Music Therapy Insurance & Waivers
We believe inclusion of music therapy as in-network insurance providers is the best way to increase equitable access to services. However, in Washington, music therapy is not in-network with any private insurance company. But individual claims have been reimbursed on a case-by-case basis. We always encourage music therapists and music therapy recipients to reach out to their insurance provider to ask about specific coverage details.
Insurance waivers are special forms of health insurance coverage with very specific inclusion criteria. The Music Therapy Task Force has successfully negotiated the inclusion of music therapy as in-network providers on a variety of these waiver programs.
Individual clients have the option to bill their private insurance out-of-network. This means the client will pay the music therapist at the time of service, then submit the paid invoice to their insurance company. If approved, the insurance company will mail a check directly to the client.
Invoices for out-of-pocket claims must have these items:
ICD-10 Diagnosis Code
ICD-10 Treatment Code
Number of units
Date of Service
Clinician National Provider Identification (NPI) number
Clinician's Tax ID number
Need more help? Email the Task Force!
Washington state has designed the Children's Intensive In-Home Behavioral Support (CIIBS) Waiver to address the needs of children and youth with Autism Spectrum Disorders (ASD); or other developmental disabilities; and who are at high or severe risk of out-of-home placement due to significantly challenging behaviors.
To become an approved provider, contact your regional representative. Contact information can be found on the CIIBS Brochure.
The Pre-Admission Screening and Resident Review (PASRR) is a screening and evaluation process for people who have been referred for nursing facility care and are determined to have an intellectual disability or related condition.
For more information download the PASRR Information for Families flyer.
To learn more about becoming a provider, email your regional contact. Contact information can be found on the PASRR Regional Contacts document.
The Community Options Program Entry System (COPES) waiver provides services to
over 39,000 individuals living in their own homes, Assisted Living Facilities (ALF) and
Adult Family Homes (AFH) in Washington state. Services available in the waiver
include: Client Support Training/Wellness Education, Skilled Nursing, Home Delivered
Meals, Environmental Modifications, Specialized Medical Equipment and Supplies,
Transportation, Adult Day Care, Adult Day Health, Community Choice Guiding, and
Community Support: Goods and Services.
For more information, download the COPES Informational Flyer.
To become an approved COPES Waiver provider, email your regional contact. Contact information can be found on the AAA Directory.
Washington State’s Medicaid Alternative Care (MAC) Program provides supportive services for unpaid “family” caregivers of a senior 55+ years old who is at risk of institutionalization (nursing home admission). Available services and supports include respite care, which allows caregivers a break from their caregiving duties, caregiver training and education, specialized equipment such as bath benches, and home delivered meals for the care
For more information, download the MAC/TSOR Fact Sheet.
To become an approved MAC/TSOR Waiver provider, email your regional contact. Contact information can be found on the AAA Directory.
New Freedom Waiver
New Freedom (NF) is a voluntary Medicaid funded program that allows eligible Participants to receive services in their home and community while managing their own service plan and budget. NF offers elders and adults with disabilities the option to manage a budget and decide for themselves what mix of services/goods will best meet their care needs.
For more information the DSHS New Freedom Wavier website.
To become an approved New Freedom Waiver provider, email your regional contact. Contact information can be found on the AAA Directory.