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016.06.36-227.300. Speech-Language Therapy Guidelines for Retrospective Review

AR ADC 016.06.36-227.300Arkansas Administrative CodeEffective: July 1, 2020

West's Arkansas Administrative Code
Title 016. Department of Human Services
Division 06. Division of Medical Services
Rule 36. Physician/Independent Lab/Crna/Radiation Therapy Center Provider Manual (Refs & Annos)
Section 224.000. Inpatient Hospital Services.
Effective: July 1, 2020
Ark. Admin. Code 016.06.36-227.300
016.06.36-227.300. Speech-Language Therapy Guidelines for Retrospective Review
Currentness
A. Medical Necessity
Speech-language therapy services must be medically necessary to the treatment of the individual's illness or injury. A diagnosis alone is insufficient documentation to support the medical necessity of therapy. 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; and
3. There must be a reasonable expectation that therapy will result in meaningful improvement or a reasonable expectation that therapy will prevent a worsening of the condition. (See the medical necessity definition in the Glossary of this manual.)
B. Types of Communication Disorders
1. Language Disorders -- Impaired comprehension or use of spoken, written or other symbol systems. This disorder may involve the following components: forms of language (phonology, morphology, syntax), content and meaning of language (semantics, prosody), function of language (pragmatics) or the perception/processing of language. Language disorders may involve one (1), all, or a combination of the above components.
2. Speech Production Disorders -- Impairment of the articulation of speech sounds, voice, or fluency. Speech Production disorders may involve one (1), all, or a combination of these components of the speech production system.
An articulation disorder may manifest as an individual sound deficiency, i.e., traditional articulation disorder, incomplete or deviant use of the phonological system, i.e., phonological disorder, or poor coordination of the oral-motor mechanism for purposes of speech production, i.e., verbal or oral apraxia, dysarthria.
3. Oral Motor/Swallowing/Feeding Disorders -- Impairment of the muscles, structures, or functions of the mouth (physiological or sensory-based) involved with the entire act of deglutition from placement and manipulation of food in the mouth through the oral and pharyngeal phases of the swallow. These disorders may or may not result in deficits to speech production.
C. Evaluation and Report Components
1. STANDARDIZED SCORING KEY:
Mild: Scores between 84-78; -1.0 standard deviation
Moderate: Scores between 77-71; -1.5 standard deviations
Severe: Scores between 70-64; -2.0 standard deviations
Profound: Scores of sixty-three (63) or lower; -2.0+ standard deviations
2. LANGUAGE: To establish medical necessity, results from a comprehensive assessment in the suspected area of deficit must be reported. (Refer to Section 227.300, part D, paragraphs 9-12 for required frequency of re-evaluations.) A comprehensive assessment for Language disorder must include:
a. Date of evaluation;
b. Child's name and date of birth;
c. Diagnosis specific to therapy;
d. Background information including pertinent medical history; and, if the child is twelve (12) months of age or younger, gestational age. The child should be tested in the child's dominant language; if not, an explanation must be provided in the evaluation.
NOTE: To calculate a child's gestational age, subtract the number of weeks born before forty (40) weeks of gestation from the chronological age. Therefore, a 7-month-old, former 28-week gestational age infant has a corrected age of four (4) months according to the following equation:
7 months -- [(40 weeks) -- 28 weeks) / 4 weeks]
7 months -- [(12) / 4 weeks]
7 months -- [3]
4 months
e. Results from an assessment specific to the suspected type of language disorder, including all relevant scores, quotients, or indexes, if applicable. A comprehensive measure of language must be included for initial evaluations. Use of one-word vocabulary tests alone will not be accepted. (For a list of accepted tests, refer to Section 214.410 of the Occupational, Physical, and Speech-Language Therapy Services Manual.);
f. If applicable, test results should be adjusted for prematurity (less than thirty-seven (37) weeks gestation) if the child is twelve (12) months of age or younger, and this should be noted in the evaluation;
g. Oral-peripheral speech mechanism examination, which includes a description of the structure and function of the orofacial structures;
h. Formal or informal assessment of hearing, articulation, voice, and fluency skills.
i. An interpretation of the results of the evaluation, including recommendations for frequency and intensity of treatment;
j. A description of functional strengths and limitations, a suggested treatment plan, and potential goals to address each identified problem; and
k. Signature and credentials of the therapist performing the evaluation.
3. SPEECH PRODUCTION (Articulation, Phonological, Apraxia): To establish medical necessity, results from a comprehensive assessment in the suspected area of deficit must be reported. (Refer to Section 227.300, part D, paragraphs 9-12 for required frequency of re-evaluations.) A comprehensive assessment for Speech Production (Articulation, Phonological, Apraxia) disorder must include:
a. Date of evaluation;
b. Child's name and date of birth;
c. Diagnosis specific to therapy;
d. Background information including pertinent medical history; and, if the child is twelve (12) months of age or younger, gestational age. The child should be tested in the child's dominant language; if not, an explanation must be provided in the evaluation.
NOTE: To calculate a child's gestational age, subtract the number of weeks born before forty (40) weeks of gestation from the chronological age. Therefore, a 7-month-old, former 28-week gestational age infant has a corrected age of four (4) months according to the following equation:
7 months -- [(40 weeks) -- 28 weeks) / 4 weeks]
7 months -- [(12) / 4 weeks]
7 months -- [3]
4 months
e. Results from an assessment specific to the suspected type of speech production disorder, including all relevant scores, quotients, or indexes, if applicable. All errors specific to the type of speech production disorder must be reported (e.g., positions, processes, motor patterns). (For a list of accepted tests, refer to Section 214.410 of the Occupational, Physical, and Speech-Language Therapy Services Manual.);
f. If applicable, test results should be adjusted for prematurity (less than thirty-seven (37) weeks gestation) if the child is twelve (12) months of age or younger, and this should be noted in the evaluation;
g. Oral-peripheral speech mechanism examination, which includes a description of the structure and function of orofacial structures;
h. Formal screening of language skills. Examples include, but are not limited to, the Fluharty-2, KLST-2, CELF-4 Screen, or TTFC;
i. Formal or informal assessment of hearing, voice, and fluency skills;
j. An interpretation of the results of the evaluation, including recommendations for frequency and intensity of treatment;
k. A description of functional strengths and limitations, a suggested treatment plan, and potential goals to address each identified problem; and
l. Signature and credentials of the therapist performing the evaluation.
4. SPEECH PRODUCTION (Voice): To establish medical necessity, results from a comprehensive assessment in the suspected area of deficit must be reported. (Refer to Section 227.300, part D, paragraphs 9-12 for required frequency of re-evaluations.) A comprehensive assessment for Speech Production (Voice) disorder must include:
a. A medical evaluation to determine the presence or absence of a physical etiology is a prerequisite for evaluation of voice disorder;
b. Date of evaluation;
c. Child's name and date of birth;
d. Diagnosis specific to therapy;
e. Background information including pertinent medical history; and, if the child is twelve (12) months of age or younger, gestational age. The child should be tested in the child's dominant language; if not, an explanation must be provided in the evaluation.
NOTE: To calculate a child's gestational age, subtract the number of weeks born before forty (40) weeks of gestation from the chronological age. Therefore, a 7-month-old, former 28-week gestational age infant has a corrected age of four (4) months according to the following equation:
7 months -- [(40 weeks) -- 28 weeks) / 4 weeks]
7 months -- [(12) / 4 weeks]
7 months -- [3]
4 months
f. Results from an assessment relevant to the suspected type of speech production disorder, including all relevant scores, quotients, or indexes, if applicable. (For a list of accepted tests, refer to Section 214.410 of the Occupational, Physical, and Speech-Language Therapy Services Manual.);
g. If applicable, test results should be adjusted for prematurity (less than thirty-seven (37) weeks gestation) if the child is twelve (12) months of age or younger, and this should be noted in the evaluation;
h. Oral-peripheral speech mechanism examination, which includes a description of the structure and function of orofacial structures;
i. Formal screening of language skills. Examples include, but are not limited to, the Fluharty-2, KLST-2, CELF-4 Screen, or TTFC;
j. Formal or informal assessment of hearing, articulation, and fluency skills;
k. An interpretation of the results of the evaluation, including recommendations for frequency and intensity of treatment;
l. A description of functional strengths and limitations, a suggested treatment plan, and potential goals to address each identified problem; and
m. Signature and credentials of the therapist performing the evaluation.
5. SPEECH PRODUCTION (Fluency): To establish medical necessity, results from a comprehensive assessment in the suspected area of deficit must be reported. (Refer to Section 227.300, part D, paragraphs 9-12 for required frequency of re-evaluations.) A comprehensive assessment for Speech Production (Fluency) disorder must include:
a. Date of evaluation;
b. Child's name and date of birth;
c. Diagnosis specific to therapy;
d. Background information including pertinent medical history; and, if the child is twelve (12) months of age or younger, gestational age. The child should be tested in the child's dominant language; if not, an explanation must be provided in the evaluation.
NOTE: To calculate a child's gestational age, subtract the number of weeks born before forty (40) weeks of gestation from the chronological age. Therefore, a 7-month-old, former 28-week gestational age infant has a corrected age of four (4) months according to the following equation:
7 months -- [(40 weeks) -- 28 weeks) / 4 weeks]
7 months -- [(12) / 4 weeks]
7 months -- [3]
4 months
e. Results from an assessment specific to the suspected type of speech production disorder, including all relevant scores, quotients, or indexes, if applicable. (For a list of accepted tests, refer to Section 214.410 of the Occupational, Physical, and Speech-Language Therapy Services Manual.);
f. If applicable, test results should be adjusted for prematurity (less than thirty-seven (37) weeks gestation) if the child is twelve (12) months of age or younger, and this should be noted in the evaluation;
g. Oral-peripheral speech mechanism examination, which includes a description of the structure and function of orofacial structures;
h. Formal screening of language skills. Examples include, but are not limited to, the Fluharty-2, KLST-2, CELF-4 Screen, or TTFC;
i. Formal or informal assessment of hearing, articulation, and voice skills;
j. An interpretation of the results of the evaluation, including recommendations for frequency and intensity of treatment;
k. A description of functional strengths and limitations, a suggested treatment plan, and potential goals to address each identified problem; and
l. Signature and credentials of the therapist performing the evaluation.
6. ORAL MOTOR/SWALLOWING/FEEDING: To establish medical necessity, results from a comprehensive assessment in the suspected area of deficit must be reported. (Refer to Section 227.300, part D, paragraphs 9-12 for required frequency of re-evaluations.) A comprehensive assessment for Oral Motor/Swallowing/Feeding disorder must include:
a. Date of evaluation;
b. Child's name and date of birth;
c. Diagnosis specific to therapy;
d. Background information including pertinent medical history; and, if the child is twelve (12) months of age or younger, gestational age. The child should be tested in the child's dominant language; if not, an explanation must be provided in the evaluation.
NOTE: To calculate a child's gestational age, subtract the number of weeks born before forty (40) weeks of gestation from the chronological age. Therefore, a 7-month-old, former 28-week gestational age infant has a corrected age of four (4) months according to the following equation:
7 months -- [(40 weeks) -- 28 weeks) / 4 weeks]
7 months -- [(12) / 4 weeks]
7 months -- [3]
4 months
e. Results from an assessment specific to the suspected type of oral motor/swallowing/feeding disorder, including all relevant scores, quotients, or indexes, if applicable. (For a list of accepted tests, refer to Section 214.410 of the Occupational, Physical, and Speech-Language Therapy Services Manual.);
f. If swallowing problems or signs of aspiration are noted, then include a statement indicating that a referral for a videofluoroscopic swallow study has been made;
g. If applicable, test results should be adjusted for prematurity (less than thirty-seven (37) weeks gestation) if the child is twelve (12) months of age or younger, and this should be noted in the evaluation;
h. Formal or informal assessment of hearing, language, articulation, voice, and fluency skills;
i. An interpretation of the results of the evaluation, including recommendations for frequency and intensity of treatment;
j. A description of functional strengths and limitations, a suggested treatment plan, and potential goals to address each identified problem; and
k. Signature and credentials of the therapist performing the evaluation.
D. Interpretation and Eligibility: Ages Birth to 21
1. LANGUAGE: Two (2) language composite or quotient scores (i.e., normed or standalone) in the area of suspected deficit must be reported, with at least one (1) being a norm-referenced, standardized test with good reliability and validity. (Use of two (2) one-word vocabulary tests alone will not be accepted.)
a. For children age birth to three (3): criterion-referenced tests will be accepted as a second measure for determining eligibility for language therapy.
b. For children age three (3) to twenty-one (21): criterion-referenced tests will not be accepted as a second measure when determining eligibility for language therapy. (When use of standardized instruments is not appropriate, see Section 227.300, part D, paragraph 8.)
c. Age birth to three (3): Eligibility for language therapy will be based upon a composite or quotient score that is -1.5 standard deviations (SD) below the mean or greater from a norm-referenced, standardized test, with corroborating data from a criterion-referenced measure. When these two (2) measures do not agree, results from a third measure that corroborate the identified deficits are required to support the medical necessity of services.
d. Age three (3) to twenty-one (21): Eligibility for language therapy will be based upon two (2) composite or quotient scores that are -1.5 standard deviations (SD) below the mean or greater. When -1.5 SD or greater is not indicated by both scores, a third standardized score indicating a -1.5 SD or greater is required to support the medical necessity of services.
2. ARTICULATION OR PHONOLOGY: Two (2) tests or procedures must be administered, with at least one (1) being from a norm-referenced, standardized test with good reliability and validity.
Eligibility for articulation or phonological therapy will be based upon standard scores (SS) of -1.5 SD or greater below the mean from two (2) tests. When -1.5 SD or greater is not indicated by both tests, corroborating data from accepted procedures can be used to support the medical necessity of services. (For a list of accepted tests, refer to Section 214.410 of the Occupational, Physical, and Speech-Language Therapy Services Manual.)
3. APRAXIA: Two (2) tests or procedures must be administered, with at least one (1) being a norm-referenced, standardized test with good reliability and validity.
Eligibility for apraxia therapy will be based upon standard scores (SS) of -1.5 SD or greater below the mean from two (2) tests. When -1.5 SD or greater is not indicated by both tests, corroborating data from a criterion-referenced test or accepted procedures can be used to support the medical necessity of services. (For a list of accepted tests, refer to Section 214.410 of the Occupational, Physical, and Speech-Language Therapy Services Manual.)
4. VOICE: Due to the high incidence of medical factors that contribute to voice deviations, a medical evaluation is a requirement for eligibility for voice therapy.
Eligibility for voice therapy will be based upon a medical referral for therapy and a functional profile of voice parameters that indicates a moderate or severe deficit/disorder.
5. FLUENCY: At least one (1) norm-referenced, standardized test with good reliability and validity, and at least one (1) supplemental tool to address effective components.
Eligibility for fluency therapy will be based upon an SS of -1.5 SD below the mean or greater on the standardized test.
6. ORAL MOTOR/SWALLOWING/FEEDING: An in-depth, functional profile of oral motor structures and function.
Eligibility for oral-motor/swallowing/feeding therapy will be based upon an in-depth functional profile of oral motor structures and function using a thorough protocol (e.g., checklist, profile) that indicates a moderate or severe deficit or disorder. When moderate or severe aspiration has been confirmed by a videofluoroscopic swallow study, the patient can be treated for pharyngeal dysphagia via the recommendations set forth in the swallow study report.
7. All subtests, components, and scores must be reported for all tests used for eligibility purposes.
8. When administration of standardized, norm-referenced instruments is inappropriate, the provider must submit an in-depth, functional profile of the child's communication abilities. An in-depth functional profile is a detailed narrative or description of a child's communication behaviors that specifically explains and justifies the following:
a. The reason standardized testing is inappropriate for this child;
b. The communication impairment, including specific skills and deficits; and
c. The medical necessity of therapy.
Supplemental instruments from Accepted Tests for Speech-Language Therapy may be useful in developing an in-depth functional profile.
9. Children (birth to age twenty-one (21)) receiving services outside of the schools must be evaluated annually.
10. Children (birth to twenty-four (24) months) in the Early Intervention Day Treatment (EIDT) Program must be evaluated every six (6) months.
11. Children (age three (3) to twenty-one (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 (3) years; however, an annual update of progress is required.
12. Children (age three (3) to twenty-one (21)) receiving privately contracted services, apart from or in addition to those within the schools, must have a full evaluation annually.
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.
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 the entry with a full signature and credentials; and
8. Graduate students must have the supervising speech-language pathologist co-sign progress notes.

Credits

Eff. Jan. 1, 2009. Amended July 1, 2020.
<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 016.06.36-227.300, AR ADC 016.06.36-227.300
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