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Habilitation Services

Habilitation services are health care services that help a person keep, learn, or improve skills and functioning for daily living.

Some members have outpatient benefits for habilitation care that are separate from their benefits for rehabilitation care.

For HMO members, authorization is required for these services.

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How to determine if a member has separate habilitation services benefits

To determine if a member has separate habilitation benefits, perform an eligibility inquiry in Online Services() using the Service Type, "Physical Therapy" or "Occupational Therapy." When the member has separate benefits, the Limitations column in your results will list Rehabilitation and Habilitation separately as shown in the screenshot below.


How to request authorization for HMO members

To request an initial authorization for habilitation services, the PCP or authorized specialist should call Clinical Intake at 1‑800-327-6716. We'll work with you to get an authorization for up to 26 PT/OT (combined) visits in the current calendar year.

To request an extension of an existing authorization, the PCP or authorized specialist should fax us a completed Habilitative Therapy Request Form for HMO Members.

When an HMO member receiving habilitation services also needs outpatient rehabilitation
If the member's benefits are The PCP or authorized specialist can
Combined Call Clinical Intake at 1-800-327-6716 to request an evaluation visit. Then, if additional visits are needed, we’ll need supporting documentation. Please follow the process for obtaining an outpatient rehab authorization extension for physical therapy or occupational therapy.
Separate Use Online Services() to enter an authorization for an initial 26 PT/OT (combined) visits. The authorization period is the current calendar year.
When an HMO member receiving outpatient rehabilitation also needs habilitation services
If the member's benefits are The PCP or authorized specialist can
Combined Call Clinical Intake at 1-800-327-6716 to request an evaluation visit. Then, if additional visits are needed, we’ll need supporting documentation. Please fax us a completed Habilitative Therapy Request Form for HMO Members.
Separate Call 1-800-327-6716 to request an authorization for an initial 26 PT/OT (combined) visits. The authorization period is the current calendar year.