Neighborhood Health Plan of Rhode Island Cuts Put Pediatric Occupational Therapy at Risk

(Middletown, North Kingstown, and East Providence, RI – August 2024) The McNeill Children’s Institute is alerting families they may see cutbacks on crucial Occupational, physical, and Speech services in all areas but most importantly pediatrics.  This decrease in service began June 15, 2024 as Neighborhood Health of Rhode Island hired Evolent to create a new process for qualification of such services.  Due to recent cuts from the Neighborhood Health Plan of Rhode Island (NHPRI) we are unable to provide services to the more severe children due to their parents being able to complete the teaching at home.  NHPRI states due to the limited progress and length of time it takes to gain skills the children with these more severe needs it is no longer medically necessary.  Before June 15, 2024 going back to when we opened in July 1, 2020 these services were in place after a doctor referral. The McNeill Children’s Institute (MCI), with a history of providing occupational therapy to underserved communities of Rhode Island, has been working to manage potential reductions in service as a result of the NHPRI cuts.

Effective July 15, 2024, NHPRI is requiring preauthorization and is partially denying or fully denying services to those in need of these services.   This in turn will have a significant impact on children, families and the public schools with children in need of Occupational Therapy (OT), Physical Therapy (PT), and Speech Therapy (ST) over and above what the school districts can offer. 

These new requirements include more stringent requirements for initial treatment authorization, and stand to lead to delays and barriers in accessing necessary therapy services. The new hurdles could reduce the accessibility and frequency of therapies critical for children with complex needs, including those with Developmental Delays, Autism, Down syndrome, ADHD, and other conditions that benefit from specialized therapeutic interventions​.

“Many of our patients rely on Neighborhood Health for insurance coverage,” MCI Founder Sarah McNeill said. “These families already navigate numerous challenges including low income, disabilities, behavioral or emotional trauma, or sensory disorders. When their children are reduced to mere numbers by an insurance plan that deems them 'not medically necessary,' it places an unfair burden on parents and schools. This lack of support risks regression in these children, leaving parents without the resources to address their needs. These parents need to fight for their child's needs to be a thriving member of society”

“NHPRI, funded partly by taxpayers, is inadvertently contributing to unemployment within the state. This situation may force our practice, along with many specialized OT/PT/ST therapy clinics in Rhode Island, to stop accepting this health insurance. We have had to partially employ our State OT employees at all 3 locations” McNeill said.

Cuts Reduce Services to Children with Disabilities

NHPRI’s authorization restrictions have a direct impact on children with disabilities, including Autism, ADHD, Behavioral and Emotional Regulation, and Sensory Processing Disorders. Many of these children require specialized therapy 2-3 times per week to perform basic daily tasks—such as brushing their teeth, using the bathroom unassisted, or eating solid food—that others take for granted. Unfortunately, NHPRI often deems these services “not medically necessary,” leaving families and schools to shoulder the burden. 

The consequences are far-reaching. Children may experience regression, parents face increased stress, and schools struggle to accommodate students who cannot thrive in a typical classroom. Moreover, our organization, dedicated to Pediatric Occupational Therapy, is impacted. Reduced schedules, staff cuts, and potential layoffs result from the inability to provide necessary therapy.

Unproductive Discussions with NHPRI

Despite multiple meetings with NHPRI, MCI’s concerns remain unaddressed. Representatives have failed to acknowledge the real-world impact on disadvantaged families. As a result, MCI may be forced to stop accepting NHPRI insurance, leaving families with limited options.

MCI urges NHPRI to reconsider its authorization restrictions. Specialized occupational therapy is essential for children’s success in school, social situations, and everyday life. By supporting these services, NHPRI can positively impact the lives of Rhode Island’s most vulnerable children.