641. Coverage by category

317:30-5-641. Coverage by category

Revised 9-1-21

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 therapist or 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 therapist or 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).

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 who:

(i) holds a certificate of clinical competence from the American Speech-Language Hearing Association(ASHA); or

(ii) has completed the equivalent educational requirements and work experience necessary for the certificate; or

(iii) has completed the academic program and is acquiring supervised work experience to qualify for the certificate.

(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 who:

(i) holds a certificate of clinical competence from ASHA; or