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Part 73      EARLY INTERVENTION SERVICES

317:30-5-640.General provisions and eligible providers
[Revised 09-12-14]

(a) General provisions.

(1) Payment is made to eligible providers certified by the Oklahoma State Department of Education (OSDE) or the Oklahoma State Department of Health (OSDH) for the delivery of Early Periodic Screening, Diagnosis and Treatment (EPSDT) services to infants and toddlers from birth up to their third birthday with developmental disabilities, pursuant to the requirements of the Individuals with Disabilities Education Improvement Act (IDEIA) of 2004, Public Law 108-446 Part C, and subsequent amendments.

(2) EPSDT services are comprehensive child-health services, designed to ensure the availability of, and access to, required health care resources and to help parents and guardians of SoonerCare eligible children use these resources.  Effective EPSDT services assure that health problems are diagnosed and treated early before they become more complex and their treatment more costly.  The OSDE and the OSDH play a significant role in educating parents about EPSDT services.

(3) An Individualized Family Services Plan (IFSP) entitles the SoonerCare eligible child to medically necessary and appropriate health related EPSDT treatment services.  Such services must be allowable under federal Medicaid regulations and must be necessary to ameliorate or correct defects of physical or mental illnesses or conditions.

(4) Federal regulations require that the State set standards and protocols for each component of EPSDT services.  The standards must provide for services at intervals that meet reasonable standards of medical and dental practice.  The standards must also provide for EPSDT services at other intervals as medically necessary to determine the existence of certain physical and mental illnesses or conditions.  SoonerCare providers who offer EPSDT screenings must assure that the screenings they provide meet the minimum standards for those services in order to be reimbursed at the level established for EPSDT services.

(b) Eligible providers. Eligible providers are state education and health departments and their contract agencies as designated in the State's Plan for Early Intervention Services, developed in response to the requirements of Part C of the IDEIA and who are enrolled as eligible SoonerCare providers.  A completed contract to provide EPSDT health related services must be submitted to the Oklahoma Health Care Authority (OHCA). Providers must have a SoonerCare provider agreement in order to receive reimbursement.
317:30-5-640.1.Periodicity schedule

[Revised 10-01-18]
(a) The Oklahoma Health Care Authority requires that all physicians providing reimbursable Early and Periodic Screening, Diagnosis and Treatment (EPSDT) screens adopt and utilize the American Academy of Pediatrics and Bright Futures periodicity schedule.

(b) Medicaid-eligible children and adolescents enrolled in SoonerCare are referred to their SoonerCare provider for EPSDT screens. In cases where the SoonerCare provider authorizes the qualified provider of health related services to perform the screen or fails to schedule an appointment within three (3) weeks and a request has been made and documented by the staff of the Oklahoma State Department of Education and Oklahoma State Department of Health (OSDH), or the latter's contractors, the OSDH may then furnish the EPSDT child-health screening and bill it as a fee-for-service activity. Results of the child-health screening are forwarded to the member's SoonerCare provider.



317:30-5-641.Coverage by category
[Revised 09-12-14]

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 OSDH and its contractors, pursuant to the State's plan for Early Intervention services required under Part C of the IDEIA.

(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 OAC 317:30-5-675 and 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

(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.

(F) Speech language evaluation.  Speech language evaluation must be provided by a state licensed speech language pathologist.

(G) Physical therapy evaluation.  Physical therapy evaluation must be provided by a State licensed physical therapist.

(H) Occupational therapy evaluation.  Occupational therapy evaluation must be provided by a State 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, Master's Degree, ASHA certified audiologist; or

(II) a State licensed, Master's degree, ASHA certified 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 a State licensed, speech language pathologist who:

(I) holds a certificate of clinical competence from 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.

(iii) Physical therapy services.  Physical therapy services must be provided by a State licensed physical therapist.

(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 State licensed occupational therapist.

(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 counselingservices.  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) State licensed Speech Language Pathologist who:

(I) holds a certificate of clinical competence from the American Speech and Hearing Association; 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;

(ii) State licensed Physical Therapist; or
(iii) State licensed Occupational Therapist.

317:30-5-641.1.Periodic and interperiodic screening examination
[Revised 06-25-06]
Refer to OAC 317:30-3-55.

317:30-5-641.2.Interperiodic screening examination [REVOKED]
[Revoked 06-25-06]

317:30-5-641.3.Reporting of suspected child abuse/neglect
[Revised 06-25-06]
Refer to OAC 317:30-5-2(b)(6).

317:30-5-642.Services [REVOKED]
[Revoked 06-25-06]

317:30-5-643.Billing [REVOKED]
[Revoked 6-27-02]

317:30-5-644.Documentation of records

[Revised 09-12-14]
   All early intervention services rendered must be reflected by documentation in the records.  Documentation of records must include the provider's signature or identifiable initials for every prescription or treatment.  Documentation of records may be completed manually or electronically in accordance with guidelines found at OAC 317:30-3-15.  Each required element of the age specific screening must be documented with a description of any noted problem anomaly or concern.  In addition, a plan for following necessary diagnostic evaluations, procedures and treatments, must be documented.

Disclaimer. The OHCA rules found on this Web site are unofficial. The official rules are published by the Oklahoma Secretary of State Office of Administrative Rules as Title 317 of the Oklahoma Administrative Code. To order an official copy of these rules, contact the Office of Administrative Rules at (405) 521-4911.