Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.05-058 - Physician/Independent Lab/CRNA/ Radiation Therapy Center Provider Manual Update Transmittal #97

Current through Register Vol. 49, No. 6, June, 2024
SECTION II
-
			 PHYSICIAN/INDEPENDENT LAB/CRNA/RADIATION THERAPY CENTER
227.100
Guidelines for Retrospective
			 Review of Occupational, Physical and
Speech Therapy Services
Arkansas Medicaid employed retrospective review of
				occupational, physical and speech therapy services for beneficiaries under age
				21. The purpose of retrospective review is promotion of effective, efficient
				and economical delivery of health care services.
The Quality Improvement Organization (QIO), Arkansas Foundation
				for Medical Care, Inc. (AFMC), under contract to the Arkansas Medicaid Program,
				performs retrospective reviews by reviewing medical records to determine if
				services delivered and reimbursed by Medicaid meet medical necessity
				requirements.
Specific guidelines have been developed for occupational,
				physical and speech therapy retrospective reviews. These guidelines are
				included for information to physicians prescribing and/or providing therapy
				services. The guidelines may be found in sections
				227.200 through
				227.320.
227.200
Occupational and Physical
			 Therapy Guidelines for Retrospective Review
A. Occupational and physical therapy services
			 are medically prescribed services for the diagnosis and treatment of movement
			 dysfunction, which results in functional disabilities.
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 will result in a meaningful improvement or
			 a reasonable expectation that therapy will prevent a worsening of the condition
			 (See
medical necessity
definition in the Glossary of this
			 manual.)
A diagnosis alone is not sufficient documentation to support
				the medical necessity of therapy. Assessment for physical and/or occupational
				therapy includes a comprehensive evaluation of the patient's physical deficits
				and functional limitations, treatment planned and goals to address each
				identified problem.
B. Evaluations:
In order to determine that therapy services are medically
				necessary, an annual evaluation must contain the following:
1. Date of evaluation.
2. Child's name and date of birth.
3. Diagnosis applicable to specific
			 therapy.
4. Background information
			 including pertinent medical history and gestational age.
5. Standardized test results, including all
			 subtest scores, if applicable. Test results, if applicable, should be adjusted
			 for prematurity if the child is one year old or less. The test results should
			 be noted in the evaluation.
6.
			 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 child's functional mobility
			 skills.
7. Assessment of the
			 results of the evaluation, including recommendations for frequency and
			 intensity of treatment.
8.
			 Signature and credentials of the therapist performing the evaluation.
C. Standardized Testing:
1. Tests used must be norm-referenced,
			 standardized tests specific to the therapy provided.
2. Tests must be age appropriate for the
			 child being tested.
3. Test results
			 must be reported as standard scores, Z scores, T scores or percentiles. Age
			 equivalent scores and percentage of delay cannot be used to qualify for
			 services.
4. A score of -1.5
			 standard deviations or more from the mean in at least one subtest area or
			 composite score is required to qualify for services.
5. If the child cannot be tested with a
			 norm-referenced standardized test, criterion-based testing or a functional
			 description of the child's gross/fine motor deficits may be used. Documentation
			 of the reason why a standardized test could not be used must be included in the
			 evaluation.
6. The Mental
			 Measurement Yearbook (MMY) is the standard reference to determine reliability
			 and validity. Refer to sections
			 227.210 and
			 227.220 for a list of
			 standardized tests recognized by the Arkansas Foundation for Medical Care, Inc.
			 (AFMC) for retrospective reviews.
D. Other Objective Tests and Measures:
1. Range of Motion: A limitation of greater
			 than ten degrees and/or documentation of how deficit limits function.
2. Muscle Tone: Modified Ashworth
			 Scale.
3. 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.
4. Transfer Skills:
			 Documented as amount of assistance required to perform transfer, e.g., maximum,
			 moderate, or minimal assistance. A deficit is defined as the inability to
			 perform a transfer safely and independently.
E. Frequency, Intensity and Duration of
			 Physical and/or Occupational Therapy Services:
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.
1. Monitoring: May be used to ensure that the
			 child is maintaining a desired skill level or to assess the effectiveness and
			 fit of equipment such as orthotics and other durable medical equipment.
			 Monitoring frequency should be based on a time interval that is reasonable for
			 the complexity of the problem being addressed.
2. Maintenance Therapy: Services that are
			 performed primarily to maintain range of motion or to provide positioning
			 services for the patient do not qualify for physical or occupational therapy
			 services. These services can be provided to the child as part of a home program
			 that can be implemented by the child's caregivers and do not necessarily
			 require the skilled services of a physical or occupational therapist to be
			 performed safely and effectively.
3. Duration of Services: Therapy services
			 should be provided as long as reasonable progress is made toward established
			 goals. If reasonable functional progress cannot be expected with continued
			 therapy, then services should be discontinued and monitoring or establishment
			 of a home program should be implemented.
F. Progress Notes:
1. Child's name.
2. Date of service.
3. Time in and time out of each therapy
			 session.
4. Objectives addressed
			 (should coincide with the plan of care).
5. A description of specific therapy services
			 provided daily and the activities rendered during each therapy session, along
			 with a form measurement.
6.
			 Progress notes must be legible.
7.
			 Therapists must sign each date of entry with a full signature and
			 credentials.
8. Graduate students
			 must have the supervising physical therapist or occupational therapist co-sign
			 progress notes.
227.210
Accepted Tests for
			 Occupational Therapy
Tests used must be norm referenced, standardized, age
				appropriate and specific to the therapy provided. The following list of tests
				is not all-inclusive. When using a test not listed here, the provider must
				include additional documentation to support the reliability and validity of the
				test. This additional information will be used as reference information if the
				chart is ever selected by Medicaid for review. An explanation of why a test
				from the approved list could not be used to evaluate the child must also be
				included. The MMYis the standard reference to determine the reliability and
				validity of the test(s) administered in an evaluation. Providers should refer
				to the
MMY
for additional information regarding specific
				tests.
DEFINITIONS:
STANDARD: Evaluations that are used to determine
				deficits.
SUPPLEMENTAL: Evaluations that are used to justify deficits and
				support other results. These should not "stand alone."
CLINICAL OBSERVATIONS: All clinical observations are
				supplemental but should be included with every evaluation, especially if
				standard scores do not qualify the child for therapy. It will be considered
				when reviewing for medical necessity.
A. Fine Motor Skills - Standard
1. Peabody Developmental Motor Scales (PDMS,
			 PDMS2)
2. Toddler and Infant Motor
			 Evaluation (TIME)
3.
			 Bruininks-Oseretsky Test of Motor Proficiency (BOMP)
B. Fine Motor Skills - Supplemental
1. Early Learning Accomplishment Profile
			 (ELAP)
2. Learning Accomplishment
			 Profile (LAP)
3. Mullen Scales of
			 Early Learning, Infant/Preschool (MSEL)
4. Miller Assessment for Preschoolers
			 (MAP)
5. Functional
			 Profile
6. Hawaii Early Learning
			 Profile (HELP)
7. Battelle
			 Developmental Inventory (BDI)
8.
			 Developmental Assessment of Young Children (DAYC)
9. Brigance Developmental Inventory
			 (BDI)
C. Visual
			 Motor-Standard
1. Developmental Test of Visual
			 Motor Integration (VMI)
2. Test of
			 Visual Motor Integration (TVMI)
3.
			 Test of Visual Motor Skills
4. Test
			 of Visual Motor Skills - R (TVMS)
D. Visual Perception - Standard
1. Motor Free Visual Perceptual
			 Test
2. Motor Free Visual
			 Perceptual Test - R (MVPT)
3.
			 Developmental Test of Visual Perceptual 2/A (DTVP)
4. Test of Visual Perceptual Skills
5. Test of Visual Perceptual Skills (upper
			 level) (TVPS)
E.
			 Handwriting - Standard
1. Evaluation Test of
			 Children's Handwriting (ETCH)
2.
			 Test of Handwriting Skills (THS)
3.
			 Children's Handwriting Evaluation Scale
F. Sensory Processing - Standard
1. Sensory Profile for
			 Infants/Toddlers
2. Sensory Profile
			 for Preschoolers
3. Sensory Profile
			 for Adolescents/Adults
4. Sensory
			 Integration and Praxis Test (SIPT)
5. Sensory Integration Inventory Revised
			 (Sll-R)
G. Sensory
			 Processing - Supplemental
1. Sensory Motor
			 Performance Analysis
2. Analysis of
			 Sensory Behavior
3. Sensory
			 Integration Inventory
4.
			 DeGangi-Berk Test of Sensory Integration
H. Activities of Daily
			 Living/Vocational/Other - Standard
1.
			 Pediatric Evaluation of Disability Inventory (PEDI)
NOTE:
The PEDI can also be used for older children
				whose functional abilities fall below that expected of a
TA
year old with no disabilities. If this is the case, the scaled score
				is the most appropriate score to consider.
2. Adaptive Behavior Scale - School
			 (ABS)
3. Jacobs Pre-vocational
			 Assessment
4. Kohlman Evaluation of
			 Daily Living Skills
5. Milwaukee
			 Evaluation of Daily Living Skills
6. Cognitive Performance Test
7. Purdue Pegboard
8. Functional Independence Measure
			 (FIM)
9. Functional Independence
			 Measure -young version (WeeFIM) I. Activities of Daily Living/Vocational/Other
			 - Standard
1. School Function Assessment
			 (SFA)
2. Bay Area Functional
			 Performance Evaluation
3. Manual
			 Muscle Test
4. Grip and Pinch
			 Strength
5. Jordan Left-Right
			 Reversal Test
6. Erhardy
			 Developmental Prehension
7. Knox
			 Play Scale
8. Social Skills Rating
			 System
9. Goodenough Harris Draw a
			 Person Scale
227.220
Accepted Tests for Physical
			 Therapy
Tests used must be norm referenced, standardized, age
				appropriate and specific to the therapy provided. The following list of tests
				is not all-inclusive. When using a test not listed here, the provider must
				include additional documentation to support the reliability and validity of the
				test. This additional information will be used as reference information if the
				chart is ever selected by Medicaid for review. An explanation of why a test
				from the approved list could not be used to evaluate the child must also be
				included. The MMYis the standard reference to determine the reliability and
				validity of the test(s) administered in an evaluation. Providers should refer
				to the
MMY
for additional information regarding specific
				tests.
A. Norm Reference
1. Adaptive Areas Assessment
2. Test of Gross Motor Development
			 (TGMD-2)
3. Peabody Developmental
			 Motor Scales, Second Ed. (PDMS-2)
4. Bruininks-Oseretsky Test of Motor
			 Proficiency (BOMP)
5. Pediatric
			 Evaluation of Disability Inventory (PEDI)
6. Test of Gross Motor Development - 2
			 (TGMD-2)
7. Peabody Developmental
			 Motor Scales (PDMS)
8. Alberta
			 Infant Motor Scales (AIM)
9.
			 Toddler and Infant Motor Evaluation (TIME)
10. Functional Independence Measure for
			 Children (WeeFIM)
11. Gross Motor
			 Function Measure (GMFM)
12.
			 Adaptive Behavior Scale - School, Second Ed. (AAMR-2)
13. Movement Assessment Battery for Children
			 (Movement ABC)
B.
			 Physical Therapy - Supplemental
1. Bayley
			 Scales of Infant Development, Second Ed. (BSID-2)
2. Neonatal Behavioral Assessment Scale
			 (NBAS)
C. Physical
			 Therapy Criterion
1. Developmental assessment
			 for students with severe disabilities, Second Ed. (DASH-2)
2. Milani-Comparetti Developmental
			 Examination
D. Physical
			 Therapy - Traumatic Brain Injury (TBI) - Standardized
1. Comprehensive Trail-Making Test
2. Adaptive Behavior Inventory
E. Physical Therapy - Piloted
Assessment of Persons Profoundly or Severely Impaired
227.300
Speech-Language Therapy Guidelines for Retrospective Review
A. Speech-language 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 speech and language
			 pathologist.
3. There must be
			 reasonable expectation that therapy will result in meaningful improvement or a
			 reasonable expectation that therapy will prevent a worsening of the condition.
			 (See
medical necessity
definition in the Glossary of the
			 Arkansas Medicaid manual.)
A diagnosis alone is not sufficient documentation to support
				the medical necessity of therapy. Assessment for speech-language therapy
				includes a comprehensive evaluation of the patient's speech language deficits
				and functional limitations, treatment planned and goals to address each
				identified problem.
B. Evaluations:
In order to determine that speech-language therapy services are
				medically necessary, an evaluation must contain the following
				information:
1. Date of
			 evaluation.
2. Child's name and
			 date of birth.
3. Diagnosis
			 specific to therapy.
4. Background
			 information including pertinent medical history and gestational age.
5. Standardized test results, including all
			 subtest scores, if applicable. Test results should be adjusted for prematurity
			 if the child is one year old or less, and this should be noted in the
			 evaluation.
6. An assessment of the
			 results of the evaluation, including recommendations for frequency and
			 intensity of treatment.
7. The
			 child should be tested in their native language; if not, an explanation must be
			 provided in the evaluation.
8.
			 Signature and credentials of the therapist performing the evaluation.
C. Feeding/Swallowing/Oral Motor:
1. Can be formally or informally
			 assessed.
2. Must have an in-depth
			 functional profile on oral motor structures and function. An in-depth
			 functional profile of oral motor structure and function is a description of a
			 child's oral motor structure that specifically notes how such structure is
			 impaired in its function and justifies the medical necessity of
			 feeding/swallowing/oral motor therapy services. 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.
3. If swallowing problems and/or signs of
			 aspiration are noted, a formal medical swallow study must be
			 submitted.
D. Voice:
A medical evaluation is a prerequisite to voice therapy.
E. Progress Notes:
1. Child's name.
2. Date of service.
3. Time in and time out of each therapy
			 session.
4. Objectives addressed
			 (should coincide with the plan of care).
5. A description of specific therapy services
			 provided daily and the activities rendered during each therapy session, along
			 with a form of measurement.
6.
			 Progress notes must be legible.
7.
			 Therapists must sign each date of entry with a full signature and
			 credentials.
8. Graduate students
			 must have the supervising speech-language pathologist co-sign progress
			 notes.
227.310
List of Accepted Tests
Tests used must be norm referenced, standardized, age
				appropriate and specific to the therapy provided. The following list of tests
				is not all-inclusive. When using a test not listed here, the provider must
				include additional documentation to support the reliability and validity of the
				test. This additional information will be used as reference information if the
				chart is ever selected by Medicaid for review. An explanation of why a test
				from the approved list could not be used to evaluate the child must also be
				included. The MMYis the standard reference to determine the reliability and
				validity of the test(s) administered in an evaluation. Providers should refer
				to the
MMY
for additional information regarding specific
				tests.
A. Speech-Language Tests -
			 Standardized
1. Preschool Language Scale,
			 Third Ed. (PLS-3)
2. Preschool
			 Language Scale, Fourth Ed. (PLS-4)
3. Test of Early Language Development, Third
			 Ed. (TELD-3)
4. Peabody Picture
			 Vocabulary Test, Third Ed. (PPVT-3)
5. Clinical Evaluation of Language
			 Fundamentals - Preschool (CELF-P)
6. Clinical Evaluation of Language
			 Fundamentals, Third Ed. (CELF-3)
7.
			 Clinical Evaluation of Language Fundamentals, Fourth Ed. (CELF-4)
8. Communication Abilities Diagnostic Test
			 (CADeT)
9. Test of Auditory
			 Comprehension of Language, Third Ed. (TACL-3)
10. Comprehensive Assessment of Spoken
			 Language (CASL)
11. Oral and
			 Written Language Scales (OWLS)
12.
			 Test of Language Development - Primary, Third Ed. (TOLD-P:3)
13. Test of Word Finding, Second Ed.
			 (TWF-2)
14. Test of Auditory
			 Perceptual Skills, Revised (TAPS-R)
15. Language Processing Test, Revised
			 (LPT-R)
16. Test of Pragmatic
			 Language (TOPL)
17. Test of
			 Language Competence, Expanded Ed. (TLC-E)
18. Test of Language Development-
			 Intermediate, Third Ed. (TOLD-l:3)
19. Fullerton Language Test for Adolescents,
			 Second Ed. (FLTA)
20. Test of
			 Adolescent and Adult Language, Third Ed. (TOAL-3)
21. Receptive One-Word Picture Vocabulary
			 Test, Second Ed. (ROWPVT-2)
22.
			 Expressive One-Word Picture Vocabulary Test, 2000 Ed. (EOWPVT)
23. Comprehensive Receptive and Expressive
			 Vocabulary Test, Second Ed. (CREVT-2)
24. Kaufman Assessment Battery for Children
			 (KABC)
B. Speech
			 Language Tests - Supplemental
1.
			 Receptive/Expressive Emergent Language Test, Second Ed. (REEL-2)
2. Nonspeech Test for Receptive/Expressive
			 Language
3. Rossetti Infant-Toddler
			 Language Scale (RITLS)
4. Mullen
			 Scales of Early Learning (MSEL)
5.
			 Reynell Developmental Language Scales
6. Illinois Test of Psycholinguistic
			 Abilities, Third Ed. (ITPA-3)
7.
			 Social Skills Rating System - Preschool & Elementary Level
			 (SSRS-1)
8. Social Skills Rating
			 System - Secondary Level (SSRS-2)
C. Birth to Age 3:
1. -(minus)1.5 SD (standard score of 77)
			 below the mean in two areas (expressive, receptive) or a -(minus) 2.0 SD
			 (standard score of 70) below the mean in one area to qualify for language
			 therapy.
2. Two language tests must
			 be reported with at least one of these being a global norm-referenced
			 standardized test with good reliability/validity. The second test may be
			 criterion referenced.
3. All
			 subtests, components, and scores must be reported for all tests.
4. All sound errors must be reported for
			 articulation, including positions and types of errors.
5. If phonological testing is submitted, a
			 traditional articulation test must also be submitted with a standardized
			 score.
6. Information regarding the
			 child's functional hearing ability must be included as a part of the therapy
			 evaluation report.
7.
			 Non-school-aged children must be evaluated annually.
8. If the provider indicates the child cannot
			 complete a norm-referenced test, the provider must submit an in-depth
			 functional profile of the child's functional communication abilities. An
			 in-depth functional profile is a description of a child's communication
			 behaviors that specifically notes where such communication behaviors are
			 impaired and justifies the medical necessity of therapy. Standardized forms are
			 available for the completion of an in-depth functional profile, but a
			 standardized form is not required.
9. Children must be evaluated at least
			 annually. Child Health Management Services (CHMS) children (birth - 2) must be
			 evaluated every 6 months.
D. Ages 3-21:
1. -(minus)1.5 SD (standard score of 77)
			 below the mean in two areas (expressive, receptive, articulation) or a -(minus)
			 2.0 SD (standard score of 70) below the mean in one area (expressive,
			 receptive, articulation).
2. Two
			 language tests must be reported with at least one of these being a global
			 norm-referenced standardized test with good reliability/validity.
			 Criterion-referenced tests will not be accepted for this age group.
3. All subtests, components and scores must
			 be reported for all tests.
4. All
			 sound errors must be reported for articulation, including positions and types
			 of errors.
5. If phonological
			 testing is submitted, a traditional articulation test must also be submitted
			 with a standardized score.
6.
			 Information regarding child's functional hearing ability must be included as a
			 part of the therapy evaluation report.
7. Non-school-age children must be evaluated
			 annually.
8. School-age children
			 must have a full evaluation every three years (a yearly update is required) if
			 therapy is school related; outside of school, annual evaluations are required.
			 "School related" means the child is of school age, attends public school and
			 receives therapy provided by the school.
9. If the provider indicates the child cannot
			 complete a norm-referenced test, the provider must submit an in-depth
			 functional profile of the child's functional communication abilities. An
			 in-depth functional profile is a description of a child's communication
			 behaviors that specifically notes where such communication behaviors are
			 impaired and justifies the medical necessity of therapy. Standardized forms are
			 available for the completion of an in-depth functional profile, but a
			 standardized form is not required.
10. IQ scores are required on all children
			 who are school age and receiving language therapy. Exception: IQ scores will
			 not be required for children under ten (10) years of age.
227.320
Intelligence
			 Quotient (IQ) Testing
Children receiving language intervention therapy must have
				cognitive testing once they reach ten (10) years of age. This also applies to
				home-schooled children. If the IQ score is higher than the qualifying language
				scores, the child qualifies for language therapy; if the IQ score is lower than
				the qualifying language test scores, the child would appear to be functioning
				at or above the expected level. In this case, the child may be denied for
				language therapy. If a provider determines that therapy is warranted, an
				in-depth functional profile must be documented. However, IQ scores will not be
				required for children under ten (10) years of age.
A. IQ Tests - Traditional
1. Stanford-Binet (S-B)
2. The Wechsler Preschool & Primary
			 Scales of Intelligence, Revised (WPPSI-R)
3. Slosson
4. Wechsler Intelligence Scale for Children,
			 Third Ed. (WISC-III)
5. Kauffman
			 Adolescent & Adult Intelligence Test (KAIT)
6. Wechsler Adult Intelligence Scale, Third
			 Ed. (WAIS-III)
7. Differential
			 Ability Scales (DAS)
B.
			 Severe & Profound IQ Test/Non-Traditional - Supplemental - Norm Reference
1. Comprehensive Test of Nonverbal
			 Intelligence (CTONI)
2. Test of
			 Nonverbal Intelligence (TONI-3) - 1997
3. Functional Linguistic Communication
			 Inventory (FLCI)
C.
			 Articulation/Phonological Assessments - Norm Reference
1. Arizona Articulation Proficiency Scale,
			 Third Ed. (Arizona-3)
2.
			 Goldman-Fristoe Test of Articulation, Second Ed. (FGTA-2)
3. Khan-Lewis Phonological Analysis
			 (KLPA)
4. Slosson Articulation
			 Language Test with Phonology (SALT-P)
5. Bankston-Bernthal Test of Phonology
			 (BBTOP)
6. Smit-Hand Articulation
			 and Phonology Evaluation (SHAPE)
7.
			 Comprehensive Test of Phonological Processing (CTOPP)
8. Assessment of Intelligibility of
			 Dysarthric Speech (AIDS)
9. Weiss
			 Comprehensive Articulation Test (WCAT)
10. Assessment of Phonological Processes - R
			 (APPS-R)
11. Photo Articulation
			 Test, Third Ed. (PAT-3)
D. Articulation/Phonological - Supplemental -
			 Norm Reference Test of Phonological Awareness (TOPA)
E. Voice/Fluency Assessments - Norm Reference
			 Stuttering Severity Instrument for Children and Adults (SSI-3)
F. Auditory Processing Assessments - Norm
			 Reference Goldman-Fristoe-Woodcock Test of Auditory Discrimination (G-F-WTAD)
G. Oral Motor - Supplemental -
			 Norm Reference Screening Test for Developmental Apraxia of Speech, Second Ed.
			 (STDAS-2) H. Traumatic Brain Injury (TBI) Assessments - Norm Reference
1. Ross Information Processing Assessment -
			 Primary
2. Test of Adolescent/Adult
			 Word Finding (TAWF)
3. Brief Test
			 of Head Injury (BTHI)
4. Assessment
			 of Language-Related Functional Activities (ALFA)
5. Ross Information Processing Assessment,
			 Second Ed. (RIPA-2)
6. Scales of
			 Cognitive Ability for Traumatic Brain Injury (SCATBI)
7. Communication Activities of Daily Living,
			 Second Ed. (CADL-2)
227.400
Recoupment Process
The Division of Medical Services (DMS), Utilization Review (UR)
				is required to initiate the recoupment process for all claims that Arkansas
				Foundation for Medical Care, Inc. (AFMC), Arkansas' only Quality Improvement
				Organization (QIO) has denied for not meeting the medical necessity
				requirement. Based on QIO findings during respective reviews, UR will initiate
				recoupments as appropriate.
Medicaid will send the provider an Explanation of Recoupment
				Notice that will include the claim date of service, Medicaid beneficiary name
				and ID number, service provided, amount paid by Medicaid, amount to be
				recouped, and the reason the claim has been denied.