MRO Billing in RT

Hello there –
A Recreational Therapist had just emailed me.
She said that the company she is working for is getting MRO billing.
She specifically asked if Recreational Therapy is a billable service for MRO.
Would you have any answers for her?
If so, let me know.
Yours,
Danny.
Here are some answers I received via the ATRA ListServ:

• Atra has a link to a resource on Medicaid waivers info public policy tab which might help.

• I'm assuming she is referring to the Medicaid Rehabilitation Option,
  perhaps in Indiana?
  
  Like a lot of mental health/Medicaid reimbursement, billing is coded
  by service options, not by the profession of the individual delivering
  the service.
  
  First, she would need to determine if rec therapists are included as
  qualified providers. If it is the MRO in IN, rec therapists would
  likely be covered as "Other Behavioral Health Professional (OBHP)." In
  states with licensure, they may be able to be included as a licensed
  professional. It appears that agencies have some flexibility in who
  meets the qualifications of an OBHP. From there, she would need to
  look at what services an OBHP can deliver. Specific to rec therapy, I
  would think that AIRS, CAIRS (children), IOT, and Skills Development
  (both individual and group) would be appropriate and OBHPs can deliver
  services. All of these address areas that a rec therapist is qualified
  to deliver, particularly social skills development, anger management,
  and skills required to increase or maintain community independence.
  For any rec therapist looking at any of these services, it will be
  important to demonstrate that the outcomes of the services are
  functional in nature as all of these services specifically exclude
  diversional recreation from a covered service.
  
  Here's the link to the provider manual so she can see more specific
  information. http://provider.indianamedicaid.com/media/23438/mro_%20provider_%20manual.pdf
  
  Hope this helps!

• Does anyone know if there is something like that in place in North Carolina? I am an RT who is running a small non-profit private practice & funding is always a challenge. If it is possible to bill for RT in this way, it would open up many more doors & we would be able to serve many more people. Thanks for all the great information!
  
  Have a great day!

• The short answer is yes, North Carolina does have something similar.
  The tricky part is that each state will be a little bit different. I
  do know in NC agencies that wish to deliver mental health services
  that are eligible for Medicaid reimbursement must be licensed by the
  state and endorsed by the local LME. At one point in time they were
  moving to all mental health agencies being externally accredited. Your
  local LME can answer specific questions about that. Typically every
  state will have a provider manual that will walk you through what's
  required in terms of provider and agency qualifications and service
  delivery requirements. The "Enhanced Mental Health and Substance Abuse
  Services" for NC are here: http://www.ncdhhs.gov/dma/mp/8A.pdf.
  
  I agree that this type of funding would open up many doors. It does
  take some leg work in understanding what is required in terms of
  infrastructure and ensuring your agency can meet those requirements.
  Services also will need a physicians order, so networking and
  marketing is of course an essential component. It would be great if
  more RTs knew about the options within their own state. Understanding
  the state Medicaid language and linking it directly to the outcomes of
  RT services can really open the door for practitioners working in
  community mental health. It opens doors for RT graduates to educate
  mental health providers that they are capable of delivering those
  services. Often mental health jobs aren't advertised to a specific
  profession, but rather as a qualified provider, which more often than
  not, our graduates meet the requirements. For those that are
  entrepreneurial in nature, it also opens the door for private
  practices that can deliver mental health RT services.
  
  Hope this helps! Have a great Friday everyone

• On ATRA website under public policy tab there is information about Medicaid in each state.