providers the con­trac­tu­al­ly required 90 days’ notice.

This means that a patient who is seen in a hos­pi­tal out­pa­tient ther­a­py depart­ment must meet one of the cri­te­ria list­ed in the pol­i­cy in order to con­tin­ue to receive care at that site. If they do not, then they must be referred/​transferred to a free­stand­ing ther­a­py clin­ic. AOTA staff have met with Anthem and AIM staff about the pol­i­cy and are in the process of com­mu­ni­cat­ing some con­cerns to Anthem, most notably the lack of any OT (or SLT) references.

Com­mer­cial plans in the fol­low­ing states are exempt­ed from this new review process: Cal­i­for­nia, Maine, and Vir­ginia. The only state where Med­ic­aid plans are impact­ed is New York.

Clin­i­cal UM Guide­line Document