Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 05 - Developmental Disabilities Services › Rule 016.05.20-005 - SPA #2020-0021 Therapy Amendments to the Occupational, Physical, and Speech-Language Therapy Services Medicaid Provider Manual, with Related Changes to other provider manuals

Current through Register Vol. 49, No. 6, June, 2024
ATTACHMENT 3.1-A
Revised: January 1, 2021
4.
b. Early
			 and Periodic Screening and Diagnosis of Individuals Under 21 Years of Age, and
			 Treatment of Conditions Found.
(14)
			 RESERVED
(15)
Physical
			 Therapy and Related Services
a.
			 Physical Therapy
(1) Services are limited to
			 eligible Medicaid recipients in the Child Health Services (EPSDT)
			 Program.
(2) Effective for dates on
			 or after
January 1, 2021
, evaluations are limited to
two (2)
units per State Fiscal Year (July 1 through June 30). Extensions of the
			 benefit limit will be provided if medically necessary.
(3) Services must be prescribed by a
			 physician and provided by or under the supervision of a qualified physical
			 therapist.
A qualified physical therapist assistant may provide services
				under the supervision of a licensed physical therapist.
All therapies' service definitions and providers must meet the
				requirements of 42 C.F.R. § 440.110.
(4) Effective for dates of service on or
			 after July 1, 2017, individual and group therapy are limited to six (6) units
			 per week. Extensions of the benefit limit will be provided if medically
			 necessary.
(1) No limitation on
			 services within the scope of the program (except for consultations, home health
			 services and personal care services) if services are EPSDT related. Extension
			 of the benefit limit for consultations (2 per State Fiscal Year), home health
			 services (50 visits per State Fiscal Year), personal care services (64 hours
			 per calendar month), personal care transportation (50 units per date of service
			 per recipient), physical therapy evaluations (
2
per State Fiscal
			 Year), occupational therapy evaluations (
2
per State Fiscal Year),
			 speech
-language
therapy evaluations (4 units per State Fiscal
			 Year), and chiropractor X-ray services (2 per State Fiscal Year) will be
			 provided if medically necessary for recipients in the Child Health Services
			 (EPSDT) Program.
Medical Screens are provided based on the recommendations of
				the American Academy of Pediatrics. Childhood immunizations are provided based
				on the Advisory Committee on Immunization Practices (ACIP).
The State will provide other health care described in Section
				1905(a) of the Social Security Act that is found to be medically necessary to
				correct or ameliorate defects and physical and mental illnesses and conditions
				discovered by the screening services, even when such health care is not
				otherwise covered under the State Plan.
b. Occupational Therapy
(1) Services are limited to eligible Medicaid
			 recipients in the Child Health Services (EPSDT) Program.
(2) Services must be prescribed by a
			 physician and provided by or under the supervision of a qualified occupational
			 therapist.
A qualified occupational therapist assistant may provide
				services under the supervision of a licensed occupational therapist.
All therapies' service definitions and providers must meet the
				requirements of 42 C.F.R. § 440.110.
(3) Effective for dates on or after
January 1, 2021
, evaluations are limited to
two (2)
units per State Fiscal Year (July 1 through June 30). Extensions of the benefit
			 limit will be provided if medically necessary.
(4) Effective for dates of service on or
			 after July 1, 2017, individual and group occupational therapy are limited to
			 six (6) units per week. Extensions of the benefit limit will be provided if
			 medically necessary.
c.
			 Services for individuals with speech, hearing and language disorders (provided
			 by or under the supervision of a speech pathologist or audiologist)
(1) Speech
-
language pathology
			 services are limited to Medicaid recipients in the Child Health Services
			 (EPSDT) Program.
(2)
			 Speech
-language
pathology services must be referred by a physician
			 and provided by or under the supervision of a qualified speech
-language
pathologist.
A qualified speech
-language
therapist assistant
				may provide services under the supervision of a licensed speech
-language
therapist.
All therapies' service definitions and providers must meet the
				requirements of 42 C.F.R. § 440.110.
(3) Evaluations are limited to four (4) units
			 per State Fiscal Year (July 1 through June 30). Extensions of the benefit limit
			 will be provided if medically necessary.
(4) Effective for dates of service on or
			 after July 1, 2017, individual and group speech
-
language pathology
			 services are limited to six (6) units per week. Extensions of the benefit limit
			 will be provided if medically
			 necessary.