Arkansas Administrative Code
Agency 016 - DEPARTMENT OF HUMAN SERVICES
Division 06 - Medical Services
Rule 016.06.06-061 - Child Health Management Services (CHMS) Update Transmittal #76; Developmental Day Treatment Clinic Sevices (DDTCS) Transmittal #79; Home Health Update Transmittal #86; Hospital/CAH/End-Stage Renal Disease Update Transmittal #105; Occupational, Physical & Speech Therapy Update Transmittal #68; Physician/Independent Lab/CRNA/Radiation Therapy Center Update Transmittal #122; and Rehabilitative Hospital Update Transmittal #71
Universal Citation: AR Admin Rules 016.06.06-061
Current through Register Vol. 49, No. 9, September, 2024
Section II Child Health Management Services
TOC required
245.110
Accepted Tests for
Occupational Therapy
Tests used must be norm-referenced, standardized, age appropriate and specific to the therapy provided. The following list of tests is not all-inclusive. When using a test not listed here, the provider must include additional documentation to support the reliability and validity of the test. This additional information will be used as reference information if the chart is ever selected by Medicaid for audit review. An explanation of why a test from the approved list could not be used to evaluate the child must also be included. The MMY is the standard reference to determine the reliability and validity of the test(s) administered in an evaluation. Providers should refer to the MMY for additional information regarding specific tests.
Definitions:
STANDARD: Evaluations that are used to determine deficits.
SUPPLEMENTAL: Evaluations that are used to justify deficits and support other results. These should not "stand alone."
CLINICAL OBSERVATIONS: All clinical observations are supplemental but should be included with every evaluation, especially if standard scores do not qualify the child for therapy. They will be considered during reviews for medical necessity.
A. Fine Motor Skills - Standard
1. Peabody Developmental Motor Scales (PDMS,
PDMS2)
2. Toddler and Infant Motor
Evaluation (TIME)
3.
Bruininks-Oseretsky Test of Motor Proficiency (BOMP)
4. Test of Infant Motor Performance
(TIMP)
B. Fine Motor
Skills - Supplemental
1. Early Learning
Accomplishment Profile (ELAP)
2.
Learning Accomplishment Profile (LAP)
3. Mullen Scales of Early Learning,
Infant/Preschool (MSEL)
4. Miller
Assessment for Preschoolers (MAP)
5. Functional Profile
6. Hawaii Early Learning Profile
(HELP)
7. Battelle Developmental
Inventory (BDI)
8. Developmental
Assessment of Young Children (DAYC)
9. Brigance Developmental Inventory
(BDI)
C. Visual Motor -
Standard
1. Developmental Test of Visual Motor
Integration (VMI)
2. Test of Visual
Motor Integration (TVMI)
3. Test of
Visual Motor Skills
4. Test of
Visual Motor Skills - R (TVMS)
D. Visual Perception - Standard
1. Motor Free Visual Perceptual
Test
2. Motor Free Visual
Perceptual Test - R (MVPT)
3.
Developmental Test of Visual Perceptual 2/A (DTVP)
4. Test of Visual Perceptual Skills
5. Test of Visual Perceptual Skills (upper
level) (TVPS)
E.
Handwriting - Standard
1. Evaluation Test of
Children's Handwriting (ETCH)
2.
Test of Handwriting Skills (THS)
3.
Children's Handwriting Evaluation Scale
F. Sensory Processing - Standard
1. Sensory Profile for
Infants/Toddlers
2. Sensory Profile
for Preschoolers
3. Sensory Profile
for Adolescents/Adults
4. Sensory
Integration and Praxis Test (SIPT)
5. Sensory Integration Inventory Revised
(SII-R)
G. Sensory
Processing - Supplemental
1. Sensory Motor
Performance Analysis
2. Analysis of
Sensory Behavior
3. Sensory
Integration Inventory
4.
DeGangi-Berk Test of Sensory Integration
H. Activities of Daily
Living/Vocational/Other - Standard
1.
Pediatric Evaluation of Disability Inventory (PEDI)
NOTE: The PEDI can also be used for older children whose functional abilities fall below that expected of a 71/2 year old with no disabilities. In this case, the scaled score is the most appropriate score to consider.
2. Adaptive
Behavior Scale - School (ABS)
3.
Jacobs Pre-vocational Assessment
4.
Kohlman Evaluation of Daily Living Skills
5. Milwaukee Evaluation of Daily Living
Skills
6. Cognitive Performance
Test
7. Purdue Pegboard
8. Functional Independence Measure (FIM) 7
years of age to adult
9. Functional
Independence Measure - young version (WeeFIM)
J.Activities of Daily Living/Vocational/Other
- Supplemental
1. School Function Assessment
(SFA)
2. Bay Area Functional
Performance Evaluation
3. Manual
Muscle Test
4. Grip and Pinch
Strength
5. Jordan Left-Right
Reversal Test
6. Erhardy
Developmental Prehension
7. Knox
Play Scale
8. Social Skills Rating
System
9. Goodenough Harris Draw a
Person Scale
245.120
Accepted Tests for Physical
Therapy Tests used must be norm referenced, standardized, age
appropriate and specific to the therapy provided. The following list of tests
is not all-inclusive. When using a test not listed here, the provider must
include additional documentation to support the reliability and validity of the
test. This additional information will be used as reference information if the
chart is ever selected by Medicaid for audit review. An explanation of why a
test from the approved list could not be used to evaluate a child must also be
included. The MMY is the standard reference to determine the
reliability and validity of the tests administered in an evaluation. Providers
should refer to the MMY for additional information regarding
specific tests.
A. Norm Reference
1. Adaptive Areas Assessment
2. Test of Gross Motor Development
(TGMD-2)
3. Peabody Developmental
Motor Scales, Second Ed. (PDMS-2)
4. Bruininks-Oseretsky Test of Motor
Proficiency (BOMP)
5. Pediatric
Evaluation of Disability Inventory (PEDI)
6. Test of Gross Motor Development - 2
(TGMD-2)
7. Peabody Developmental
Motor Scales (PDMS)
8. Alberta
Infant Motor Scales (AIM)
9.
Toddler and Infant Motor Evaluation (TIME)
10. Functional Independence Measure for
Children (WeeFIM)
11. Gross Motor
Function Measure (GMFM)
12.
Adaptive Behavior Scale - School, Second Ed. (AAMR-2)
13. Movement Assessment Battery for Children
(Movement ABC)
14. Test of Infant
Motor Performance (TIMP)
15.
Functional Independence Measure (FIM) 7 years of age to adult
B. Physical Therapy - Supplemental
1. Bayley Scales of Infant Development,
Second Ed. (BSID-2)
2. Neonatal
Behavioral Assessment Scale (NBAS)
3. Mullen Scales of Early Learning Profile
(MSEL)
4. Hawaii Early Learning
Profile (HELP)
C.
Physical Therapy Criterion
1. Developmental
assessment for students with severe disabilities, Second Ed. (DASH-2)
2. Milani-Comparetti Developmental
Examination
D. Physical
Therapy - Traumatic Brain Injury (TBI) - Standardized
1. Comprehensive Trail-Making Test
2. Adaptive Behavior Inventory
E. Physical Therapy - Piloted
Assessment of Persons Profoundly or Severely Impaired
245.220
Intelligence Quotient (IQ)
Testing Children receiving language intervention therapy must have
cognitive testing once they reach ten (10) years of age. This also applies to
home-schooled children. If the IQ score is higher than the qualifying language
scores, then the child qualifies for language therapy; if the IQ score is lower
than the qualifying language test scores, the child would appear to be
functioning at or above expected level. In this case, the child may be denied
for language therapy. If a provider determines that therapy is warranted, an
in-depth functional profile must be submitted.
However, IQ scores are not required for children under ten (10) years of age.
A. IQ
Tests - Traditional
1. Stanford-Binet
(S-B)
2. The Wechsler Preschool
& Primary Scales of Intelligence, Revised (WPPSI-R)
3. Slosson
4. Wechsler Intelligence Scale for Children,
Third Ed. (WISC-III)
5. Kauffman
Adolescent & Adult Intelligence Test (KAIT)
6. Wechsler Adult Intelligence Scale, Third
Ed. (WAIS-III)
7. Differential
Ability Scales (DAS)
8. Reynolds
Intellectual Assessment Scales (RAIS)
B. Severe & Profound IQ
Test/Non-Traditional - Supplemental - Norm-Referenced
1. Comprehensive Test of Nonverbal
Intelligence (CTONI)
2. Test of
Nonverbal Intelligence (TONI-3) - 1997
3. Functional Linguistic Communication
Inventory (FLCI)
C.
Articulation/Phonological Assessments - Norm-Referenced
1. Arizona Articulation Proficiency Scale,
Third Ed. (Arizona-3)
2.
Goldman-Fristoe Test of Articulation, Second Ed. (GFTA-2)
3. Khan-Lewis Phonological Analysis
(KLPA-2)
4. Slosson Articulation
Language Test with Phonology (SALT-P)
5. Bernthal-Bankson Test of Phonology
(BBTOP)
6. Smit-Hand Articulation
and Phonology Evaluation (SHAPE)
7.
Comprehensive Test of Phonological Processing (CTOPP)
8. Assessment of Intelligibility of
Dysarthric Speech (AIDS)
9. Weiss
Comprehensive Articulation Test (WCAT)
10. Assessment of Phonological Processes - R
(APPS-R)
11. Photo Articulation
Test, Third Ed. (PAT-3)
12.
Structured Photographic Articulation Test II Featuring Dudsberry (SPAT-D
II)
D.
Articulation/Phonological Assessments - Supplemental - Norm-Referenced Test of
Phonological Awareness (TOPA)
E.
Voice/Fluency Assessments - Norm-Referenced Stuttering Severity Instrument for
Children and Adults (SSI-3)
F.
Auditory Processing Assessments - Norm-Referenced Goldman-Fristoe-Woodcock Test
of Auditory Discrimination (G-F-WTAD)
G. Oral Motor - Supplemental -
Norm-Referenced Screening Test for Developmental Apraxia of Speech, Second Ed.
(STDAS-2)
H.Traumatic Brain Injury
(TBI) Assessments - Norm-Referenced
1. Ross
Information Processing Assessment - Primary
2. Test of Adolescent/Adult Word Finding
(TAWF)
3. Brief Test of Head Injury
(BTHI)
4. Assessment of
Language-Related Functional Activities (ALFA)
5. Ross Information Processing Assessment,
Second Ed. (RIPA-2)
6. Scales of
Cognitive Ability for Traumatic Brain Injury (SCATBI)
7. Communication Activities of Daily Living,
Second Ed. (CADL-2)
Section II
Developmental Day Treatment Clinic Services
TOC required
220.110
Accepted Tests for
Occupational Therapy Tests used must be norm referenced, standardized,
age appropriate and specific to the therapy provided. The following list of
tests is not all-inclusive. When using a test not listed here, the provider
must include additional documentation to support the reliability and validity
of the test. This additional information will be used as reference information
if the chart is ever selected by Medicaid for review. An explanation of why a
test from the approved list could not be used to evaluate the child must also
be included. The MMY is the standard reference to determine
the reliability and validity of the test(s) administered in an evaluation.
Providers should refer to the MMY for additional information
regarding specific tests.
Definitions:
STANDARD: Evaluations that are used to determine deficits.
SUPPLEMENTAL: Evaluations that are used to justify deficits and support other results. These should not "stand alone."
CLINICAL OBSERVATIONS: All clinical observations are supplemental but should be included with every evaluation, especially if standard scores do not qualify the child for therapy. They will be considered during reviews for medical necessity.
A. Fine Motor Skills - Standard
1. Peabody Developmental Motor Scales (PDMS,
PDMS2)
2. Toddler and Infant Motor
Evaluation (TIME)
3.
Bruininks-Oseretsky Test of Motor Proficiency (BOMP)
4. Test of Infant Motor Performance
(TIMP)
B. Fine Motor
Skills - Supplemental
1. Early Learning
Accomplishment Profile (ELAP)
2.
Learning Accomplishment Profile (LAP)
3. Mullen Scales of Early Learning,
Infant/Preschool (MSEL)
4. Miller
Assessment for Preschoolers (MAP)
5. Functional Profile
6. Hawaii Early Learning Profile
(HELP)
7. Battelle Developmental
Inventory (BDI)
8. Developmental
Assessment of Young Children (DAYC)
9. Brigance Developmental Inventory
(BDI)
C. Visual Motor -
Standard
1. Developmental Test of Visual Motor
Integration (VMI)
2. Test of Visual
Motor Integration (TVMI)
3. Test of
Visual Motor Skills
4. Test of
Visual Motor Skills - R (TVMS)
D. Visual Perception - Standard
1. Motor Free Visual Perceptual
Test
2. Motor Free Visual
Perceptual Test - R (MVPT)
3.
Developmental Test of Visual Perceptual 2/A (DTVP)
4. Test of Visual Perceptual Skills
5. Test of Visual Perceptual Skills (upper
level) (TVPS)
E.
Handwriting - Standard
1. Evaluation Test of
Children's Handwriting (ETCH)
2.
Test of Handwriting Skills (THS)
3.
Children's Handwriting Evaluation Scale
F. Sensory Processing - Standard
1. Sensory Profile for
Infants/Toddlers
2. Sensory Profile
for Preschoolers
3. Sensory Profile
for Adolescents/Adults
4. Sensory
Integration and Praxis Test (SIPT)
5. Sensory Integration Inventory Revised
(SII-R)
G. Sensory
Processing - Supplemental
1. Sensory Motor
Performance Analysis
2. Analysis of
Sensory Behavior
3. Sensory
Integration Inventory
4.
DeGangi-Berk Test of Sensory Integration
H. Activities of Daily
Living/Vocational/Other - Standard
1.
Pediatric Evaluation of Disability Inventory (PEDI)
NOTE: The PEDI can also be used for older children whose functional abilities fall below that expected of a 71/2 year old with no disabilities. In this case, the scaled score is the most appropriate score to consider.
2. Adaptive
Behavior Scale - School (ABS)
3.
Jacobs Pre-vocational Assessment
4.
Kohlman Evaluation of Daily Living Skills
5. Milwaukee Evaluation of Daily Living
Skills
6. Cognitive Performance
Test
7. Purdue Pegboard
8. Functional Independence Measure (FIM) 7
years of age to adult
9. Functional
Independence Measure - young version (WeeFIM)
I.Activities of Daily Living/Vocational/Other
- Supplemental
1. School Function Assessment
(SFA)
2. Bay Area Functional
Performance Evaluation
3. Manual
Muscle Test
4. Grip and Pinch
Strength
5. Jordan Left-Right
Reversal Test
6. Erhardy
Developmental Prehension
7. Knox
Play Scale
8. Social Skills Rating
System
9. Goodenough Harris Draw a
Person Scale
220.120
Accepted Tests for Physical
Therapy Tests used must be norm referenced, standardized, age
appropriate and specific to the therapy provided. The following list of tests
is not all-inclusive. When using a test not listed here, the provider must
include additional documentation to support the reliability and validity of the
test. This additional information will be used as reference information if the
chart is ever selected by Medicaid for review. An explanation of why a test
from the approved list could not be used to evaluate the child must also be
included. The MMY is the standard reference to determine the
reliability and validity of the test(s) administered in an evaluation.
Providers should refer to the MMY for additional information
regarding specific tests.
A. Norm Reference
1. Adaptive Areas Assessment
2. Test of Gross Motor Development
(TGMD-2)
3. Peabody Developmental
Motor Scales, Second Ed. (PDMS-2)
4. Bruininks-Oseretsky Test of Motor
Proficiency (BOMP)
5. Pediatric
Evaluation of Disability Inventory (PEDI)
6. Test of Gross Motor Development - 2
(TGMD-2)
7. Peabody Developmental
Motor Scales (PDMS)
8. Alberta
Infant Motor Scales (AIM)
9.
Toddler and Infant Motor Evaluation (TIME)
10. Functional Independence Measure for
Children (WeeFIM)
11. Gross Motor
Function Measure (GMFM)
12.
Adaptive Behavior Scale - School, Second Ed. (AAMR-2)
13. Movement Assessment Battery for Children
(Movement ABC)
14. Test of Infant
Motor Performance (TIMP)
15.
Functional Independence Measure (FIM) 7 years of age to
adult
B. Physical Therapy
- Supplemental
1. Bayley Scales of Infant
Development, Second Ed. (BSID-2)
2.
Neonatal Behavioral Assessment Scale (NBAS)
3. Mullen Scales of Early Learning Profile
(MSEL)
4. Hawaii Early Learning
Profile (HELP)
C. Physical
Therapy Criterion
1. Developmental assessment
for students with severe disabilities, Second Ed. (DASH-2)
2. Milani-Comparetti Developmental
Examination
D. Physical
Therapy - Traumatic Brain Injury (TBI) - Standardized
1. Comprehensive Trail-Making Test
2. Adaptive Behavior
Inventory
E. Physical
Therapy - Piloted Assessment of Persons Profoundly or Severely Impaired
220.220
Intelligence Quotient (IQ) Testing Children receiving language
intervention therapy must have cognitive testing once they reach ten (10) years
of age. This also applies to home-schooled children. If the IQ score is higher
than the qualifying language scores, the child qualifies for language therapy;
if the IQ score is lower than the qualifying language test scores, the child
would appear to be functioning at or above the expected level. In this case,
the child may be denied for language therapy. If a provider determines that
therapy is warranted, an in-depth functional profile must be submitted.
However, IQ scores are not required for children under ten (10) years of age.
A. IQ
Tests - Traditional
1. Stanford-Binet
(S-B)
2. The Wechsler Preschool
& Primary Scales of Intelligence, Revised (WPPSI-R)
3. Slosson
4. Wechsler Intelligence Scale for Children,
Third Ed. (WISC-III)
5. Kauffman
Adolescent & Adult Intelligence Test (KAIT)
6. Wechsler Adult Intelligence Scale, Third
Ed. (WAIS-III)
7. Differential
Ability Scales (DAS)
8. Reynolds
Intellectual Assessment Scales (RIAS)
B. Severe & Profound IQ
Test/Non-Traditional - Supplemental - Norm Reference
1. Comprehensive Test of Nonverbal
Intelligence (CTONI)
2. Test of
Nonverbal Intelligence (TONI-3) - 1997
3. Functional Linguistic Communication
Inventory (FLCI)
C.
Articulation/Phonological Assessments - Norm Reference
1. Arizona Articulation Proficiency Scale,
Third Ed. (Arizona-3)
2Goldman-Fristoe Test of Articulation, Second
Ed. (GFTA-2)
3. Khan-Lewis
Phonological Analysis (KLPA-2)
4.
Slosson Articulation Language Test with Phonology (SALT-P)
5. Bankston-Bernthal Test of Phonology
(BBTOP)
6. Smit-Hand Articulation
and Phonology Evaluation (SHAPE)
7.
Comprehensive Test of Phonological Processing (CTOPP)
8. Assessment of Intelligibility of
Dysarthric Speech (AIDS)
9. Weiss
Comprehensive Articulation Test (WCAT)
10. Assessment of Phonological Processes - R
(APPS-R)
11. Photo Articulation
Test, Third Ed. (PAT-3)
12.
Structured Photographic Articulation Test II Featuring Dudsberry (SPAT-D
II)
D.
Articulation/Phonological Assessments - Supplemental - Norm Reference Test of
Phonological Awareness (TOPA)
E.
Voice/Fluency Assessments - Norm Reference Stuttering Severity Instrument for
Children and Adults (SSI-3)
F.
Auditory Processing Assessments - Norm Reference Goldman-Fristoe-Woodcock Test
of Auditory Discrimination (G-F-WTAD)
G. Oral Motor - Supplemental - Norm Reference
Screening Test for Developmental Apraxia of Speech, Second Ed. (STDAS-2)
H.Traumatic Brain Injury (TBI)
Assessments - Norm Reference
1. Ross
Information Processing Assessment - Primary
2. Test of Adolescent/Adult Word Finding
(TAWF)
3. Brief Test of Head Injury
(BTHI)
4. Assessment of
Language-Related Functional Activities (ALFA)
5. Ross Information Processing Assessment,
Second Ed. (RIPA-2)
6. Scales of
Cognitive Ability for Traumatic Brain Injury (SCATBI)
7. Communication Activities of Daily Living,
Second Ed. (CADL-2)
Section II
Home Health
TOC not required
218.161
Norm Reference
A. Adaptive Areas Assessment
B. Test of Gross Motor Development
(TGMD-2)
C. Peabody Developmental
Motor Scales, Second Ed. (PDMS-2)
D. Bruininks-Oseretsky Test of Motor
Proficiency (BOT)
E. Pediatric
Evaluation of Disability Inventory (PEDI)
F. Test of Gross Motor Development - 2
(TGMD-2)
G. Peabody Developmental
Motor Scales (PDMS)
H.Alberta
Infant Motor Scales (AIM)
I.
Toddler and Infant Motor Evaluation (TIME)
J. Functional Independence Measure for
Children (WeeFIM)
K. Gross Motor
Function Measure (GMFM)
L. Adaptive
Behavior Scale - School, Second Ed. (AAMR-2)
M. Movement Assessment Battery for Children
(Movement ABC)
N. Test of Infant
Motor Performance (TIMP)
O.
Functional Independence Measure (FIM); Ages 7 through 20
218.162
Physical Therapy -
Supplemental
A. Bayley Scales of
Infant Development, Second Ed. (BSID-2)
B. Neonatal Behavioral Assessment Scale
(NBAS)
C. Mullen Scales of Early
Learning Profile (MSEL)
D. Hawaii
Early Learning Profile (HELP)
TOC required
218.102
Standardized
Testing
A. Tests used must be
norm-referenced, standardized and specific to the therapy provided.
1. Tests must be age appropriate for the
child being tested.
2. Test results
must be reported as standard scores, Z scores, T scores or
percentiles.
3. Age-equivalent
scores and percentage of delay do not justify the medical necessity of
services.
B. A score of
negative 1.50 standard deviations or more from the mean in at least 1 subtest
area or composite score is required to qualify for services.
C. The Mental Measurement Yearbook
(MMY) is the standard reference for determining a
test's reliability and validity.
D.
When a child cannot be tested with a norm-referenced, standardized test, then
criterion-based testing or a functional description of his or her gross and
fine motor deficits may be used
1. In such a
case, documentation of the reason(s) that a standardized test could not be used
must be included in the evaluation.
2. Listings of tests that AFMC accepts
without requiring documentation of their reliability and validity can be found
in this provider manual between sections
218.120 and
218.228, inclusive.
218.121
Fine
Motor Skills - Standard
A. Peabody
Developmental Motor Scales (PDMS, PDMS2)
B. Toddler and Infant Motor Evaluation
(TIME)
C. Bruininks-Oseretsky Test
of Motor Proficiency (BOMP)
D. Test
of Infant Motor Performance (TIMP)
218.123
Visual Motor - Standard
A. Developmental Test of Visual Motor
Integration (VMI)
B. Test of Visual
Motor Integration (TVMI)
C. Test of
Visual Motor Skills
D. Test of
Visual Motor Skills - R (TVMS)
E.
Pediatric Evaluation of Disability Inventory (PEDI)
1. The PEDI can also be used for older
children whose functional abilities fall below that expected of a 71/2
year old with no disabilities.
2.
When the PEDI is used for older children, the scaled score is the most
appropriate score to consider.
F. Adaptive Behavior Scale - School
(ABS)
G. Jacobs Pre-vocational
Assessment
H.Kohlman Evaluation of
Daily Living Skills
I. Milwaukee
Evaluation of Daily Living Skills
J. Cognitive Performance Test
K. Purdue Pegboard
L. Functional Independence Measure (FIM); 7
through 20 years of age.
M.
Functional Independence Measure - young version (WeeFIM)
218.131
Norm Reference
A. Adaptive Areas Assessment
B. Test of Gross Motor Development
(TGMD-2)
C. Peabody Developmental
Motor Scales, Second Ed. (PDMS-2)
D. Bruininks-Oseretsky Test of Motor
Proficiency (BOMP)
E. Pediatric
Evaluation of Disability Inventory (PEDI)
F. Test of Gross Motor Development - 2
(TGMD-2)
G. Peabody Developmental
Motor Scales (PDMS)
H.Alberta
Infant Motor Scales (AIM)
I.
Toddler and Infant Motor Evaluation (TIME)
J. Functional Independence Measure for
Children (WeeFIM)
K. Gross Motor
Function Measure (GMFM)
L. Adaptive
Behavior Scale - School, Second Ed. (AAMR-2)
M. Movement Assessment Battery for Children
(Movement ABC)
N. Test of Infant
Motor Performance (TIMP)
O.
Functional Independence Measure (FIM); 7 through 20 years of age.
218.132
Physical Therapy -
Supplemental
A. Bayley Scales of
Infant Development, Second Ed. (BSID-2)
B. Neonatal Behavioral Assessment Scale
(NBAS)
C. Mullen Scales of Early
Learning Profile (MSEL)
D. Hawaii
Early Learning Profile (HELP)
218.133
Physical Therapy Criterion
A. Developmental Assessment for
Students with Severe Disabilities, Second Ed. (DASH-2)
B. Milani-Comparetti Developmental
Examination
218.220
Intelligence Quotient (IQ)
A.
Children receiving language intervention therapy must have cognitive testing
once they reach 10 years of age, whether they are in public school or they are
home-schooled.
B. Providers must
maintain in their records the IQ scores of their patients who are 10 through 20
years of age and receiving language therapy.
C. Language therapy may be determined not
medically necessary if a child's IQ is less than or equal to his or her
language score, because the child is deemed to be functioning at or above the
expected level.
1. If a provider determines
that therapy is warranted despite the relationship of IQ to language score, the
provider must complete an in-depth functional profile.
2. If the child's IQ is higher than his or
her language scores, then the child qualifies for language therapy
D. Accepted IQ tests are listed in
sections 218.221 through
218.228.
218.221
IQ Tests - Traditional
A. Stanford-Binet
B. The Wechsler Preschool & Primary
Scales of Intelligence, Revised (WPPSI-R)
C. Slosson
D. Wechsler Intelligence Scale for Children,
Third Ed. (WISC-III)
E. Kauffman
Adolescent & Adult Intelligence Test (KAIT)
F. Wechsler Adult Intelligence Scale, Third
Ed. (WAIS-III)
G. Differential
Ability Scales (DAS)
H. Reynolds
Intellectual Assessment Scales (RIAS)
218.222
Severe and Profound IQ
Test/Non-Traditional - Supplemental - Norm Reference
A. Comprehensive Test of Nonverbal
Intelligence (CTONI)
B. Test of
Nonverbal Intelligence (TONI-3) - 1997
C. Functional Linguistic Communication
Inventory (FLCI)
218.223
Articulation/Phonological Assessments - Norm Reference
A. Arizona Articulation Proficiency Scale,
Third Ed. (Arizona-3)
B.
Goldman-Fristoe Test of Articulation, Second Ed. (FGTA-2)
C. Khan-Lewis Phonological Analysis
(KLPA-2)
D. Slosson Articulation
Language Test with Phonology (SALT-P)
E. Bankston-Bernthal Test of Phonology
(BBTOP)
F. Smit-Hand Articulation
and Phonology Evaluation (SHAPE)
G.
Comprehensive Test of Phonological Processing (CTOPP)
H.Assessment of Intelligibility of Dysarthric
Speech (AIDS)
I. Weiss Comprehensive
Articulation Test (WCAT)
J.
Assessment of Phonological Processes - R (APPS-R)
K. Photo Articulation Test, Third Ed.
(PAT-3)
L. Structured Photographic
Articulation Test II featuring Dudsberry (SPAT-D-II)
TOC not required
214.310
Accepted
Tests for Occupational Therapy
Tests used must be norm referenced, standardized, age appropriate and specific to the therapy provided. The following list of tests is not all-inclusive. When using a test not listed here, the provider must include additional documentation to support the reliability and validity of the test. This additional information will be used as reference information if the chart is selected by Medicaid for review. An explanation of why a test from the approved list could not be used to evaluate the child should be included. The MMY is the standard reference to determine the reliability and validity of the test(s) administered in the evaluation. Providers should refer to the MMY for additional information regarding specific tests.
Definitions:
STANDARD: Evaluations that are used to determine deficits.
SUPPLEMENTAL: Evaluations that are used to justify deficits and support other results. These should not "stand alone."
CLINICAL OBSERVATIONS: All clinical observations are supplemental but should be included with every evaluation, especially if standard scores do not qualify the child for therapy. The observations will be considered during reviews for medical necessity.
A. Fine Motor Skills - Standard
1. Peabody Developmental Motor Scales (PDMS,
PDMS2)
2. Toddler and Infant Motor
Evaluation (TIME)
3.
Bruininks-Oseretsky Test of Motor Proficiency (BOMP)
4. Test of Infant Motor Performance
(TIMP)
B. Fine Motor
Skills - Supplemental
1. Early Learning
Accomplishment Profile (ELAP)
2.
Learning Accomplishment Profile (LAP)
3. Mullen Scales of Early Learning,
Infant/Preschool (MSEL)
4. Miller
Assessment for Preschoolers (MAP)
5. Functional Profile
6. Hawaii Early Learning Profile
(HELP)
7. Battelle Developmental
Inventory (BDI)
8. Developmental
Assessment of Young Children (DAYC)
9. Brigance Developmental Inventory
(BDI)
C. Visual Motor -
Standard
1. Developmental Test of Visual Motor
Integration (VMI)
2. Test of Visual
Motor Integration (TVMI)
3. Test of
Visual Motor Skills
4. Test of
Visual Motor Skills - R (TVMS)
D. Visual Perception - Standard
1. Motor Free Visual Perceptual
Test
2. Motor Free Visual
Perceptual Test - R (MVPT)
3.
Developmental Test of Visual Perceptual 2/A (DTVP)
4. Test of Visual Perceptual Skills
5. Test of Visual Perceptual Skills (upper
level) (TVPS)
E.
Handwriting - Standard
1. Evaluation Test of
Children's Handwriting (ETCH)
2.
Test of Handwriting Skills (THS)
3.
Children's Handwriting Evaluation Scale
F. Sensory Processing - Standard
1. Sensory Profile for
Infants/Toddlers
2. Sensory Profile
for Preschoolers
3. Sensory Profile
for Adolescents/Adults
4. Sensory
Integration and Praxis Test (SIPT)
5. Sensory Integration Inventory Revised
(SII-R)
G. Sensory
Processing - Supplemental
1. Sensory Motor
Performance Analysis
2. Analysis of
Sensory Behavior
3. Sensory
Integration Inventory
4.
DeGangi-Berk Test of Sensory Integration
H. Activities of Daily
Living/Vocational/Other - Standard
1.
Pediatric Evaluation of Disability Inventory (PEDI)
NOTE: The PEDI can also be used for older children whose functional abilities fall below that expected of a 71/2 year old with no disabilities. In this case, the scaled score is the most appropriate score to consider.
2. Adaptive
Behavior Scale - School (ABS)
3.
Jacobs Pre-vocational Assessment
4.
Kohlman Evaluation of Daily Living Skills
5. Milwaukee Evaluation of Daily Living
Skills
6. Cognitive Performance
Test
7. Purdue Pegboard
8. Functional Independence Measure - 7 years
of age to adult (FIM)
9. Functional
Independence Measure - young version (WeeFIM)
I.Activities of Daily Living/Vocational/Other
- Supplemental
1. School Function Assessment
(SFA)
2. Bay Area Functional
Performance Evaluation
3. Manual
Muscle Test
4. Grip and Pinch
Strength
5. Jordan Left-Right
Reversal Test
6. Erhardy
Developmental Prehension
7. Knox
Play Scale
8. Social Skills Rating
System
9. Goodenough Harris Draw a
Person Scale
214.320
Accepted Tests for Physical
Therapy
Tests used must be norm referenced, standardized, age appropriate and specific to the therapy provided. The following list of tests is not all-inclusive. When using a test not listed here, the provider must include additional documentation to support the reliability and validity of the test. This additional information will be used as reference information if the chart is selected by Medicaid for review. An explanation of why a test from the approved list could not be used to evaluate a child should be included. The MMY is the standard reference to determine the reliability and validity of the tests administered in the evaluation. Providers should refer to the MMY for additional information regarding specific tests.
A. Norm Reference
1. Adaptive Areas Assessment
2. Test of Gross Motor Development
(TGMD-2)
3. Peabody Developmental
Motor Scales, Second Ed. (PDMS-2)
4. Bruininks-Oseretsky Test of Motor
Proficiency (BOMP)
5. Pediatric
Evaluation of Disability Inventory (PEDI)
6. Test of Gross Motor Development - 2
(TGMD-2)
7. Peabody Developmental
Motor Scales (PDMS)
8. Alberta
Infant Motor Scales (AIM)
9.
Toddler and Infant Motor Evaluation (TIME)
10. Functional Independence Measure for
Children (WeeFIM)
11. Gross Motor
Function Measure (GMFM)
12.
Adaptive Behavior Scale - School, Second Ed. (AAMR-2)
13. Movement Assessment Battery for Children
(Movement ABC)
14. Test of Infant
Motor Performance (TIMP)
15.
Functional Independence Measure - 7 years of age to adult (FIM)
B. Physical Therapy - Supplemental
1. Bayley Scales of Infant Development,
Second Ed. (BSID-2)
2. Neonatal
Behavioral Assessment Scale (NBAS)
3. Mullen Scales of Early Learning Profile
(MSEL)
4. Hawaii Early Learning
Profile (HELP)
C.
Physical Therapy Criteria
1. Developmental
assessment for students with severe disabilities, Second Ed. (DASH-2)
2. Milani-Comparetti Developmental
Examination
D. Physical
Therapy - Traumatic Brain Injury (TBI) - Standardized
1. Comprehensive Trail-Making Test
2. Adaptive Behavior Inventory
E. Physical Therapy - Piloted
Assessment of Persons Profoundly or Severely Impaired
214.420
Intelligence Quotient (IQ) Testing
Children receiving language intervention therapy must have cognitive testing once they reach ten (10) years of age. This also applies to home-schooled children. If the IQ score is higher than the qualifying language scores, the child qualifies for language therapy; if the IQ score is lower than the qualifying language test scores, the child would appear to be functioning at or above the expected level. In this case, the child may be denied for language therapy. If a provider determines that therapy is warranted, an in-depth functional profile must be documented. However, IQ scores are not required for children under ten (10) years of age.
A. IQ Tests - Traditional
1. Stanford-Benet (S-B)
2. The Wechsler Preschool & Primary
Scales of Intelligence, Revised (WPPSI-R)
3. Slosson
4. Wechsler Intelligence Scale for Children,
Third Ed. (WISC-III)
5. Kauffman
Adolescent & Adult Intelligence Test (KAIT)
6. Wechsler Adult Intelligence Scale, Third
Ed. (WAIS-III)
7. Differential
Ability Scales (DAS)
8. Reynolds
Intellectual Assessment Scales (RIAS)
B. Severe & Profound IQ
Test/Non-Traditional - Supplemental - Norm Reference
1. Comprehensive Test of Nonverbal
Intelligence (CTONI)
2. Test of
Nonverbal Intelligence (TONI-3) - 1997
3. Functional Linguistic Communication
Inventory (FLCI)
C.
Articulation/Phonological Assessments - Norm-Reference
1. Arizona Articulation Proficiency Scale,
Third Ed. (Arizona-3)
2.
Goldman-Fristoe Test of Articulation, Second Ed. (GFTA-2)
3. Khan-Lewis Phonological Analysis
(KLPA-2)
4. Slosson Articulation
Language Test with Phonology (SALT-P)
5. Bernthal-Bankson Test of Phonology
(BBTOP)
6. Smit-Hand Articulation
and Phonology Evaluation (SHAPE)
7.
Comprehensive Test of Phonological Processing (CTOPP)
8. Assessment of Intelligibility of
Dysarthric Speech (AIDS)
9. Weiss
Comprehensive Articulation Test (WCAT)
10. Assessment of Phonological Processes - R
(APPS-R)
11. Photo Articulation
Test, Third Ed. (PAT-3)
12.
Structured Photographic Articulation Test II Featuring Dudsberry (SPAT-D
II)
D.
Articulation/Phonological Assessments - Supplemental - Norm-Reference Test of
Phonological Awareness (TOPA)
E.
Voice/Fluency Assessments - Norm-Reference Stuttering Severity Instrument for
Children and Adults (SSI-3)
F.
Auditory Processing Assessments - Norm-Reference Goldman-Fristoe-Woodcock Test
of Auditory Discrimination (G-F-WTAD)
G. Oral Motor - Supplemental - Norm-Reference
Screening Test for Developmental Apraxia of Speech, Second Ed. (STDAS-2)
H.Traumatic
Brain Injury (TBI) Assessments - Norm-Reference
1. Ross Information Processing Assessment -
Primary
2. Test of Adolescent/Adult
Word Finding (TAWF)
3. Brief Test
of Head Injury (BTHI)
4. Assessment
of Language-Related Functional Activities (ALFA)
5. Ross Information Processing Assessment,
Second Ed. (RIPA-2)
6. Scales of
Cognitive Ability for Traumatic Brain Injury (SCATBI)
7. Communication Activities of Daily Living,
Second Ed. (CADL-2)
TOC not required
227.210
Accepted Tests for Occupational Therapy
Tests used must be norm referenced, standardized, age appropriate and specific to the therapy provided. The following list of tests is not all-inclusive. When using a test not listed here, the provider must include additional documentation to support the reliability and validity of the test. This additional information will be used as reference information if the chart is ever selected by Medicaid for review. An explanation of why a test from the approved list could not be used to evaluate the child must also be included. The MMY is the standard reference to determine the reliability and validity of the test(s) administered in an evaluation. Providers should refer to the MMY for additional information regarding specific tests.
DEFINITIONS:
STANDARD: Evaluations that are used to determine deficits.
SUPPLEMENTAL: Evaluations that are used to justify deficits and support other results. These should not "stand alone."
CLINICAL OBSERVATIONS: All clinical observations are supplemental but should be included with every evaluation, especially if standard scores do not qualify the child for therapy. It will be considered when reviewing for medical necessity.
A. Fine Motor Skills - Standard
1. Peabody Developmental Motor Scales (PDMS,
PDMS2)
2. Toddler and Infant Motor
Evaluation (TIME)
3.
Bruininks-Oseretsky Test of Motor Proficiency (BOMP)
4. Test of Infant Motor Performance
(TIMP)
B. Fine Motor
Skills - Supplemental
1. Early Learning
Accomplishment Profile (ELAP)
2.
Learning Accomplishment Profile (LAP)
3. Mullen Scales of Early Learning,
Infant/Preschool (MSEL)
4. Miller
Assessment for Preschoolers (MAP)
5. Functional Profile
6. Hawaii Early Learning Profile
(HELP)
7. Battelle Developmental
Inventory (BDI)
8. Developmental
Assessment of Young Children (DAYC)
9. Brigance Developmental Inventory
(BDI)
C. Visual Motor -
Standard
1. Developmental Test of Visual Motor
Integration (VMI)
2. Test of Visual
Motor Integration (TVMI)
3. Test of
Visual Motor Skills
4. Test of
Visual Motor Skills - R (TVMS)
D. Visual Perception - Standard
1. Motor Free Visual Perceptual
Test
2. Motor Free Visual
Perceptual Test - R (MVPT)
3.
Developmental Test of Visual Perceptual 2/A (DTVP)
4. Test of Visual Perceptual Skills
5. Test of Visual Perceptual Skills (upper
level) (TVPS)
F.
Handwriting - Standard
1. Evaluation Test of
Children's Handwriting (ETCH)
2.
Test of Handwriting Skills (THS)
3.
Children's Handwriting Evaluation Scale
G. Sensory Processing - Standard
1. Sensory Profile for
Infants/Toddlers
2. Sensory Profile
for Preschoolers
3. Sensory Profile
for Adolescents/Adults
4. Sensory
Integration and Praxis Test (SIPT)
5. Sensory Integration Inventory Revised
(SII-R)
H.Sensory
Processing - Supplemental
1. Sensory Motor
Performance Analysis
2. Analysis of
Sensory Behavior
3. Sensory
Integration Inventory
4.
DeGangi-Berk Test of Sensory Integration
I. Activities of Daily
Living/Vocational/Other - Standard
1.
Pediatric Evaluation of Disability Inventory (PEDI)
NOTE: The PEDI can also be used for older children whose functional abilities fall below that expected of a 71/2 year old with no disabilities. If this is the case, the scaled score is the most appropriate score to consider.
2.
Adaptive Behavior Scale - School (ABS)
3. Jacobs Pre-vocational Assessment
4. Kohlman Evaluation of Daily Living
Skills
5. Milwaukee Evaluation of
Daily Living Skills
6. Cognitive
Performance Test
7. Purdue
Pegboard
8. Functional Independence
Measure (FIM) 7 years of age to adult
9. Functional Independence Measure - young
version (WeeFIM)
J.Activities of Daily Living/Vocational/Other
- Standard
1. School Function Assessment
(SFA)
2. Bay Area Functional
Performance Evaluation
3. Manual
Muscle Test
4. Grip and Pinch
Strength
5. Jordan Left-Right
Reversal Test
6. Erhardy
Developmental Prehension
7. Knox
Play Scale
8. Social Skills Rating
System
9. Goodenough Harris Draw a
Person Scale
227.220
Accepted Tests for Physical
Therapy
Tests used must be norm referenced, standardized, age appropriate and specific to the therapy provided. The following list of tests is not all-inclusive. When using a test not listed here, the provider must include additional documentation to support the reliability and validity of the test. This additional information will be used as reference information if the chart is ever selected by Medicaid for review. An explanation of why a test from the approved list could not be used to evaluate the child must also be included. The MMY is the standard reference to determine the reliability and validity of the test(s) administered in an evaluation. Providers should refer to the MMY for additional information regarding specific tests.
A. Norm
Reference
1. Adaptive Areas
Assessment
2. Test of Gross Motor
Development (TGMD-2)
3. Peabody
Developmental Motor Scales, Second Ed. (PDMS-2)
4. Bruininks-Oseretsky Test of Motor
Proficiency (BOMP)
5. Pediatric
Evaluation of Disability Inventory (PEDI)
6. Test of Gross Motor Development - 2
(TGMD-2)
7. Peabody Developmental
Motor Scales (PDMS)
8. Alberta
Infant Motor Scales (AIM)
9.
Toddler and Infant Motor Evaluation (TIME)
10. Functional Independence Measure for
Children (WeeFIM)
11. Gross Motor
Function Measure (GMFM)
12.
Adaptive Behavior Scale - School, Second Ed. (AAMR-2)
13. Movement Assessment Battery for Children
(Movement ABC)
14. Test of Infant
Motor Performance (TIMP)
15.
Functional Independence Measure (FIM) 7 years of age to adult
B. Physical Therapy - Supplemental
1. Bayley Scales of Infant Development,
Second Ed. (BSID-2)
2. Neonatal
Behavioral Assessment Scale (NBAS)
3. Mullen Scales of Early Learning Profile
(MSEL)
4. Hawaii Early Learning
Profile (HELP)
C.
Physical Therapy Criterion
1. Developmental
assessment for students with severe disabilities, Second Ed. (DASH-2)
2. Milani-Comparetti Developmental
Examination
D. Physical
Therapy - Traumatic Brain Injury (TBI) - Standardized
1. Comprehensive Trail-Making Test
2. Adaptive Behavior Inventory
E. Physical Therapy - Piloted
Assessment of Persons Profoundly or Severely Impaired
227.320
Intelligence Quotient (IQ) Testing
Children receiving language intervention therapy must have cognitive testing once they reach ten (10) years of age. This also applies to home-schooled children. If the IQ score is higher than the qualifying language scores, the child qualifies for language therapy; if the IQ score is lower than the qualifying language test scores, the child would appear to be functioning at or above the expected level. In this case, the child may be denied for language therapy. If a provider determines that therapy is warranted, an in-depth functional profile must be documented. However, IQ scores will not be required for children under ten (10) years of age.
A. IQ Tests - Traditional
1. Stanford-Binet (S-B)
2. The Wechsler Preschool & Primary
Scales of Intelligence, Revised (WPPSI-R)
3. Slosson
4. Wechsler Intelligence Scale for Children,
Third Ed. (WISC-III)
5. Kauffman
Adolescent & Adult Intelligence Test (KAIT)
6. Wechsler Adult Intelligence Scale, Third
Ed. (WAIS-III)
7. Differential
Ability Scales (DAS)
8. Reynolds
Intellectual Assessment Scales (RAIS)
B. Severe & Profound IQ
Test/Non-Traditional - Supplemental - Norm Reference
1. Comprehensive Test of Nonverbal
Intelligence (CTONI)
2. Test of
Nonverbal Intelligence (TONI-3) - 1997
3. Functional Linguistic Communication
Inventory (FLCI)
C.
Articulation/Phonological Assessments - Norm Reference
1. Arizona Articulation Proficiency Scale,
Third Ed. (Arizona-3)
2.
Goldman-Fristoe Test of Articulation, Second Ed. (FGTA-2)
3. Khan-Lewis Phonological Analysis
(KLPA-2)
4. Slosson Articulation
Language Test with Phonology (SALT-P)
5. Bankston-Bernthal Test of Phonology
(BBTOP)
6. Smit-Hand Articulation
and Phonology Evaluation (SHAPE)
7.
Comprehensive Test of Phonological Processing (CTOPP)
8. Assessment of Intelligibility of
Dysarthric Speech (AIDS)
9. Weiss
Comprehensive Articulation Test (WCAT)
10. Assessment of Phonological Processes - R
(APPS-R)
11. Photo Articulation
Test, Third Ed. (PAT-3)
12.
Structured Photographic Articulation Test II Featuring Dudsberry (SPAT-D
II)
D.
Articulation/Phonological - Supplemental - Norm Reference
E. Test of Phonological Awareness
(TOPA)
F. Voice/Fluency Assessments
- Norm Reference Stuttering Severity Instrument for Children and Adults
(SSI-3)
G. Auditory Processing
Assessments - Norm Reference Goldman-Fristoe-Woodcock Test of Auditory
Discrimination (G-F-WTAD)
H. Oral
Motor - Supplemental - Norm Reference Screening Test for Developmental Apraxia
of Speech, Second Ed. (STDAS-2)
I.Traumatic Brain Injury (TBI) Assessments -
Norm Reference
1. Ross Information Processing
Assessment - Primary
2. Test of
Adolescent/Adult Word Finding (TAWF)
3. Brief Test of Head Injury (BTHI)
4. Assessment of Language-Related Functional
Activities (ALFA)
5. Ross
Information Processing Assessment, Second Ed. (RIPA-2)
6. Scales of Cognitive Ability for Traumatic
Brain Injury (SCATBI)
7.
Communication Activities of Daily Living, Second Ed. (CADL-2)
TOC required
216.102
Standardized Testing
A. Tests used
must be norm-referenced, standardized and specific to the therapy planned.
1. Tests must be age appropriate for the
child being tested.
2. Test results
must be reported as standard scores, Z scores, T scores or
percentiles.
3. Age-equivalent
scores and percentage of delay do not justify the medical necessity of
services.
B. A score of
negative 1.50 standard deviations or more from the mean in at least 1 subtest
area or composite score is required to qualify for services.
C. The Mental Measurement Yearbook
(MMY) is the standard reference for determining a
test's reliability and validity.
D.
When a child cannot be tested with a norm-referenced, standardized test, then
criterion-based testing or a functional description of his or her gross and
fine motor deficits may be used.
1. In such a
case, documentation of the reason(s) that a standardized test could not be used
must be included in the evaluation.
2. Listings of tests that AFMC accepts
without requiring documentation of their reliability and validity can be found
in this provider manual between sections
216.120 and
216.228, inclusive.
216.121
Fine
Motor Skills - Standard
A. Peabody
Developmental Motor Scales (PDMS, PDMS2)
B. Toddler and Infant Motor Evaluation
(TIME)
C. Bruininks-Oseretsky Test
of Motor Proficiency (BOMP)
D. Test
of Infant Motor Performance (TIMP)
216.123
Visual Motor - Standard
A. Developmental Test of Visual Motor
Integration (VMI)
B. Test of Visual
Motor Integration (TVMI)
C. Test of
Visual Motor Skills
D. Test of
Visual Motor Skills - R (TVMS)
E.
Pediatric Evaluation of Disability Inventory (PEDI)
1. The PEDI can also be used for older
children whose functional abilities fall below that expected of a 71/2
year old with no disabilities.
2.
When the PEDI is used for older children, the scaled score is the most
appropriate score to consider.
F. Adaptive Behavior Scale - School
(ABS)
G. Jacobs Pre-vocational
Assessment
H. Kohlman Evaluation of
Daily Living Skills
I. Milwaukee
Evaluation of Daily Living Skills
J. Cognitive Performance Test
K. Purdue Pegboard
L. Functional Independence Measure (FIM); 7
through 20 years of age
M.
Functional Independence Measure - young version (WeeFIM)
216.131
Norm Reference
A. Adaptive Areas Assessment
B. Test of Gross Motor Development
(TGMD-2)
C. Peabody Developmental
Motor Scales, Second Ed. (PDMS-2)
D. Bruininks-Oseretsky Test of Motor
Proficiency (BOMP)
E. Pediatric
Evaluation of Disability Inventory (PEDI)
F. Test of Gross Motor Development - 2
(TGMD-2)
G. Peabody Developmental
Motor Scales (PDMS)
H.Alberta
Infant Motor Scales (AIM)
I.
Toddler and Infant Motor Evaluation (TIME)
J. Functional Independence Measure for
Children (WeeFIM)
K. Gross Motor
Function Measure (GMFM)
L. Adaptive
Behavior Scale - School, Second Ed. (AAMR-2)
M. Movement Assessment Battery for Children
(Movement ABC)
N. Test of Infant
Motor Performance (TIMP)
O.
Functional Independence Measure (FIM); 7 through 20 years of age
216.132
Physical Therapy -
Supplemental
A. Bayley Scales of
Infant Development, Second Ed. (BSID-2)
B. Neonatal Behavioral Assessment Scale
(NBAS)
C. Mullen Scales of Early
Learning Profile (MSEL)
D. Hawaii
Early Learning Profile (HELP)
216.133
Physical Therapy Criterion
A. Developmental Assessment for
Students with Severe Disabilities, Second Ed. (DASH-2)
B. Milani-Comparetti Developmental
Examination
216.220
Intelligence Quotient (IQ)
A.
Children receiving language intervention therapy must have cognitive testing
once they reach ten (10) years of age, whether they are in public school or
they are home-schooled.
B.
Providers must maintain in their records the IQ scores of their patients who
are 10 through 20 years of age and receiving language therapy.
C. Language therapy may be determined not
medically necessary if a child's IQ is less than or equal to his or her
language score, because the child is deemed to be functioning at or above the
expected level.
1. If a provider determines
that therapy is warranted despite the relationship of IQ to language score, the
provider must complete an in-depth functional profile.
2. If the child's IQ is higher than his or
her language scores, then the child qualifies for language therapy
D. Accepted IQ tests are listed in
sections 216.221 through
216.228.
216.221
IQ Tests - Traditional
A. Stanford-Binet
B. The Wechsler Preschool & Primary
Scales of Intelligence, Revised (WPPSI-R)
C. Slosson
D. Wechsler Intelligence Scale for Children,
Third Ed. (WISC-III)
E. Kauffman
Adolescent & Adult Intelligence Test (KAIT)
F. Wechsler Adult Intelligence Scale, Third
Ed. (WAIS-III)
G. Differential
Ability Scales (DAS)
H. Reynolds
Intellectual Assessment Scales (RIAS)
216.222
Severe and Profound IQ
Test/Non-Traditional - Supplemental - Norm Reference
A. Comprehensive Test of Nonverbal
Intelligence (CTONI)
B. Test of
Nonverbal Intelligence (TONI-3) - 1997
C. Functional Linguistic Communication
Inventory (FLCI)
216.223
Articulation/Phonological Assessments - Norm Reference
A. Arizona Articulation Proficiency Scale,
Third Ed. (Arizona-3)
B.
Goldman-Fristoe Test of Articulation, Second Ed. (GFTA-2)
C. Khan-Lewis Phonological Analysis
(KLPA-2)
D. Slosson Articulation
Language Test with Phonology (SALT-P)
E. Bankston-Bernthal Test of Phonology
(BBTOP)
F. Smit-Hand Articulation
and Phonology Evaluation (SHAPE)
G.
Comprehensive Test of Phonological Processing (CTOPP)
H. Assessment of Intelligibility of
Dysarthric Speech (AIDS)
I. Weiss
Comprehensive Articulation Test (WCAT)
J. Assessment of Phonological Processes - R
(APPS-R)
K. Photo Articulation
Test, Third Ed. (PAT-3)
L.
Structured Photographic Articulation Test II featuring Dudsberry
(SPATD-II)
Disclaimer: These regulations may not be the most recent version. Arkansas may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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