Therapeutic Rehabilitation Program services — H2019/H2020

Anthem would like to ensure providers have this information regarding the provision and reimbursement for Therapeutic Rehabilitation Program (TRP) services. Effective September 1, 2024, Anthem will apply the following diagnostic criteria on a prepayment basis. No additional documentation is required with claim submission:

• Therapeutic rehabilitation program (TRP) is a rehabilitative service to treat adults with severe mental illness (SMI) and children with SED (Severe Emotional Disability). For those receiving TRP services, the SMI or SED would be the primary reason the recipient is seeking treatment.
• TRP is not intended to treat individuals with a substance use disorder as the primary reason for seeking treatment.
• TRP is designed to maximize reduction of mental disability and restoration of the recipient’s best possible functional level.
• TRP services should be designed to reduce disabilities related to social, personal, and daily living skills resulting from SMI or SED, as well as the restoration of these skills.
• Component services of TRP are delivered using a variety of psychiatric rehabilitation techniques to address SMI and SED and focus on improving daily living skills, self-monitoring of symptoms and side effects, emotional regulation skills, crisis coping skills, and interpersonal skills.
• TRP services may be provided individually or in a group setting.

Additional therapeutic rehabilitation program requirements TRP should include the following:

• An individualized plan of care identifying measurable goals and objectives, including a discharge and relapse prevention plan
• Coordination of services the individual may be receiving and referral to other necessary support services as needed. TRP services may be provided by the following:
  • An approved behavioral health practitioner, except for a licensed clinical alcohol and drug counselor (LCADC)
  • An approved behavioral health practitioner under supervision, except for a certified alcohol and drug counselor (CADC) or licensed clinical alcohol and drug counselor associate (LCADCA)
  • An adult, family, or youth peer support specialist working under the supervision of an approved behavioral health practitioner

Please refer to the following applicable Kentucky Administrative Regulation (KAR).

907 KAR 15:005. Definitions for 907 KAR Chapter 15.
https://apps.legislature.ky.gov/law/kar/titles/907/015/005/

907 KAR 15:010. Coverage provisions and requirements regarding behavioral health services provided by individual approved behavioral health practitioners, behavioral health provider groups, and behavioral health multi-specialty groups.
https://apps.legislature.ky.gov/law/kar/titles/907/015/010/

907 KAR 15:020. Coverage provisions and requirements regarding services provided by behavioral health services organizations for mental health treatment.
https://apps.legislature.ky.gov/law/kar/titles/907/015/020/

Questions? Simply contact your provider relationship management representative.