Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 73 - EARLY INTERVENTION SERVICES › Section 317:30-5-641 - Coverage by category

Current through Vol. 41, No. 20, July 1, 2024
Payment is made for early intervention services as set
					 forth in this Section.
(1)
Adults.
There is no coverage for services rendered to adults.
(2)
Children.
Payment
				  is made for compensable services rendered by the Oklahoma State Department of
				  Health (OSDH) and its contractors, pursuant to the State's plan for Early
				  Intervention services required under Part C of the IDEA .
(A)
Child health screening
				  examination.
An initial screening may be requested by the family of an
				  eligible individual at any time and must be provided without regard to whether
				  the individual's age coincides with the established periodicity schedule.
				  Coordination - referral is made to the SoonerCare provider to assure at a
				  minimum, that periodic screens are scheduled and provided in accordance with
				  the periodicity schedule following the initial screening.
(B)
Child health encounter (EPSDT
				  partial screen).
The child health encounter (the EPSDT partial screen)
				  may include a diagnosis and treatment encounter, a follow-up health encounter,
				  or a home visit. A child health encounter may include:
(i) Child health history,
(ii) Physical examination,
(iii) Developmental assessment,
(iv) Nutrition assessment and counseling,
(v) Social assessment and
				  counseling,
(vi) Indicated
				  laboratory and screening tests,
(vii) Screening for appropriate
				  immunizations,
(viii) Health
				  counseling, and
(ix) Treatment of
				  common childhood illness and conditions.
(C)
Hearing and Hearing Aid
				  evaluation.
Hearing evaluations must meet guidelines found at Oklahoma
				  Administrative Code (OAC)
				  317:30-5-676.
(D)
Audiometry test.
Audiometric test (Immittance [Impedance] audiometry or tympanometry) includes
				  bilateral assessment of middle ear status and reflex studies (when appropriate)
				  provided by a state licensed audiologist as listed in OAC
				  317:30-5-675(d)
				  (1) and (2).
(E)
Ear
				  impression (for earmold).
Ear impression (for earmold) includes taking
				  impression of client's ear and providing a finished earmold which is used with
				  the client's hearing aid provided by a state licensed audiologist as listed in
				  OAC
				  317:30-5-675(d)
				  (1) and (2).
(F)
Speech
				  language evaluation.
Speech language evaluation must be provided by a
				  fully licensed speech- language pathologist.
(G)
Physical therapy evaluation.
Physical therapy evaluation must be provided by a fully licensed physical
				  therapist.
(H)
Occupational
				  therapy evaluation.
Occupational therapy evaluation must be provided by
				  a fully licensed occupational therapist.
(I)
Psychological evaluation and
				  testing.
Psychological evaluation and testing must be provided by
				  State-licensed, board certified, psychologists.
(J)
Vision testing.
Vision
				  testing examination must be provided by a State licensed Doctor of Optometry
				  (O.D.) or licensed physician specializing in ophthalmology (M.D. or D.O.). At a
				  minimum, vision services include diagnosis and treatment for defects in vision.
(K)
Treatment
				  encounter.
A treatment encounter may occur through the provision of
				  individual, family or group treatment services to infants and toddlers who are
				  identified as having specific disorders or delays in development, emotional or
				  behavioral problems, or disorders of speech, language, vision, or hearing.
				  These types of encounters are initiated following the completion of a
				  diagnostic encounter and subsequent development of the Individual Family
				  Services Plan (IFSP), and may include the following:
(i)
Hearing and Vision Services.
These services include assisting the family in managing the child's vision
				  and/or hearing disorder such as auditory training, habilitation training,
				  communication management, orientation and mobility, and counseling the family.
				  This encounter is designed to assist children and families with management
				  issues that arise as a result of hearing and/or vision loss. These services are
				  usually provided by vision impairment teachers or specialists and orientation
				  specialists, and mobility specialists. These services may be provided in the
				  home or community setting, such as a specialized day care center. Hearing
				  services must be provided by:
(I) A
				  state-licensed audiologist ; or
(II) A fully licensed, speech- language
				  pathologist; or
(III) An
				  audiologist or speech- language pathologist who has completed the equivalent
				  educational requirements and work experience necessary for the certificate or
				  has completed the academic program and is acquiring supervised work experience
				  to qualify for the certificate.
(ii)
Speech-language therapy
				  services.
Speech-language therapy services must be provided by:
(I) A fully licensed, speech-language
				  pathologist who meets the requirements found at OAC
				  317:30-5-675(a)
				  (1) through (3);
(II) A licensed
				  speech-language pathology assistant who is working under the supervision of a
				  speech-language pathologist and meets the requirements found at OAC
				  317:30-5-675(b)
				  (1) through (4); or
(III) A
				  licensed speech-language pathology clinical fellow, who is working under the
				  supervision of a fully licensed speech-language pathologist and meets the
				  requirements found at OAC
				  317:30-5-675(c)
				  (1) through (4).
(iii)
Physical therapy services.
Physical therapy services must be
				  provided by a fully licensed physical therapistor physical therapist assistant,
				  per OAC
				  317:30-5-290.1.
(iv)
Occupational therapy
				  services.
Occupational therapy may include provision of services to
				  improve, develop or restore impaired ability to function independently and must
				  be provided by a fully licensed occupational therapistor occupational therapy
				  assistant, per OAC
				  317:30-5-295.
(v)
Nursing services.
Nursing services may include the provision of services to protect the health
				  status of infants and toddlers, correct health problems, and assist in removing
				  or modifying health related barriers and must be provided by a registered nurse
				  or licensed practical nurse under supervision of a registered nurse. Services
				  may include medically necessary procedures rendered in the child's home.
(vi)
Psychological
				  services.
Psychological and counseling services are planning and
				  managing a program of psychological services, including the provision of
				  counseling or consultation to the family of the infant or toddler, when the
				  service is for the direct benefit of the child and assists the family to better
				  understand and manage the child's disabilities. Psychological services must be
				  provided by a State-licensed psychologist.
(vii)
Psychotherapy counseling
				  services.
Psychotherapy counseling services are the provision of
				  counseling for children and parents. All services must be for the direct
				  benefit of the child. Psychotherapy counseling services must be provided by a
				  State licensed Social Worker, a State Licensed Professional Counselor, a State
				  licensed Psychologist, State licensed Marriage and Family Therapist, or a State
				  licensed Behavioral Practitioner, or under Board Supervision to be licensed in
				  one of the above stated areas.
(viii)
Family Training and Counseling
				  for Child Development.
Family Training and Counseling for Child
				  Development services are the provision of training and counseling regarding
				  concerns and problems in development. Services integrate therapeutic
				  intervention strategies into the daily routines of a child and family in order
				  to restore or maintain function and/or to reduce dysfunction resulting from a
				  mental or physical disability or developmental delay. All services must be for
				  the direct benefit of the child. Family Training and Counseling for Child
				  Development services must be provided by a Certified Child Development
				  Specialist.
(L)
Immunizations.
Immunizations must be coordinated with the Primary
				  Care Physician for those infants and toddlers enrolled in SoonerCare. An
				  administration fee, only, can be paid for immunizations provided by the OSDH.
(M)
Assistive
				  Technology.
Assistive technology is the provision of services that help
				  to select a device and assist a student with a disability(ies) to use an
				  Assistive Technology device including coordination with other therapies and
				  training of the child and caregiver. Services must be provided by a:
(i) A fully licensed speech-language
				  pathologist as listed in OAC
				  317:30-5-675(a)
				  (1) through (3);
(ii) A fully
				  licensed physical therapist as listed in OAC
				  317:30-5-290.1(a);
				  or
(iii) A fully licensed
				  occupational therapist as listed in OAC
				  317:30-5-295(a).