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Rep. Dobrevich urges committee to make play therapy a reimbursable Medicaid service
Summary
Representative Joshua Dobrevich introduced a two-page bill (referred to as Age 58 in testimony) to add play therapy to Vermont Medicaid’s reimbursable services, citing audit clawbacks and inconsistent guidance from the Department of Vermont Health Access.
Representative Joshua Dobrevich asked the House Human Services Committee to take up “Age 58,” a two-page bill to add play therapy to Vermont Medicaid’s reimbursable services.
Dobrevich said the change would close a gap flagged by a Department of Vermont Health Access (DVHA) audit that has led to providers being clawed back payments. “Therapists across [the] state are foregoing the use of, or being penalized for using play therapy,” Dobrevich said, and added that the bill would “clarify coverage, support evidence-based care, and stand out for Vermonters who deserve better.”
The bill would add play therapy to the Agency of Human Services’ health care administrative rules as a reimbursable Medicaid modality, Dobrevich said. He described the bill as two pages with a modest fiscal note and proposed two amendments: (1) revise language about eligible play therapy credentials to focus on qualified clinicians and supervised rosters, and (2) specify that clinicians must be enrolled with Medicaid to bill for the service.
Committee members questioned how commercial insurers handle play therapy and whether existing Medicaid rules already allow it. Representative Theresa Wood said commercial insurers such as Blue Cross Blue Shield and UnitedHealthcare generally include play therapy within psychotherapy and do not separate it out in notes. Wood noted she had emailed Monica Olga, Medicaid director at the Agency of Human Services, to ask who the committee should contact at DVHA about the issue.
Dobrevich told the committee that DVHA guidance in policy manuals is vague: play therapy “can be a tool if it’s tied to evidence-based approaches like CBT,” but auditors have flagged clinicians and pursued clawbacks when play therapy appears in session notes. He described audit examples in which a note saying “played for 10 minutes” led auditors to question billing for the entire hour and to recoup payments.
Members discussed EPSDT (Early and Periodic Screening, Diagnosis, and Treatment) requirements for children on Medicaid and whether play therapy should be explicitly recognized under psychotherapy definitions for children. Wood said EPSDT requires certain services for children and expressed surprise that play therapy was not clearly included under current definitions for psychotherapy.
Dobrevich offered to provide witnesses from the therapeutic community; Wood said she would invite a DVHA representative to testify and requested clinicians willing to appear. No formal vote or committee action was recorded during the introduction.
The committee’s discussion emphasized clarifying guidance to prevent audits and financial clawbacks while preserving clinical options for children and adults who benefit from play-based approaches.
