Oklahoma Administrative Code
Title 317 - Oklahoma Health Care Authority
Chapter 30 - Medical Providers-Fee for Service
Subchapter 5 - Individual Providers and Specialties
Part 73 - EARLY INTERVENTION SERVICES
Section 317:30-5-641 - Coverage by category
Universal Citation: OK Admin Code 317:30-5-641
Current through Vol. 42, No. 1, September 16, 2024
Payment is made for early intervention services as set forth in this Section.
(1) Adults. There is no coverage for services rendered to adults.
(2) Children. Payment is made for compensable services rendered by the Oklahoma State Department of Health (OSDH) and its contractors, pursuant to the State's plan for Early Intervention services required under Part C of the IDEA .
(A)
Child health screening
examination. An initial screening may be requested by the family of an
eligible individual at any time and must be provided without regard to whether
the individual's age coincides with the established periodicity schedule.
Coordination - referral is made to the SoonerCare provider to assure at a
minimum, that periodic screens are scheduled and provided in accordance with
the periodicity schedule following the initial screening.
(B)
Child health encounter (EPSDT
partial screen). The child health encounter (the EPSDT partial screen)
may include a diagnosis and treatment encounter, a follow-up health encounter,
or a home visit. A child health encounter may include:
(i) Child health history,
(ii) Physical examination,
(iii) Developmental assessment,
(iv) Nutrition assessment and counseling,
(v) Social assessment and
counseling,
(vi) Indicated
laboratory and screening tests,
(vii) Screening for appropriate
immunizations,
(viii) Health
counseling, and
(ix) Treatment of
common childhood illness and conditions.
(C)
Hearing and Hearing Aid
evaluation. Hearing evaluations must meet guidelines found at Oklahoma
Administrative Code (OAC)
317:30-5-676.
(D)
Audiometry test.
Audiometric test (Immittance [Impedance] audiometry or tympanometry) includes
bilateral assessment of middle ear status and reflex studies (when appropriate)
provided by a state licensed audiologist as listed in OAC
317:30-5-675(d)
(1) and (2).
(E)
Ear
impression (for earmold). Ear impression (for earmold) includes taking
impression of client's ear and providing a finished earmold which is used with
the client's hearing aid provided by a state licensed audiologist as listed in
OAC
317:30-5-675(d)
(1) and (2).
(F)
Speech
language evaluation. Speech language evaluation must be provided by a
fully licensed speech- language pathologist.
(G)
Physical therapy evaluation.
Physical therapy evaluation must be provided by a fully licensed physical
therapist.
(H)
Occupational
therapy evaluation. Occupational therapy evaluation must be provided by
a fully licensed occupational therapist.
(I)
Psychological evaluation and
testing. Psychological evaluation and testing must be provided by
State-licensed, board certified, psychologists.
(J)
Vision testing. Vision
testing examination must be provided by a State licensed Doctor of Optometry
(O.D.) or licensed physician specializing in ophthalmology (M.D. or D.O.). At a
minimum, vision services include diagnosis and treatment for defects in vision.
(K)
Treatment
encounter. A treatment encounter may occur through the provision of
individual, family or group treatment services to infants and toddlers who are
identified as having specific disorders or delays in development, emotional or
behavioral problems, or disorders of speech, language, vision, or hearing.
These types of encounters are initiated following the completion of a
diagnostic encounter and subsequent development of the Individual Family
Services Plan (IFSP), and may include the following:
(i)
Hearing and Vision Services.
These services include assisting the family in managing the child's vision
and/or hearing disorder such as auditory training, habilitation training,
communication management, orientation and mobility, and counseling the family.
This encounter is designed to assist children and families with management
issues that arise as a result of hearing and/or vision loss. These services are
usually provided by vision impairment teachers or specialists and orientation
specialists, and mobility specialists. These services may be provided in the
home or community setting, such as a specialized day care center. Hearing
services must be provided by:
(I) A
state-licensed audiologist ; or
(II) A fully licensed, speech- language
pathologist; or
(III) An
audiologist or speech- language pathologist who has completed the equivalent
educational requirements and work experience necessary for the certificate or
has completed the academic program and is acquiring supervised work experience
to qualify for the certificate.
(ii)
Speech-language therapy
services. Speech-language therapy services must be provided by:
(I) A fully licensed, speech-language
pathologist who meets the requirements found at OAC
317:30-5-675(a)
(1) through (3);
(II) A licensed
speech-language pathology assistant who is working under the supervision of a
speech-language pathologist and meets the requirements found at OAC
317:30-5-675(b)
(1) through (4); or
(III) A
licensed speech-language pathology clinical fellow, who is working under the
supervision of a fully licensed speech-language pathologist and meets the
requirements found at OAC
317:30-5-675(c)
(1) through (4).
(iii)
Physical therapy services. Physical therapy services must be
provided by a fully licensed physical therapistor physical therapist assistant,
per OAC
317:30-5-290.1.
(iv)
Occupational therapy
services. Occupational therapy may include provision of services to
improve, develop or restore impaired ability to function independently and must
be provided by a fully licensed occupational therapistor occupational therapy
assistant, per OAC
317:30-5-295.
(v)
Nursing services.
Nursing services may include the provision of services to protect the health
status of infants and toddlers, correct health problems, and assist in removing
or modifying health related barriers and must be provided by a registered nurse
or licensed practical nurse under supervision of a registered nurse. Services
may include medically necessary procedures rendered in the child's home.
(vi)
Psychological
services. Psychological and counseling services are planning and
managing a program of psychological services, including the provision of
counseling or consultation to the family of the infant or toddler, when the
service is for the direct benefit of the child and assists the family to better
understand and manage the child's disabilities. Psychological services must be
provided by a State-licensed psychologist.
(vii)
Psychotherapy counseling
services. Psychotherapy counseling services are the provision of
counseling for children and parents. All services must be for the direct
benefit of the child. Psychotherapy counseling services must be provided by a
State licensed Social Worker, a State Licensed Professional Counselor, a State
licensed Psychologist, State licensed Marriage and Family Therapist, or a State
licensed Behavioral Practitioner, or under Board Supervision to be licensed in
one of the above stated areas.
(viii)
Family Training and Counseling
for Child Development. Family Training and Counseling for Child
Development services are the provision of training and counseling regarding
concerns and problems in development. Services integrate therapeutic
intervention strategies into the daily routines of a child and family in order
to restore or maintain function and/or to reduce dysfunction resulting from a
mental or physical disability or developmental delay. All services must be for
the direct benefit of the child. Family Training and Counseling for Child
Development services must be provided by a Certified Child Development
Specialist.
(L)
Immunizations. Immunizations must be coordinated with the Primary
Care Physician for those infants and toddlers enrolled in SoonerCare. An
administration fee, only, can be paid for immunizations provided by the OSDH.
(M)
Assistive
Technology. Assistive technology is the provision of services that help
to select a device and assist a student with a disability(ies) to use an
Assistive Technology device including coordination with other therapies and
training of the child and caregiver. Services must be provided by a:
(i) A fully licensed speech-language
pathologist as listed in OAC
317:30-5-675(a)
(1) through (3);
(ii) A fully
licensed physical therapist as listed in OAC
317:30-5-290.1(a);
or
(iii) A fully licensed
occupational therapist as listed in OAC
317:30-5-295(a).
Added at 12 Ok Reg 751, eff 1-5-95 through 7-14-95 (emergency); Added at 12 Ok Reg 3131, eff 7-27-95; Amended at 16 Ok Reg 1927, eff 6-11-99; Amended at 18 Ok Reg 2579, eff 6-25-01; Amended at 23 Ok Reg 2562, eff 6-25-06
Disclaimer: These regulations may not be the most recent version. Oklahoma 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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