"Currently, recreational therapists predominantly practice in rehabilitation, acute care, and residential care settings due in part to health care insurance restrictions."

- Heather R. Porter, John Shank, Yoshitaka Iwasaki, Promoting a Collaborative Approach With Recreational Therapy to Improve Physical Activity Engagement in Type 2 Diabetes,  Therapeutic Recreational Journal, Vol. XLVI, No. 3, pp. 202-217, 2012

​There are over 1,000 health insurance companies in the United States and they all have specific policies as to what they will cover. We do not have the medical billing staffing resources to address these issues. 

It isn't that we don't accept insurance, it is that insurance may not accept us (and/or it will take us hiring staff and/or additional vendors to find out if our services are accepted). Insurers have different rules about what type of provider they will cover and what specific types of services from that provider will be covered. We want to help our clients with evidence-based services as soon as possible so we utilize a direct payment process. 

There are products that claim to be able to assist with determining if insurance will cover health care services such as https://reimbursify.com/individual-page/ or https://www.thrizer.com/for-clients . We have no relationship with these firms and share them only as a potential resource for clients. 

Mental Health insurance benefits are different from physical rehabilitation benefits. 

What is it?

"The CLASS program provides services to persons with a related condition who need habilitation services. Persons with a related condition have a qualifying disability, other than a diagnosis of an intellectual disability, that originated before the age of 22 and that affects their ability to function in daily life. Services include adaptive aids and medical supplies, behavioral support, case management, nursing, respite care, specialized therapies, employment services and support family services." 

Who can get CLASS?

"CLASS services are available to Texas residents not living in an institutional setting who: 

● Have been diagnosed with a related condition prior to age 22 as described in the Texas Approved Diagnostic Codes for Persons with Related Conditions. 

● Have a qualifying adaptive behavior level. 

● Meet the level-of-care criteria for placement in an ICF/IID. 

● Do not exceed specified income and resource limits. 

● Are not enrolled in any other Medicaid waiver program. 

● Demonstrate need for one or more services monthly. The diagnosis may be due to a condition such as cerebral palsy, muscular dystrophy, spina bifida, epilepsy, head injuries or any of the approved diagnoses for related conditions.

Individuals must also exhibit substantial functional limitation in at least three of the following areas of major life activities: 

• Learning 

• Mobility 

• Self-care 

• Language 

• Self-direction (age 10 and over) 

• Independent living (age 10 and over) Individuals must be eligible for or be receiving Supplemental Security Income (SSI) or Medicaid. Financial eligibility is determined by the Social Security Administration or by the Texas Health and Human Services Commission (HHSC) using SSI-related criteria. Note: CLASS services may not be available right away. The applicant’s name may be placed on an interest list and then contacted when services become available."

What is the purpose?

"CLASS provides home and community-based services to individuals with related conditions as a cost-effective alternative to an intermediate care facility for individuals with an intellectual disability or related conditions (ICF/IID)."

How do I get it?

Those interested in receiving CLASS are placed on an interest list by calling 877- 438-5658 and asking for the CLASS Waiver Program. The person will be contacted when funding becomes available. [...] For more information please contact CLASSPolicy@HHSC.state.tx.us [.]"

The Consumer Directed Services (CDS) is NOT available for Recreational Therapy. 

"Through CDS, individuals who live in their own home or family home can self-direct certain services and will assume and retain responsibility to: 

1. Recruit their service providers. 

2. Conduct criminal history checks. 

3. Determine the competency of service providers. 

4. Hire, train, manage and fire their service providers."

How does it work?

"A case management agency (CMA) and a direct services agency (DSA) help CLASS Program individuals in organizing various services needed to achieve maximum levels of independence. Services provided are based on the unique needs of the individual and on an individual plan of care (IPC) developed by the service planning team, which includes (at a minimum) the individual, the case manager and DSA representative."

If I have it, how do I use it for Inclusion Therapies services?

"Specialized therapy services must be related to the person’s disability. Specific therapeutic goals must be in place for each specialized therapy provided under the CLASS program to address the person’s disability. A current physician's order for each therapy is required before the delivery of specialized therapy services. Physician's orders are not necessary for an evaluation only."

"Adding a therapy to your plan will always take 2 budget changes and about 3-4 months[.]"

"The U.S. Department of Education enforces Section 504 of the Rehabilitation Act of 1973, as amended, (Section 504) a civil rights statute which prohibits discrimination against individuals with disabilities. The Office  for Civil Rights (OCR) also enforces Title II of the Americans with Disabilities Act of 1990 (Title II), which extends this prohibition against discrimination to the full range of state and local government services, programs, and activities (including public schools) regardless of whether they receive any Federal financial assistance."  In Texas, here is a Section 504 Fact Sheet.