Billing Manual and Data System Invoicing Procedures for ... · Billing Manual . and . Data System Invoicing Procedures . ... The contractor shall provide books, records, evidence

Arizona Early Intervention Program Billing Manual

Billing Manual Page 1 of 24

The Arizona Department of Economic Security/ Arizona Early Intervention Program (ADES/AzEIP)

Billing Manual

and

Data System Invoicing Procedures

for

Team-Based Early Intervention Services

Revised and Effective July 2018


Public Comment Period Billing Manual Page 2 of 24

TABLE OF CONTENTS CHAPTER 1 - GENERAL OVERVIEW ................................................................................................................ 3

1.1 Fiscal Requirements .......................................................................................................................... 3 1.2 Service Authorization ......................................................................................................................... 3 1.3 Elements that Determine the Amount Paid for Each Service ............................................................ 4 1.4 Documentation, Data Entries and General Procedures .................................................................... 4 1.5 Non-Billable Services - Change Request (Former “Offline Invoice”) ................................................. 5 1.6 Timely Submission of Invoices .......................................................................................................... 5 1.7 Payment Recoupment ....................................................................................................................... 6

CHAPTER 2 – THIRD PARTY BILLING/ USE OF PUBLIC OR PRIVATE INSURANCE .................................. 7 2.1 TPL reimbursable services with parental consent: ............................................................................ 7 2.2 TPL Waiver Requests ........................................................................................................................ 8 2.3 Health Savings Account (HSA) or a Health Reimbursement Account (HRA) ................................... 8 2.4 Third Party Liability (TPL)/Insurance Invoice Submissions ............................................................... 8

CHAPTER 3 - DISCIPLINE-SPECIFIC BILLING ................................................................................................. 9 3.1: Core Team, Psychology and Social Work ........................................................................................ 9 3.2: Service Coordination....................................................................................................................... 10

CHAPTER 4 - LOCATION SETTING ................................................................................................................. 11 [NH] Natural - Home .......................................................................................................................... 11 [NC] Natural - Community .................................................................................................................. 11 [CI] Other Setting ............................................................................................................................. 11

CHAPTER 5 - INITIAL PLANNING PROCESS BILLABLE UNITS .................................................................. 12 IPP Services and limitations ........................................................................................................................ 12

Referral .................................................................................................................................................. 12 Initial Phone call ..................................................................................................................................... 12 Initial Home Visit without Screening ...................................................................................................... 12 Initial Home Visit with Screening ........................................................................................................... 13 Eligibility Determination: Record Review ............................................................................................... 13 Eligibility Determination: Evaluation ....................................................................................................... 13 Service Providing Agency Eligibility Determination and Coordination: .................................................. 13 Initial Child and Family Assessment after Record Review .................................................................... 15 Initial Child and Family Assessment after Evaluation ............................................................................ 15 Initial Individualized Family Service Plan ............................................................................................... 15

CHAPTER 6 - TEAM CONFERENCING (TC) .................................................................................................... 15 CHAPTER 7 – DEDICATED SC TRAVEL ......................................................................................................... 16

7.1 General Mileage Reimbursement Information ................................................................................. 16 7.2 Non-reimbursable Mileage Expenses .............................................................................................. 16 7.3 Mileage Documentation ................................................................................................................... 16 7.4 Mileage Review ................................................................................................................................ 16

APPENDIX “A” – DEFINITIONS........................................................................................................................ 17 APPENDIX “B” – ZIP CODES/ TIER TABLE .................................................................................................... 20 APPENDIX “C” – RATES .................................................................................................................................. 23 APPENDIX “D” – BILLING MATRIX ................................................................................................................. 24



CHAPTER 1 - GENERAL OVERVIEW The Arizona Department of Economic Security/Arizona Early Intervention Program (ADES/AzEIP) Billing Manual effective July 1, 2018 replaces all previous versions of the Billing Manual. This manual applies to all ADES/AzEIP Team-Based Early Intervention Services (TBEIS) contracts and agreements, and contains important details regarding proper billing procedures. This includes definitions and information regarding the services, billing codes, tiers, travels, etc. All services for children with AzEIP only eligibility, DDD State only eligibility and DDD Targeted Case Management (TCM) eligibility will be entered in the AzEIP data system. This does not apply for children with Arizona Long Term Care System (ALTCS) eligibility. When invoicing the ADES/Department of Developmental Disabilities (ADES/DDD) for services provided to ADES/DDD Long Term Care eligible (LTC) children, the contractor must utilize the established billing process and follow the requirements contained in their user manual for provider billing (please refer to the following ADES/DDD link for more information: https://des.az.gov/services/disabilities/developmental-child-and-adult/help-providers). The ADES/DDD will pay the contractor using the ADES/AzEIP rates. 1.1 Fiscal Requirements The contractor shall:

a. Identify and coordinate funds in accordance with Individuals with Disabilities Act (IDEA) Part C, ensuring that all available funding sources are utilized.

b. Invoice in accordance with the federal regulation 34 CFR Subpart F and the AzEIP Billing Manual. c. Be responsible for repayment of funds to the ADES for any incorrect invoice items including but not

limited to, audit findings, post payment reviews, monitoring findings. d. Ensure that books, records, evidence and other documents, including but not limited to Insurance

Explanation of Benefits (EOB), Consents to Bill Health Insurance, Evaluation Reports, Arizona Health Care Cost Containment System (AHCCCS) Member Service Request relevant to services and billing are securely stored for a period of five years after the payment of service and the completion of an audit.

e. Implement mechanisms to ensure the accuracy and reliability of fiscal data. f. Ensure fiscal noncompliance is corrected immediately when identified through fiscal monitoring or audits

in accordance with requirements. g. Adhere to all fiscal requirements and if in the circumstance where the contractor cannot fulfill areas of

the contract that leads to overutilization and misuse of Part C funds, contract sanctions will be taken.

1.2 Service Authorization The Initial Planning Process (IPP) service authorization is delineated in Chapter 5 of this document. The IFSP team is the authorizing body for determining the service type, frequency, intensity, method and duration, and start and end dates necessary for ongoing services to support the family and child in achieving the identified outcomes. Therefore, all IFSP services provided must be documented on the IFSP services page (paper documentation) and entered into the ADES/AzEIP data system within ten (10) days of the activity. All services provided that are not documented on the IFSP that follows AzEIP Policies and Procedures, are not considered authorized and will not be reimbursed. Apart from early intervention services authorized by the IFSP team, documented on the IFSP, and entered into the ADES/AzEIP data system, ADES/AzEIP has set forth maximum units (Appendix D). Exceptions to any service limitations outlined in this billing manual or appendices must be approved by the ADES/AzEIP. A request with the appropriate and proper documentation must be submitted to ADES/AzEIP via email to [email protected] and [email protected].

https://des.az.gov/services/disabilities/developmental-child-and-adult/help-providers

mailto:[email protected]




1.3 Elements that Determine the Amount Paid for Each Service The ADES/AzEIP TBEIS contracts procure early intervention services using the following disciplines, as defined by Part C of the Individuals with Disabilities Education Act (IDEA):

• Occupational Therapist (OT) • Physical Therapist (PT) • Speech-Language Pathologist (SLP) • Developmental Special Instructionist (DSI) • Service Coordinator (SC) • Psychologist (PSYCH) • Social Worker (SW) • Other IDEA services as determined necessary

Each zip code is assigned one of four tier designations (Appendix B). Each tier designation is assigned a rate, by discipline or group of disciplines, which is identified in the Team-Based Early Intervention contract. The contract specifies a “natural” (home or community) and “clinic” (other) rate for each therapy discipline or group of disciplines, by tier designation (i.e. Base, Tier 1, Tier 2, or Tier 3). Services provided after a child turns three years old will not be reimbursed to the contractors unless compensatory services were awarded to the child and family as a result of a formal complaint. 1.4 Documentation, Data Entries and General Procedures All services delivered to or on behalf of a child and family must be recorded in the ADES/AzEIP data system. The contractor shall enter all provided services within 10 days of the service delivery and then invoice appropriately within the time frames for each service. Delayed service entries (after 10 days) may considered non-compliant and may become non-billable. When a subsequent referral is received for a child after exiting the AzEIP, the contractor shall immediately contact the AzEIP data system help desk. The help desk will determine if the referral will be considered as a re-referral or re-opening of the original referral. The contractor shall ensure that all service deliveries from previous referrals have been entered in the data system. The contractor shall ensure that all services, travel information for mileage reimbursement, family consents, insurance, and IFSP information have been entered and if applicable updated in the data system for the billable month prior to the invoice submission (i.e. if the contractor is in the process of submitting the invoice for services provided in July in August, all services and IFSP information for July must be entered in the system prior to the submission). All invoices are subject to state and federal audit. All early intervention professionals are required to complete documentation in accordance with applicable State and Federal Laws, Licensing Regulations, and ADES/AzEIP policies and procedures. The contractor shall provide books, records, evidence and other documents, including but not limited to Insurance Explanation of Benefits (EOB), Consents to Bill Health Insurance, Evaluation Reports, AHCCCS Member Service Requests relevant to services provided to authorized representatives of the State of Arizona and the federal government to inspect and review these records within 7 calendar days of the request. The contractor shall adhere to all documentation requirements outlined in this billing manual and in AzEIP policies and procedures. Each contractor must maintain proof of hours worked (e.g., time sheets with dates, start and end time) by all early intervention professionals, administrative, and operating staff charging time under this contract to be available to ADES/AzEIP upon request. All services must have a professional provider listed on the invoice. Prior to delivering services to the child and family, the contractor shall confirm the correct assignment of the child in the data system. The contractor shall not provide any service for a child which is assigned to a different contractor. This is always a non-billable service.



The contractor shall ensure that all entries made into the data system are accurately entered into the correct child record. All entries made in the data system shall reflect what is documented in the hard copy of the child file and adhere to AzEIP Policy and Procedures documentation requirements. No entries should be made based on memory, assumptions or as placeholder for the to-be referenced paper document. The contractor shall review all data from the previous IFSP to ensure it remains accurate and contact the help desk if there is any issue, before creating a new IFSP in the data system. A closed IFSP cannot be adjusted, edited, or reopened by anyone, including the help desk. The contractor shall always create a new IFSP in the data system when the initial or previous IFSP has been adjusted to meet the needs of the child. No information entered within an existing IFSP in the data system shall be edited. Failure to do so will result in services not being reimbursed. The contractor shall ensure that data entry errors are not repetitive. AzEIP fiscal staff have the right to approve or deny data entry errors that seem to be consistent and ongoing. 1.5 Non-Billable Services - Change Request (Former “Offline Invoice”) The contractor may submit electronic requests within the service delivery page to change non-billable services to billable service deliveries. Non-billable services will be reviewed and approved accordingly per the billing manual regulations and AzEIP policies and procedures. For these electronic requests the contractor shall:

a. Ensure that all line items that are indicated as ‘non-billable’ are evaluated internally by the contractors billing staff to confirm that no corrections are needed prior to the secondary invoice.

b. Contact the help desk and provide all necessary documentation on each non-billable item as an initial step. • The help desk shall always be the first point of contact for any non-billable items and will assist in

resolving system related issues.

1.6 Timely Submission of Invoices Regular Monthly Invoice Submissions (Non-TPL) Invoices for services not billable to insurance or without parental consent to bill insurances (Non-TPL) shall be submitted through the ADES/AzEIP data system by or on the 15th of the month or the next business day following the month in which the service was provided. A second and therefore final invoice may be submitted up to 75 days following the initial submission deadline. Third Party Liability (TPL)/Insurance Invoice Submissions TPL (see for further details Chapter 2 – Third Party Liability Billing) invoices for services with parental consent to bill the private or public insurance shall be submitted after the provider has received an approval or denial from the insurance but no later than nine months after the service month. The extended timeframe for the submittal of the insurance does not extend the responsibility to enter the service timely within of ten days of delivery. Service delivery entries after ten days shall count against the contractor’s compliance/accountability.



1.7 Payment Recoupment The contractor shall reimburse the ADES upon demand, or the ADES may deduct from future payments the following:

a. Any amounts received by the contractor from the ADES for contract services which have been inaccurately reported or are found to be unsubstantiated;

b. Any amounts paid by the contractor to a subcontractor not authorized in writing by the ADES; c. Any amounts paid by the ADES for services which duplicate services covered or reimbursed by other

specific grants, contracts, or payments; d. Any amounts expended for items or purposes determined unallowable by the ADES when this contract

provides for the reimbursement of costs; e. Any amounts paid by the ADES for which the contractor’s books, records, and other documents are not

sufficient to clearly substantiate that those amounts were used by the contractor to perform contract services;

f. Any amounts received by the contractor from the ADES which are identified as a financial audit exception;

g. Any amounts paid or reimbursed in excess of the contract or service reimbursement ceiling; h. Any payments made for services rendered before the contract begin date or after the contract

termination date.



CHAPTER 2 – THIRD PARTY BILLING/ USE OF PUBLIC OR PRIVATE INSURANCE

Early Intervention Programs (EIPs) must ensure all funding sources (private insurance, Medicaid/Arizona Healthcare Cost Containment System (AHCCCS), Arizona Long Term Care System (ALTCS) and the Comprehensive Medical and Dental Program (CMDP)) are accessed before Part C funding is used as a funding source. However, parents must be fully informed of any potential costs to them, and they must provide consent prior to an agency or program attempts to access their private or public insurance. Each child’s record must have a current, completed copy of the “Consent for Insurance” form in the child’s file and the ADES/AzEIP data system, before their private/public health insurance is accessed for payment of ADES/AzEIP services. ADES/AzEIP advises its contractors to fully inform families of the implications for providing consent for insurance when there is a health savings account (HSA) associated with their private health insurance plan. If the child is eligible for AHCCCS, including CMDP, the contractor must follow the AHCCCS/AzEIP procedures (please refer to the AHCCCS toolbox: https://des.az.gov/services/disabilities/early-intervention/azeip-ahcccs-toolkit-service-coordinators. If the services requested through the AHCCCS Health Plan have not been approved or denied prior to the planned start date for the early intervention service on the IFSP, the service may be invoiced to ADES/AzEIP until the approval or denial from the health plan is received. Once approval is obtained the costs must shift to the AHCCCS Health Plan (subject to post-payment review) (see also – TPL waivers). Effective July 2015, ADES/AzEIP and AHCCCS aligned their contract and policy language to provide children and their families the opportunity to receive IFSP services, determined medically-necessary by the health plan, through the ADES/AzEIP TBEIS provider, regardless of whether or not the ADES/AzEIP TBEIS provider has a contact with the child’s health plan. As a result, ADES/AzEIP contractors do not need to have a contract with the AHCCCS health plans; this is not a reason to seek a waiver from the ADES/AzEIP invoice team. 2.1 TPL reimbursable services with parental consent:

• As defined by IDEA the contractor shall always enter the full and true amount received by the insurance in the AzEIP data system.

• If the family has a deductible, the contractor must bill the insurance company for the service and, when denied, bill ADES/AzEIP until the deductible is met.

• If the family has a co-pay and the private insurance company reimburses the contractor less than the ADES/AzEIP contracted rate, the contractor may bill ADES/AzEIP the difference between the ADES/AzEIP contracted rate and the insurance payment, and any co-pay collected. The contractor should not collect the co-pay unless required to do so by the contractor’s agreement with the Health Plan. If a co-pay is collected, the amount collected shall be added to the insurance payment, before billing ADES.

o For Example: The private insurance company pays $60.00 for one unit of speech therapy in the

natural environment and the family has a $10.00 co-pay. The contracted ADES/AzEIP rate for the service is $84.12. The contractor can bill ADES/AzEIP the difference between the ADES/AzEIP

contracted rate and the amount paid by insurance, which would be $24.12 ($84.12 - $60.00 = $24.12).

If the contractor’s agreement with the Health Plan requires the contractor to collect the co-pay, the contractor would add the co-pay amount to the amount paid by insurance, and bill ADES/AzEIP for the difference. Therefore, the Contractor could bill ADES/AzEIP $14.12 ($84.12 – ($60.00+$10.00) = $14.12).

• If the public insurance payment is less than the ADES contracted rate, the contractor must accept the public insurance payment as payment in full. All required TPL (Explanation of Benefits) information and documentation must be recorded in the child’s record in the ADES/AzEIP data system.

• Upon request the contractor shall present the documentation to ADES/AzEIP at any time within the retention period.

https://des.az.gov/services/disabilities/early-intervention/azeip-ahcccs-toolkit-service-coordinators

https://des.az.gov/services/disabilities/early-intervention/azeip-ahcccs-toolkit-service-coordinators



2.2 TPL Waiver Requests

• The contractor may request a TPL Waiver if a service is not covered through the insurance company. This request can be submitted after a denial has been received and can only be submitted for services that have not been billed yet and occurred after the first service (which had been denied). After approval by ADES/AzEIP, this process allows the contractor to submit TPL eligible services directly to ADES/AzEIP without submitting the claim to the insurance company.

• The contractor shall submit the waiver request the Insurance/TPL Waiver page of the AzEIP data system for the appropriate service and health plan and submit the proper and complete documentation within 90 days of the service (email or if possible upload).

• The following reasons may be accepted: o The service is deemed “Not Medically Necessary”, o The service is not covered under the family’s insurance plan; o The service is not covered for the child’s specific diagnosis; o Service is not covered for providers who are “out of network” or “not authorized” (private

insurance only) AHCCCS insurers no longer require ADES/AZEIP providers to be contracted with them to obtain payment for services provided to families of children who are AHCCCS-eligible;

o Prior authorization from the insurance company is required and could not be obtained. • Upon provided documentation the ADES/AzEIP office will approve or deny the request. In the event of

an approval, the length of the waiver will be determined based on the provided documentation. TPL Waiver Requests must be (re)submitted after expiration.

• ADES/AzEIP will not pay for serviced denied by third parties due to improper documentation or when the claim hasn’t been submitted within the appropriated timeframe (i.e., the claim was not submitted within 30 days after the service has been provided. The insurance company declined the claim. AzEIP will not pay for these services and shall count against the contractor’s compliance/accountability.

2.3 Health Savings Account (HSA) or a Health Reimbursement Account (HRA)

• Refer to AzEIP Financial Policies, Chapter 9, which states that there will be no out-of-pocket costs to families for early intervention services. Families must be fully informed of any potential costs when consenting to use their insurance, particularly if they utilize an HRA or HSA, to fund their early intervention services.

o Follow AzEIP procedure manual regarding HSA and HRA accounts. o In those instances where a family has an HSA or HRA and the child is determined ALTCS

eligible, work with ADES/DDD at [email protected]. AzEIP providers must follow DDD Provider Policy Manual Chapter 57-A Third Party Liability Guidelines for further billing instructions https://des.az.gov/sites/default/files/Complete-Provider-Manual-1-3-18-2.pdf.

2.4 Third Party Liability (TPL)/Insurance Invoice Submissions The contractor shall enter all services and activities in the data system within 10 days of the activity, TPL is no exception to this rule. Delayed service entries (after 10 days) may considered non-compliant and may become non-billable. If the provided service is a TPL eligible service and the parent provided the consent to bill the responsible person/child’s insurance, the contractor shall wait until the insurance claim is paid or denied before submitting the invoice to ADES/AzEIP. These services must be billed to ADES/AzEIP within nine months of the service month. Refer to Chapter 2 and include details of invoicing In the event an insurance company has not responded to the contractor within nine months for a pending claim, the contractor shall submit an invoice to ADES/AzEIP to meet the nine month deadline. The invoice must detail each service, by child and date, for which an insurance claim is pending. After the contractor receives an insurance payment, the contractor must notify ADES/AzEIP, submit a correction with the Reversal/Void Invoice Line Item Request form, and reimburse ADES/AzEIP for the payments made.


https://des.az.gov/sites/default/files/Complete-Provider-Manual-1-3-18-2.pdf



CHAPTER 3 - DISCIPLINE-SPECIFIC BILLING Section 3.1 and 3.2 below identify disciplines included in the TBEIS contracts, and describes other pertinent information, such as qualifications, service unit definitions, etc. The services under the TBEIS contract must be provided by qualified personnel in accordance with the ADES/AzEIP policy and procedures, and appropriate state licensure requirements when required. All early intervention professionals must complete their profile in the ADES/AzEIP data system. 3.1: Core Team, Psychology and Social Work

Discipline ● Occupational therapist (OT) • Physical therapist (PT) • Speech-language pathologist (SLP) • Developmental Special Instructionist (DSI) • Social Worker (SW) • Psychologist (PSYCH)

Definition See Appendix A.

Service Unit 1 hour, billable in 15 minute increments.

Service Limitation 12 hours per day including travel per team member across multiple children. Services can be chosen from the appropriate list depending on the discipline of the professional provider. (Appendix “”)

Service Authorization The IPP must be completed within 45 days of referral to ADES/AzEIP. The services on the child’s IFSP must start on or before the planned start date on the IFSP, but no later than 45 days from the date the family consents to the service (i.e., signs the IFSP), unless the service has a planned start date greater than 45 days from the date of the IFSP. In these instances, the service is timely if it starts on or before the Planned Start Date.

Documentation In the child’s ADES/AzEIP data system record and as required by the professional’s licensure and scope of practice, if relevant (see professional provider page of ADES/AzEIP Data System). All services must be entered within 10 days of the service delivery activity. Services entered after a child exited are considered non-billable.

Rules The provider shall enter the service in the service delivery page by choosing the appropriate service from available service list according to the his/her discipline. The provider must enter and fill all required fields on that page as i.e. date, start time, end time, location setting.



3.2: Service Coordination

Definition See Appendix A.

Service Unit 1 hour, billable in 15-minute increments.

Service Limitations Up to a maximum of seven (7) units per child may be billed for SC activities in the IPP process (see Chapter 5).

Up to a maximum of 12 units per day across multiple children (including travel).

Documentation A service coordination log must be completed for each contact and/or activity the service coordinator conducts directly with the child and family (must include parent signature) or non-directly on behalf of the child and family, including actual time spent on each activity (start and end time). Service coordination activities must be thoroughly documented and entered into the ADES/AzEIP data system on the Service Delivery page. ADES/AzEIP Service Coordination logs and data system entries may be reviewed and monitored for accuracy. Billing entries for service coordination activities will be entered throughout the month for every 15 minutes of actual time worked.

Rules The contractor may not bill for no-shows or contact attempts (i.e. didn’t not

reach client via phone or leaving voice messages or texting families).

Administrative duties of a dedicated Service Coordinator are not billable activities. Examples of non-billable activities are: 1) scanning paperwork 2) interoffice communications within provider organizations 3) internal audit procedures 4) broad communications to families about upcoming events.



CHAPTER 4 - Location Setting

[NH] Natural - Home [NC] Natural - Community Definition Early intervention services shall, to the maximum extent appropriate to the

needs of the child, be provided in the natural environment.

Natural environments are those settings that are natural or normal for the child’s age peers who have no disabilities.

Services are billed using the Home or Community setting when the early intervention professional provides direct services to the child and/or family in the natural environment.

Travel time and mileage are not billed separately as they are built into the rate.

The unit rate includes completion of documentation requirements, such as required training and licensure/insurance documentation and cannot be billed separately.

Discipline(s) OT, PT, SLP, DSI, PSYCH, SW Service Authorization Initial Planning Process, as delineated in Chapter 5, and the IFSP. Documentation Child Record - IFSP in the “Service Setting” Home or Community Setting is

selected on the Service Delivery page in the ADES/AzEIP data system.

Rules IFSP team decision. [CI] Other Setting Definition Service provided in a non-natural environment or provider location will be

billed at the Other setting rate, which is the clinic rate. Early intervention may only be provided in an environment other than a natural environment when the outcomes cannot be achieved in a natural environment. In these rare instances, the Justification section of the IFSP must be completed, including the justification for the decision with a timeline to bring the service into the natural environment. Please see Chapter 3 of the ADES/AzEIP Policies regarding the Other setting. The unit rate includes completion of documentation requirements.

Discipline(s) OT, PT, SLP, DSI, PSYCH, SW, SC Service Authorization IFSP; Child Record Service Limitation Initial Planning Process, as delineated in Chapter 5, and the child and

family’s IFSP. Documentation Child Record, including the IFSP justification for the provision of early

intervention services in other than natural environments.

Rules Must be documented, with justification on the IFSP, including a plan for transitioning to the natural environment. Other setting must be selected on the Service Delivery page of the ADES/AzEIP data system.



CHAPTER 5 - Initial Planning Process Billable Units

The contractor shall invoice the actual and true amount of units used for provided services but no more than the maximum units identified below, per child, during each initial planning process (IPP) function. The following activities outline unit utilization for potential functions during the initial planning process; not every function is implemented with each child referred and therefore not all units will be billed for each child. Additional units may be authorized only with prior approval from ADES/AzEIP on an individual family/caregiver basis. The proceeding chapters provide the specific information needed to bill the IPP units by entering as service delivery in the ADES/AzEIP data system. (ASDB Vision and Hearing Specialist, provided by ASDB, are not billed through the ADES/AzEIP data system.)

IPP Services and limitations Referral Activity Description Receives referral (phone, fax, e-mail) and, if appropriate, enters referral data Discipline(s) OT, PT, SLP, DSI, PSYCH, SW, SC (or authorized administrative staff) Maximum units 0.25 other setting Documentation AzEIP data system and Contact Log

Rules When Central Referral receives the referral, contractor may not use a data entry modifier upon receipt of referral.

Initial Phone call Activity Description Initial contact with the family including verification of child information (i.e.

correct name spelling, DOB, address, etc.), description of the program and preparation of the initial visit

Discipline(s) Dedicated SC or OT, PT, SLP, DSI if acting as dual role. Maximum units 0.25 other setting Documentation AzEIP data system and Contact Log

Rules When Central Referral receives the referral, contractor may not use a data entry modifier upon receipt of referral.

Initial Home Visit, developmental screening not conducted Activity Description Completes initial home visit following AzEIP’s Policies and Procedures;

including but not limited to, providing information about early intervention, including family rights, financial matters, gathers consents, etc., and does not complete a full developmental screening, but still may complete other screenings (i.e., hearing screening, vision screening, etc.)

Discipline(s) Service coordinator (dedicated or dual role) Maximum units 2 units Documentation Data system, SC contact log, initial visit documents.

Rules Service delivery must be entered as direct service units according to discipline.



Initial Home Visit, developmental screening conducted

Activity Description Completes initial home visit following AzEIP’s Policies and Procedures; including but not limited to, providing information about early intervention, including family rights, financial matters, gathers consents, etc., and completes a full developmental screening, and may also complete other screenings (i.e., hearing screening, vision screening, etc.)

Discipline(s) Service coordinator (dedicated or dual role) Maximum units 2 units Documentation Data system, SC contact log, initial visit documents, consent to screen,

screening documents

Rules Service delivery must be entered as direct service units according to discipline.

Eligibility Determination: Record Review

Activity Description If available, review medical or discharge records to determine if ADES/AzEIP eligibility can be determined based on established condition, or recent, appropriate evaluation(s) within the last 6 months.

Discipline(s) OT, PT, SLP, DSI, Psych or SW Maximum units 1 unit in other setting (use main office zip code for location). Documentation Data system, Contact Log, records reviewed, Prior Written Notice stating

eligibility based on records.

Rules Record review must be completed by appropriate professional with expertise. For example, a speech evaluation must be reviewed by a Speech Language Pathologist. Cannot be billed if an evaluation has been completed within the IPP.

Eligibility Determination: Evaluation

Activity Description If no records are available, schedule and conducts a developmental evaluation to determine ADES/AzEIP eligibility.

Discipline(s) OT, PT, SLP, DSI, Psych or SW Documentation Data system, Contact Log, Developmental Evaluation Report, Prior Written

Notice.

Rules Evaluation includes report writing and must be completed by two different disciplines, not including a dedicated service coordinator. Cannot been billed if record review has been billed before an evaluation has been completed within the IPP.

Service Providing Agency Eligibility Determination and Coordination:

Activity Description Coordinate with ADES/AzEIP service providing agency (ASDB, DDD) to determine if eligible for agencies. Service Coordinator must ensure service providing agency (ASDB, DDD) have necessary information to determine eligibility and, if eligible, schedule initial IFSP meeting.

Discipline(s) Dedicated SC or OT, PT, SLP, DSI if acting as dual role. Maximum units 1 unit in other setting (use main office zip code for location). Documentation Data system, Contact Log, pertinent emails and Records Released Log

Rules Every child determined AzEIP eligible with a consent to share PII or bill insurance will be sent to DDD to determine eligibility. When a child has



records with evidence of bilateral hearing or vision loss the records should be sent to ASDB if not already ASDB eligible.



Initial Child and Family Assessment after Record Review

Activity Description If the child’s eligibility is based on the review of records, the family and child assessment will be conducted by two professionals representing core team disciplines, psychology, social work, ASDB vision or hearing specialist and a dedicated service coordinator when SC is not dual role.

Discipline(s) SC, OT, PT, SLP, DSI, Psych, SW Maximum units SC: 2 units, Core Team: 4 units amongst participating providers Documentation Data system, Contact Log, Consent for Assessment, Child and Family

Assessment pages in IFSP

Rules All Child and Family Assessments must be multidisciplinary and gather a family’s resources, priorities and concerns as well as present levels of development across all domains. A team may use an approved assessment tool to gather necessary information.

Initial Child and Family Assessment after Evaluation

Activity Description If the child’s eligibility is based on evaluation, the family and child

assessment will be conducted by one of the professionals representing core team disciplines, psychology or social work, ASDB vision or hearing specialist who was involved in the evaluation and the Service Coordinator (this may be DDD’s or ASDB’s service coordinator, if eligibility is known.)

Discipline(s) SC, OT, PT, SLP, DSI, Psych, SW Maximum units SC: 2 units, Core Team: 2 units amongst participating providers Documentation Data system, Contact Log, Consent for Assessment, Child and Family

Assessment pages in IFSP

Rules All Child and Family Assessments must be multidisciplinary and gather a family’s resources, priorities and concerns as well as present levels of development across all domains. A team may use an approved assessment tool to gather necessary information.

Initial Individualized Family Service Plan

Activity Description The initial IFSP will be conducted by either a dedicated or dual role service coordinator with the participation and input of the core team member(s) involved in the Child and Family Assessment.

Discipline(s) SC, OT, PT, SLP, DSI, Psych, SW Maximum units SC: 1.5 units, Core Team: 3 units amongst participating providers Documentation AzEIP data system, Contact Log, IFSP

Rules At minimum, one evaluating team member and SC.

CHAPTER 6 - Team Conferencing (TC)

The contractor shall bill no more than the 0.25 units per month, per child and per discipline. Additionally, the contractor shall not exceed 0.75 units per child per discipline within a period of three months.



CHAPTER 7 – Dedicated SC Travel

Mileage reimbursement is allowed when the contractor delivers service coordination activities directly, in-person, to children and families referred to and enrolled in the AzEIP. Mileage reimbursements are additional payments that are separate from the service provided and will not be charged against the IFSP SC unit limitation. Contractors are not required to submit mileage reimbursement for direct service coordination activities; however, if a contractor chooses to submit mileage reimbursement to AzEIP, all of the following guidelines must be adhered to. 7.1 General Mileage Reimbursement Information Mileage is reimbursable at the state reimbursement rate of 44.5 cents per mile for direct services provided by contracted dedicated service coordinators and is limited to the business miles traveled using the most practical direct route to and from each destination. If the most direct route is unavailable (e.g., traffic detour), then the provider must note the reason for additional mileage. An amount must be calculated and excluded from the daily business miles for normal commuting miles when traveling between a personal residence and post of duty. If a contracted dedicated service coordinator telecommutes or has no regular post of duty post within their designated regional boundary, all travel within a fifty (50) mile radius of one’s residence is considered commuting. One (1) daily roundtrip commute between one’s home and a direct, in-person service coordination activity is reimbursable only to the extent that each one-way leg of the roundtrip exceeds fifty (50) miles. 7.2 Non-reimbursable Mileage Expenses Actual expenses of operating a vehicle (gas, oil, repairs, etc.) are not reimbursable by AzEIP. Additionally, mileage related to team conferencing, trainings, non-service coordination activities, etc. will not be reimbursed. 7.3 Mileage Documentation Contracted dedicated service coordinators must maintain a mileage log to substantiate business miles in the AzEIP data system. The vehicle’s odometer reading should be used to determine allowable business mileage and documented in the mileage log. If odometer readings are not available, map mileage may be used for determining distances traveled. The mileage log should include the date, start and end odometer reading (if applicable) or miles, the complete address for the location from which one departed and the destination at which one arrived for each service coordination activity. General locations or destinations such as “Phoenix” or “Tucson” are not acceptable and will not be reimbursed. However, a major intersection, if it lies within one-half (1/2) mile of one’s domicile, may be used in lieu of one’s home address. This is allowed to protect, a client’s personal information; and shall not to be used to increase one’s reported mileage or requested travel reimbursement. All travel entries must be entered in the AzEIP data system no later than on the 14th or the next business day following the month. Only one mileage payment per Dedicated Service Coordinator per month is allowed. 7.4 Mileage Review All contracted Dedicated Service Coordinators are subject to a review of their mileage logs in order to substantiate mileage was delivered in accordance with the amount paid to the contractor. Mileage logs should be filed by month and year and must be maintained for a period of at least five years. The mileage log must be made available upon request from ADES/AzEIP within ten (10) business days of request. When the miles traveled do not appear reasonable, ADES/AzEIP or its designee will use MapQuest at www.mapquest.com to verify the accuracy of the miles recorded on the mileage logs. The provider is notified if the review resulted in a Pass or Fail. If there are miles on the mileage log that failed the review, then the reimbursement previously paid to the provider for those miles is recovered from the provider’s next scheduled Electronic Funds Transfer (EFT) payment.

Arizona Early Intervention Program Billing Manual/ “Appendix – “A”

Public Comment Period Appendix A Page 17 of 24

Appendix “A” – Definitions 1. Arizona State Schools for the Deaf and the Blind (ASDB) – an AzEIP service providing agency that serves

infants and toddlers birth to three years of age who have a significant auditory or visual impairment. ASDB will provide the vision and/or hearing specialist on early intervention teams under the TBEIS contracts.

2. Assessment – the ongoing procedure used by qualified personnel to identify the child's unique strengths and needs and the early intervention services appropriate to meet those needs throughout the child’s eligibility for AzEIP.

3. Contractor – Organization which works on behalf of ADES/AzEIP in providing early intervention services to

children in natural and clinical settings while adhering to the ADES/AzEIP Mission Statement and Principles

4. Contractor Services – include early intervention services that can be provided by the following disciplines: a. occupation therapist; b. physical therapist; c. psychologist; d. service coordinator; e. social worker; f. speech-language pathologist, and; g. developmental special instructionist.

5. Core Team – the team of early intervention professionals who support an eligible child and his/her family. The following specialists comprise a Core Team:

a. Service Coordinator (AzEIP or DDD); b. Occupational Therapist; c. Physical Therapist; d. Speech Language Pathologist; e. Developmental Special Instructionist (DSI); and If applicable:

f. Psychologist; g. Social Worker; h. Teacher of the visually impaired; i. Teacher of the hearing impaired.

6. Data System – any ADES electronic data system that contractors will be required to use to collect and report

data to AzEIP.

7. Day a. Day means calendar day unless otherwise indicated as business day. b. Business day means Monday through Friday, except for Federal and State holidays (unless holidays

are specifically included in the designation of business day, as in § 300.148(d)(1)(ii)). 8. Division of Developmental Disability (DDD) – an AzEIP service providing agency and division in the ADES

that serves infants and toddlers who are eligible under A.R.S. §36-551(17).. 9. Early Intervention Services – developmental services identified in IDEA, Part C, C.F.R. Section 303.13 (b). 10. Evaluation – the procedures used by qualified personnel to determine a child’s initial and continuing eligibility

for ADES/AzEIP. An initial evaluation refers to the child’s evaluation to determine his or her initial eligibility for ADES/AzEIP. Evaluations may occur during the IPP process, during the family/child assessment process, or take place after the child is in the program and being provided ongoing services. In conducting an evaluation, no single procedure may be used as the sole criterion for determining a child’s eligibility for ADES/AzEIP. Procedures include:

a. administering an evaluation instrument; b. taking the child’s history (including interviewing the parent); c. identifying the child’s level of functioning in each of the developmental areas (cognitive development,

physical development, including vision and hearing), communication development, social or emotional development, and adaptive development);



d. gathering information from other sources such as family members, other care-givers, medical providers, social workers and educators, if necessary, to understand the full scope of the child’s unique strengths and needs; and

e. reviewing medical, educational, or other records.

Evaluation tools used must be interpreted as designed. Generally, two standard deviations below the mean or an age equivalent indicating 50 percent delay meets ADES/AzEIP eligibility criteria. Informed clinical opinion must also be utilized in every eligibility determination. Evaluations are conducted (and billed) for two purposes only 1) to determine a child’s initial eligibility for ADES/AzEIP, and 2) to re-determine a child’s continuing eligibility for the program.

11. Individualized Family Service Plan (IFSP) – a written plan for providing early intervention services to an

AzEIP eligible infant or toddler and the child’s family that: a. is based on the evaluation of the child and the assessment of the child and family; b. is based on priorities and concerns of the family and the interests of the child; c. includes parental consent; d. is implemented on or before the planned start date(s) for each service; and e. is developed in accordance with IDEA, Part C and its implementing regulations at 34 C.F.R.

§§ 303.342, 303.343 and 303.345

12. IFSP Meeting – a meeting convened by a Service Coordinator to develop an initial, annual, or periodic review of the IFSP as outlined in AzEIP Policy and Procedures.

13. IFSP Team – the following group of individuals who must participate in each initial, periodic, and annual IFSP meeting:

a. IDEA Parent(s); b. other family members, if requested by the parent(s); c. an advocate or any other person outside of the family, if requested by the parent(s); d. the designated AzEIP or DDD service coordinator; e. the person(s) directly involved in conducting the assessment/evaluations; and f. person(s) who will be providing services, if appropriate

14. Individualized Education Program (IEP) meeting – the meeting held by the school district to develop

the child’s IEP to be effective on or before the child’s 3rd birthday, 15. Initial Planning Process (IPP) – the events and activities that must be completed within 45 days from

the date a referral is received by AzEIP, including screening and evaluation (if applicable), eligibility determination, and if determined AzEIP eligible, the initial child and family assessment to identify the family’s priorities, resources and interests, and development of the IFSP.

16. Initial Referral – the first time a child, birth to three, is referred to the Arizona Early Intervention Program

via a ADES/AzEIP Team-based model contractor, ADES/AzEIP, DDD or ASDB for the purpose of determining if s/he is eligible for ADES/AzEIP as a child with a developmental delay or disability and who might need early intervention. The “initial referral” is complete when sufficient contact information is provided to identify and locate the child, e.g. name, address and/or phone number.

17. Joint Visit (JV) – two or more team members providing a direct service to the child and family together 18. Non-Team Lead (NTL) – is used rarely, for a very short defined period of time, which is specified on the

IFSP. NTL is used when one team member might meet alone with a family, but must closely coordinate and coach the Team Lead during weekly team meetings.

19. Service Coordinator (SC) – the early intervention professional who supports the family to ensure services are provided as written on the IFSP. Every child is assigned either a dedicated (AzEIP or DDD) or dual role service coordinator.

a. Dedicated SC: the service coordinator solely provides service coordination to the family and

does not have any other role on the team and cannot act as Team Lead. b. Dual Role SC: the Early Intervention Professional (OT, PT, SLP, DSI) who is chosen as the

Team Lead for the child also serves as the family’s service coordinator.



20. Rates – rates were adjusted 4% February 1, 2015

a. Natural Settings Rate: Early intervention services will, to the maximum extent appropriate to the needs of the child, be provided in the natural environment (Home and Community based settings). Natural environments are those settings that are natural or normal for the child’s age peers who have no disabilities. (Early intervention may only be provided in an environment other than a natural environment when the outcomes cannot be achieved in a natural environment. The Justification page of the IFSP must be completed.) The natural rate is billed when the early intervention professional provides direct services to the child and/or family in the natural environment, and includes initial and ongoing assessments. Travel time and mileage are not billed separately as they are built into the rate. The unit rate includes completion of documentation requirements.

b. Other Rate: “Other” settings may only be used when a service cannot be provided in the natural environment. In these rare instances, the Justification page of the IFSP will be completed, including the justification for the decision with a timeline to bring the service into the natural environment. The timeline should be no longer than three months. The Other Setting is selected on the Service Delivery page in the ADES/AzEIP data system in these circumstances. The unit rate includes completion of documentation requirements.

c. Evaluation Rate: Each multidisciplinary evaluation team member may bill for his/her time conducting an evaluation, in-person (direct services) with families and one hour per team using the Other Setting, non-direct, for report writing. Travel time and mileage are not billed separately.

d. Service Coordination Rate: Service coordination does not have a natural rate, as the majority of service coordination activities occur in the office setting. Service coordinators can bill for their travel time for conducting service coordination activities, which are activities conducted with the family.

e. Multiple Children Rates: These rates apply when the service is provided to more than one child, such as when there are two eligible children who are twins or are in a foster home. The team lead and other team members must individualize services to reflect the family's priorities, identified functional outcomes, and expand caregivers' ability to support their children in the context of their routines. This framework promotes simultaneously engaging children as caregivers do throughout the daily routines, rather that working with children sequentially.

21. Team Conference – a weekly meeting convened by the contractor which includes all core team

members, the Contractor’s psychologist and social worker, ASDB hearing and vision specialists, and DDD personnel as appropriate. Parent(s) whose children are on the team meeting agenda and scheduled for discussion are invited to participate in the portion of the team meeting related to their child and family. Team meetings fulfill a critical role in TBEIS, and are used as a venue to review and discuss progress toward IFSP outcomes for the identified children on the agenda, provide primary coaching opportunities, ensure joint accountability for all children assigned to that team across all disciplines, and ensure that services are provided in accordance with the IFSP.

22. Team Lead – the primary core team member who acts as the liaison between the family and the IFSP

team for the provision of TBEIS. The team lead selected must be the best possible long-term match to support in achieving the child and family’s outcomes.

23. Waivers allow for ongoing direct services, for a specific discipline (OT, PT, SLP), to be billed on regular (not TPL) invoices, even though the family as provided consent to bill insurance. The purpose of the waiver is to allow for the billing of future services, without having to go through the TPL process, when it is expected that payment will be denied by the health plan or insurance company.

Arizona Early Intervention Program Billing Manual/ “Appendix – “B”

Public Comment Period Appendix B Page 20 of 24

Appendix “B” – Zip Codes/ Tier Table

ZipCode Tier County ZipCode Tier County ZipCode Tier County

85001 Base Maricopa 85118 1 Pinal 85254 Base Maricopa 85002 Base Maricopa 85119 1 Pinal 85255 Base Maricopa 85003 Base Maricopa 85120 1 Pinal 85256 Base Maricopa 85004 Base Maricopa 85121 2 Pinal 85257 Base Maricopa 85005 Base Maricopa 85122 2 Pinal 85258 Base Maricopa 85006 Base Maricopa 85123 2 Pinal 85259 Base Maricopa 85007 Base Maricopa 85127 1 Maricopa 85260 Base Maricopa 85008 Base Maricopa 85128 2 Pinal 85262 Base Maricopa 85009 Base Maricopa 85130 2 Pinal 85263 Base Maricopa 85010 Base Maricopa 85131 2 Pinal 85264 Base Maricopa 85011 Base Maricopa 85132 2 Pinal 85266 Base Maricopa 85012 Base Maricopa 85135 3 Gila 85267 Base Maricopa 85013 Base Maricopa 85137 2 Pinal 85268 Base Maricopa 85014 Base Maricopa 85138 2 Pinal 85281 Base Maricopa 85015 Base Maricopa 85139 2 Pinal 85282 Base Maricopa 85016 Base Maricopa 85140 1 Pinal 85283 Base Maricopa 85017 Base Maricopa 85141 2 Pinal 85284 Base Maricopa 85018 Base Maricopa 85142 1 Maricopa 85286 Base Maricopa 85019 Base Maricopa 85143 1 Pinal 85287 Base Maricopa 85020 Base Maricopa 85145 Base Pinal 85295 Base Maricopa 85021 Base Maricopa 85147 2 Pinal 85296 Base Maricopa 85022 Base Maricopa 85172 2 Pinal 85297 Base Maricopa 85023 Base Maricopa 85173 3 Pinal 85298 Base Maricopa 85024 Base Maricopa 85178 1 Pinal 85301 Base Maricopa 85025 Base Maricopa 85190 1 Maricopa 85302 Base Maricopa 85026 Base Maricopa 85191 2 Pinal 85303 Base Maricopa 85027 Base Maricopa 85192 3 Gila 85304 Base Maricopa 85028 Base Maricopa 85193 2 Pinal 85305 Base Maricopa 85029 Base Maricopa 85194 2 Pinal 85306 Base Maricopa 85031 Base Maricopa 85201 Base Maricopa 85307 Base Maricopa 85032 Base Maricopa 85202 Base Maricopa 85308 Base Maricopa 85033 Base Maricopa 85203 Base Maricopa 85309 Base Maricopa 85034 Base Maricopa 85204 Base Maricopa 85310 Base Maricopa 85035 Base Maricopa 85205 Base Maricopa 85311 Base Maricopa 85037 Base Maricopa 85206 Base Maricopa 85312 Base Maricopa 85039 Base Maricopa 85207 Base Maricopa 85313 Base Maricopa 85040 Base Maricopa 85208 Base Maricopa 85318 Base Maricopa 85041 Base Maricopa 85209 Base Maricopa 85320 1 Maricopa 85042 Base Maricopa 85210 Base Maricopa 85321 3 Pima 85043 Base Maricopa 85212 Base Maricopa 85322 1 Maricopa 85044 Base Maricopa 85213 Base Maricopa 85323 Base Maricopa 85045 Base Maricopa 85215 Base Maricopa 85324 2 Yavapai 85048 Base Maricopa 85221 2 Pinal 85325 3 La Paz 85050 Base Maricopa 85224 Base Maricopa 85326 1 Maricopa 85051 Base Maricopa 85225 Base Maricopa 85328 3 La Paz 85053 Base Maricopa 85226 Base Maricopa 85329 Base Maricopa 85054 Base Maricopa 85233 Base Maricopa 85331 Base Maricopa 85061 Base Maricopa 85234 Base Maricopa 85332 2 Yavapai 85064 Base Maricopa 85236 Base Maricopa 85333 3 Yuma 85083 Base Maricopa 85241 2 Pinal 85334 3 La Paz 85085 Base Maricopa 85247 2 Pinal 85335 Base Maricopa 85086 Base Maricopa 85248 Base Maricopa 85336 3 Yuma 85087 1 Maricopa 85249 Base Maricopa 85337 1 Maricopa 85097 Base Maricopa 85250 Base Maricopa 85338 Base Maricopa 85098 Base Maricopa 85251 Base Maricopa 85339 Base Maricopa 85117 1 Pinal 85253 Base Maricopa 85340 Base Maricopa



ZipCode Tier County ZipCode Tier County ZipCode Tier County 85341 Base Pima 85540 3 Greenlee 85648 2 Santa Cruz 85342 2 Maricopa 85541 3 Gila 85650 Base Cochise 85343 1 Maricopa 85542 3 Gila 85652 Base Pima 85344 2 La Paz 85543 3 Graham 85653 Base Pima 85345 Base Maricopa 85544 3 Gila 85654 Base Pima 85346 3 La Paz 85545 3 Gila 85655 3 Cochise 85347 3 Yuma 85546 3 Graham 85658 Base Pima 85348 3 La Paz 85548 3 Graham 85662 2 Santa Cruz 85349 3 Yuma 85550 3 Gila 85670 Base Cochise 85350 3 Yuma 85551 3 Graham 85671 Base Cochise 85351 Base Maricopa 85552 3 Graham 85701 Base Pima 85352 3 Yuma 85553 2 Gila 85702 Base Pima 85353 Base Maricopa 85554 2 Gila 85704 Base Pima 85354 1 Maricopa 85601 2 Pima 85705 Base Pima 85355 Base Maricopa 85602 2 Cochise 85706 Base Pima 85356 3 Yuma 85603 3 Cochise 85707 Base Pima 85357 3 La Paz 85605 2 Cochise 85708 Base Pima 85358 1 Maricopa 85606 2 Cochise 85709 Base Pima 85359 3 La Paz 85607 3 Cochise 85710 Base Pima 85360 3 Mohave 85608 3 Cochise 85711 Base Pima 85361 1 Maricopa 85609 2 Cochise 85712 Base Pima 85362 3 Yavapai 85610 3 Cochise 85713 Base Pima 85363 Base Maricopa 85611 2 Santa Cruz 85714 Base Pima 85364 3 Yuma 85613 Base Cochise 85715 Base Pima 85365 3 Yuma 85614 2 Pima 85716 Base Pima 85366 3 Yuma 85615 3 Cochise 85717 Base Pima 85367 3 Yuma 85616 2 Cochise 85718 Base Pima 85369 3 Yuma 85617 3 Cochise 85719 Base Pima 85371 2 La Paz 85618 3 Pima 85721 Base Pima 85373 Base Maricopa 85619 Base Pima 85723 Base Pima 85374 Base Maricopa 85620 2 Cochise 85724 Base Pima 85375 Base Maricopa 85621 2 Santa Cruz 85730 Base Pima 85376 Base Maricopa 85622 Base Pima 85731 Base Pima 85377 Base Maricopa 85623 3 Pima 85732 Base Pima 85378 Base Maricopa 85624 2 Santa Cruz 85734 BASE Pima 85379 Base Maricopa 85625 2 Cochise 85735 Base Pima 85381 Base Maricopa 85626 2 Cochise 85736 Base Pima 85382 Base Maricopa 85627 2 Cochise 85737 Base Pima 85383 Base Maricopa 85628 2 Santa Cruz 85739 Base Pima 85385 Base Maricopa 85629 Base Pima 85741 Base Pima 85387 Base Maricopa 85630 3 Cochise 85742 Base Pima 85388 Base Maricopa 85631 3 Pima 85743 Base Pima 85390 1 Maricopa 85632 2 Cochise 85744 Base Pima 85392 Base Maricopa 85633 2 Pima 85745 Base Pima 85395 Base Maricopa 85634 3 Pima 85746 Base Pima 85396 1 Maricopa 85635 3 Cochise 85747 Base Pima 85501 3 Gila 85636 2 Cochise 85748 Base Pima 85502 3 Gila 85637 2 Santa Cruz 85749 Base Pima 85530 3 Graham 85638 2 Cochise 85750 Base Pima 85531 3 Graham 85639 2 Pima 85751 Base Pima 85532 3 Gila 85640 2 Santa Cruz 85752 Base Pima 85533 3 Greenlee 85641 Base Pima 85755 Base Pima 85534 3 Greenlee 85643 3 Cochise 85756 Base Pima 85535 3 Greenlee 85644 2 Cochise 85757 Base Pima 85536 3 Graham 85645 2 Santa Cruz 85775 Base Pima 85539 3 Gila 85646 2 Santa Cruz 85901 3 Navajo



ZipCode Tier County ZipCode Tier County ZipCode Tier County

85902 3 Navajo 86043 3 Coconino 86433 3 Mohave 85911 3 Navajo 86044 3 Coconino 86434 3 Mohave 85912 3 Navajo 86045 3 Coconino 86435 3 Coconino 85920 3 Apache 86046 2 Coconino 86436 3 Mohave 85922 3 Greenlee 86047 3 Coconino 86437 3 Mohave 85923 3 Navajo 86052 3 Coconino 86438 3 Mohave 85924 3 Apache 86053 3 Coconino 86439 3 Mohave 85925 3 Apache 86054 3 Navajo 86440 3 Mohave 85926 3 Navajo 86301 Base Yavapai 86441 3 Mohave 85927 3 Apache 86302 Base Yavapai 86442 3 Mohave 85928 3 Navajo 86303 Base Yavapai 86443 3 Mohave 85929 3 Navajo 86304 Base Yavapai 86444 3 Mohave 85930 3 Apache 86305 Base Yavapai 86445 3 Mohave 85931 3 Coconino 86312 Base Yavapai 86446 3 Mohave 85932 3 Apache 86313 Base Yavapai 86502 3 Apache 85933 3 Navajo 86314 Base Yavapai 86503 3 Apache 85934 3 Navajo 86315 Base Yavapai 86504 3 Apache 85935 3 Navajo 86320 3 Yavapai 86505 3 Apache 85936 3 Apache 86321 3 Yavapai 86506 3 Apache 85937 3 Navajo 86322 Base Yavapai 86507 3 Apache 85938 3 Apache 86323 Base Yavapai 86508 3 Apache 85939 3 Navajo 86324 Base Yavapai 86510 3 Navajo 85940 3 Apache 86325 Base Yavapai 86511 3 Apache 85941 3 Navajo 86326 Base Yavapai 86512 3 Apache 85942 3 Navajo 86327 Base Yavapai 86514 3 Apache 86001 Base Coconino 86329 Base Yavapai 86515 3 Apache 86002 Base Coconino 86331 Base Yavapai 86520 3 Navajo 86003 Base Coconino 86332 2 Yavapai 86535 3 Apache 86004 Base Coconino 86333 Base Yavapai 86538 3 Apache 86005 Base Coconino 86334 2 Yavapai 86540 3 Apache 86011 Base Coconino 86335 Base Yavapai 86544 3 Apache 86015 Base Coconino 86336 Base Yavapai 86545 3 Apache 86016 Base Coconino 86337 2 Yavapai 86547 3 Apache 86017 Base Coconino 86338 2 Yavapai 86556 3 Apache 86018 Base Coconino 86340 Base Yavapai 86446 3 Mohave 86019 Base Coconino 86341 Base Yavapai 86502 3 Apache 86020 3 Coconino 86342 Base Yavapai 86503 3 Apache 86021 3 Mohave 86343 2 Yavapai 86504 3 Apache 86022 3 Coconino 86351 2 Yavapai 86505 3 Apache 86023 2 Coconino 86401 1 Mohave 86506 3 Apache 86024 2 Coconino 86402 1 Mohave 86507 3 Apache 86025 3 Coconino 86403 3 Mohave 86508 3 Apache 86028 3 Apache 86404 3 Mohave 86510 3 Navajo 86029 3 Navajo 86405 3 Mohave 86511 3 Apache 86030 3 Coconino 86406 3 Mohave 86512 3 Apache 86031 3 Navajo 86409 1 Mohave 86514 3 Apache 86032 3 Navajo 86411 1 Mohave 86515 3 Apache 86033 3 Navajo 86412 3 Mohave 86520 3 Navajo 86034 3 Navajo 86413 3 Mohave 86535 3 Apache 86035 3 Coconino 86426 3 Mohave 86538 3 Apache 86036 3 Coconino 86427 3 Mohave 86540 3 Apache 86038 Base Coconino 86429 3 Mohave 86544 3 Apache 86039 3 Coconino 86430 3 Mohave 86545 3 Apache 86040 3 Coconino 86431 3 Mohave 86547 3 Apache 86042 3 Coconino 86432 3 Mohave 86556 3 Apache

Arizona Early Intervention Program Billing Manual/ “Appendix – “C”

Public Comment Period Appendix C Page 23 of 24

Appendix “C” – Rates

Service Age Setting Base Rate

Tier 1 (10%)

Tier 2 (25%)

Tier 3 (50%)

Therapy & Psychological Services 0-2 Clinical $61.58 $67.74 $76.97 $92.37 Natural $84.12 $92.53 $105.14 $126.17

Therapy & Psychological Services, 2 Children 0-2

Clinical $38.49 $42.34 $48.11 $57.73 Natural $52.57 $57.83 $65.72 $78.86

Therapy & Psychological Services, 3 Children 0-2


Developmental Special Instruction (Bachelor's) 0-2


Developmental Special Instruction (Bachelor's), 2 Children 0-2


Developmental Special Instruction (Bachelor's), 3 Children 0-2


Developmental Special Instruction (Master's) 0-2


Developmental Special Instruction (Master's), 2 Children 0-2


Developmental Special Instruction (Master's), 3 Children 0-2


Social Work (Bachelor's) 0-2 Clinical $27.13 $29.85 $33.91 $40.70 Natural $39.93 $43.91 $49.90 $59.88

Social Work (Bachelor's), 0-2

Clinical $16.96 $18.66 $21.20 $25.44 2 Children Natural $24.95 $27.45 $31.19 $37.43 Social Work (Bachelor's),

0-2 Clinical $13.56 $14.92 $16.96 $20.35

3 Children Natural $19.96 $21.95 $24.95 $29.94

Social Work (Master's) 0-2 Clinical $38.98 $42.88 $48.72 $58.47 Natural $55.12 $60.63 $68.90 $82.68

Social Work (Master's), 0-2

Clinical $24.36 $26.80 $30.45 $36.55 2 Children Natural $34.44 $37.90 $43.07 $51.68 Social Work (Master's),

0-2 Clinical $19.49 $21.43 $24.36 $29.23

3 Children Natural $27.56 $30.32 $34.44 $41.34 Service Coordination 0-2 All $40.19 $44.21 $50.23 $60.28 Service Coordination Travel 0-2 Miles $0.445 per mile Evaluation (OT, PT, SLP, Psych), 0-2 All $160.00 (Rate per evaluation) Evaluation Rate (DSI, SW) 0-2 All $115.00 (Rate per evaluation)

Arizona Early Intervention Program Billing Manual/ “Appendix – “D”

Public Comment Period Appendix D Page 24 of 24

Appendix “D” – Billing Matrix

Service Delivery Option IPP/Ongoing Max

Units Across Multiple Team Members

Per (Day, Week, Mo, Qtr, Yr)

OT, PT, SLP

DSI Psych, SW

AT SC

Assistive Technology Device Ongoing N/A No N/A

X

Assistive Technology services Ongoing 8 No per day per child

X

X

Assistive Technology services -Multiple 2 Ongoing 8 No per day per child

X

X

Assistive Technology services -Multiple 3 Ongoing 8 No per day per child

X

X

Assistive Technology Evaluation IPP 4 Yes Per Child

X X

Assistive Technology Evaluation Multiple 2 IPP 4 Yes Per Child

X X

Assistive Technology Evaluation Multiple 3 IPP 4 Yes Per Child

X X

Assistive Technology Assessment Ongoing 4 Yes Per Child

X

X

Assistive Technology Assessment Multiple 2 Ongoing 4 Yes Per Child

X

X

Assistive Technology Assessment Multiple 3 Ongoing 4 Yes Per Child

X

X

Child & Family Assessment Initial IPP 4 Yes per child X X X X X Child & Family Assessment Other Ongoing 2 No per discipline per child X X X X X Child & Family Assessment Annual Ongoing 2 No per discipline per child X X X X X Initial Home Visit (No Screening Conducted) IPP 2 No per discipline per child X Initial Home Visit (Screening Conducted) IPP 2 No per discipline per child X Joint Visit Ongoing 8 No per day per child X X X X

Joint Visit - Multiple 2 Ongoing 8 No per day per child X X X X

Joint Visit - Multiple 3 Ongoing 8 No per day per child X X X X

Non Team Lead Ongoing 8 No per day per child X X X X

Non Team Lead - Multiple 2 Ongoing 8 No per day per child X X X X

Non Team Lead - Multiple 3 Ongoing 8 No per day per child X X X X

Team Lead Ongoing 8 No per day per child X X X

Team Lead - Multiple 2 Ongoing 8 No per day per child X X X

Team Lead - Multiple 3 Ongoing 8 No per day per child X X X

Team Lead - Non-Direct Ongoing 1 No Per child within 3 months X X X Evaluation for Initial Eligibility IPP N/A No Per Child X X X

Evaluation for Eligibility Redetermination Ongoing N/A No Per Child X X X

Family Training, Counseling and Home Visits Ongoing 8 No per day per child X X X

IFSP Initial Meeting IPP 2 No per discipline per day X X X X X IFSP Interim Meeting IPP 2 No per discipline per day X X X X X IFSP Addendum Meeting Ongoing 2 No per discipline per day X X X X X IFSP Annual Review Meeting Ongoing 2 No per discipline per day X X X X X Service Coordination IPP and ongoing 8 No per day per child

X

Service Coordination - Non Direct IPP and ongoing 8 No per day per child

X Service Coordinator Travel IPP and ongoing N/A No Miles Reimbursement

X

Other Service Ongoing 8 No per day per child X X X

X Team Conference Ongoing 0.25 /

0.75 No per 1 month/3 months per

Team Member per child X X X X X

Documents

Billing Manual and Data System Invoicing Procedures for ... · Billing Manual . and . Data System Invoicing Procedures . ... The contractor shall provide books, records, evidence