227.210
Accepted Tests for
Occupational Therapy
Tests used must be norm referenced, standardized, age appropriate and
specific to tine tinerapy provided. The following list of
tests is not all-inclusive. When using a test not listed here, the provider
must include additional documentation to support the reliability and validity
of the test. This additional information will be used as reference information
if the chart is ever 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 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 tor additional information
regarding specific tests.
DEFINITIONS:
STANDARD: Evaluations that are used to determine deficits.
SUPPLEMENTAL: Evaluations that are used to justify deficits and support
other results. These should not "stand alone."
CLINICAL OBSERVATIONS: All clinical observations are supplemental but
should be included with every evaluation, especially if standard scores do not
qualify the child for therapy. It will be considered when reviewing for 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 (FLAP)
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)
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 7½ 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
227.220
Accepted Tests for Physical
Therapy
Tests used must be norm referenced, standardized, age appropriate and
specific to tine tinerapy provided. The following list of
tests is not all-inclusive. When using a test not listed here, the provider
must include additional documentation to support the reliability and validity
of the test. This additional information will be used as reference information
if the chart is ever 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 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 tor additional information
regarding specific tests.
A. Norm
Reference
1. Adaptive Areas
Assessment
2. Test of Gross Motor
Development (TGMD-2)
3. Peabody
Developmental Motor Scales, Second Ed. (PDMS-2)
4. Bruininks-Oseretsky Test of Motor
Proficiency (BOMP)
5.
Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2)
6. Pediatric Evaluation of Disability
Inventory (PEDI)
7. Test of Gross
Motor Development - 2 (TGMD-2)
8.
Peabody Developmental Motor Scales (PDMS)
9. Alberta Infant Motor Scales
(AIM)
10. Toddler and Infant Motor
Evaluation (TIME)
11. Functional
Independence Measure for Children (WeeFIM)
12. Gross Motor Function Measure
(GMFM)
13. Adaptive Behavior Scale
- School, Second Ed. (AAMR-2)
14.
Movement Assessment Battery for Children (Movement ABC)
15. Test of Infant Motor Performance
(TIMP)
16. Functional Independence
Measure (FIM) 7 years of age to adult
B. Physical Therapy - Supplemental
1. Bayley Scales of Infant Development,
Second Ed. (BSID-2)
2. Neonatal
Behavioral Assessment Scale (NBAS)
3. Mullen Scales of Early Learning Profile
(MSEL)
4. Hawaii Early Learning
Profile (HELP)
C.
Physical Therapy Criterion
1. Developmental
assessment for students with severe disabilities. Second Ed. (DASH-2)
2. Milani-Comparetti Developmental
Examination
D. Physical
Therapy - Traumatic Brain Injury (TBI) - Standardized
1. Comprehensive Trail-Making Test
2. Adaptive Behavior Inventory
E. Physical Therapy - Piloted
Assessment of Persons Profoundly or Severely Impaired
227.310
Accepted Tests for
Speech-Language Therapy
Tests used must be norm referenced, standardized, age appropriate and
specific to tine tinerapy provided. The following list of
tests is not all-inclusive. When using a test not listed here, the provider
must include additional documentation to support the reliability and validity
of the test. This additional information will be used as reference information
if the chart is ever 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 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 tor additional information
regarding specific tests.
A.
Speech-Language Tests - Standardized
1.
Preschool Language Scale, Third Ed. (PLS-3)
2. Preschool Language Scale, Fourth Ed.
(PLS-4)
3. Test of Early Language
Development, Third Ed. (TELD-3)
4.
Peabody Picture Vocabulary Test, Third Ed. (PPVT-3)
5. Clinical Evaluation of Language
Fundamentals - Preschool (CELF-P)
6. Clinical Evaluation of Language
Fundamentals, Third Ed. (CELF-3)
7.
Clinical Evaluation of Language Fundamentals, Fourth Ed. (CELF-4)
8. Communication Abilities Diagnostic Test
(CADeT)
9. Test of Auditory
Comprehension of Language, Third Ed. (TACL-3)
10. Comprehensive Assessment of Spoken
Language (CASL)
11. Oral and
Written Language Scales (OWLS)
12.
Test of Language Development - Primary, Third Ed. (T0LD-P:3)
13. Test of Word Finding, Second Ed.
(TWF-2)
14. Test of Auditory
Perceptual Skills, Revised (TAPS-R)
15. Language Processing Test, Revised
(LPT-R)
16. Test of Pragmatic
Language (TOPL)
17. Test of
Language Competence, Expanded Ed. (TLC-E)
18. Test of Language Development -
Intermediate, Third Ed. (T0LD-I:3)
19. Fullerton Language Test for Adolescents,
Second Ed. (FLTA)
20. Test of
Adolescent and Adult Language, Third Ed. (TOAL-3)
21. Receptive One-Word Picture Vocabulary
Test, Second Ed. (ROWPVT-2)
22.
Expressive One-Word Picture Vocabulary Test, 2000 Ed. (EOWPVT)
23. Comprehensive Receptive and Expressive
Vocabulary Test, Second Ed. (CREVT-2)
24. Kaufman Assessment Battery for Children
(KABC)
25. Receptive/Expressive
Emergent Language Test, Third Edition (REEL-3)
B. Speech Language Tests - Supplemental
1. Receptive/Expressive Emergent Language
Test, Second Ed. (REEL-2)
2.
Nonspeech Test for Receptive/Expressive Language
3. Rossetti Infant-Toddler Language Scale
(RITLS)
4. Mullen Scales of Early
Learning (MSEL)
5. Reynell
Developmental Language Scales
6.
Illinois Test of Psycholinguistic Abilities, Third Ed. (ITPA-3)
7. Social Skills Rating System - Preschool
& Elementary Level (SSRS-1)
8.
Social Skills Rating System - Secondary Level (SSRS-2)
C. Birth to Age 3:
1. -(minus)1.5 SD (standard score of 77)
below the mean in two areas (expressive, receptive) or a -(minus) 2.0 SD
(standard score of 70) below the mean in one area to qualify for language
therapy.
2. Two language tests must
be reported with at least one of these being a global norm-referenced
standardized test with good reliability/validity. The second test may be
criterion referenced.
3. All
subtests, components, and scores must be reported for all tests.
4. All sound errors must be reported for
articulation, including positions and types of errors.
5. If phonological testing is submitted, a
traditional articulation test must also be submitted with a standardized
score.
6. Information regarding the
child's functional hearing ability must be included as a part of the therapy
evaluation report.
7.
Non-school-aged children must be evaluated annually.
8. If the provider indicates the child cannot
complete a norm-referenced test, the provider must submit an in-depth
functional profile of the child's functional communication abilities. An
in-depth functional profile is a description of a child's communication
behaviors that specifically notes where such communication behaviors are
impaired and justifies the medical necessity of therapy. Standardized forms are
available for the completion of an in-depth functional profile, but a
standardized form is not required.
9. Children must be evaluated at least
annually. Child Health Management Services (CHMS) children (birth - 2) must be
evaluated every 6 months.
D. Ages 3 - 21:
1. -(minus)1.5 SD (standard score of 77)
below the mean in two areas (expressive, receptive, articulation) or a -(minus)
2.0 SD (standard score of 70) below the mean in one area (expressive,
receptive, articulation).
2. Two
language tests must be reported with at least one of these being a global
norm-referenced standardized test with good reliability/validity.
Criterion-referenced tests will not be accepted for this age group.
3. All subtests, components and scores must
be reported for all tests.
4. All
sound errors must be reported for articulation, including positions and types
of errors.
5. If phonological
testing is submitted, a traditional articulation test must also be submitted
with a standardized score.
6.
Information regarding child's functional hearing ability must be included as a
part of the therapy evaluation report.
7. Non-school-age children must be evaluated
annually.
8. School-age children
must have a full evaluation every three years (a yearly update is required) if
therapy is school related; outside of school, annual evaluations are required.
"School related" means the child is of school age, attends public school and
receives therapy provided by the school.
9. If the provider indicates the child cannot
complete a norm-referenced test, the provider must submit an in-depth
functional profile of the child's functional communication abilities. An
in-depth functional profile is a description of a child's communication
behaviors that specifically notes where such communication behaviors are
impaired and justifies the medical necessity of therapy. Standardized forms are
available for the completion of an in-depth functional profile, but a
standardized form is not required.
10. IQ scores are required on all children
who are school age and receiving language therapy. Exception: IQ scores will
not be required for children under ten (10) years of age.
