201.000
Arkansas Medicaid Participation Requirements
Individual and group providers of occupational therapy,
physical therapy and speech-language pathology services must meet the following
criteria to be eligible to participate in the Arkansas Medicaid Program.
A. A provider of therapy services must meet
the enrollment criteria for the type of therapy to be provided as established
and outlined in section
202.000 of this manual.
B. A provider of therapy services has the
option of enrolling in the Title XVIII (Medicare) Program. Item 1-C. of the
Contract To Participate In The Arkansas Medical Assistance Program Administered
By The Division Of Medical Services Title XIX (Medicaid) further requires
acceptance of assignment under Title XVIII (Medicare) in order to receive
payment under Title XIX (Medicaid) for any applicable deductible or coinsurance
that may be due and payable under Title XIX (Medicaid). Services furnished to
an individual enrolled under Medicare who is also eligible for Medicaid,
including Qualified Medicare Beneficiaries (QMB) may only be
reimbursed on an assignment related basis. When a beneficiary is
dually eligible for Medicare and Medicaid, providers must bill Medicare prior
to billing Medicaid. The beneficiary may not be billed for the charges.
Providers enrolled to participate in the Title XVIII (Medicare) Program must
notify the Arkansas Medicaid Program of their National Provider
Identifier.
C. The provider must
complete and submit to the Medicaid Provider Enrollment Unit a provider
application (form DMS-652), a Medicaid contract (form DMS-653) and a Request
for Taxpayer Identification Number and Certification (Form W-9).
View or print a provider application (form DMS-652), Medicaid
contract (form DMS-653) and Request for Taxpayer Identification Number and
Certification (Form W-9).
D. The following documents must accompany the
provider application and the Medicaid contract.
1. A copy of all certifications and licenses
verifying compliance with enrollment criteria for the therapy discipline to be
practiced. (See section
202.000 of this
manual.)
2. If enrolled in the
Title XVIII (Medicare) Program, an out-of-state provider must submit a copy of
verification that reflects current enrollment in that program.
E. Enrollment as a Medicaid
provider is conditioned upon approval of a completed provider application and
the execution of a Medicaid provider contract. Persons and entities that are
excluded or debarred under any state or federal law, regulation or rule are not
eligible to enroll, or to remain enrolled, as Medicaid providers.
F. A copy of subsequent state license renewal
must be forwarded to the Medicaid Provider Enrollment Unit within 30 days of
issuance. If the renewal document(s) have not been received within this
timeframe, the provider will have an additional and final 30 days to
comply.
G. Failure to timely submit
verification of license renewal will result in termination of enrollment in the
Arkansas Medicaid Program.
H. The
provider must adhere to all applicable professional standards of care and
conduct.
201.110
chool Districts, Education Service Cooperatives, and Developmental Day
Treatment Clinic Services
If a school district, an education service cooperative or a
Developmental Day Treatment Clinic Services provider contracts
with an individual qualified therapist or speech-language pathologist, the
criteria for group providers of therapy services apply (See section
201.100 of the Occupational,
Physical, Speech Therapy Services manual). The qualified individual is
considered the provider of therapy services and must complete an application
and contract with the Division of Medical Services. The individual provider
will not bill Arkansas Medicaid for services as they are contracted through the
facility. However, Medicaid participation will be indicated by the provider
identification number indicated as a performing provider when the facility
bills for services.
Therapists directly employed by a facility will be
required to enroll with the Arkansas Medicaid Program as an individual provider
but will not bill Arkansas Medicaid directly for services nor indicate their
individual Medicaid provider identification number for services provided as an
employee of the billing facility. Therefore, the individual therapist's
Medicaid participation will appear inactive to the Medicaid enrollment system.
EDS will annually notify all providers, at the address currently on file with
Arkansas Medicaid for the individual's enrollment, that no activity with the
Medicaid program for the calendar year will inactivate their individual
provider participation. It will be necessary for each individual therapy
provider-employee to complete and return form DMS-0663
(V iew or print form
DMS-0663) on an annual basis to have their enrollment
remain active and not purged due to inactivity. All forms are located in
Section V of each manual.
The following requirements apply only to Arkansas school
districts and education service cooperatives that employ (via a form W-4
relationship) qualified therapists or qualified speech-language pathologists to
provide therapy services.
A. The
Arkansas Department of Education must certify a school district or education
service cooperative.
1. The Arkansas
Department of Education must provide a list, updated on a regular basis, of all
school districts and education service cooperatives certified by the Arkansas
Department of Education to the Medicaid Provider Enrollment Unit of the
Division of Medical Services.
2.
The Local Education Agency (LEA) number must be used as the license number for
the school district or education service cooperative.
B. The school district or education service
cooperative must enroll as a provider of therapy services. Refer to section
201.000 for the process to enroll
as a provider and for information regarding applicable restrictions to
enrollment.
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
Mental Measurement Yearbook (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. Bruininks-Oseretsky Test of Motor
Proficiency, Second Edition (BOT-2)
5. 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
Mental Measurement Yearbook (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.
Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2)
6. Pediatric Evaluation of Disability
Inventory (PEDI)
7. Test of Gross
Motor Development - 2 (TGMD-2)
8.
Peabody Developmental Motor Scales (PDMS)
9. Alberta Infant Motor Scales
(AIM)
10. Toddler and Infant Motor
Evaluation (TIME)
11. Functional
Independence Measure for Children (WeeFIM)
12. Gross Motor Function Measure
(GMFM)
13. Adaptive Behavior Scale
- School, Second Ed. (AAMR-2)
14.
Movement Assessment Battery for Children (Movement ABC)
15. Test of Infant Motor Performance
(TIMP)
16. 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
214.410
Accepted
Tests for Speech-Language 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 in the evaluation 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 should be included. The Mental Measurement Yearbook (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.
A. Speech-Language Tests -
Standardized
1. Preschool Language Scale,
Third Ed. (PLS-3)
2. Preschool
Language Scale, Fourth Ed. (PLS-4)
3. Test of Early Language Development, Third
Ed. (TELD-3)
4. Peabody Picture
Vocabulary Test, Third Ed. (PPVT-3)
5. Clinical Evaluation of Language
Fundamentals - Preschool (CELF-P)
6. Clinical Evaluation of Language
Fundamentals, Third Ed. (CELF-3)
7.
Clinical Evaluation of Language Fundamentals, Fourth Ed. (CELF-4)
8. Communication Abilities Diagnostic Test
(CADT)
9. Test of Auditory
Comprehension of Language, Third Ed. (TACL-3)
10. Comprehensive Assessment of Spoken
Language (CASL)
11. Oral and
Written Language Scales (OWLS)
12.
Test of Language Development - Primary, Third Ed. (TOLD-P:3)
13. Test of Word Finding, Second Ed.
(TWF-2)
14. Test of Auditory
Perceptual Skills, Revised (TAPS-R)
15. Language Processing Test, Revised
(LPT-R)
16. Test of Pragmatic
Language (TOPL)
17. Test of
Language Competence, Expanded Ed. (TLC-E)
18. Test of Language Development -
Intermediate, Third Ed. (TOLD-I:3)
19. Fullerton Language Test for Adolescents,
Second Ed. (FLTA)
20. Test of
Adolescent and Adult Language, Third Ed. (TOAL-3)
21. Receptive One-Word Picture Vocabulary
Test, Second Ed. (ROWPVT-2)
22.
Expressive One-Word Picture Vocabulary Test, 2000 Ed. (EOWPVT)
23. Comprehensive Receptive and Expressive
Vocabulary Test, Second Ed. (CREVT-2)
24. Kaufman Assessment Battery for Children
(KABC)
25. Receptive-Expressive
Emergent Language Test, Third Edition (REEL-3)
B. Speech-Language Tests - Supplemental
1. Receptive-Expressive Emergent Language
Test, Second Ed. (REEL-2)
2.
Nonspeech Test for Receptive/Expressive Language
3. Rossetti Infant-Toddler Language Scale
(RITLS)
4. Mullen Scales of Early
Learning (MSEL)
5. Reynell
Developmental Language Scales
6.
Illinois Test of Psycholinguistic Abilities, Third Ed. (ITPA-3)
7. Social Skills Rating System - Preschool
& Elementary Level (SSRS-1)
8.
Social Skills Rating System - Secondary Level (SSRS-2)
C. Birth to Age 3:
1. A - (minus) 1.5 SD (standard score of 77)
below the mean in two areas (expressive, receptive) or a - (minus) 2.0 SD
(standard score of 70) below the mean in one area to qualify for language
therapy.
2. Two language tests must
be reported, with at least one of these being a global, norm-referenced,
standardized test with good reliability and validity. The second test may be
criterion referenced.
3. All
subtests, components and scores must be reported for all tests.
4. All sound errors must be reported for
articulation, including positions and types of errors.
5. If phonological testing is submitted, a
traditional articulation test must also be submitted with a standardized
score.
6. Information regarding the
child's functional hearing ability must be included as a part of the therapy
evaluation report.
7.
Non-school-age children must be evaluated annually.
8. If the provider indicates that the child
cannot complete a norm-referenced test, the provider must submit an in-depth
functional profile of the child's functional communication abilities. An
in-depth functional profile is a description of a child's communication
behaviors that specifically notes where such communication behaviors are
impaired and justifies the medical necessity of therapy. Standardized forms are
available for the completion of an in-depth functional profile, but a
standardized form is not required.
9. Children must be evaluated at least
annually. Children (birth to age 2) in the Child Health Management Services
(CHMS) Program must be evaluated every 6 months.
D. Ages 3 to 20:
1. A - (minus) 1.5 SD (standard score of 77)
below the mean in two areas (expressive, receptive, articulation) or a -
(minus) 2.0 SD (standard score of 70) below the mean in one area (expressive,
receptive, articulation)
2. Two
language tests must be reported, with at least one of these being a global,
norm-referenced, standardized test with good reliability and validity.
Criterion-referenced tests will not be accepted for this age group.
3. All subtests, components and scores must
be reported for all tests.
4. All
sound errors must be reported for articulation including positions and types of
errors.
5. If phonological testing
is submitted, a traditional articulation test must also be submitted with a
standardized score.
6. Information
regarding the child's functional hearing ability must be included as a part of
the therapy evaluation report.
7.
Non-school-age children must be evaluated annually.
8. School-age children must have a full
evaluation every three years (a yearly update is required) if therapy is school
related; outside of school, annual evaluations are required. "School related"
means the child is of school age, attends public school and receives therapy
provided by the school.
9. If the
provider indicates that the child cannot complete a norm-referenced test, the
provider must submit an in-depth functional profile of the child's functional
communication abilities. An in-depth functional profile is a description of a
child's communication behaviors that specifically notes where such
communication behaviors are impaired and justifies the medical necessity of
therapy. Standardized forms are available for the completion of an in-depth
functional profile, but a standardized form is not required.
10. IQ scores are required for all children
who are school age and receiving language therapy. Exception: IQ scores
are not required for children under ten (10) years of age.
