Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.05-059 - Rehabilitative Hospital Provider Manual Update Transmittal #51

Current through Register Vol. 49, No. 6, June, 2024
SECTION II
-
			 REHABILITATIVE HOSPITAL GENERAL INFORMATION CONTENTS
216.000
Guidelines for Retrospective
			 Review of Occupational, Physical and
Speech Therapy Services
The Quality Improvement Organization (QIO), Arkansas Foundation
				for Medical Care, Inc. (AFMC), under contract with the Arkansas Medicaid
				Program, performs retrospective reviews of medical records to determine the
				medical necessity of services paid for by Medicaid.
AFMC has developed guidelines for retrospective review of
				occupational, physical and speech-language therapy services furnished to
				Medicaid beneficiaries under the age of 21. Those guidelines are included in
				this manual to assist providers in determining and documenting the medical
				necessity of occupational, physical and speech-language therapy
				services.
216.100
Guidelines for Retrospective Review of Occupational and Physical Therapy
			 for Beneficiaries Under the Age of 21
A. Occupational and physical therapy services
			 are services prescribed by a physician for the diagnosis and treatment of
			 movement dysfunction.
B.
			 Occupational and physical therapy services must be medically necessary to the
			 treatment of the individual's illness or injury. To be considered medically
			 necessary, the following conditions must be met:
1. The services must be considered under
			 accepted standards of practice to be a specific and effective treatment for the
			 patient's condition.
2. The
			 services must be of such a level of complexity or the patient's condition must
			 be such that the services required can be safely and effectively performed only
			 by or under the supervision of a qualified physical or occupational
			 therapist.
3. There must be
			 reasonable expectation that therapy a. Will result in a meaningful improvement
			 of a condition or b. Will prevent a worsening of the condition.
C. A diagnosis alone is not
			 sufficient documentation to support the medical necessity of therapy.
D. Assessment for physical or occupational
			 therapy includes
1. A comprehensive evaluation
			 of the patient's physical deficits and functional limitations,
2. The treatment(s) planned to address each
			 identified problem and
3. Treatment
			 goals and objectives.
216.101
Documenting Evaluations
Documentation of an annual evaluation must contain the
				following:
A. Date of
			 evaluation
B. Patient's name and
			 date of birth
C. Diagnosis
			 applicable to specific therapy
D.
			 Background information including pertinent medical history (and gestational age
			 when applicable)
E. Standardized
			 test results, including all subtest scores, when applicable
Rehabilitative Hospital
F. Test results adjusted for prematurity,
			 when applicable, when the child is one year old or younger
G. Objective information describing the
			 child's gross/fine motor abilities/deficits, e.g., range of motion
			 measurements, manual muscle testing, muscle tone or a narrative description of
			 the patient's functional mobility skills.
H. Assessment of the results of the
			 evaluation, including recommendations for frequency and intensity of
			 treatment.
I. Signature and
			 credentials of the therapist performing the evaluation.
216.102
Standardized Testing
A. Tests used must be norm-referenced,
			 standardized tests specific to the therapy provided.
1. Tests must be age appropriate for the
			 child being tested.
2. Test results
			 must be reported as standard scores, Z scores, T scores or
			 percentiles.
3. Age-equivalent
			 scores and percentage of delay do not justify the medical necessity of
			 services.
B. A score of
			 negative 1.50 standard deviations or more from the mean in at least one subtest
			 area or composite score is required to qualify for services.
C. If the child cannot be tested with a
			 norm-referenced, standardized test, criterion-based testing or a functional
			 description of the patient's gross/fine motor deficits may be used.
			 Documentation of the reason(s) that a standardized test could not be used must
			 be included in the evaluation.
D.
			 The Mental Measurement Yearbook (MMY) is the standard reference to determine
			 reliability/validity. Refer to sections
			 217.112 through
			 217.119 for listings of the
			 standardized tests accepted by AFMC.
216.103
Other Objective Tests and
			 Measures
A.
Range of
			 Motion:
A limitation of greater than ten degrees and/or documentation of
			 how the deficit limits function.
B.
Muscle Tone:
Modified Ashworth Scale.
C.
Manual Muscle Test:
A
			 deficit is a muscle strength grade of fair (3/5) or below that impedes
			 functional skills. With increased muscle tone, as in cerebral palsy, testing is
			 unreliable.
D.
Transfer
			 Skills:
Documented as the amount of assistance required to perform
			 transfer, i.e., maximum, moderate or minimal assistance. A deficit is defined
			 as the inability to perform a transfer safely and independently.
216.104
Progress
			 Notes
Progress notes must be legible and include:
A. Patient's name
B. Date of service
C. Time in and time out of each therapy
			 session
D. Objectives addressed
			 (should correspond to the plan of care)
E. Descriptions of specific therapy services
			 provided and activities conducted during each therapy session, including
			 progress measurements
F.
			 Therapist's full signature and credentials for each date of service
G. Co-signature of supervising physical
			 therapist or occupational therapist on graduate student's notes
216.105
Frequency, Intensity
			 and Duration of Therapy Services
A.
			 Frequency, intensity and duration of therapy services must be medically
			 necessary and realistic for the age of the patient and the severity of the
			 deficit or disorder.
B. Therapy is
			 indicated if there is a potential for functional improvement as a direct result
			 of these services.
216.106
Duration of Services
A. Therapy services may be provided as long
			 as reasonable progress is made toward established goals.
B. When reasonable functional progress cannot
			 be expected with continued therapy, the provider must discontinue therapy
			 services but may work with the patient's caregiver(s) to help establish an
			 in-home maintenance therapy plan, with monitoring.
216.107
In-Home Maintenance
			 Therapy
A. Services that are performed
			 primarily to maintain range of motion or to provide positioning services for
			 the patient do not routinely require the skilled services of a physical or
			 occupational therapist to perform safely and effectively.
B. Such services can be provided to the child
			 as part of a home program administered by the child's caregivers, with
			 occasional monitoring by the therapist.
216.108
Monitoring In-Home Maintenance
			 Therapy
A provider may monitor in-home maintenance therapy to ensure
				that the child is maintaining a desired skill level or to assess the
				effectiveness and fit of equipment, such as orthotics and durable medical
				equipment.
A. Monitoring frequency
			 should be based on an interval that is reasonable for the complexity of the
			 problem(s) being addressed.
B. If a
			 hospital providing therapy services cannot monitor in-home maintenance therapy
			 by seeing the patient in the outpatient hospital, the provider must ask the
			 primary care physician (PCP) to refer the case to an individual or group
			 provider in the Occupational, Physical and Speech Therapy Program or- when
			 applicable to physical therapy - a Home Health provider.
216.110
Definitions of Terms
A.
Standard:
Evaluations that
			 are used to determine deficits.
B.
Supplemental:
Evaluations that are used to justify deficits and
			 support other results. Supplemental tests may not supplant standard
			 tests.
C.
Clinical
			 observations:
Clinical observations always have a supplemental role in
			 the evaluation, but the must always be included. Detail, precision and
			 comprehensiveness of clinical observations are especially important when
			 standard scores do not qualify the patient for therapy and the clinical notes
			 constitute the primary justification of medical necessity.
216.120
Accepted Tests for Occupational
			 Therapy
A. Tests must be norm
			 referenced, standardized, age appropriate and specific to the therapy
			 provided.
B. The listing of tests
			 in sections
			 216.121 through
			 216.129 is not
			 all-inclusive.
C. When a test not
			 listed is used, the provider must document the reliability and validity of the
			 test.
D. The
MMY
is the standard reference for determining the reliability and validity
			 of tests administered in an evaluation.
E. An explanation why a test from the
			 approved list could not be used to evaluate the patient must also be
			 included.
216.121
Fine Motor Skills - Standard
A.
			 Peabody Developmental Motor Scales (PDMS, PDMS2)
B. Toddler and Infant Motor Evaluation
			 (TIME)
C. Bruininks-Oseretsky Test
			 of Motor Proficiency (BOMP)
216.122
Fine Motor Skills -
			 Supplemental
A. Early Learning
			 Accomplishment Profile (ELAP)
B.
			 Learning Accomplishment Profile (LAP)
C. Mullen Scales of Early Learning,
			 Infant/Preschool (MSEL)
D. Miller
			 Assessment for Preschoolers (MAP)
E. Functional Profile
F. Hawaii Early Learning Profile
			 (HELP)
G. Battelle Developmental
			 Inventory (BDI)
H. Developmental
			 Assessment of Young Children (DAYC)
I. Brigance Developmental Inventory
			 (BDI)
216.123
Visual Motor - Standard
A.
			 Developmental Test of Visual Motor Integration (VMI)
B. Test of Visual Motor Integration
			 (TVMI)
C. Test of Visual Motor
			 Skills
D. Test of Visual Motor
			 Skills - R (TVMS)
216.124
Visual Perception -
			 Standard
A. Motor Free Visual
			 Perceptual Test
B. Motor Free
			 Visual Perceptual Test - R (MVPT)
C. Developmental Test of Visual Perceptual
			 2/A (DTVP)
D. Test of Visual
			 Perceptual Skills
E. Test of Visual
			 Perceptual Skills (upper level) (TVPS)
216.125
Handwriting
A. Evaluation Test of Children's Handwriting
			 (ETCH)
B. Test of Handwriting
			 Skills (THS)
C. Children's
			 Handwriting Evaluation Scale
216.126
Sensory Processing -
			 Standard
A. Sensory Profile for
			 Infants/Toddlers
B. Sensory Profile
			 for Preschoolers
C. Sensory Profile
			 for Adolescents/Adults
D. Sensory
			 Integration and Praxis Test (SIPT)
E. Sensory Integration Inventory Revised
			 (Sll-R)
216.127
Sensory Processing - Supplemental
A. Sensory Motor Performance
			 Analysis
B. Analysis of Sensory
			 Behavior
C. Sensory Integration
			 Inventory
D. DeGangi-Berk Test of
			 Sensory Integration
216.128
Activities of Daily
			 Living/Vocational/Other - Standard
A.
			 Pediatric Evaluation of Disability Inventory (PEDI)
1. The PEDI can also be used for older
			 children whose functional abilities fall below that expected of a
TA
year old with no disabilities.
2. When this is the case, the scaled score is
			 the most appropriate score to consider.
B. Adaptive Behavior Scale - School
			 (ABS)
C. Jacobs Pre-vocational
			 Assessment
D. Kohlman Evaluation of
			 Daily Living Skills
E. Milwaukee
			 Evaluation of Daily Living Skills
F. Cognitive Performance Test
G. Purdue Pegboard
H. Functional Independence Measure
			 (FIM)
I. Functional Independence
			 Measure - young version (WeeFIM)
216.129
Activities of Daily
			 Living/Vocational/Other - Supplemental
A. School Function Assessment (SFA)
B. Bay Area Functional Performance
			 Evaluation
C. Manual Muscle
			 Test
D. Grip and Pinch
			 Strength
E. Jordan Left-Right
			 Reversal Test
F. Erhardy
			 Developmental Prehension
G. Knox
			 Play Scale
H. Social Skills Rating
			 System
I. Goodenough Harris Draw a
			 Person Scale
216.130
Accepted Tests for Physical Therapy
A. Tests used must be norm referenced,
			 standardized, age appropriate and specific to the therapy provided.
B. The lists of tests in sections
			 216.131 through
			 216.135 are not
			 all-inclusive.
C. When using a test
			 not listed, the provider must document the reliability and validity of the
			 test.
D. The MMY is the standard
			 reference for determining the reliability and validity of tests administered in
			 an evaluation.
E. An explanation
			 why a test from the approved list could not be used to evaluate a patient must
			 also be included.
216.131
Norm Reference
A. Adaptive Areas Assessment
B. Test of Gross Motor Development
			 (TGMD-2)
C. Peabody Developmental
			 Motor Scales, Second Ed. (PDMS-2)
D. Bruininks-Oseretsky Test of Motor
			 Proficiency (BOMP)
E. Pediatric
			 Evaluation of Disability Inventory (PEDI)
F. Test of Gross Motor Development - 2
			 (TGMD-2)
G. Peabody Developmental
			 Motor Scales (PDMS)
H. Alberta
			 Infant Motor Scales (AIM) H. Alberta Infant Motor Scales (AIM)
I. Toddler and Infant Motor Evaluation
			 (TIME)
J. Functional Independence
			 Measure for Children (WeeFIM)
K.
			 Gross Motor Function Measure (GMFM)
L. Adaptive Behavior Scale - School, Second
			 Ed. (AAMR-2)
M. Movement Assessment
			 Battery for Children (Movement ABC)
216.132
Physical Therapy -
			 Supplemental
A. Bayley Scales of
			 Infant Development, Second Ed. (BSID-2)
B. Neonatal Behavioral Assessment Scale
			 (NBAS)
216.133
Physical Therapy Criterion
A.
			 Developmental assessment for students with severe disabilities, Second Ed.
			 (DASH-2)
B. Milani-Comparetti
			 Developmental Examination
216.134
Physical Therapy - Traumatic
			 Brain Injury (TBI) - Standardized
A.
			 Comprehensive Trail-Making Test
B.
			 Adaptive Behavior Inventory
216.135
Physical Therapy -
			 Piloted
Assessment of Persons Profoundly or Severely Impaired
216.200
Speech-Language
			 Therapy Guidelines for Retrospective Review
216.201
Medical Necessity
A. A diagnosis alone is not sufficient
			 documentation to support the medical necessity of therapy.
B. Assessment for speech-language therapy
			 includes
1. A comprehensive evaluation of the
			 patient's speech-language deficits and functional limitations,
2. Treatment(s) planned to address each
			 identified problem and
3. Treatment
			 goals and objectives.
C.
			 The services must be considered under accepted standards of practice to be a
			 specific and effective treatment for the patient's condition.
D. The services must be of such a level of
			 complexity or the patient's condition must be such that the services required
			 can be safely and effectively performed only by or under the supervision of a
			 qualified speech and language pathologist.
E. There must be reasonable expectation that
			 therapy
1. Will result in a meaningful
			 improvement of the condition or
2.
			 Will prevent a worsening of the condition.
216.202
Documenting Evaluations
Documentation of a speech-language evaluation must include the
				following information:
A. Patient's
			 name and date of birth
B. Diagnosis
			 specific to therapy
C. Background
			 information including pertinent medical history and gestational age
D. Standardized test results, including all
			 subtest scores when applicable
E.
			 Adjustment of test results for prematurity, when applicable, when the child is
			 one year old or younger
F. An
			 assessment of the results of the evaluation, including recommendations for
			 frequency and intensity of treatment
G. An explanation why the child was not
			 tested in his or her native language, when such is the case
H. Signature and credentials of the therapist
			 performing the evaluation
216.203
Feeding/Swallowing/Oral
			 Motor
A. May be formally or informally
			 assessed
B. Must have an in-depth
			 functional profile on oral motor structures and function
C. An in-depth functional profile of oral
			 motor structure and function is a description of a patient's oral motor
			 structure that specifically
1. Notes how such
			 structure is impaired in its function and
2. Justifies the medical necessity of
			 feeding/swallowing/oral motor therapy services.
D. Standardized forms are available for the
			 completion of an in-depth functional profile of oral motor structure and
			 function, but a standardized form is not required.
216.204
Voice
A medical evaluation is a prerequisite for voice
				therapy.
216.205
Progress Notes
Progress notes must be legible and must include the following
				information.
A. Patient's
			 name
B. Date of service
C. Time in and time out of each therapy
			 session
D. Objectives addressed
			 (must directly correspond to the plan of care)
E. Descriptions of
F. Specific therapy services provided
			 and
G. Activities
			 conducted
H. Measurements of
			 progress with respect to treatment goals and objectives
I. Therapist's full signature and credentials
			 for each date of service
J. The
			 supervising speech and language pathologist's co-signature on graduate
			 students' progress notes
216.210
Accepted Tests
A. Tests must be norm referenced,
			 standardized, age appropriate and specific to the therapy provided.
B. The listing of tests in sections
			 216.211 and
			 216.212 is not
			 all-inclusive.
C. When using a test
			 not listed in section
			 218.211 or
			 218.212, the provider must
			 maintain documentation supporting the reliability and validity of the test
			 used.
D. An explanation why a test
			 from the approved list could not be used to evaluate a patient must be included
			 in the documentation.
E. The MMY is
			 the standard reference for determining the reliability and validity of test(s)
			 administered in an evaluation.
216.211
Speech-Language Tests -
			 Standardized
A. Preschool Language
			 Scale, Third Ed. (PLS-3)
B.
			 Preschool Language Scale, Fourth Ed. (PLS-4)
C. Test of Early Language Development, Third
			 Ed. (TELD-3)
D. Peabody Picture
			 Vocabulary Test, Third Ed. (PPVT-3)
E. Clinical Evaluation of Language
			 Fundamentals - Preschool (CELF-P)
F. Clinical Evaluation of Language
			 Fundamentals, Third Ed. (CELF-3)
G.
			 Clinical Evaluation of Language Fundamentals, Fourth Ed. (CELF-4)
H.  Communication Abilities Diagnostic Test
			 (CADeT)
I. Test of Auditory
			 Comprehension of Language, Third Ed. (TACL-3)
J. Comprehensive Assessment of Spoken
			 Language (CASL)
K. Oral and Written
			 Language Scales (OWLS)
L. Test of
			 Language Development - Primary, Third Ed. (TOLD-P:3)
M. Test of Word Finding, Second Ed.
			 (TWF-2)
N. Test of Auditory
			 Perceptual Skills, Revised (TAPS-R)
O. Language Processing Test, Revised
			 (LPT-R)
P. Test of Pragmatic
			 Language (TOPL)
Q. Test of Language
			 Competence, Expanded Ed. (TLC-E)
R.
			 Test of Language Development - Intermediate, Third Ed. (TOLD-l:3)
S. Fullerton Language Test for Adolescents,
			 Second Ed. (FLTA)
T. Test of
			 Adolescent and Adult Language, Third Ed. (TOAL-3)
U. Receptive One-Word Picture Vocabulary
			 Test, Second Ed. (ROWPVT-2)
V.
			 Expressive One-Word Picture Vocabulary Test, 2000 Ed. (EOWPVT)
W. Comprehensive Receptive and Expressive
			 Vocabulary Test, Second Ed. (CREVT-2)
X. Kaufman Assessment Battery for Children
			 (KABC)
216.212
Speech-Language Tests - Supplemental
A. Receptive/Expressive Emergent Language
			 Test, Second Ed. (REEL-2)
B.
			 Nonspeech Test for Receptive/Expressive Language
C. Rossetti Infant-Toddler Language Scale
			 (RITLS)
D. Mullen Scales of Early
			 Learning (MSEL)
E. Reynell
			 Developmental Language Scales
F.
			 Illinois Test of Psycholinguistic Abilities, Third Ed. (ITPA-3)
G. Social Skills Rating System - Preschool
			 & Elementary Level (SSRS-1)
H.
			 Social Skills Rating System - Secondary Level (SSRS-2)
216.213
Birth to Three
A. Annual evaluation is required for children
			 aged birth through 2 years who are receiving speech-language therapy.
B. To qualify for language therapy, a child
			 must score negative 1.5 standard deviations (SD; standard score of 77) from the
			 mean in two areas (expressive, receptive) or negative 2.0 SD (standard score of
			 70) from the mean in one area.
C.
			 Two language tests must be reported.
1. At
			 least one test must be a global, norm-referenced, standardized test with good
			 reliability and validity.
2. The
			 second test may be criterion referenced.
D. All subtests, components, and scores must
			 be reported for all tests.
E. All
			 sound errors must be reported for articulation, including positions and types
			 of errors.
F. If phonological
			 testing is used, a traditional articulation test must also be included with a
			 standardized score.
G. Information
			 regarding the patient's functional hearing ability must be included in the
			 therapy evaluation report.
H. If
			 the patient cannot complete a norm-referenced test, the provider must complete
			 an in-depth functional profile of the patient's functional communication
			 abilities.
1. An in-depth functional profile
			 is a description of a patient's communication behaviors that a. Specifically
			 notes where such communication behaviors are impaired and b. Justifies the
			 medical necessity of therapy.
2.
			 Standardized forms are available for the completion of an in-depth functional
			 profile, but a standardized form is not required.
216.214
Ages 3 through
			 20
A. Negative 1.5 SD (standard score
			 of 77) from the mean in two areas (expressive, receptive, articulation) or
			 negative 2.0 SD (standard score of 70) from the mean in one area (expressive,
			 receptive, articulation) is required to qualify for language therapy.
B. Two language tests must be reported.
1. At least one test must be a global,
			 norm-referenced, standardized test with good reliability and
			 validity.
2. Criterion-referenced
			 tests will not be accepted for this age group.
C. All subtests, components and scores must
			 be reported for all tests.
D. All
			 sound errors must be reported for articulation, including positions and types
			 of errors.
E. If phonological
			 testing is used, a traditional articulation test must also be completed with a
			 standardized score.
F. Information
			 regarding patient's functional hearing ability must be included in the therapy
			 evaluation report.
G. Children who
			 are not of school age or who do not attend public school must be evaluated
			 annually.
H. School-aged children
			 who attend public school and whose therapy is provided by the school must have
			 a full evaluation every three years, with an annual update.
I. If the patient cannot complete a
			 norm-referenced test, the provider must complete an in-depth functional profile
			 of the patient's functional communication abilities.
1. An in-depth functional profile is a
			 description of a patient's communication behaviors that specifically notes
			 where such communication behaviors are impaired and justifies the medical
			 necessity of therapy.
2.
			 Standardized forms are available for the completion of an in-depth functional
			 profile, but a standardized form is not required.
216.220
Intelligence
			 Quotient (IQ)
A. Children receiving
			 language intervention therapy must have cognitive testing once they reach ten
			 (10) years of age, whether they are in public school or they are
			 home-schooled.
B. Language therapy
			 may be determined not medically necessary if a child's IQ is less than or equal
			 to his or her language score, because the child is deemed to be functioning at
			 or above the expected level.
1. If a provider
			 determines that therapy is warranted despite the relationship of IQ to language
			 score, the provider must complete an in-depth functional profile.
2. If the child's IQ is higher than his or
			 her language scores, then the child qualifies for language therapy
C. Accepted IQ tests are listed in
			 sections 216.221 through
			 216.228.
216.221
IQ Tests - Traditional
A. Stanford-Binet
B. The Wechsler Preschool & Primary
			 Scales of Intelligence, Revised (WPPSI-R)
C. Slosson
D. Wechsler Intelligence Scale for Children,
			 Third Ed. (WISC-III)
E. Kauffman
			 Adolescent & Adult Intelligence Test (KAIT)
F. Wechsler Adult Intelligence Scale, Third
			 Ed. (WAIS-III)
G. Differential
			 Ability Scales (DAS)
216.222
Severe and Profound IQ
			 Test/Non-Traditional - Supplemental
A.
			 Comprehensive Test of Nonverbal Intelligence (CTONI)
B. Test of Nonverbal Intelligence (TONI-3) -
			 1997
C. Functional Linguistic
			 Communication Inventory (FLCI)
216.223
Articulation/Phonological
			 Assessments
A. Arizona Articulation
			 Proficiency Scale, Third Ed. (Arizona-3)
B. Goldman-Fristoe Test of Articulation,
			 Second Ed. (GFTA-2)
C. Khan-Lewis
			 Phonological Analysis (KLPA)
D.
			 Slosson Articulation Language Test with Phonology (SALT-P)
E. Bankson-Bernthal Test of Phonology
			 (BBTOP)
F. Smit-Hand Articulation
			 and Phonology Evaluation (SHAPE)
G.
			 Comprehensive Test of Phonological Processing (CTOPP) H. Assessment of
			 Intelligibility of Dysarthric Speech (AIDS)
I. Weiss Comprehensive Articulation Test
			 (WCAT)
J. Assessment of
			 Phonological Processes - R (APPS-R)
K. Photo Articulation Test, Third Ed.
			 (PAT-3)
216.224
Articulation/Phonological Assessments - Supplemental
Test of Phonological Awareness (TOPA)
216.225
Voice/Fluency
			 Assessments
A. Stuttering Severity
			 Instrument for Children and Adults (SSI-3)
B. Language Sample - A language sample with
			 an in-depth profile of the percentage of stuttering and type of stuttering that
			 occurs during conversational speech.
216.226
Auditory Processing
			 Assessments
Goldman-Fristoe-Woodcock Test of Auditory Discrimination
				(G-F-WTAD)
216.227
Oral Motor - Supplemental
Screening Test for Developmental Apraxia of Speech, Second Ed.
				(STDAS-2)
216.228
Traumatic Brain Injury (TBI) Assessments
A. Ross Information Processing Assessment-
			 Primary
B. Test of Adolescent/Adult
			 Word Finding (TAWF)
C. Brief Test
			 of Head Injury (BTHI)
D. Assessment
			 of Language-Related Functional Activities (ALFA)
E. Ross Information Processing Assessment,
			 Second Ed. (RIPA)
F. Scales of
			 Cognitive Ability for Traumatic Brain Injury (SCATBI)
G. Communication Activities of Daily Living,
			 Second Ed. (CADL-2)