Expanded Benefits - Therapy Services
Group Therapy (Behavioral Health) - Members may receive unlimited services with prior authorization per their plan of care. Services include Group Therapy and Brief Group Medical Therapy.
Individual Therapy Sessions for Caregiver - Available to all members with prior authorization. Services include therapeutic behavioral services, in fifteen (15) minutes increments up to twelve (12) hours per year.
Individual/Family Therapy - Members may receive unlimited services with prior authorization per their plan of care. Services include individual and family therapy, brief individual psychotherapy, and training and educational services related to the care and treatment of a patient’s disabling mental health problems.
Occupational Therapy - Available to all members with prior authorization. Services include one (1) evaluation and one (1) re-evaluation per year, and up to seven (7) therapy treatment units per week.
Pet Therapy - Members may receive unlimited services with prior authorization per their plan of care. This is an activity therapy related to the care and treatment of patient's disabling mental health problems.
Physical Therapy - Available to all members with prior authorization. Services include one (1) evaluation and one (1) re-evaluation per year, and up to seven (7) therapy treatment units per week.
Recreational Therapy - Available to all members with prior authorization. This is an activity therapy related to the care and treatment of patient's disabling mental health problems. Members may receive up to 30 hours per year.
Respiratory Therapy - Available to all members with prior authorization. Services include one (1) evaluation and one (1) re-evaluation per year, and up to one (1) respiratory therapy visit per day.
Specialized Camps and Social Opportunities - Available to all members with prior authorization. This is an activity therapy such as music, dance, art or play therapies not for recreation related to the care and treatment of patient's disabling mental health problems. Members may receive up to $1,500 hours per year.
Speech Therapy - Available to all members with prior authorization. Services include one (1) evaluation and re-evaluation per year, one (1) evaluation of oral and pharyngeal swallowing function per year, up to seven (7) therapy treatment units per week, one (1) augmentative and alternative communication (AAC) initial evaluation, and one (1) AAC re-evaluation per year, and up to four (4) thirty (30)-minute AAC fitting, adjustment, and training sessions per year.
Substance Abuse Treatment or Detoxification Services (Outpatient) - Members may receive unlimited services with prior authorization per their plan of care. Services include ambulatory setting substance abuse treatment or detoxification services.
Therapeutic Behavioral On-Site Services - Available to members ages 18-20 with prior authorization per their plan of care. Includes up to nine (9) hours per month of behavior management.
