Arkansas Administrative Code
Agency 016 - DEPARTMENT OF HUMAN SERVICES
Division 06 - Medical Services
Rule 016.06.17-016 - CHMS & DDTCS Manual and SPA Changes
Current through Register Vol. 49, No. 9, September, 2024
Section II
Child Health Management Services
Management Services (CHMS) Providers
Child Health Management Services (CHMS) providers must meet the Provider Participation and enrollment requirements contained within Section 140.000 of this manual as well as the following criteria to be eligible to participate in the Arkansas Medicaid Program:
For an academic medical center CHMS program, services may be provided at different sites operated by the academic medical center as long as the CHMS program falls under one administrative structure within the academic medical center.
OR
A request for certification/licensure must be directed in writing to each of the following organizations:
The Department of Health or its designees shall conduct an annual CHMS Certification Review to substantiate continued compliance with these regulations and standards.
A formal report, listing any cited deficiencies, shall be forwarded by the reviewer to the CHMS clinic within fifteen (15) working days of the certification review.
CHMS providers are required to maintain the following medical/clinical records.
Complete and accurate clinical records must be maintained for any patient who receives direct services from the CHMS clinic. Each record must contain, at a minimum, the following information:
If the physician or CHMS provider believes that the child has a significant developmental diagnosis, disability, or delay such that he or she does not need a developmental screen, the physician or CHMS provider may send relevant documentation for review by the Third Party Vendor's clinician. The Third Party Vendor's Clinician will determine the necessity of a developmental screen.
The following additional records must be maintained for patients receiving day treatment in pediatric day programs.
Individuals with Disabilities Education Act (IDEA)
DDS is the lead agency responsible for the general administration and supervision of the programs and activities utilized to carry out the provisions of Part C of the IDEA. First Connections is the DDS program in Arkansas that administers, monitors, and carries out all Part C of IDEA activities and responsibilities for the state. The First Connections program ensures that appropriate early intervention services are available to all infants and toddlers from birth to thirty-six (36) months of age (and their families) that are suspected of having a developmental delay.
Each CHMS must, within two (2) working days of receipt of referral of an infant or toddler thirty-six (36) months of age or younger, present the family with DDS-approved information about the Part C program, First Connections, so that the parent/guardian can make an informed choice regarding early intervention options. Each CHMS must maintain appropriate documentation of parent choice in the child record.
Local Education Agencies (LEA) have the responsibility to ensure that children, ages three (3) until entry into kindergarten, who have or are suspected of having a disability under Part B of IDEA (Part B), receive a Free Appropriate Public Education. The Arkansas Department of Education provides each CHMS with the option of participating in Part B as a LEA. Participation as a LEA requires a CHMS to provide special education and related services in accordance with Part B (Special Education Services) to all children with disabilities it is serving aged three (3) until entry into Kindergarten. A participating CHMS is also eligible to receive a portion of the federal grant funds made available to LEAs under Part B in any given fiscal year.
Each CHMS must therefore make an affirmative election to either provide or not provide Special Education Services to all children with disabilities it is serving aged three (3) until entry into kindergarten as follows:
A CHMS may change its election at any time; however, a decision to change will only be effective as of July 1st. A CHMS must inform DDS of its intent to change its election no later than March 1st for its election to be effective as of July 1st of the same calendar year. Any decision to change an election received by DDS after March 1st will not be effective until July 1st of the next calendar year. Any time a CHMS elects to cease providing Special Education Services, the CHMS must complete a Special Education Referral Form (or any successor form) for each child age three (3) or older it is currently serving, and submit each one to the appropriate LEA.
View or print the Arkansas Department of Education Special Education contact information.
Medicaid (Medical Assistance) is designed to assist Medicaid beneficiaries in obtaining medical care within the guidelines specified in Section I of this manual. Reimbursement may be made for Child Health Management Services (CHMS) provided to eligible Medicaid beneficiaries at qualified provider facilities.
Child Health Management Services (CHMS) comprises an array of clinic services intended to provide full medical multi-discipline diagnosis, evaluation and treatment for the purpose of intervention, treatment and prevention of long term disability for Medicaid beneficiaries.
Beneficiaries of Child Health Management Services must have a diagnosis of developmental disability or delay. These services are not designed to be used as a well-child check-up.
Entry into the CHMS clinic system will begin with a referral from the patient's primary care physician (PCP) after review of the results of the developmental screen. The PCP's approval of the plan for treatment must be in place to initiate care.
Services are limited to the following components:
|
Audiology |
Neuropsychology |
Psychological |
|
Behavior |
Nutrition |
Social work |
|
Day Treatment Services |
Occupational/Physical Therapy |
Speech/Language Pathology |
|
Medical (to include nursing) |
Psychiatry |
Therapy |
Services are outpatient only and are available to eligible Medicaid patients under age 21. The CHMS provider will provide services in one or more of the above components. The CHMS provider will bill only for those services that are medically necessary. Prior authorization is required to admit a child into Child Health Management Services. See Section 240.000 of this manual for prior authorization procedures.
All services provided to a child must be included in an individual treatment plan signed by the CHMS pediatrician and include follow-up to ensure treatment has been done. (See Section 218.200.)
The CHMS clinic must establish a patient referral system within the clinic, to hospitals and other health care providers. (See Section 221.000).
Beneficiaries that are enrolled in a program that is dually certified as a DDTCS and CHMS cannot be billed under both programs during the same enrollment period. An enrollment period is defined as the twelve (12) months of allowed billing after the developmental screen is administered and a prescription is written for CHMS or DDTCS services for the beneficiary.
Beneficiaries that continue to qualify for either DDTCS or CHMS during the enrollment period can transfer to another CHMS or DDTCS program based on parent choice. These beneficiaries do not have to undergo another developmental screen.
Beneficiaries that graduate or no longer qualify for DDTCS or CHMS before the end of the enrollment period must be referred to the third party vendor for a developmental screen and obtain a new prescription before they can be reenrolled in a DDTCS or CHMS program.
A facility used for the provision of Child Health Management Services. Each facility must be enrolled with Medicaid to obtain a unique Medicaid Provider Number for identification purposes. Administrative, financial, clinical and managerial responsibility for the clinic may rest with a provider organization.
Clinic services are defined as preventive, diagnostic, therapeutic, rehabilitative or palliative items or services that are:
The Arkansas Department of Human Services and its designated representatives.
The entity responsible for the operation of a CHMS clinic.
Assessment of hearing problems or other chronic ear problems.
Provision of counseling and therapy for behavior related problems identified by psychological, social and developmental medical evaluations.
Assessment, treatment planning and provision of an integrated developmentally based program of services to strengthen and enhance appropriate developmental outcomes.
A complete medical evaluation that will identify developmental problems and/or coexisting medical problems and provide a plan of treatment or referral for the remediation or management of medical problems.
Psychological testing in such areas as intelligence, achievement, emotional/behavioral, academic and social development; assessment of visual motor integration skills and adaptive behavior; assessment of psychomotor speed and strength, memory executive functioning including attention, problem solving and mental flexibility, verbal fluency and word finding.
Assessment of a child's nutritional deficiencies or special needs to include a plan of treatment to prevent, improve or resolve a developmental or other medical condition.
Evaluation, therapy and programming recommendations for motor dysfunction patients; coordination with medical and speech pathology assessments to maximize muscle function and coordination.
Psychiatric evaluation that will identify psychological and/or behavioral problems and provide a plan of treatment or referral to appropriate treatment. Provision of counseling and therapy may be included.
Psychological testing/assessment in such areas as development, intelligence, achievement, emotional, behavioral, academic and social development and assessment of visual motor integration skills and adaptive behavior.
Assessment of social/emotional risks or problems through the gathering of information from patient, family and others related to the treatment planning of the patient. A social history is used to describe all pertinent facts including assessment of family dynamics and need for intervention by CHMS staff.
Assessment of language development, oral-motor functions, articulation problems, strengths and weaknesses in auditory processing capabilities and the provision of therapy for problems identified.
Provision of counseling and therapy for problems identified by psychological, social and medical evaluations.
This professional must possess at a minimum a Bachelor's Degree plus one of the following:
or
or
There must be one (1) ECDS for every fifty (50) beneficiaries enrolled at a CHMS site.
Licensed in the State of Arkansas as a practical nurse.
Licensed in the State of Arkansas as a Psychologist (Ph.D. or PsyD) and has completed postdoctoral training in neuropsychology (including neurophysiology, clinical neuropsychology and neuropsychological assessment).
Dietitian licensed or registered by the State of Arkansas who has special training in the nutritional needs of children.
Licensed in the State of Arkansas as a registered nurse practitioner or advanced practice nurse with documented expertise in pediatrics.
Licensed in the State of Arkansas to practice surgery and/or medicine and has documentable skills in the required CHMS specified subspecialty area.
Licensed in the State of Arkansas and completed an accepted residency in child and adolescent psychiatry.
Licensed in the State of Arkansas as a psychological examiner.
Licensed in the State of Arkansas to provide evaluation, screening and therapeutic services.
Licensed in the State of Arkansas as a registered nurse.
Licensed in the State of Arkansas as an LSW, LCSW holding, at a minimum, a B.A. in Social Work or a Master's Degree in Social Work.
Speech therapist, physical therapist, licensed counselor and occupational therapist, etc. shall be considered as professional clinical personnel provided that they meet the requirements for registration or licensing in their respective professions within the State of Arkansas.
The following standards must be met or exceeded by all Child Health Management Services clinics in the state of Arkansas.
Specifically, in the classroom setting, the following staff-to-beneficiary ratios** must be observed:
The CHMS clinic must adopt policies and procedures which safeguard patient legal, civil and human rights including, but not limited to:
Referral to a CHMS clinic may be made for any medically indicated reason as identified by the primary care physician (PCP). This referral can be made for diagnosis and/or treatment. The population typically served by CHMS providers is defined as follows:
"Children with Special Health Care Needs (CSHCN) are those who have or are at increased risk of chronic physical, developmental, behavioral, or emotional conditions and who require health and related services of a type or amount beyond that required by children generally," as defined by the Bureau of Maternal and Child Health.
CHMS are a combination of diagnostic and daily trans-disciplinary treatment programs and are a melding of developmental, medical, health and therapeutic services, some of which might be considered only educational or social. The medical aspect of these children's special needs and their needs for care by specially trained personnel makes these services health care.
Child Health Management Services are delivered to those children with the most significant medical and/or developmental diagnoses and those presenting with multiple/complex conditions. These children may require one of the following services:
developmental scales, administered by qualified personnel authorized in the manual accompanying the instrument used, which indicate impairment of general functioning similar to that of developmentally disabled persons;
NOTE: Each of these six conditions is sufficient for determination of eligibility independent of each other. This means that a person who is intellectually disabled does not have to have a diagnosis of autism spectrum disorder, epilepsy, spina bifida, down syndrome, or cerebral palsy. Conversely, a person who has autism spectrum disorder, cerebral palsy, epilepsy, spina bifida, or Down syndrome does not have to have an intellectual disability to receive services.
NOTE: In the case of individuals being evaluated for service, eligibility shall be based upon their condition closely related to an intellectual disability by virtue of their adaptive behavior functioning.
Patients referred for developmental concerns are eligible for CHMS if they qualify on two or more developmental evaluations administered by appropriate CHMS professionals:
The developmental evaluation must be comprehensive and include a norm referenced (standardized) evaluation and a criterion referenced evaluation. For all evaluations, the evaluator must document that the test protocols for each instrument were followed and that the evaluator met the qualifications to administer the instrument.
Under the direction of a CHMS physician and with input from the diagnostic evaluation team, an individualized treatment plan will be developed. This plan will include physician orders/prescription for services to be provided. A PCP referral/approval/prescription will be obtained. This includes occupational, physical and speech therapy services.
A DMS-640 form is required for a PCP, or attending physician if the beneficiary is exempt from PCP managed care program requirements, referral and a separate DMS-640 form is required for a prescription for occupational, physical and speech therapy services. The PCP or attending physician must use form DMS-640 when making referrals and prescribing occupational, physical or speech therapy services. View or print form DMS-640. A copy of the prescription must be maintained in the child's CHMS record; the PCP or attending physician retains the original prescription. If occupational, physical and speech therapy sessions are missed; make-up therapy services must not exceed the prescribed number of minutes per week without an additional PCP/attending physician prescription on form DMS-640.
The CHMS physician will determine the appropriate treatment to address the diagnosis, treatment needs and family concerns identified for the beneficiary.
For those children receiving day treatment services on a daily or weekly basis, the individualized treatment plan will be written for a period of 12 months and will be updated as needed.
Prior authorization is required for admission into the CHMS program and for treatment procedures. Intervention/treatment services must be included in the individual treatment plan to be considered for coverage. Refer to Section 262.120 for a listing of the treatment procedure codes that require prior authorization.
Intervention/Treatment Services are defined as assessment and provision of an integrated developmentally based program of services (such as therapy treatment) to strengthen and enhance appropriate developmental outcomes. This treatment service is typically provided multiple times per week based on the orders/treatment plan signed by the CHMS physician.
Therapy Treatment Services may include psychotherapy, speech/language therapy, occupational therapy, physical therapy, behavioral therapy, family counseling, individual and group counseling, pediatric medical treatment and diagnostic services, nutrition and cognitive services. These treatment services are available for children from birth to age 21 and are provided based on the physician's prescription, which authorizes the amount of day treatment needed.
Inspection of care will be performed in conjunction with the certification site visits. A team of healthcare professionals will assess the care needed by and provided to a sampling of CHMS patients.
For each inspection of care visit, the QIO will select patients currently being served by the CHMS clinic. The QIO team will review medical records, and may interview patients, parents and staff and observe treatment in progress.
Any child determined to not meet the requirements for enrollment in a CHMS clinic will be decertified from the program. A written notification will be given to the clinic with a copy mailed to the parents of the patient. The clinic/parents will be allowed thirty (30) calendar days to request reconsideration of the patient decertification to the QIO. A reconsideration of the decertification will be completed with notification to the clinic and parents within fifteen (15) working days from receipt of the appeal.
A written report of the inspection of care finding will be mailed to the Division of Medical Services.
The steps in the intake process are as follows:
Day treatment services for Medicaid beneficiaries must be prior authorized in accordance with the following procedures.
The request must include a report of the findings from the developmental screen, the diagnostic evaluation and a current plan for treatment. Review for medical necessity will be performed on the information sent by the provider. This information must substantiate the need for the child to receive services in a multidisciplinary CHMS clinic, including that the child meets the eligibility criteria laid out in Section 217.000.
Refer to the flow chart in Section 244.000 of this manual for the process outlined above.
Arkansas Medicaid conducts retrospective review of the first 90 minutes per week of occupational, physical and speech therapy services. The purpose of retrospective review is to promote effective, efficient and economical delivery of health care services.
The Quality Improvement Organization (QIO), under contract to the Arkansas Medicaid Program, performs retrospective reviews of medical records to determine if services delivered and reimbursed by Medicaid meet medical necessity requirements. View or print QIO contact information.
For the provider's information specific guidelines have been developed for occupational, physical and speech therapy retrospective reviews. These guidelines may be found in Sections 245.100 through 245.220.
Occupational and physical therapy services must be medically necessary to the treatment of the individual's illness or injury. A diagnosis alone is not sufficient documentation to support the medical necessity of therapy. To be considered medically necessary, the following conditions must be met:
To establish medical necessity, a comprehensive assessment in the suspected area of deficit must be performed. A comprehensive assessment must include:
NOTE: To calculate a child's gestational age, subtract the number of weeks born before 40 weeks of gestation from the chronological age. Therefore, a 7-month-old, former 28 week gestational age infant has a corrected age of 4 months according to the following equation:
7 months - [(40 weeks) - 28 weeks) / 4 weeks]
7 months - [(12) / 4 weeks]
7 months - [3]
4 months
The frequency, intensity and duration of therapy services should always be medically necessary and realistic for the age of the child and the severity of the deficit or disorder. Therapy is indicated if improvement will occur as a direct result of these services and if there is a potential for improvement in the form of functional gain.
Speech-language therapy services must be medically necessary to the treatment of the individual's illness or injury. A diagnosis alone is not sufficient documentation to support the medical necessity of therapy. To be considered medically necessary, the following conditions must be met:
An articulation disorder may manifest as an individual sound deficiency, i.e., traditional articulation disorder, incomplete or deviant use of the phonological system, i.e. phonological disorder or poor coordination of the oral-motor mechanism for purposes of speech production, i.e. verbal and/or oral apraxia, dysarthria.
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
NOTE: To calculate a child's gestational age, subtract the number of weeks born before 40 weeks of gestation from the chronological age. Therefore, a 7-month-old, former 28 week gestational age infant has a corrected age of 4 months according to the following equation:
7 months - [(40 weeks) - 28 weeks) / 4 weeks]
7 months - [(12) / 4 weeks]
7 months - [3]
4 months
NOTE: To calculate a child's gestational age, subtract the number of weeks born before 40 weeks of gestation from the chronological age. Therefore, a 7-month-old, former 28 week gestational age infant has a corrected age of 4 months according to the following equation:
7 months - [(40 weeks) - 28 weeks) / 4 weeks]
7 months - [(12) / 4 weeks]
7 months - [3]
4 months
NOTE: To calculate a child's gestational age, subtract the number of weeks born before 40 weeks of gestation from the chronological age. Therefore, a 7-month-old, former 28 week gestational age infant has a corrected age of 4 months according to the following equation:
7 months - [(40 weeks) - 28 weeks) / 4 weeks]
7 months - [(12) / 4 weeks]
7 months - [3]
4 months
NOTE: To calculate a child's gestational age, subtract the number of weeks born before 40 weeks of gestation from the chronological age. Therefore, a 7-month-old, former 28 week gestational age infant has a corrected age of 4 months according to the following equation:
7 months - [(40 weeks) - 28 weeks) / 4 weeks]
7 months - [(12) / 4 weeks]
7 months - [3]
4 months
NOTE: To calculate a child's gestational age, subtract the number of weeks born before 40 weeks of gestation from the chronological age. Therefore, a 7-month-old, former 28 week gestational age infant has a corrected age of 4 months according to the following equation:
7 months - [(40 weeks) - 28 weeks) / 4 weeks]
7 months - [(12) / 4 weeks]
7 months - [3]
4 months
Eligibility for articulation and/or phonological therapy will be based upon standard scores (SS) of -1.5 SD or greater below the mean from two tests. When -1.5 SD or greater is not indicated by both of these tests, corroborating data from accepted procedures can be used to support the medical necessity of services. (To view a current list of Accepted Tests for Speech-Language Therapy, refer to Section 214.410 of the Occupational, Physical, Speech Therapy Services Manual.)
Eligibility for apraxia therapy will be based upon standard scores (SS) of -1.5 SD or greater below the mean from two tests. When -1.5 SD or greater is not indicated by both of these tests, corroborating data from a criterion-referenced test and/or accepted procedures can be used to support the medical necessity of services. (To view a current list of Accepted Tests for Speech-Language Therapy, refer to Section 214.410 of the Occupational, Physical, Speech Therapy Services Manual.)
Eligibility for voice therapy will be based upon a medical referral for therapy and a functional profile of voice parameters that indicates a moderate or severe deficit/disorder.
Eligibility for fluency therapy will be based upon an SS of -1.5 SD below the mean or greater on the standardized test.
Eligibility for oral-motor/swallowing/feeding therapy will be based upon an in-depth functional profile of oral motor structures and function using a thorough protocol (e.g., checklist, profile) that indicates a moderate or severe deficit or disorder. When moderate or severe aspiration has been confirmed by videofluoroscopic swallow study, the patient can be treated for pharyngeal dysphagia via the recommendations set forth in the swallow study report.
The following diagnosis and evaluation procedure codes are limited to two (2) diagnosis and evaluation encounters per state fiscal year (July 1 through June 30). If additional diagnosis and evaluation procedures are required, the CHMS provider must request an extension of benefits.
|
Procedure Codes |
|||||||
|
92550 |
92551 |
92552 |
92553 |
92555 |
92557 |
92558 |
92567 |
|
92570 |
92582 |
92585 |
92586 |
92587 |
92588 |
96105 |
96111 |
|
96118* |
99201 |
99202 |
99203 |
99204 |
99205 |
||
*Effective for dates of service on and after March 1, 2006, procedure code 96117 was made non-payable and was replaced with procedure code 96118.
A(...)This symbol, along with text in parentheses, indicates the Arkansas 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 |
|
90791 |
U9 |
A(Diagnostic evaluation/review of records (1 unit = 15 minutes), maximum of 3 units; limited to 6 units per state fiscal year) |
|
90833 |
U9 |
A(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 with medical evaluation and management services) |
|
90836 |
U9 |
A(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 with medical evaluation and management services) |
|
90838 |
U9 |
A(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 with medical evaluation and management services) |
|
90887 |
Interpretation of diagnosis (1 unit = 15 minutes), maximum of 3 units; limited to 6 units per state fiscal year |
|
|
92521 |
UA |
A(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 |
A(Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthia) (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, dysarthia) 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) |
|
96101 |
UA, UB |
Psychological testing battery (1 unit = 15 minutes), maximum of 4 units; limited to 8 units per state fiscal year Effective for dates of service on and after March 1, 2006, procedure code 96100 was replaced with procedure code 96101. |
|
97001 |
Evaluation for physical therapy (1 unit = 30 minutes), maximum of 4 units per state fiscal year |
|
|
97003 |
Evaluation for occupational therapy (1 unit = 30 minutes), maximum of 4 units per state fiscal year |
|
|
97802 |
Nutrition Screening: Review of recent nutrition history, medical record, current laboratory and anthropometric data and conference with patient, caregiver or other CHMS professional (1 unit = 15 minutes). Maximum of 2 units; limited to 4 units per state fiscal year |
|
|
97802 |
U1 |
Nutrition Assessment: Assessment/evaluation of current nutritional status through history of nutrition, activity habits and current laboratory data, weight and growth history and drug profile; determination of nutrition needs; formulation of medical nutrition therapy plan and goals of treatment; a conference will be held with parents and/or other CHMS professionals or a written plan for medical nutrition therapy management will be provided (1 unit = 15 minutes). Maximum of 2 units; limited to 4 units per state fiscal year |
|
97802 |
U2 |
Comprehensive Nutrition Assessment: Assessment/ evaluation of current nutritional status through initial history of nutrition, activity and behavioral habits; review of medical records; current laboratory data, weight and growth history, nutrient analysis and current anthropometric data (when available); determination of energy, protein, fat, carbohydrate and macronutrient needs; formulation of medical nutrition therapy plan and goals of treatment. May conference with parent(s)/guardian or caregivers and/or physician for implementation of medical nutrition therapy management or provide a written plan for implementation (1 unit = 15 minutes). Maximum of 4 units; limited to 8 units per state fiscal year |
Refer to Section 202.000 of this manual for Arkansas 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.
A(...)This symbol, along with text in parentheses, indicates the Arkansas 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 |
|
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 |
A(Evaluation of speech fluency (e.g., stuttering, cluttering) (1 unit = 15 minutes; maximum of 4 units) |
|
92522 |
U1, UA |
A(Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthia) (1 unit = 15 minutes; maximum of 4 units) |
|
92523 |
U1, UA |
A ( 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 |
U1 |
High Complex medical exam |
|
99215 |
U1 |
*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.
Section II
Developmental Day Treatment Clinic Services
Individuals with Disabilities Education Act (IDEA)
DDS is the lead agency responsible for the general administration and supervision of the programs and activities utilized to carry out the provisions of Part C of the IDEA. First Connections is the DDS program in Arkansas that administers, monitors, and carries out all Part C of IDEA activities and responsibilities for the state. The First Connections program ensures that appropriate early intervention services are available to all infants and toddlers from birth to thirty-six (36) months of age (and their families) that are suspected of having a developmental delay.
Each DDTCS must, within two (2) working days of receipt of referral of an infant or toddler thirty-six (36) months of age or younger, present the family with DDS-approved information about the Part C program, First Connections, so that the parent/guardian can make an informed choice regarding early intervention options. Each DDTCS must maintain appropriate documentation of parent choice in the child record.
Local Education Agencies (LEA) have the responsibility to ensure that children, ages three (3) until entry into kindergarten, who have or are suspected of having a disability under Part B of IDEA (Part B), receive a Free Appropriate Public Education. The Arkansas Department of
Education provides each DDTCS with the option of participating in Part B as a LEA. Participation as a LEA requires a DDTCS to provide special education and related services in accordance with Part B (Special Education Services) to all children with disabilities it is serving aged three (3) until entry into Kindergarten. A participating DDTCS is also eligible to receive a portion of the federal grant funds made available to LEAs under Part B in any given fiscal year.
Each DDTCS must therefore make an affirmative election to either provide or not provide Special Education Services to all children with disabilities it is serving aged three (3) until entry into kindergarten as follows:
A DDTCS may change its election at any time; however, a decision to change will only be effective as of July 1st. A DDTCS must inform DDS of its intent to change its election no later than March 1st for its election to be effective as of July 1st of the same calendar year. Any decision to change an election received by DDS after March 1st will not be effective until July 1st of the next calendar year. Any time a DDTCS elects to cease providing Special Education Services, the DDTCS must complete a Special Education Referral Form (or any successor form) for each child age three (3) or older it is currently serving, and submit each one to the appropriate LEA.
View or print the Arkansas Department of Education Special Education contact information.
Beneficiaries who continue to qualify for either DDTCS or CHMS during the enrollment period can transfer to another CHMS or DDTCS program based on parent choice. These beneficiaries do not have to undergo another developmental screen.
Beneficiaries who graduate or no longer qualify for DDTCS or CHMS before the end of the enrollment period must be referred to the third party vendor for a developmental screen and obtain a new prescription before they can be reenrolled in a DDTCS or CHMS program.
Diagnosis and evaluation services (D&E) constitute the process of determining a person's eligibility for habilitation services in one of the three levels of care.
D&E services are covered separately from DDTCS habilitation training services. D&E services are reimbursed on a per unit basis with one unit equal to one hour of service. The length of the service may not exceed one unit per date of service. The billable unit includes time spent administering the test, time spent scoring the test and/or time spent writing a test report.
D&E services are covered once each calendar year if the service is deemed medically necessary by a physician. For children in the early intervention and pre-school levels of care, the child must be determined to need D&E services by the developmental screen conducted in accordance with the Manual Governing Independent Assessments and Developmental Screens.
If the physician or DDTCS provider believes that the child has a significant developmental diagnosis, disability, or delay such that he or she does not need a developmental screen, the physician or DDTCS provider may send relevant documentation for review by the Third Party Assessor's clinician. The Clinician will determine the necessity of a developmental screen.
Reimbursement for covered services will be approved only when the individual's attending physician has determined DDTCS core services are medically necessary.
NOTE: Each of these six conditions is sufficient for determination of eligibility independent of each other. This means that a person who is intellectually disabled does not have to have a diagnosis of autism spectrum disorder, epilepsy, spina bifida, down syndrome, or cerebral palsy. Conversely, a person who has autism spectrum disorder, cerebral palsy, epilepsy, spina bifida, or Down syndrome does not have to have an intellectual disability to receive services.
NOTE: In the case of individuals being evaluated for service, eligibility shall be based upon their condition closely related to an intellectual disability by virtue of their adaptive behavior functioning.
Approval of Therapy Benefits
Approval of Therapy Services Denial
When the Division of Medical Services (DMS) denies coverage of services, the beneficiary may request a fair hearing to appeal the denial of services from the Department of Human Services. (See DDS Policy 1076.)
The appeal request must be in writing and received by the appropriate office within thirty (30) days of the date of the denial notification. (See Sections 160.000 and 190.000.)
Arkansas Medicaid conducts retrospective review of the first 90 minutes per week of occupational, physical and speech therapy services. The purpose of retrospective review is to promote effective, efficient and economical delivery of health care services.
The Quality Improvement Organization (QIO), under contract to the Arkansas Medicaid Program, performs retrospective reviews of medical records to determine if services delivered and reimbursed by Medicaid meet medical necessity requirements. View or print QIO contact information.
Specific guidelines have been developed for occupational, physical and speech therapy retrospective reviews. These guidelines may be found in Sections 220.100 through 220.220.
Occupational and physical therapy services must be medically necessary to the treatment of the individual's illness or injury. A diagnosis alone is not sufficient documentation to support the medical necessity of therapy. To be considered medically necessary, the following conditions must be met:
To establish medical necessity, a comprehensive assessment in the suspected area of deficit must be performed. A comprehensive assessment must include:
NOTE: To calculate a child's gestational age, subtract the number of weeks born before 40 weeks of gestation from the chronological age. Therefore, a 7-month-old, former 28 week gestational age infant has a corrected age of 4 months according to the following equation:
7 months - [(40 weeks) - 28 weeks) / 4 weeks]
7 months - [(12) / 4 weeks]
7 months - [3]
4 months
The frequency, intensity and duration of therapy services should always be medically necessary and realistic for the age of the child and the severity of the deficit or disorder. Therapy is indicated if improvement will occur as a direct result of these services and if there is a potential for improvement in the form of functional gain.
Speech-language therapy services must be medically necessary to the treatment of the individual's illness or injury. A diagnosis alone is not sufficient documentation to support the medical necessity of therapy. To be considered medically necessary, the following conditions must be met:
An articulation disorder may manifest as an individual sound deficiency, i.e., traditional articulation disorder, incomplete or deviant use of the phonological system, i.e. phonological disorder, or poor coordination of the oral-motor mechanism for purposes of speech production, i.e. verbal and/or oral apraxia, dysarthria.
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
NOTE: To calculate a child's gestational age, subtract the number of weeks born before 40 weeks of gestation from the chronological age. Therefore, a 7-month-old, former 28 week gestational age infant has a corrected age of 4 months according to the following equation:
7 months - [(40 weeks) - 28 weeks) / 4 weeks]
7 months - [(12) / 4 weeks]
7 months - [3]
4 months
NOTE: To calculate a child's gestational age, subtract the number of weeks born before 40 weeks of gestation from the chronological age. Therefore, a 7-month-old, former 28 week gestational age infant has a corrected age of 4 months according to the following equation:
7 months - [(40 weeks) - 28 weeks) / 4 weeks]
7 months - [(12) / 4 weeks]
7 months - [3]
4 months
NOTE: To calculate a child's gestational age, subtract the number of weeks born before 40 weeks of gestation from the chronological age. Therefore, a 7-month-old, former 28 week gestational age infant has a corrected age of 4 months according to the following equation:
7 months - [(40 weeks) - 28 weeks) / 4 weeks]
7 months - [(12) / 4 weeks]
7 months - [3]
4 months
NOTE: To calculate a child's gestational age, subtract the number of weeks born before 40 weeks of gestation from the chronological age. Therefore, a 7-month-old, former 28 week gestational age infant has a corrected age of 4 months according to the following equation:
7 months - [(40 weeks) - 28 weeks) / 4 weeks]
7 months - [(12) / 4 weeks]
7 months - [3]
4 months
NOTE: To calculate a child's gestational age, subtract the number of weeks born before 40 weeks of gestation from the chronological age. Therefore, a 7-month-old, former 28 week gestational age
infant has a corrected age of 4 months according to the following equation:
7 months - [(40 weeks) - 28 weeks) / 4 weeks]
7 months - [(12) / 4 weeks]
7 months - [3]
4 months
Eligibility for articulation and/or phonological therapy will be based upon standard scores (SS) of -1.5 SD or greater below the mean from two tests. When -1.5 SD or greater is not indicated by both of these tests, corroborating data from accepted procedures can be used to support the medical necessity of services. (To view a current list of Accepted Tests for Speech-Language Therapy, refer to Section 214.410 of the Occupational, Physical, Speech Therapy Services Manual).
Eligibility for apraxia therapy will be based upon standard scores (SS) of -1.5 SD or greater below the mean from two tests. When -1.5 SD or greater is not indicated by both of these tests, corroborating data from a criterion-referenced test and/or accepted procedures can be used to support the medical necessity of services. (To view a current list of Accepted Tests for Speech-Language Therapy, refer to Section 214.410 of the Occupational, Physical, Speech Therapy Services Manual.)
Eligibility for voice therapy will be based upon a medical referral for therapy and a functional profile of voice parameters that indicates a moderate or severe deficit/disorder.
Eligibility for fluency therapy will be based upon an SS of -1.5 SD below the mean or greater on the standardized test.
Eligibility for oral-motor/swallowing/feeding therapy will be based upon an in-depth functional profile of oral motor structures and function using a thorough protocol (e.g., checklist, profile) that indicates a moderate or severe deficit or disorder. When moderate or severe aspiration has been confirmed by videofluoroscopic swallow study, the patient can be treated for pharyngeal dysphagia via the recommendations set forth in the swallow study report.
Prior authorization is not required for DDTCS core service or for the first 90 minutes per week of occupational, physical and speech therapy services.
DDTCS core services are reimbursable on a per unit basis. Partial units are not reimbursable. Service time less than a full unit of service may not be rounded up to a full unit of service and may not be carried over to the next service date.
|
Procedure Code |
Required Modifier |
Description |
|
T1015 |
U4 |
Early Intervention Services (1 unit equals 1 encounter of two hours or more; maximum of 1 unit per day.) |
|
T1015 |
Adult Development Services (1 unit equals 1 hour of service; maximum of 5 cumulative units per day.) |
|
|
T1015 |
U1 |
Pre-School Services (1 unit equals 1 hour of service; maximum of 5 cumulative units per day.) |
|
T1023 |
UB |
Diagnosis and Evaluation Services (not to be billed for therapy evaluations) (1 unit equals 1 hour of service; maximum of 1 unit per date of service.) |
DDS STANDARDS for Certification, Investigation and
Monitoring
FOR CENTER-BASED COMMUNITY
SERVICES
DIVISION OF DEVELOPMENTAL DISABILITIES
SERVICES
PHILOSOPHY & MISSION STATEMENT
The Division of Developmental Disabilities Services (DDS), the DDS
Board, and its providers are dedicated to the pursuit of the following
__________________________ goals:__________________________
. Advocating for adequate funding, staffing, and services to address the needs of persons with developmental disabilities.
. Encouraging an interdisciplinary service system to be utilized in the delivery of appropriate individualized and quality services.
. Protecting the constitutional rights of individuals with disabilities and their rights to personal dignity, respect and freedom from harm.
. Assuring that individuals with developmental disabilities who receive services from DDS are provided uninterrupted essential services until such time a person no longer needs to depend on these services.
. Encouraging family, parent/guardian, individual, and public/community involvement in program development, delivery, and evaluation.
. Engaging in statewide planning that ensures optimal and innovative growth of the Arkansas service system to meet the needs of persons with developmental disabilities and to assist such persons to achieve independence, productivity, and integration into the community.
To accomplish its mission, DDS, the DDS Board, and its providers are committed to the principle and practices of:
normalization; least restrictive alternatives; affirmation of individuals'
constitutional rights; provision of quality services;
the interdisciplinary service delivery model;
and the positive management of challenging behaviors.
INTRODUCTION
The licensing standards for DDS Community Programs have been developed to accomplish: normalization, least restrictive alternatives, affirmation of individuals' constitutional rights, provision of quality services, the interdisciplinary service delivery model, and the positive management of challenging behaviors.
Individual program plans shall be developed with the participation of the individual (18 years and older), as appropriate, the family, and representatives of the services required. The team is responsible for assessing needs, developing a plan to meet them, and contributing to its implementation.
NOTE: It is imperative that all Medicaid providers be enrolled with the Division of Medical Services and meet all enrollment requirements for the specific Medicaid Program for which they are enrolling as an Arkansas Medicaid Provider.
All standards are applicable to all services provided, unless otherwise specified.
Administrative Rules and Regulation Sub-Committee of the Arkansas Legislative Council: October 4, 2007
Effective Date: November 1, 2007
Implementation Date: November 1, 2007
Grandfathering Period: November 1, 2007-October 31, 2008
Guiding Principles: The Governing Board/organization/Leadership is that body of people who have been chosen by the corporation and vested with legal authority to be responsible for directing the business and affairs of the corporation. The responsibilities assured by each Board/organization member by their acceptance of membership are to provide effective and ethical governance leadership on behalf of its owners'/stakeholders' interest to ensure that the organization focuses on its purpose and outcomes for persons served, resulting in the organization's long-term success and stability.
The mission statement of the organization is based on the Board/organization's philosophical motivations, the services provided, and values of the members. The mission statement should identify the population to be served and the services to be provided. This description shall be nondiscriminatory by reason of sex, age, disability, creed, marital status, ethnic, or national membership.
NOTE: See Arkansas Code Ann. §§ 20-48-201 - 20-48-211 for examples of Board/organization responsibilities._____________________________________________________________________
NOTE: All information regarding your organization shall be readily available to staff, consumers,
referral and funding sources, and the interested public pursuant to the Freedom of Information Act.
Note: The Board/organization and its committees should meet with a frequency sufficient
to discharge their responsibilities effectively.
i.e. Parliamentary Procedure, Robert's Rules of Order, etc.);
Board/organization for review by DDS. Minutes shall accurately document all members present and any action taken at the committee meetings to include any committee recommendations to the Board/organization.
Note: The intent of the standard does not rule out a business relationship, but does call for the governing body to decide in advance what relationships are in the best interest of the organization.
Note: Paid employees serving on the Board as of 11/01/07 may continue to serve for the remainder of their current term at which time they must rotate off the Board.
Note: The Board/organization of Directors, at its discretion, may assign this responsibility to staff.
Guiding Principle: An organized training program for Board/organization Members prepares them for their responsibilities and assures that they are kept up-to-date on issues concerning services offered to individuals with a developmental disability.
Note: Possible Training resources include Aspen Publications, which has materials on Board/organization and Administrator training. (www.aspenpublishers.com) Resources or additional information should be obtained from DDS Licensure.
Note: Sections 102 & 104 do not apply to organizations that are not governed by a Board
of Directors
NOTE: DDS SHALL NOT BECOME DIRECTLY INVOLVED IN PERSONNEL ISSUES UNLESS IT DIRECTLY IMPACTS CONSUMER CARE AND/OR SAFETY.
Note: The organization may contact Arkansas Transit Association for further information on drug testing
NOTE: The items in 202A.5 and 202A.6 WILL not be rated for employees hired prior to July 1, 1986.
Note: Staff holding professional licenses may be used in lieu of criminal
background and adult and child maltreatment checks.
Note: Staff holding professional licenses may be used in lieu of criminal background and adult and child maltreatment checks.
Guiding Principle: Staff Training is an organized program which prepares new employees to perform their assigned duties competently and maintains and improves the competencies of all employees. Staff Training for the organization shall provide an on-going mechanism for the evaluation of the impact of the program on services provided to individuals with developmental disabilities. This should include service outcomes to individuals, meeting of the organization objectives and overall mission, compliance with regulatory and professional standards and positive changes in staff performance and attitudes. The needs of individuals with developmental disabilities require the efforts of competent personnel who continually seek to expand knowledge in their fields.
Cross, or Medic First Aid, applicable for ALL direct service personnel)
NOTE: In addition to those areas addressed in these standards, other identified needs based on staff input should be addressed.
NOTE: SEE APPENDIX B for Training Resources
Human Services General Provisions i. Ark. Code Ann. §§ 20-78-215 -- Child sexual abuse - Federal funds j. U.S.C. § 12101 et. seq. --Americans with Disabilities Act of 1990 P. L.
101-336 k. 20 U.S.C. § 1400 et. seq. (Part B and Part C -- P. L. 94-142 Individuals with Disability Education (IDEA) P.L. 99-457 Part C l. 42U.S.C. § 2000a- 2000 h-6-- Title VI of the Civil Rights Act of 1964 m. 29 U.S.C. §§ 706(8) Rehabilitation Act of 1973, 794 - 794(b) Section 504
n. 5 U.S.C. § 552a -- Federal Privacy Act o. 42 U.S.C. § 6000- 6083 -- Developmentally Disabled Assistance & Bill of Rights Act of 1984
Note: SEE APPENDIX B for Training Resources
Note: For all transportation workers employed prior to 11/01/07, documentation of the required training must be on file no later than 11/01/08.
Guiding Principle: The organization shall implement a system of rights that nurtures and protects the dignity and respect of the persons served. The organization shall protect and promote the rights of the persons served. This commitment shall guide the delivery of services and ongoing interactions with the persons served.
and then only for the purposes of the upkeep of their own living space and of common living area and grounds that the individual shares with others.
The information listed in 402.3 A-I must be provided upon admission and annually thereafter.
Guiding Principle: The organization identifies clear protocols related to formal complaints, including grievances and appeals. An organization may have separate policies and procedures for grievances and appeals, or may include these in a common policy and procedure covering complaints, grievances, and appeals. A review of formal complaints, grievances, and appeals gives the organization valuable information to facilitate change that results in better customer service and results for the persons served.
Guiding Principle: A successful health and safety program goes beyond compliance with regulatory requirements and strives to manage risk and to protect the health and safety of persons served, employees, and visitors. A successful health and safety program addresses both minimizing potential hazards and compliance activities.
NOTE: For individuals 3-21 years of age, destruction of incident reports must be in compliance with Department of Education .
An emergency safety situation is defined as unanticipated behavior that places the person served or others at serious threat of violence or risk of injury if no intervention occurs.
Note: The number three (3) means three (3) distinct incidents. The three (3) distinct occurrences could take place in one (1) day.
someone other than item H
Note: An individual for whom a guardian has been appointed retains all legal and civil rights except those which have been expressly limited by court order or which have been specifically granted by order of the court to the guardian. 4.
NOTE: See Section 521 for further guidelines
(Children's services Section).
Guiding Principle: Individual's with developmental disabilities and their families have competencies, capabilities and personal goals that shall be recognized, supported, encouraged, and any assistance to such individual's shall be provided in an individualized manner, consistent with the unique strengths, resources, priorities, concerns, abilities, and capabilities of such individuals. Any plan of service developed should significantly reflect the person for whom it is intended. Services/ supports are most effective when they are adapted to address individual outcomes
NOTE: See individual program sections for specific time frames (Children's services, See Section 521).
Note: Example of barriers are: lack of contract work, lack of funds, lack of staff, individual absent due to illness, prosthetic devices, equipment space, etc. The responsible person may be staff member, individual, family, etc.
Note: Utilization of title is recommended. This could be the individual or parent/guardian.
NOTE: Contact DDS for a list of providers that provide the requested service.
NOTE: See the specific programming section for more detailed information (Children's services 521).
. The specific services furnished;
. The date and actual beginning and ending time of day the services were performed; . Name(s) and title(s) of the person(s) providing the service(s); . The relationship of the services to the goals and objectives described in the person's individualized plan of care and
As a key element in establishing goals/objectives/ personal outcomes, the agency shall assess an individual's/family's preferences, desires, lifestyle choices, strengths, needs, skills, etc. through individual observations or interviews. Documentation of the assessment shall be maintained in the individual's file. At a minimum, the assessment must include:
Vocational Maintenance & Monitoring A. Case Notes
Ratios for Day Programming for Children 0-3 Years 1:4
Ratios for Day Programming for Children 3-5 Years
1:7 If non-integrated according to December 1st child count 1:9 If integrated at the December 1st child count, the center can send in documentation to DDS and use the alternative ratio of 1:9. Provider shall be required to assure DDS that the integrated status is maintained and it will be checked periodically during licensure visits.
The organization shall maintain a 1:10 ratio throughout the building using the following definition.
One direct care staff person that has visual contact while ACTIVELY ENGAGED in providing support and supervision to consumers.
A minimum of forty (40) square feet of program training area per individual served shall be required. This is program-training area only. This does not include halls, storage areas, or administrative offices.
Menus shall be kept on file for a minimum of three (3) months.
NOTE: 'Responsible person' shall be defined by the organization's policy.
NOTE: DDS recommends a 1 to 10 Ratio at all times.
Note: DDS recommends gas heaters with a pilot light and automatic cut-off valve which automatically cuts off gas to the main burner when the pilot light goes out.
Note: The recommended standard for range of comfort is from 65 to 80 degrees F (U.S. Atmospheric Standards 29.1)
Battery operated or electronic smoke detectors, heat sensors, carbon monoxide detectors and/or sprinklers shall be provided in all buildings where services are provided and shall meet life safety codes.
Fire extinguishers shall be required to the extent specified by the State Fire Marshall or his designee and shall be checked annually.
that follows the Life Safety Code 101 and additional National Fire Prevention Agency publications.
The organization shall maintain emergency lighting, (i.e., flashlight or other battery operated lights) as required by the life safety codes.
The organization shall maintain a first aid kit and current first aid manual at all sites where services are provided on a regular, consistent basis.
Note: This can be obtained through Poison Control Center at University of Arkansas
Medical Science Center in Little Rock if you cannot get locally.
Provisions shall be made to control water temperature at facilities where services are provided on a regular, consistent basis.
Note: This standard shall apply only to service areas and where consumers are working.
APPENDIX A SUGGESTED BOARD/ORGANIZATION TRAINING TOPICS
Policy Development and Implementation
Planning and Evaluation
Equal Employment Opportunity/Affirmative Action
Employee Performance Evaluation
Team Building
Performance Management
Effective meetings
Due Process
Freedom of Information
Overview of Department of Human Services
Overview of Developmental Disabilities Services
Philosophy and Goals
Programs, Practices, Policies and procedures of Local Organizations
Overview of Community Integration
History, Philosophy, Causes and Types, Functional Levels, Severity Levels, Prevention and Program Issues in Mental Retardation and Other Developmental Disabilities.
Introduction to Principles of Normalization
Legal rights of Individuals with a Developmental Disability
Interdisciplinary Approach Overview
Age Appropriate Programming
Medications - Implications, Side Effects, legality of Administering
Overview of Federal and State Laws related to serving people with Developmental Disabilities (see index):
U.S.C. S2000a - 2000 h-6; Ark. Code Ann. SS 6-41-222; 20 U.S.C S 14000 et. seq. (Part B & Part H); 29 U.S.C SS 706(8), 794-794(b);
|
ARKANSAS CODE ANNOTATIONS |
ACTS |
|
|
Ark. Code Ann. SS |
6-41-201 - 6-41-222 |
102 of 1972 Handicapped Children's Act |
|
Ark. Code Ann. SS |
20-48-201 - 20-48-211 |
265 of 1969 AR Mental Retardation Act |
|
Ark. Code Ann. SS |
25-19-101 - 25-19-515 |
AR Freedom of Information Act |
|
Ark. Code Ann. SS |
12-12-501 - 12-12-515 |
397 of 1975 Child Abuse and Neglect Act |
|
Ark. Code Ann. SS |
5-28-101 - 5-28-109, 5-28-201 - 5-28-215, 5-28-301 - 5-28-305 |
452 of 1983 Adult Abuse |
|
Ark. Code Ann. SS |
28-65-101 - 28-65-109, 28-65-201 - 28-65-220, 28-65-301 - 28-65-320, 28-65-401 - 28-65-403, 28-65-502, 28-65-601 - 28-65-602 |
940 of 1985 Guardianship Law |
|
Ark. Code Ann. SS |
25-10-102 - 25-10-116, 20-46-202, 20-46-310, 25-2-104, 25-2-105, 25-2-107 |
348 of 1985 DHS Reorganization |
|
Ark. Code Ann. SS |
20-48-601 - 20-48-611 |
611 of 1987 Location of Community Homes |
|
Ark. Code Ann. SS |
12-12-501 et. Seq. |
Child Maltreatment |
|
Ark. Code Ann. SS |
27-34-101 - 27-34-107 |
Child Safety Seat Use |
|
Ark. Code Ann. SS |
20-78-215 |
1050 of 1985 Federal Funds for Child Sexual Abuse |
|
Ark. Code Ann. SS |
6-21-609 |
854 of 1987 Exposure to Smoke |
|
UNI TED STATES CITATIONS |
ACTS |
|
|
42 U.S.C. S2000a - 2000 h-6 |
Title VI of the Civil Rights Act of 1964 |
|
|
20 U.S.C. S14000 et. Seq. |
P. L. 94-142 Individuals with Disability Education (IDEA) P.L. 99-457 Part H |
|
|
29 U.S.C. SS 706(8), 794 - 794(b) |
Rehabilitation Act of 1973 Section 504 |
|
|
42 U. S. C. S 552 |
Federal Freedom of Information Act |
|
|
42 U.S.C. S 6000 - 6083 |
Developmentally Disabled Assistance and Bill of Rights Act of 1984 and Amendments of 1987 |
|
|
5 U.S.C. S 552a |
Federal Privacy Act |
|
|
42 U.S.C. S 12101 et. Seq. |
Americans with Disabilities Act of 1990 P. L. 101-336 |
|
|
42 U. S. C. S 6000 - 6009 |
P. L. 98-527 Developmentally Disabled Assistance & Bill of Rights Act of 1984 |
|
|
6021 - 6030 |
||
|
6041 - 6043 |
||
|
6061 - 6064 |
||
|
6081 - 6083 |
||
ATTACHMENT 3.1-A
AMOUNT, DURATION AND SCOPE OF SERVICES PROVIDED
CATEGORICALLY NEEDY
Apnea (cardiorespiratory) monitors are provided for eligible recipients in the Child Health Services (EPSDT) Program. Use of the apnea monitors must be medically necessary and prescribed by a physician. Prior authorization is not required for the initial one month period. If the apnea monitor is needed longer than the initial month, prior authorization is required.
CHMS services provide full medical multi-discipline diagnosis and evaluation for the purpose of early intervention and prevention for eligible recipients in the Child Health Services (EPSDT) Program. Services are provided, if identified by an Independent Assessment in accordance with the Independent Assessment Manual, in a multi-disciplinary clinic settings and pediatric day program/ intervention settings. Services are limited to the following components:
audiology assessment behavior counseling and therapy
day treatment
medical evaluation neuropsychology testing nutrition assessment occupational therapy/physical therapy psychiatric evaluation psychological
social/emotional assessment speech and language pathology counseling and therapy
CHMS treatment requires prior authorization to determine and verify the patient's need for CHMS services. Effective March 1, 2000, all CHMS treatment services will require prior authorization. Two of the CHMS treatment procedure codes, Z1573 and Z1574, are limited to four (4) per State Fiscal Year (July 1 through June 30). Extension of the benefit limit will be provided if medically necessary.
Limited to comprehensive day treatment centers offering the following scope of services:
Effective for dates of services on or after July 1, 2017, individual and group therapy are limited to six (6) units per week. One unit equals 15 minutes. Evaluations are limited to four (4) units per State Fiscal Year (July 1 through June 30). One unit equals 30 minutes. Extensions of the benefit limit will be provided if medically necessary.
Apnea (cardiorespiratory) monitors are provided for eligible recipients in the Child Health Services (EPSDT) Program. Use of the apnea monitors must be medically necessary and prescribed by a physician. Prior authorization is not required for the initial one month period. If the apnea monitor is needed longer than the initial month, prior authorization is required.
CHMS services provide full medical multi-discipline diagnosis and evaluation for the purpose of early intervention and prevention for eligible recipients in the Child Health Services (EPSDT) Program. Services are provided, if identified by an Independent Assessment in accordance with the Independent Assessment Manual, in a multi-disciplinary clinic settings and pediatric day program/ intervention settings. Services are limited to the following components:
audiology assessment behavior counseling and therapy
day treatment
medical evaluation neuropsychology testing nutrition assessment occupational therapy/physical therapy psychiatric evaluation psychological
social/emotional assessment speech and language pathology counseling and therapy
CHMS treatment requires prior authorization to determine and verify the patient's need for CHMS services. Effective March 1, 2000, all CHMS treatment services will require prior authorization. Two of the CHMS treatment procedure codes, Z1573 and Z1574, are limited to four (4) per State Fiscal Year (July 1 through June 30). Extension of the benefit limit will be provided if medically necessary.
Limited to comprehensive day treatment centers offering the following scope of services:
Core services are provided at three separate levels of care:
Effective for dates of services on or after July 1, 2017, individual and group therapy are limited to six (6) units per week. One unit equals 15 minutes. Evaluations are limited to four (4) units per State Fiscal Year (July 1 through June 30). One unit equals 30 minutes. Extensions of the benefit limit will be provided if medically necessary.
