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 that is not listed below, the provider must include documentation in the evaluation to support the reliability and validity of the test. This additional information will be used as reference information if the chart is 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 Mental Measurement Yearbook (MMY) is 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. The following definitions of terms are applied to the lists of accepted tests:
• STANDARD: Evaluations that are used to determine deficits.
• SUPPLEMENTAL: Evaluations that are used to identify deficits and support other results. Supplemental tests may not supplant standard tests.
• CLINICAL OBSERVATIONS: Clinical observations have a supplemental role in the evaluation and should always be included. Detail, precision and comprehensiveness of clinical observations are especially important when standard scores do not qualify the patient for therapy and the clinical notes constitute the primary justifications of 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)
4. Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2)
5. Test of Infant Motor Performance (TIMP)
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 (SII-R)
6. Sensory Profile School Companion, First Edition-School Companion
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 7 1/2 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) 7 years of age to adult
9. Functional Independence Measure - young version (WeeFIM)
I. Activities of Daily Living/Vocational/Other - Supplemental
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
Credits
Eff. Sept. 1, 2008. Amended Feb. 1, 2010.
<Editor’s Note: Nonfunctioning links so in original.>
Current with amendments received through February 15, 2024. Some sections may be more current, see credit for details.
Ark. Admin. Code 016.06.36-227.210, AR ADC 016.06.36-227.210
