Arkansas Department of Education Division of Elementary and Secondary Education Arkansas Medicaid School-Based Therapy Provider Evaluation Guidelines for Retrospective Review

Memo Information

Memo Number
LS-19-012
Memo Date
8/20/2018
Memo Type
Administrative
Unit
Learning Services
Regulatory Authority
Ark Code Ann ยง 20-77-107
Response Required
NO
Attention
Federal Programs; Superintendents; General Business Managers

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Memo Text

The purpose of this memo is to inform school district personnel of school-based therapy provider evaluations. The Arkansas Foundation for Medical Care (AFMC), a contractor of the Arkansas Medicaid Program, has clarified the following Arkansas Medicaid Provider Manual Program Policy Regulations regarding school-based therapy evaluations for retrospective review. 

Arkansas Medicaid Provider Manual Program Policy Regulations 

 
Occupational and Physical Therapy (Section II, Part 214.300, Subsection C, items 11-13) 
Item 11 - Children (birth to age 21) receiving services outside of the public schools must be evaluated annually. 
Item 12 - Children (birth to age 2) in the Child Health Management Services (CHMS) program must be evaluated every six (6) months. 
Item 13 - Children (age three to 21) receiving services within public schools, as a part of an Individual Program Plan (IPP) or an Individual Education Plan (IEP), must have a full evaluation every three years; however, an annual update of progress is required. “School-related” means the child is of school age, attends public school and receives therapy provided by the school. 

Speech (Section II, Part 214.400, Subsection D) 
Item 9 - Children (birth to age 21) receiving services outside of the schools must be evaluated annually. 
Item 10 - Children (birth to 24 months) in the Child Health Management Services (CHMS) Program must be evaluated every 6 months. 
Item 11 - Children (age 3 to 21) receiving services within schools as part of an Individual Program Plan (IPP) or an Individual Education Plan (IEP) must have a full evaluation every three years; however, an annual update of progress is required. “School-related” means the child is of school age, attends public school and receives therapy provided by the school. 
Item 12 - Children (age 3 to 21) receiving privately contracted services, apart from or in addition to those within the schools, must have a full evaluation annually. 
Item 13 - IQ scores are required for all children who are school age and receiving language therapy. Exception: IQ scores are not required for children under ten (10) years of age. 

  • Regulation Clarification 
    The Arkansas Department of Education (ADE) and educational institutions within the authority of the ADE (i.e. public school districts, educational service cooperatives, public school district-associated pre-k programs) is permitted to perform evaluations for children ages three (3) to twenty-one (21) years of age for educational/school-related purposes. Evaluations conducted on behalf of an educational institution and within Individual Education Plan (IEP) guidelines and requirements is valid for a three (3)-year period from the date the evaluation was conducted. 

    The evaluation may transfer with a student between educational institutions. The educational institution must draft a letter stating acceptance/acknowledgement of the incoming evaluation. 

    A district may accept an evaluation performed by a private provider conducted for non-educational purposes, but must draft a letter stating acceptance/acknowledgement of the incoming evaluation, which allows the district to utilize the existing evaluation through the expiration date of one (1) year from the date the evaluation was conducted; after this time, a full evaluation must be performed.

 

 Required Documentation (Section II, Part 204.000, Subsection A) 
Item 4 - Where applicable, an Individualized Family Service Plan (IFSP), Individual Program Plan (IPP) or *Individual Educational Plan *IEP),established pursuant to Part C of the Individuals with Disabilities Education Act. *The entire volume of the IEP is not required for documentation purposes of retrospective review or audit of a facility’s therapy services. Pages one (1) and two (2), the Goals and Objectives page (pertinent to the therapy requested) and the Signature Page of the IEP are all that are normally required for verification as review documentation. 

 

  • Regulation Clarification 
    In order for AFMC to determine the education purpose of the evaluation, the education institution must follow the guidelines listed above or, if the education institution is using the updated IEP format, the entire IEP document should be submitted for review. 

The ADE Medicaid in the Schools, AFMC, Division of Developmental Disabilities Services (DDS), and Division of Medicaid Services (DMS) staff will continue to collaborate to ensure school district personnel have the support necessary to operate and efficient and effective Medicaid program. 


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