Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 05 - Developmental Disabilities Services › Rule 016.05.22-002 - Developmental Therapy Services Manual Section II

Current through Register Vol. 49, No. 6, June, 2024
SECTION II
- DEVELOPMENTAL THERAPY
			 SERVICES CONTENTS
200.000
DEVELOPMENTAL THERAPY SERVICES GENERAL INFORMATION
201.000
Arkansas Medicaid Participation
			 Requirements for Developmental 7-1-22
Therapy Services
A provider must meet the following participation requirements
				to qualify as a developmental therapy Service Provider under the Arkansas
				Medicaid Program:
A. Complete the
			 Provider Participation and enrollment requirements contained within Section
			 140.000 of the Arkansas Medicaid Provider Manual; and
B. Obtain certification as a First
			 Connections Developmental Therapy Service Provider from the Arkansas Department
			 of Human Services, Division of Developmental Disabilities Services
			 (DDS).
201.100
Providers of
			 Developmental Therapy Services in Arkansas and Bordering States 7-1-22
Providers of developmental therapy services in Arkansas and
				within fifty (50) miles of the state line in the six (6) bordering states
				(Louisiana, Mississippi, Missouri, Oklahoma, Tennessee, and Texas) may be
				enrolled as Developmental Therapy Service Providers if they meet all Arkansas
				Medicaid Program participation requirements.
202.000
Developmental Therapy Service
			 Documentation 7-1-22
A. Developmental
			 Therapy Providers must maintain records for each client that include
			 sufficient, contemporaneous, written documentation demonstrating the medical
			 necessity of the developmental therapy services provided.
B. Service documentation must include the
			 following items:
1. The date and beginning and
			 ending time for each developmental therapy service;
2. The name(s) and credential(s) of the
			 person(s) providing the developmental therapy services;
3. The name(s) of the Parent(s) or
			 caregiver(s) present and participating in the developmental therapy
			 service;
4. A description of the
			 setting where the developmental therapy service is provided, which must include
			 a physical address;
5. The
			 relationship of the developmental therapy service to the goals and objectives
			 described in the client's individual family service plan (IFSP); and
6. Written progress notes signed or initialed
			 by the person(s) providing the developmental therapy service describing the
			 client's status with respect to their IFSP goals and objectives; duplicative or
			 cut and paste progress notes are not permitted.
The Arkansas Medicaid Program will accept electronic signatures
				in compliance with Arkansas Code §
												25-31-103
				et seq.
211.000
Introduction 7-1-22
The Arkansas Medicaid Program assists eligible Medicaid
				individuals to obtain medical care in accordance with the guidelines specified
				in Section I of this Manual. The Arkansas Medicaid Program will reimburse
				enrolled DDS certified First Connections Developmental Therapy Service
				Providers for medically necessary covered developmental therapy services when
				such services are provided to an eligible client pursuant to the requirements
				in this manual.
212.000
Establishing Program Eligibility 7-1-22
212.100
Age Requirement 7-1-22
A client must be under three (3) years of age to receive
				covered developmental therapy services under the Arkansas Medicaid
				Program.
212.200
Prescription 7-1-22
Covered developmental therapy services require a written
				prescription signed and dated by the client's primary care or attending
				physician or advanced practice registered nurse (APRN) holding a certificate of
				prescriptive authority.
A. The
			 prescription must identify the client's medical needs and demonstrate the
			 medical necessity for the developmental therapy services.
B. A prescription for developmental therapy
			 services is valid for the shorter of the length of time specified on the
			 prescription or one (1) year.
212.300
Qualifying Diagnosis or
			 Developmental Delay 7-1-22
A. A client
			 must meet one (1) of the following to be eligible to receive covered
			 developmental therapy services:
1. A score on
			 both an age- appropriate standardized norm and criterion referenced
			 developmental evaluation that indicates a developmental delay of twenty-five
			 percent (25%) of the client's chronological age or greater in one (1) or more
			 of the five (5) development domains: motor, social, cognitive, self-help or
			 adaptive, or communication;
2. A
			 written informed clinical opinion from the individual family service plan
			 (IFSP) team that details the specific developmental concern or condition that
			 forms the basis of the informed clinical opinion. The informed clinical opinion
			 must describe the rationale, contributing factors, and specific developmental
			 evaluation results that indicate the client qualifies for First Connections,
			 including without limitation why developmental evaluations do not clearly
			 reflect the client's functional ability. It must also explain why developmental
			 therapy services are medically necessary to prevent further developmental
			 delay; or
3. A documented
			 developmental diagnosis of a condition that has a high probability of
			 developmental delay, including without limitation:
i. Down's syndrome and other chromosomal
			 abnormalities associated with intellectual disability;
ii. Congenital syndromes and conditions
			 associated with delays in development such as fetal alcohol syndrome,
			 intra-uterine drug exposure, prenatal rubella, and severe macrocephaly and
			 microcephaly;
iii. Metabolic
			 disorders;
iv. Intra-cranial
			 hemorrhage;
v. Malignancy or
			 congenital anomaly of brain or spinal cord;
vi. Spina bifida;
vii. Seizure disorder, asphyxia, respiratory
			 distress syndrome, neurological disorder, and sensory impairments;
			 and
viii. Maternal Acquired Immune
			 Deficiency Syndrome.
213.000
Non-covered Services
			 7-1-22
A. The Arkansas Medicaid
			 Program will only reimburse for those services listed in Section 214.000.
			 Additionally, the Arkansas Medicaid Program will only reimburse when such
			 services are provided to a Medicaid client meeting the eligibility requirements
			 in Section 212.000 by a DDS First Connections Developmental Therapy Provider
			 meeting all the requirements of this Manual.
B. Arkansas Medicaid ARKids First-B coverage
			 does not reimburse for developmental therapy services.
214.000
Covered Developmental Therapy
			 Services 7-1-22
Covered developmental therapy services under the Arkansas
				Medicaid Program include the following:
A. Developmental evaluation and
			 individualized family service plan (IFSP) development services; and
B. Developmental Therapeutic
			 activities.
214.100
Developmental Evaluation and IFSP Development Services 7-1-22
A. A Developmental Therapy Provider may be
			 reimbursed by the Arkansas Medicaid Program for medically necessary
			 developmental testing evaluation and IFSP development services.
1. Medical necessity for developmental
			 evaluation and IFSP development services is demonstrated by a written
			 prescription from the client's physician or advanced practice registered nurse
			 (APRN) holding a certificate of prescriptive authority.
2. A Developmental Therapy Provider may not
			 be reimbursed for developmental evaluation and IFSP development services if,
			 within the previous six (6) months, the Arkansas Medicaid Program has
			 reimbursed an Early Intervention Day Treatment Provider for providing EIDT
			 evaluation and treatment planning services to the client. See Section 214.100
			 of the Early Intervention Day Treatment Medicaid Manual.
B. Developmental evaluation and IFSP
			 development services include the administration of all necessary diagnostic
			 instruments and tests, interviews, and other information gathering sessions
			 that are required to complete the comprehensive multi-disciplinary
			 developmental evaluation used to determine a client's eligibility for
			 developmental therapy services and develop the client's individualized family
			 service plan.
1. Any evaluation instrument
			 used as part of the comprehensive multi-disciplinary developmental evaluation
			 must be age appropriate and administered by an evaluator with the required
			 qualifications and credentials.
2.
			 Each evaluator must document that they were qualified to administer each
			 evaluation instrument and that the test protocols for each instrument were
			 followed.
C.
			 Developmental evaluation and IFSP development services must be performed in a
			 Natural Environment setting unless DDS has determined that developmental
			 evaluation and IFSP treatment planning cannot be performed satisfactorily in a
			 Natural Environment setting. A "Natural Environment" setting is any typical
			 home or community setting for a similarly aged infant or toddler without a
			 disability or delay that the client and their family frequent, such as the
			 client's home, neighborhood playground, park, or childcare program the client
			 attends with typically developing peers.
D. Developmental evaluation and IFSP
			 development services must include the participation of one (1) or more Parents,
			 family members, or other caregivers.
E. Developmental evaluation and IFSP
			 development services are reimbursed on a per unit basis. The billable unit
			 includes time spent administering an evaluation, scoring an evaluation, and
			 writing an Evaluation Report along with time spent developing the IFSP with the
			 family and Service Coordinator. View or print the billable developmental
			 evaluation and IFSP development services codes.
214.200
Developmental Therapeutic
			 Activities 7-1-22
A. A Developmental
			 Therapy Provider may be reimbursed by the Arkansas Medicaid Program for
			 medically necessary developmental therapeutic activities. Medical necessity for
			 developmental therapeutic activities is demonstrated by a written prescription
			 from the client's physician or advanced practice registered nurse (APRN)
			 holding a certificate of prescriptive authority.
B. Developmental therapeutic activities must
			 involve providing direct one-on-one instruction to a client, with the Parent or
			 a parent-identified caregiver present and involved. The developmental
			 therapeutic activities must be based on a need identified in the individual
			 family service plan (IFSP).
C.
			 Developmental therapeutic activities must be performed in a Natural Environment
			 setting.
1. A "Natural Environment" is any
			 typical home or community setting for a similarly aged infant or toddler
			 without a disability or delay that the client and their family frequent, such
			 as the client's home, neighborhood playground, park, or childcare program the
			 client attends with typically developing peers.
2. Developmental therapeutic activities may
			 be performed in settings other than Natural Environment only with developmental
			 justification of need approved by DDS that documents the developmental
			 therapeutic activities provided in a Natural Environment setting failed to
			 support the client in reaching IFSP goals and objectives.
D. Developmental therapeutic activities must
			 include the participation of one (1) or more Parents, family members, or other
			 parent-identified caregivers.
E.
			 Developmental therapeutic activities are reimbursed on a per unit basis. View
			 or print the billable developmental therapeutic activities codes.
215.000
Individual
			 Family Service Plan (IFSP) 7-1-21
A.
			 Each client receiving developmental therapy services must have an individual
			 family service plan (IFSP). The IFSP is a written, individualized plan to
			 improve the client's condition that must contain, at a minimum:
1. The client's present level of development
			 stated in months with the percentage of client's chronological age delay in
			 each of the five (5) developmental domains, based on professionally acceptable
			 objective criteria;
2. The family's
			 resources, priorities, and concerns related to the development of the
			 client;
3. One (1) or more family
			 outcomes stating what the Parent(s) and family will accomplish;
4. A list of the client's functional
			 outcomes, which must be:
i. Specific,
			 functional, family-driven;
ii.
			 Linked to client and family activities and routines; and
iii. Measurable in a range of months, not to
			 exceed six (6);
5. The
			 action steps that will be taken to reach each functional outcome;
6. The accompanying developmental therapeutic
			 activity service delivery information, which must include:
i. The location for each developmental
			 therapeutic activity session;
ii. A
			 schedule of developmental therapeutic activity sessions that includes the
			 frequency and intensity of each developmental therapeutic activity
			 session;
iii. The name of the
			 Developmental Therapy Service Provider;
iv. The specific date by which the client
			 will be expected to achieve the outcome tied to the developmental therapeutic
			 activities; and
v. The funding
			 source for the developmental therapeutic activities;
7. A list of other services that the client
			 or family will need or receive in order to achieve the client's
			 outcomes;
8. The comprehensive
			 multi-disciplinary developmental evaluation results; and
9. The original signature and date signed of
			 all parties participating in an IFSP meeting.
B. The IFSP must be re-evaluated and updated
			 at least every six (6) months by an interdisciplinary team that includes, at a
			 minimum, the Developmental Therapy Provider, the Service Coordinator, and the
			 client's Parent or /guardian. All parties participating in an IFSP update
			 meeting must sign and date the updated IFSP.
230.000
REIMBURSEMENT
231.000
Method of Reimbursement
			 7-1-22
A. Developmental therapy
			 services use "fee schedule" reimbursement methodology. Under the fee schedule
			 methodology, reimbursement is made at the lower of the billed charge or the
			 maximum allowable reimbursement for the procedure under the Arkansas Medicaid
			 Program. The maximum allowable reimbursement for a procedure is the same for
			 all Developmental Therapy Service Providers.
B. A full unit of service must be rendered to
			 bill a unit of service.
C. Partial
			 units of service may not be rounded up and are not reimbursable.
232.000
Fee Schedules
			 7-1-22
The Arkansas Medicaid Program provides fee schedules on the DHS
				website. View or print the developmental therapy services fee schedule. Fee
				schedules do not address coverage limitations or special instructions applied
				by the Arkansas Medicaid Program before final payment is determined. Fee
				schedules and procedure codes do not guarantee payment, coverage, or the
				reimbursement amount. Fee schedule and procedure code information may be
				changed or updated at any time to correct a discrepancy or
				error.