Medicaid: Provider Type 34

Medicaid: Provider Type 34

Nevada Medicaid has implemented a 10% reimbursement rate increase for Provider Type 34, Subspecialty 28 – Occupational Therapy. This increase applies to all Occupational Therapy claims with dates of service on or after Jan 1, 2025.

 

The increase, made possible through a State Plan Amendment (SPA) approved by both Nevada Medicaid and the Centers for Medicare & Medicaid Services (CMS), taps into funding connected to a U.S. Department of Justice settlement focused on strengthening Nevada’s children’s mental health infrastructure.

 

Additional enhancements include:

  • A 5% add-on for services provided in rural areas
  • A 5% add-on for in-home services delivered to youth (ages 0–20) with a Serious Emotional Disturbance (SED) diagnosis
  • When both apply, providers may be eligible for up to a 10% add-on for a total of 20% increase.
Policy Progress Without Legislation

As detailed in Nevada Medicaid Web Announcement 3657, this win came as a welcome surprise to many in the provider community. While the announcement quickly spread across professional networks and social media celebratory posts, the achievement resulted from behind-the-scenes, sustained advocacy, not new legislation.

 

This victory is rooted in the foundational work of Tilton’s Therapy, a Nevada-based mobile therapy practice. Starting in March 2024, the organization initiated a series of meetings with Medicaid leadership, presenting targeted proposals to improve access to community-based therapy services. By October, the proposed SPA was brought forward at a public hearing and officially approved by January 2025—an unusually swift policy turnaround, thanks to strategic collaboration and shared commitment.

 

Tilton's efforts highlighted the essential role of therapy in meeting behavioral health needs, especially in rural and underserved areas. This advocacy laid the groundwork for a statewide win that benefits occupational therapy providers and those they serve.

 

This progress also reflects a growing recognition of occupational therapy’s holistic, whole-person care model and its expanding role in Nevada’s behavioral health system. It demonstrates the impact of strong partnerships between providers and agencies when grounded in clinical expertise, fiscal strategy, and a shared focus on public health.

Laying the Groundwork for Future Reform

While this rate increase is a meaningful step forward, it does not fully resolve longstanding disparities in therapy reimbursement across provider types, particularly for physical and speech therapy rates. Still, it sets a valuable precedent and strengthens momentum for continued reform.

 

NOTA remains committed to:

  • Advocating for rate parity across all rehabilitation disciplines and settings.
  • Elevating OT’s visibility and leadership in behavioral and mental health systems
  • Empowering providers—including those at Tilton’s and beyond—to drive systemic change

Policy change can feel overwhelming, especially when systems move quickly and unpredictably. That’s why NOTA is here: to support, inform, and connect occupational therapy professionals across Nevada. Our Advocacy Committee meets the first Wednesday of each month at 6:00 p.m. via Zoom—and all members are encouraged to join the conversation.

Stay Involved

Change is ongoing. In just the past month, the Nevada Health Authority launched, federal budget shifts impacted therapy services nationwide, and this rate increase went into effect—all at once.

 

We invite you to:

  • Join a NOTA committee.
  • Share your ideas, feedback, or concerns about Medicaid or system gaps
  • Ask questions—we’re here to help

You can reach us anytime at nevadaota@gmail.com.

 

Together, we’re building a Medicaid system that values occupational therapy and proves what sustained, provider-led advocacy can accomplish.