Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.09-040 - Developmental Day Treatment Clinic Services (DDTCS) Provider Manual Update #115

Current through Register Vol. 49, No. 6, June, 2024
Section II
Developmental Day Treatment Clinic Services
214.210
Occupational, Physical and
			 Speech Therapy
Optional services available through DDTCS include occupational,
				physical and speech therapy and evaluation as an essential component of the
				plan of care for an individual accepted for developmental disabilities
				services. Therapy services are not included in the core services and are
				provided in addition to the core services. Procedural and benefit differences
				are based on the beneficiaries age (under age 21 and over age 21 yrs).
A. The DDTCS client's primary care physician
			 (PCP) or attending physician must refer a client for evaluation for
			 occupational, physical or speech therapy services. For clients under the age of
			 21, the use of form DMS-640 is required.
View or print form
			 DMS-640
. The DDTCS client's primary care physician (PCP) or
			 attending physician must also prescribe occupational, physical and/or speech
			 therapy services and again, for clients under the age of 21, the use of an
			 additional form DMS-640 is required for the prescription. The prescribed
			 therapy must be included in the individual's DDTCS plan of care. A copy of the
			 prescription must be maintained in the beneficiary's records. The original
			 prescription is to be maintained by the physician. After the initial referral
			 and initial prescription, subsequent referrals and prescriptions for continued
			 therapy may be made at the same time using the same DMS-640 for clients under
			 age 21. Instructions for completion of form DMS-640 are located on the back of
			 the form. Medicaid will accept an electronic signature provided it is
			 compliance with Arkansas Code
			 25-31-103.
B. Therapies in the DDTCS Program may be
			 provided only to individuals whose plan of care includes one of the three
			 levels of care (early intervention, pre-school or adult development). Medicaid
			 does not cover optional therapy services furnished by a DDTCS provider as
			 "stand-alone" services. To ensure quality care, group therapy sessions are
			 limited to no more than four persons in a group.
1. When a DDTCS provider renders therapy
			 services in conjunction with a DDTCS core service, therapy services must be
			 billed by the DDTCS provider according to billing instructions in Section II of
			 this manual.
2. DDTCS providers may
			 not bill under the Medicaid Occupational, Physical and Speech Therapy Program
			 for therapy services available in the DDTCS Program and provided to DDTCS
			 clients.
3. Therapy services may
			 not be provided during the same time period DDTCS core services are
			 provided.
C. Arkansas
			 Medicaid applies the following therapy benefits to all therapy services
			 provided in the DDTCS program:
1. Medicaid
			 will reimburse up to four (4) occupational, physical and speech therapy
			 evaluation units (1 unit = 30 minutes) per discipline, per state fiscal year
			 (July 1 through June 30) without authorization. Additional evaluation units for
			 beneficiaries under age 21 will require an extended therapy request.
2. Medicaid will reimburse up to four (4)
			 occupational, physical and speech therapy units (1 unit = 15 minutes) daily,
			 per discipline, without authorization. Additional daily therapy units will
			 require an extended therapy request for beneficiaries under age 21.
3. All requests for extended therapy services
			 must comply with sections 217.000 through 217.100 for beneficiaries under age
			 21.
4. All requests for benefit
			 extensions for therapy services provided in the DDTCS
program to beneficiaries age 21 years and over must comply with
				sections 217.700 through 217.800.
D. Make-up therapy sessions are covered for
			 beneficiaries under age 21 in the event a therapy session is canceled or
			 missed, if determined medically necessary and prescribed by the beneficiary's
			 PCP. A make-up therapy session requires a separate prescription from the
			 original previously received. Form DMS-640 must be used by the PCP for make-up
			 therapy session prescriptions for beneficiaries under age 21.
E. Therapy services carried out by an
			 unlicensed therapy student may be covered only when the following criteria are
			 met:
1. Therapies performed by an unlicensed
			 student must be under the direction of a licensed therapist and the direction
			 is such that the licensed therapist is considered to be providing the medical
			 assistance.
2. The licensed
			 therapist must be present and engaged in student oversight during the entirety
			 of any encounter.