Clinician (Direct Provision)

Allows Individuals to access certain therapeutic services that are not covered by Medicaid or other insurance. The allowed Clinician services are:

• Hippotherapy

• Therapeutic Riding

• Aquatic Therapy

• Art Therapy

• Massage Therapy

• Music Therapy

• Play Therapy

The hourly amount paid to the therapist cannot exceed the 90th percentile for the hourly wage for the therapeutic or consultant’s professional discipline (i.e., the standard occupational code) published by the Bureau of Labor Statistics (BLS), see http://www.bls.gov/soc/home.htm.

All reimbursement submissions for Clinician Direct Services must include:

• Invoice from the provider that includes:

  • Provider name and credentials

  • Date(s) of service

  • Service type

  • Number of hours/units

  • Rate and total cost

Documentation the FI needs to have on file to continue reimbursement of services.

• Copy of the provider’s current NYS license (submitted at least once annually or when it expires).

• Clinician Recommendation or Physician Order, if required (Massage Therapy, Music Therapy, Therapeutic Riding if medically indicated).

• Semi-Annual progress reports approved by the individual’s medical doctor.

  • Notes must verify service delivery and relate it to the individual’s Valued Outcome as listed in the active Life Plan.