Arkansas Administrative Code
Agency 016 - DEPARTMENT OF HUMAN SERVICES
Division 06 - Medical Services
Rule 016.06.16-027 - NPI-16, Ther 1-16, DDTCS 1-16, Rehabhsp 1-16, ARKids 2-16, PHYS 2-16, Hospital 1-16, CHMS 1-16 and "SPA-2016-TBD? Draft only"

Universal Citation: AR Admin Rules 016.06.16-027

Current through Register Vol. 49, No. 9, September, 2024

Section II ARKids First-B

222.600 Occupational, Physical and Speech Therapy Benefits 7-1-17

Occupational, physical and speech therapy services are available to beneficiaries in the ARKids First-B program and must be performed by a qualified, Medicaid participating Occupational, Physical or Speech Therapist. A referral for an occupational, physical or speech therapy evaluation and prescribed treatment must be made by the beneficiary's PCP or attending physician if exempt from the PCP program. All therapy services for ARKids First-B beneficiaries require referrals and prescriptions be made utilizing the "Occupational, Physical and Speech Therapy for Medicaid Eligible Recipients Under Age 21" form DMS-640. View or print form DMS-640.

Occupational, physical and speech therapy referrals and covered services are further defined in the Physicians and in the Occupational, Physical and Speech Therapy Provider Manuals. Physicians and therapists must refer to those manuals for additional rules and regulations that apply to occupational, physical or speech therapy services for ARKids First-B beneficiaries.

Arkansas Medicaid applies the following daily therapy benefits to occupational, physical and speech therapy services in this program:

A. Medicaid will reimburse up to four (4) occupational, physical and speech therapy evaluation units (1 unit = 30 minutes) per state fiscal year (July 1 through June 30) without authorization. Additional evaluation units will require an extended therapy request.

B. Medicaid will reimburse up to six (6) occupational, physical and speech therapy units (1 unit = 15 minutes) weekly, per discipline, without authorization. Additional therapy units will require an extended therapy request.

C. All requests for extended therapy services must comply with the guidelines located within the Occupational, Physical and Speech Therapy Provider Manual.

____________Section II

Developmental Day Treatment Clinic Services__________

214.210 Occupational, Physical and Speech Therapy 7-1-17 Optional services available through DDTCS include occupational, physical and speech therapy and evaluation as an essential component of the plan of care for an individual accepted for developmental disabilities services. Therapy services are not included in the core services and are provided in addition to the core services. Procedural and benefit differences are based on the beneficiaries age (under age 21 and over age 21 yrs).

A. The DDTCS client's primary care physician (PCP) or attending physician must refer a client for evaluation for occupational, physical or speech therapy services. For clients under the age of 21, the use of form DMS-640 is required. View or print form DMS-640. The DDTCS client's primary care physician (PCP) or attending physician must also prescribe occupational, physical and/or speech therapy services and again, for clients under the age of 21, the use of an additional form DMS-640 is required for the prescription. The prescribed therapy must be included in the individual's DDTCS plan of care. A copy of the prescription must be maintained in the beneficiary's records. The original prescription is to be maintained by the physician. After the initial referral and initial prescription, subsequent referrals and prescriptions for continued therapy may be made at the same time using the same DMS-640 for clients under age 21. Instructions for completion of form DMS-640 are located on the back of the form. Medicaid will accept an electronic signature provided it is compliance with Arkansas Code 25-31-103.

B. Therapies in the DDTCS Program may be provided only to individuals whose plan of care includes one of the three levels of care (early intervention, pre-school or adult development). Medicaid does not cover optional therapy services furnished by a DDTCS provider as "stand-alone" services. To ensure quality care, group therapy sessions are limited to no more than four persons in a group.

1. When a DDTCS provider renders therapy services in conjunction with a DDTCS core service, therapy services must be billed by the DDTCS provider according to billing instructions in Section II of this manual.

2. DDTCS providers may not bill under the Medicaid Occupational, Physical and Speech Therapy Program for therapy services available in the DDTCS Program and provided to DDTCS clients.

3. Therapy services may not be provided during the same time period DDTCS core services are provided.

C. Arkansas Medicaid applies the following therapy benefits to all therapy services provided in the DDTCS program:

1. Medicaid will reimburse up to four (4) occupational, physical and speech therapy evaluation units (1 unit = 30 minutes) per discipline, per state fiscal year (July 1 through June 30) without authorization. Additional evaluation units for beneficiaries under age 21 will require an extended therapy request.

2. Medicaid will reimburse up to six (6) occupational, physical and speech therapy units (1 unit = 15 minutes) weekly, per discipline, without authorization. Additional daily therapy units will require an extended therapy request for beneficiaries underage 21.

3. All requests for extended therapy services must comply with Sections 217.000 through 217.100 for beneficiaries under age 21.

4. All requests for benefit extensions for therapy services provided in the DDTCS program to benefrciaries age 21 years and over must comply with Sections 217.700 through 217.800.

D. Make-up therapy sessions are covered for beneficiaries under age 21 in the event a therapy session is canceled or missed, if determined medically necessary and prescribed by the beneficiary's PCP. A make-up tiierapy session requires a separate prescription from tlie original previously received. Form DMS-640 must be used by the PCP for makeup therapy session prescriptions for beneficiaries under age 21.

E. Therapy services carried out by an unlicensed therapy student may be covered only when the following criteria are met:

1. Therapies performed by an unlicensed student must be under the direction of a licensed therapist and the direction is such that the licensed therapist is considered to be providing the medical assistance.

2. The licensed therapist must be present and engaged in student oversight during the entirety of any encounter.

214.500 Occupational, Physical and Speech Therapies Provided In the 7-1-17

DDTCS Program For Beneficiaries 21 Years of Age and Older

A. Medicaid will reimburse up to four (4) occupational, physical and speech therapy evaluation units (1 unit = 30 minutes) per discipline, for an eligible beneficiary, per state fiscal year (July 1 through June 30).

B. IVIedicaid will reimburse up to six (6) occupational, physical and speech therapy units (1 unit =15 minutes) weekly, per discipline, for an eligible t)eneficiary.

C. All requests for benefit extensions for therapy services for beneficiaries over age 21 must comply with Sections 217.700 through 217.800.

262.110 Occupational, Physical and Speech Therapy Procedure Codes 7-1-17

DDTCS therapy services may be provided only outside the time DDTCS core services are furnished. The following procedure codes must be used for therapy services in the DDTCS Program for Medicaid beneficiaries of all ages.

A. Occupational Therapy Procedure Codes

Procedure Code	Required Modifier(s)	Description
97003	' '	Evaluation for occupational therapy (30-minute unit; maximum of 4 units per state fiscal year, July 1 through June 30)
97150	U1,UB	Group occupational therapy by occupational therapy assistant (15-minute unit; maximum of 6 units per week, maximum of 4 clients per group)
97150	U2	Group occupational therapy by Occupational Therapist (15-minute unit; maximum of 6 units per week, maximum of 4 clients per group)
97530	-	Individual occupational therapy by Occupational Therapist (15-minute unit; maximum of 6 units per week)
97530	UB	Individual occupational therapy by occupational therapy assistant (15-minute unit; maximum of 6 units per week)

B. Physical Therapy Procedure Codes

97001	-	Evaluation for physical therapy (30-minute unit; maximum of 4 units per state fiscal year, July 1 through June 30)
97110	-	Individual physical therapy by Physical Therapist (15-minute unit; maximum of 6 units per week)
97110	UB	Individual physical therapy by physical therapy assistant (15-minute unit; maximum of 6 units per week)
97150	"	Group physical therapy by Physical Therapist (15-minute unit; maximum of 6 units per week, maximum of 4 clients per group)
97150	UB	Group physical therapy by physical therapy assistant (15-minute unit; maximum of 6 units per week, maximum of 4 clients per group)

C. Speech Therapy Procedure Codes

92521	UA	AEvaluation of speech fluency (e.g. stuttering, cluttering) (maximum of four 30-minute units per state fiscal year, July 1 through June 30)
92522	UA	AEvaluation of speech sound production (e.g. articulation, phonological process, apraxia, dysarthria) (maximum of four 30-minute units per state fiscal year, July 1 through June 30)
92523	UA	***Evaluation of speech sound production (e.g. articulation, phonological process, apraxia, dysarthria) with evaluation of language comprehension and expression (e.g. receptive and expressive language) (maximum of four 30-minute units per state fiscal year, July 1 through June 30)
92524	UA	*Behavioral and qualitative analysis of voice and resonance (maximum of four 30-minute units per state fiscal year, July 1 through June 30)
92507	-	Individual speech session by Speech Therapist (15-minute unit; maximum of 6units per week)
92507	UB	Individual speech therapy by speech language pathology assistant (15-minute unit; maximum of 6 units per week)
92508	"	Group speech session by Speech Therapist (15-minute unit; maximum of 6 units per week, maximum of 4 clients per group)
92508	UB	Group speech therapy by speech language pathology assistant (15-minute unit; maximum of 6 units per week, maximum of 4 clients per group)

NOTE: A{...) This symbol, along with text in parentheses, indicates the Arkansas

IVIedicaid description of the service. When using a procedure code with this symbol, the service must meet the indicated Arkansas IVIedicaid description.

Section II

Occupational, Physical, Speech Therapy Services_______

214.310 Accepted Tests for Occupational Therapy 7-1-17

Tests used must be norm-referenced, standardized, age appropriate and specific to tiie suspected area(s) of deficit. The following list of tests is not all-inclusive. When using a test that is not listed below, the provider must include an explanation and justification in the evaluation report to support the use of the chosen test. The Mental Measurement Yearbook (MMY) is the standard reference for determining the reliability and validity of the test(s) administered in an evaluation. Providers should refer to the MMY for additional information regarding specific tests. These definitions are applied to the lists of accepted tests:

* STANDARDIZED: Tests that are used to determine the presence or absence of deficits; any diagnostic tool or procedure that has a standardized administration and scoring process and compares results to an appropriate normative sample.

* SUPPLEMENTAL: Tests and tools that are not nonn-referenced, such as screeners, criterion-referenced measures, descriptive-design tools, structured probes, and clinical analysis procedures. These tools are numerous with new ones being frequently created/published. These measures are only used to further document deficits and support standardized test results. These measures do not replace the use of standardized tests. You are free to use supplemental tools of your own choosing to guide data collection, to generate in-depth, functional profiles, and/or to support standardized testing when appropriate, or as indicated in these regulations. (See Section 214.400, part D, paragraph 8.)

* CLINICAL OBSERVATIONS: Clinical observations have a supplemental role in the evaluation process and should always be included. They are especially important when standard scores do not accurately reflect a child's deficits in order to qualify the child for therapy. A detailed narrative or description of a child's limitations and how they affect functional performance may constitute the primary justification of medical necessity when a standardized evaluation is inappropriate. (See Section 214.400, part D, paragraph 8.)

A. Occupational Therapy Tests - Standardized (Newer editions of currently listed tests are also acceptable. Previous versions that have original protocols available are also accepted.)

Test	Abbreviation
Adaptive Behavior Scale - School Edition	ABS-S
Ashworth Scale
Box & Block Test of Manual Dexterity	BBT
Bruininks-Oseretsky Test of Motor Proficiency	BOMP
Bruininks-Oseretsky Test of Motor Proficiency - Second Edition	BOT-2
Children's Handwriting Evaluation Scale	CHES
Cognitive Perfonnance Test	CPT
DeGangi-Beri[LESS THAN] Test of Sensory Integration	TSI
Developmental Test of Visual Motor Integration	VMI
Developmental Test of Visual Perception, Second Edition	DTVP
Evaluation Tool of Children's Handwriting	ETCH
Functional Independence Measure - young version	WeeFIM
Functional Independence Measure - 7 years of age to adult	FIM
Jacobs Prevocational Skills Assessment
Kohlman Evaluation of Living Skills	KELS
Miller Function and Participation Scales	M-Fun
Milwaukee Evaluation of Daily Living Skills	MEDLS
Motor Free Visual Perception Test	MVPT
Motor Free Visual Perception Test - Revised	MVPT-R
Mullen Scales of Early Learning	MSEL
Peabody Developmental Motor Scales - 2	PDMS-2
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 7 1/2 year old with no disabilities. In this case, the scaled score is the most appropriate score to consider.

Purdue Pegboard Test
Range of Motion	ROM
Sensory Integration and Praxis Test	SIPT
Sensory Integration Inventory Revised	Sll-R
Sensory Processing Measure	SPM
Sensory Processing Measure-Preschool	SPM-P
Sensory Profile, Adolescent/Adult
Sensory Profile, Infant/Toddler
Sensory Profile
Sensory Profile School Companion
Test of Handwriting Skills	THS
Test of Infant Motor Performance	TIMP
Test of Visual Motor Integration	TVMI
Test of Visual Motor Skills	TVMS
Test of Visual Motor Skills - R	TVMS-R
Test of Visual Perceptual Skills	TVPS
Test of Visual Perceptual Skills - Upper Level	TVPS
Toddler and Infant Motor Evaluation	TIME
Wide Range Assessment of Visual Motor Abilifies	WRAVMA

214.320 Accepted Tests for Physical Therapy

Tests used must be norm-referenced, standardized, age appropriate and specific to the suspected area(s) of deficit. The following list of tests is not all-inclusive. When using a test that is not listed below, the provider must include an explanation and justification in the evaluation report to support the use of the chosen test. The Mental Measurement Yearbook (MMY) is the standard reference for determining the reliability and validity of the tests administered in an evaluation. Providers should refer to the MMYfor additional information regarding specific tests. These definitions are applied to the following lists of accepted tests:

STANDARDIZED: Tests that are used to determine the presence or absence of deficits; any diagnostic tool or procedure that has a standardized administration and scoring process and compares the results to an appropriate normative sample.

SUPPLEMENTAL: Tests and tools that are not norm-referenced, such as screeners, criterion-referenced measures, descriptive-design tools, structured probes, and clinical analysis procedures. These tools are numerous with new ones being frequently created/published. These measures are only used to further document deficits and support standardized test results. These measures do not replace the use of standardized tests. You are free to use supplemental tools of your own choosing to guide data collection, to generate in-depth, functional profiles, and/or to support standardized testing when appropriate, or as indicated in these regulations. (See Section 214.400, part D, paragraph 8.)

CLINICAL OBSERVATIONS: Clinical observations have a supplemental role in the evaluation process and should always be included. They are especially important when standard scores do not accurately reflect a child's deficits in order to qualify the child for therapy. A detailed narrative or description of a child's limitations and how they affect functional performance may constitute the primary justification of medical necessity when a standardized evaluation is inappropriate (See Section 214.400, part D, paragraph 8).

A. Physical Therapy Tests - Standardized (Newer editions of currently listed tests are also acceptable. Previous versions that have original protocols available are also accepted.)

Test	Abbreviation
Alberta Infant Motor Scale	AIMS
Adaptive Behavior Inventory	ABI
Adaptive Behavior Scale - School, Second Edition	ABS-S:2
Ashworth Scale
Assessment of Adaptive Areas	AAA
Bruininks-Oseretsky test of Motor Proficiency	BOMP
Bruininks-Oseretsky Test of Motor Proficiency, Second Edition	BOT-2
Comprehensive Trail-Making Test	CTMT
Functional Independence Measure for Children	WeeFIM
Functional Independence Measure - 7 years of age to adult	FIM
Gross Motor Function Measure	GMFM
Movement Assessment Battery for Children	Movement ABC
Mullen Scales of Early Learning	MSEL
Peabody Developmental Motor Scales, Second Edition	PDMS-2
Pediatric Balance Scale	PBS
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 7 Vz year old with no disabilities, in this case, the scaled score is the most appropriate score to consider.

Range of Motion - Functional Perfonnance Impairments	ROM
Sensory Processing Measure	SPM
Sensory Processing Measure-Preschool	SPM-P
Test of Infant Motor Perfonnance	TIMP
Test of Gross Motor Development, Second Edition	TGMD-2
Toddler and Infant Motor Evaluation

214.410 Accepted Tests for Speech-Language Therapy

Tests used must be nonn-referenced, standardized, age appropriate and specific to the disorder, or components of the disorder, being assessed. The following list of tests is not all-inclusive. When using a test that is not listed below, the provider must include an explanation and justification in the evaluation report to support the use of the chosen test. The Mental Measurement Yearbook (MMY) is the standard reference to detemiine the reliability and validity of the test(s) administered in the evaluation. Providers should refer to the MMY for additional information regarding specific tests. These definitions are applied to the following lists of accepted tests:

* STANDARDIZED: Tests that are used to detemiine the presence or absence of deficits; any diagnostic tool or procedure that has a standardized administration and scoring process and compares results to an appropriate nonnative sample.

* SUPPLEMENTAL: Tests and tools that are not nomri-referenced, such as screeners, criterion-referenced measures, descriptive-design tools, structured probes, and clinical analysis procedures. These tools are numerous with new ones being frequently created/published. These measures are only used to further document deficits and support standardized test results. These measures do not replace the use of standardized tests. You are free to use supplemental tools of your own choosing to guide data collection, to generate in-depth, functional profiles, and/or to support standardized testing when appropriate, or as indicated in these regulations. (See Section 214.400, part D, paragraph 8.)

* CLINICAL ANALYSIS PROCEDURES: Specific analysis methods used for in-depth examination of clinical data obtained during assessment and used to further document deficits and support standardized results. Clinical analysis procedures may not replace standardized tests. Exception: Procedures from this list may be used to analyze data collected and assist in generating an in-depth, functional profile. (See Section 214.400, part D, paragraph 8.)

* CLINICAL OBSERVATIONS: Clinical obsen/ations have an important role in the evaluation process and should always be included. They are especially important when standard scores do not accurately reflect a child's deficits in order to qualify the child for therapy. A detailed narrative or description of the child's communication behaviors (in-depth, functional profile) may constitute the primary justification of medical necessity. (See Section 241.200, part D, paragraph 8.)

* STANDARDIZED SCORING KEY:

Mild: Scores between 84-78; -1.0 standard deviation Moderate: Scores between 77-71; -1.5 standard deviations Severe: Scores between 70-64; -2.0 standard deviations

Profound: Scores of 63 or lower; -2.0+ standard deviations

A. Language Tests - Standardized (Newer editions of currently listed tests are also acceptable. Previous versions that have original protocols available are also accepted.)

Test	Abbreviation
Assessment of Language-Related Functional Activities	ALFA
Assessment of Literacy and Language	ALL
Behavior Rating Inventory of Executive Function	BRIEF
Behavioral Assessment of the Dysexecutive Syndrome for Children	BADS-C
Brief Test of Head Injury	BTHI
Children's Communication Checklist [Diagnostic for pragmatics]	CCC
Clinical Evaluation of Language Fundamentals - Preschool	CELF-P
Clinical Evaluation of Language, Fifth Edition	CELF-5
Clinical Evaluation of Language Fundamentals Metalinguistics	CELF-5
Communication Abilities Diagnostic Test	CADeT
Communication Activities of Daily Living, Second Edition	CADL-2
Comprehensive Assessment of Spoken Language	CASL
Comprehensive Receptive and Expressive Vocabulary Test, Second Edition	CREVT-2
Comprehensive Test of Phonological Processing	CTOPP-2
Diagnostic Evaluation of Language Variation - Norm-Referenced	DELV-NR
Emerging Literacy and Language Assessment	ELLA
Expressive Language Test	ELT-2
Expressive One-Word Picture Vocabulary Test, 4000 Edition	EOWPVT-4
Fullerton Language Test for Adolescents, Second Edition	FLTA
Goldman-Fristoe-Woodcock Test of Auditory Discrimination	GFWTAD
HELP Test-Elementary	HELP
Illinois Test of Psycholinguistic Abilities, Third Edition	ITPA-3
Language Processing Test, Third Edition	LPT-3
Listening Comprehension Test Adolescent	LCT-A
Listening Comprehension Test, Second Edition	LCT-2
Montgomery Assessment of Vocabulary Acquisition	MAVA
Mullen Scales of Early Learning	MSEL
Oral and Written Language Scales	OWLS II
Peabody Picture Vocabulary Test, Fourth Edition	PPVT-4
Phonological Awareness Test, Second Edition	PAT-2
Preschool Language Scale, Fourth Edition	PLS-4
Receptive One-Word Picture Vocabulary Test, Fourth Edition	ROWPVT-4
Receptive-Expressive Emergent Language Test, Tfiircl Edition	REEL-3
Ross Information Processing Assessment, Second Edition	RIPA-2
Scales of Cognitive Ability for Traumatic Brain Injury	SCATBI
Social Competence and Behavior Evaluation, Preschool Edition	SCBE
Social Emotional Assessment/Evaluation	SEAM
Social Language Development Test-Adolescent	SLDT-A
Social Language Development Test-Elementary	SLDT-E
Social Responsiveness Scale	SRS
Social Skills Rating System - Preschool & Elementary Level	SSRS-PE
Social Skills Rating System - Secondary Level	SSRS-S
Strong Mandative Assessment Procedure	SNAP
Structured Photographic Expressive Language Test	SPELT-3
Test of Adolescent and Adult Language, Fourth Edition	TOAL-4
Test of Adolescent /Adult Word Finding	TAWF
Test for Auditory Comprehension of Language, Fourth Edition	TACL-4
Test of Auditory Perceptual Skills - Revised	TAPS-R
Test of Auditory Perceptual Skills, Third Edition	TAPS-3
Test of Auditory Reasoning and Processing Skills	TARPS
Test of Early Communication and Emerging Language	TECEL
Test of Early Language Development, Third Edition	TELD-3
Test of Expressive Language	TEXL
Test of Language Development - Intemiediate, Fourth Edition	TOLD-l:4
Test of Language Development - Primary, Fourth Edition	TOLD-P:4
Test of Narrative Language	TNL
Test of Phonological Awareness	TOPA-2
Test of Pragmatic Language, Second Edition	TOPL-2
Test of Problem Solving- Adolescent	TOPS-2
Test of Problem Solving - Revised Elementary	TOPS-3
Test of Reading Comprehension, Third Edition	TORC-2
Test of Semantic Skills: Intermediate	TOSS-I
Test of Semantic Skills: Primary	TOSS-P
Test of Word Finding, Third Edition	TWF-3
Test of Word Finding in Disclosure	TWFD
Test of Word Knowledge	TOWK
Test of Written Language, Fourth Edition	TWL-4
The Listening Test
Wepman's Auditory Discrimination Test, Second Edition	ADT
Word Test - 2 Adolescent	WT2A
Word Test - 3 Elementary	WT3E

B. Language - Clinical Analysis Procedures - Language sampling and analysis, which may include, but is not limited to, the following:

Test	Abbreviation
Mean Length of Utterance	MLU
Type Token Ratio	TTR
Developmental Sentence Score	DSS
Stmctural analysis (Brown's stages)
Semantic analysis
Discourse analysis

C. Speech Production Tests - Standardized

Test	Abbreviation
Apraxia Battery for Adults, Second Edition	ABA-2
Arizona Articulation Proficiency Scale, Third Edition	Arizona-3
Assessment of Intelligibility of Dysarthric Speech	AIDS
Bernthal-Bankson Test of Phonology	BBTOP
Clinical Assessment of Articulation and Phonology, Second Edition	CAAP-2
Diagnostic Evaluation of Articulation and Phonology, U.S. Edition	DEAP
Goldman-Fristoe Test of Articulation, Third Edition	GFTA-3
Hodson Assessment of Phonological Patterns - Third Edition	HAPP-3
Kaufman Speech Praxis Test	KSPT
Khan-Lewis Phonological Analysis	KLPA-3
Photo Articulation Test, Third Edition	PAT-3
Slosson Articulation Language Test with Phonology	SALT-P
Smit-Hand Articulation and Phonology Evaluation	SHAPE
Structured Photographic Articulation Test II Featuring Dudsberry	SPAT-D II
Stuttering Severity Instrument for Children and Adults	SSI-3
Test for Childhood Stuttering	TOCS
Weiss Comprehensive Articulation Test	WCAT

D. Speech Production: Tests and tools that are not norm-referenced, such as screeners, criterion-referenced measures, descriptive-design tools, structured probes, and clinical analysis procedures. These tools are numerous with new ones being frequently created/published. These measures are only used to further document deficits and support standardized test results. These measures do not replace the use of standardized tests. You are free to use supplemental tools of your own choosing to guide data collection, to generate in-depth, functional profiles, and/or to support standardized testing when appropriate, or as indicated in these regulations. (See Section 214.400, part D, paragraph 8.)

E. Speech Production - Clinical Analysis Procedures - Speech sampling and analysis, which may include the following:

1. Debra Beckman's oral-motor assessment procedures

2. Food chaining questionnaire

3. Instrumentation-based voice evaluation

4. Item and replica analysis

5. Percentage of consonants correct

6. Percentage of intelligibility

7. Percentage of phonemes correct

8. Percentage of syllables stuttered

9. Perceptual voice evaluation

10. Phonetic inventory

11. Phonological process analysis

12. Suzanne Evans-Morris oral-motor assessment procedures

216.100 Extended Therapy Services 7-1-17

Arkansas Medicaid applies the following therapy benefits to all therapy services in this program:

A. Medicaid will reimburse up to four (4) occupational, physical and speech therapy evaluation units (1 unit = 30 minutes) per discipline, per state fiscal year (July 1 through June 30) without authorization. Additional evaluation units will require an extended therapy request.

B. Medicaid will reimburse up to six (6) occupational, physical and speech therapy units (1 unit =15 minutes) weekly, per discipline, without authorization. Additional therapy units will require an extended therapy request.

C. All requests for extended therapy services must comply with Sections 216.300 through 216.315.

262.100 Occupational, Physical, Speech Therapy Procedure Codes 7-1-17

The following occupational, physical and speech-language pathology procedure codes are payable for therapy services indicated. Refer to Section IV - Glossary - for definitions of "group" and "individual" as they relate to therapy sessions.

A. OCCUPATIONAL THERAPY

Procedure Code	Required Modifiers	Description
97003	Evaluation for Occupational Therapy (30-minute unit; maximum of 4 units per state fiscal year, July 1 through June 30)
97530	-	Individual Occupational Therapy (15-minute unit; maximum of 6 units per week)
97150	U2	Group Occupational Therapy (15-minute unit; maximum of 6 units per week, maximum of 4 clients per group)
97530	UB	Individual Occupational Therapy by Occupational Therapy Assistant (15-minute unit; maximum of 6 units per week)
97150	UB, U1	Group Occupational Therapy by Occupational Therapy Assistant (15-minute unit; maximum of 6 units per week, maximum of 4 clients per group)

B. PHYSICAL THERAPY

Procedure Code	Required Modifier	Description
97001	Evaluation for Physical Therapy (30-minute unit; maximum of 4 units per state fiscal year, July 1 through June 30)
97110	-	Individual Physical Therapy (15-minute unit; maximum of 6 units per week)
97150	Group Physical Therapy (15-minute unit; maximum of 6 units per week, maximum of 4 clients per group)
97110	UB	Individual Physical Therapy by Physical Therapy Assistant (15-minute unit; maximum of 6 units per week)
97150	UB	Group Physical Therapy by Physical Therapy Assistant (15-minute unit; maximum of 6 units per week, maximum of 4 clients per group)

C. SPEECH-LANGUAGE PATHOLOGY

***(...) This symbol, along with text in parentheses, indicates the Arkansas Medicaid description of the product. When using a procedure code with this symbol, the product must meet the indicated Arkansas Medicaid description.

Procedure Code	Required IVIodlfier	Description
92507	-	Individual Speech Session (15-minute unit; maximum of 6 units per week)
92508	Group Speech Session (15-minute unit; maximum of 6 units perweel[LESS THAN], maximum of 4 clients per group)
92507	UB	Individual Speech Therapy by Speech-Language Pathology Assistant (15-minute unit; maximum of 6 units per week)
92508	UB	Group Speech Therapy by Speech-Language Pathology Assistant (15-minute unit; maximum of 6 units perweel[LESS THAN], maximum of 4 clients per group)
92521	UA	***(Evaluation of speech fluency (e.g. stuttering, cluttering) (30-minute unit; maximum of 4 units per state fiscal year, July 1 through June 30)
92522	UA	***(Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria) (30-minute unit; maximum of 4 units per state fiscal year, July 1 through June 30)
92523	UA	#*(Evaluation of speech production (e.g., articulation, phonological process, apraxia, dysarthria) with evaluation of language comprehension and expression (e.g., receptive and expressive language) (30-minute unit; maximum of 4 units per state fiscal year, July 1 through June 30)
92524	UA	***Behavioral and qualitative analysis of voice and resonance (30-minute unit; maximum of 4 units per state fiscal year, July 1 through June 30)

Section II

Child Health Management Services______

262.120 Treatment Procedure Codes

The following treatment procedures are payable for services included in the child's treatment plan. Prior authorization is required for all CHMS treatment procedures. See Section 240.000 of this manual for prior authorization requirements. See Glossary - Section IV - for definitions of "individual" and "group" as they relate to therapy services.

Procedure Codes
90847 90849	97762*	99211	99212
99213 99214	99215

*Effective for dates of service on and after March 1, 2006, procedure code 97703 was made non-payable and was replaced with procedure code 97762.

Procedure Code	Required Modifier(s)	Description
T1024	Brief Consultation, on site - A direct service contact by a CHMS professional on-site with a patient for the purpose of: obtaining the full range of needed services; monitoring and supervising the patient's functioning; establishing support for the patient and gathering infonnation relevant to the patient's individual treatment plan.
T1024	U1	Collateral Services, on site - Face-to-face contact on-site by a CHMS professional with other professionals, caregivers or other parties on behalf of an identified patient to obtain or provide relevant information necessary to the patient's assessment, evaluation or treatment.
90846	U4	Family therapy, on-site, for therapy as part of the treatment plan, without the patient present (1 unit = 15 minutes)
90847	U4	Family therapy, on site, for therapy as part of the treatment plan, with the patient present (1 unit = 15 minutes)
99367	UA	Treatment Plan - Plan of treatment developed by CHMS professionals and the patient's caregiver(s). Plan must include short- and long-term goals and objectives and include appropriate activities to meet those goals and objectives (1 unit = 15 minutes).
H2011	Crisis Management Visit, on site - An unscheduled/ unplanned direct service contact on site with the identified patient for the purpose of preventing physical injury, inappropriate behavior or placement in a more restrictive service delivery system (1 unit = 15 minutes)
S9470	Nutrition Counseling/Consultation - Conference with parent/guardian and/or PCP to provide results of evaluation, discuss medical nutrition therapy plan and goals of treatment and education. May provide detailed menus for home use and information on sources of special nutrition products (1 unit = 30 minutes)
90832	U9	*(Individual psychotherapy, insight-oriented, behavior-modifying and/or supportive, in an office or outpatient facility, approximately 20 to 30 minutes, face-to-face with the patient)
90834	U9	*(Individual psychotherapy, insight-oriented, behavior-modifying and/or supportive, in an office or outpatient facility, approximately 45 to 50 minutes, face-to-face with the patient)
90837	U9	*(Individual psychotherapy, insight-oriented, behavior-modifying and/or supportive, in an office or outpatient facility, approximately 75 to 80 minutes, face-to-face with the patient)
90853	-	Group Psychotherapy/counseling (1 unit = 5 minutes)
92507	-	Individual Speech Session by Speech-Language Pathology Therapist (1 unit =15 minutes), maximum of 6 units per week
92507	UB	Individual Speech Therapy by Speech-Language Pathology Assistant (1 unit =15 minutes), maximum of 6 units per week
92508	-	Group Speech Session by Speech-Language Pathology Therapist (1 unit =15 minutes), maximum of 6 units per week, maximum of 4 clients per group
92508	UB	Group Speech Therapy by Speech-Language Pathology Assistant (1 unit =15 minutes), maximum of 6 units per week, maximum of 4 clients per group
97110	-	Individual Physical Therapy by Physical Therapist (1 unit = 15 minutes), maximum of 6 units per week
97110	UB	Individual Physical Therapy by Physical Therapy Assistant (1 unit =15 minutes), maximum of 6 units per week
97150	"	Group Physical Therapy by Physical Therapist (1 unit =15 minutes), maximum of 6 units per week, maximum of 4 clients per group
97150	U2	Group Occupational Therapy by Occupational Therapist (1 unit = 15 minutes), maximum of 6 units per week, maximum of 4 clients per group
97150	UI.UB	Group Occupational Therapy by Occupational Therapy Assistant (1 unit =15 minutes), maximum of 6 units per week, maximum of 4 clients per group
97150	UB	Group Physical Therapy by Physical Therapy Assistant (1 unit =15 minutes), maximum of 6 units per week, maximum of 4 clients per group
97530	-	Individual Occupational Therapy by Occupational Therapist (1 unit = 15 minutes), maximum of 6 units per week
97530	UB	Individual Occupational Therapy by Occupational Therapy Assistant (1 unit =15 minutes), maximum of 6 units per week
97530 U1	Developmental Motor Activity Services -Hndividualized activities provided by, or under the direction of, an Early Childhood Developmental Specialist to improve general motor sl[LESS THAN]ills by increasing coordination, strength and/or range of motion. Activities will be directed toward accomplishment of a motor goal identified in the patient's individualized treatment plan as authorized by the responsible CHMS physician (1 unit = 15 minutes)
97532 -	Cognitive Development Services - Individualized activities to increase the patient's intellectual development and competency. Activities will be those appropriate to carry out the treatment plan for the patient as authorized by the responsible CHMS physician. Cognitive Development Services will be provided by or under the direction of an Early Childhood Developmental Specialist. Activities will address goals of cognitive and communication skills development: (1 unit = 15 minutes).
97535 UB	Self Care and Social/Emotional Developmental Services - Individualized activities provided by or under the direction of an Early Childhood Developmental Specialist to increase the patient's self-care skills and/or ability to interact with peers or adults in a daily life setting/situation. Activities will be those appropriate to carry out the treatment plan for the patient as authorized by the responsible CHMS physician. (1 unit= 15 minutes).
97803 -	Nutrition follow-up: Reassess recent nutrition history, new anthropometer and laboratory data to evaluate progress toward meeting medical nutritional goals. May include a conference with parent or other CHMS professional (1 unit = 15 minutes).

Medicaid will reimburse up to six (6) occupational, physical and speech therapy units (1 unit = 15 minutes) weekly, per discipline, without authorization. Additional daily therapy units will require an extended therapy request for beneficiaries under age 21.

Please refer to the Occupational, Physical, Speech Therapy Services Manual for further instructions regarding prior authorization protocol.

262.130 CHMS Procedure Codes - Foster Care Program 7-1-17

Refer to Section 202.000 of this manual for Ari[LESS THAN]ansas Medicaid Participation Requirements for Providers of Comprehensive Health Assessments for Foster Children.

The following procedure codes are to be used for the mandatory comprehensive health assessments of children entering the Foster Care Program. These procedures do not require prior authorization.

***(...)This symbol, along with text in parentheses, indicates the Ari[LESS THAN]ansas Medicaid description of the service. When using a procedure code with this symbol, the service must meet the indicated Arkansas Medicaid description.

Procedure Code	Required Modifier(s)	Description	hhhhuhkhhho
T1016	Informing (1 unit = 15 minutes), maximum of 4 units
T1023	Staffing (1 unit =15 minutes), maximum of 4 units
T1025	Developmental Testing
90791	U1.	U9	Diagnostic Interview, includes evaluation and reports (1 unit = 15 minutes), maximum of 8 units
92521	U1.	UA	***(Evaluation of speech fluency (e.g., stuttering, cluttering) (1 unit =15 minutes; maximum of 4 units)
92522	U1,	UA	***(Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthia) (1 unit = 15 minutes; maximum of 4 units)
92523	U1,	UA	***( Evaluation of speech production (e.g., articulation, phonological process, apraxia, dysarthia) with evaluation of language comprehension and expression (e.g. receptive and expressive language) (1 unit = 15 minutes; maximum of 4 units)
92524	U1.	UA	*%(Behavioral and qualitative analysis of voice and resonance) (1 unit = 15 minutes; maximum of 4 units)
92551	U1	Audio Screen
92567	U1	Tympanometry
92587**	U1	Evoked otoacoustic emissions; limited (single stimulus level, either transient or distortion products)
95961	UA	Cortical Function Testing
96101*	U1,	UA	Psychological Testing, 2 or more (1 unit = 15 minutes), maximum of 8 units
96101*	UA	Interpretation (1 unit = 15 minutes), maximum of 8 units
99173	Visual Screen
99205 99215	U1 U1	High Complex medical exam

'Effective for dates of service on and after March 1, 2006, procedure code 96100 was made non-payable and was replaced with procedure code 96101.

**Effective for dates of service on and after January 1, 2007, procedure code 92587 is payable.

Notice:

The current Arkansas State Plan may be viewed at the following link: https://www.medicaid.state.ar.us/General/units/ppd.aspx

State Plan Amendment pages (SPAs) included in this packet are proposed changes to the Arkansas State Plan until they receive final approval from the Centers for Medicare and Medicaid Services (CMS). Interested parties are encouraged to visit the included link for the most up-to-date information available.

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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Arkansas Administrative CodeAgency 016 - DEPARTMENT OF HUMAN SERVICESDivision 06 - Medical ServicesRule 016.06.16-027 - NPI-16, Ther 1-16, DDTCS 1-16, Rehabhsp 1-16, ARKids 2-16, PHYS 2-16, Hospital 1-16, CHMS 1-16 and "SPA-2016-TBD? Draft only"

Arkansas Administrative Code
Agency 016 - DEPARTMENT OF HUMAN SERVICES
Division 06 - Medical Services
Rule 016.06.16-027 - NPI-16, Ther 1-16, DDTCS 1-16, Rehabhsp 1-16, ARKids 2-16, PHYS 2-16, Hospital 1-16, CHMS 1-16 and "SPA-2016-TBD? Draft only"