RetiredCareSourcePolicy N/A

Adult Developmental Treatment (ADDT) Services - AR PASSE

CareSource policy describing medical necessity, coverage conditions, service definitions, documentation, and service limits for Adult Developmental Treatment (ADDT) outpatient day services for beneficiaries age 21+ with developmental disabilities in Arkansas PASSE.

Policy Summary

PayerCareSource

PolicyAdult Developmental Treatment (ADDT) Services - AR PASSE

Policy CodePolicy N/A

Change TypeArchived

Effective DateNov 1, 2022

Next Review Date

Key ActionEnsure the beneficiary's IPP is authorized with the physician's original personal signature and maintain daily documentation supporting medical necessity and IPP goals.

SourceLink

POLICY UPDATE CHANGES

Policy archived effective 10/31/2023.

21+Minimum beneficiary age for ADDT services

1 hourMinimum billable unit length for assessment services

5Maximum reimbursable habilitative service units per day

4Maximum group therapy size

Medically Necessary / Eligibility for ADDT

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Medically Necessary / Eligibility for ADDT

CareSource considers ADDT medically necessary when ALL of the following clinical criteria are met:

ALL of the following

Beneficiary is an outpatient 21 years of age or older.
- Qualifying developmental disabilities (any of the following suffice)
  - Intellectual disability (IQ scores two or more standard deviations below the mean on a standardized intelligence test administered by a qualified professional).
  - Cerebral palsy established by medical examination.
  - Spina bifida established by medical examination.
  - Down syndrome established by physician diagnosis.
  - Epilepsy established by neurological and/or physician examination.
  - Autism Spectrum Disorder established by team evaluation including at least a licensed physician and a licensed psychologist (and a licensed speech pathologist for some references).
  - Other conditions closely related to intellectual disabilities resulting in impairment of general intellectual functioning or adaptive behavior similar to intellectual disability or requiring similar services.
  - Dyslexia resulting from intellectual disability, cerebral palsy, epilepsy, spina bifida, Down syndrome, or ASD as established by a team evaluation.
- Disability has continued or is expected to continue indefinitely; constitutes a substantial handicap to functioning without appropriate support services.
Services are ordered by physician (written prescription).
Services are provided in accordance with a written Individual Program Plan (IPP) authorized and signed (original personal signature) by the physician determining medical necessity.
Delegated or stamped signatures are not allowed; electronic signatures accepted if compliant with Arkansas Code § 25-31-103.
Beneficiary is an outpatient who travels to and from treatment site on same day, does not reside in an ICF/IID, and is not an inpatient of a hospital.

Service Limits and Conditions of Coverage

Service Limits / Conditions of Coverage

Services are subject to the following conditions and limits:

ALL of the following

Assessment services are covered separately and reimbursed per unit where one unit equals one hour; assessment services are covered once per calendar year if medically necessary; length must not exceed one unit per date of service.
Adult habilitative services are provided based on IPP goals; units equal one hour in facility; maximum five units reimbursable per day; transit time is excluded from unit calculation.
Group therapy sessions limited to no more than four persons.
Therapy (occupational, physical, speech) in the ADDT program is optional but only covered when included in the IPP and after PCP/attending physician referral and physician prescription; optional therapies may not be billed as stand-alone services outside the ADDT program.
Therapy services may not be provided during the same time period as ADDT core services; ADDT providers may not bill under the Medicaid Occupational, Physical and Speech Therapy Program for therapy services provided to ADDT clients.
Prevocational services may be provided only to persons not expected to join the general workforce or transitional sheltered workshops within one year; must not be job-task oriented or address explicit employment objectives; compensation must be less than 50% of minimum wage for training to qualify as prevocational.
Therapies performed by unlicensed therapy students are covered only if the licensed therapist is present and engaged in oversight for the entire encounter and the services are provided under the direction of the licensed therapist.
Nursing services available for medically fragile or complex needs if prescribed by PCP and performed by a licensed nurse; administration of medication alone or taking temperature/first aid do not qualify; evaluation must specify needed nursing services and number of nursing units needed per day.
Documentation requirements: daily service records must include date, actual start/end times, specific covered services furnished, names/titles of providers, relationship of services to IPP goals, and weekly or more frequent progress notes signed/initialed; medical records must support medical necessity and contain IPP; electronic signatures accepted if compliant with Arkansas Code § 25-31-103.

Service thresholds / limits

Assessment unit length1 hour (minimum billable unit); assessments <1 hour are non-covered

Maximum habilitative units per day5 units (each = 1 hour)

Group therapy maximum size4 persons

Prevocational wage thresholdCompensation must be <50% of minimum wage for training to qualify as prevocational

Non-covered Services

The following services are explicitly not covered under ADDT:

ANY of the following

Assessment services and adult habilitative services less than 1 hour in length.
Supervised living services.
Educational services.
Services to inpatients.

Denial Risk

Non-covered service denials

Claims for assessment or habilitative services less than one hour, supervised living services, educational services, or services provided to inpatients are not covered under ADDT and will be denied as non-covered services.

What Providers Must Do

Prior Authorization

Physician authorization of IPP

The Individual Program Plan (IPP) must be authorized and signed with the physician's original personal signature; delegation or stamped signatures are not allowed. Electronic signatures are acceptable if compliant with Arkansas Code § 25-31-103.

Prior Authorization

Physician order / prescription required for therapies

Occupational, physical, or speech therapy in the ADDT program requires referral by the beneficiary's primary care physician (PCP) or attending physician and a physician prescription; a copy of the prescription must be maintained in the beneficiary's records.

Documentation Required

Maintain comprehensive beneficiary medical record and daily documentation

Providers must maintain medical records that support medical necessity and include the beneficiary's IPP; daily service documentation must include date, actual start and end times, the specific covered services furnished, names and titles of providers, relationship of services to IPP goals, and weekly or more frequent progress notes signed or initialed. Electronic signatures are accepted if compliant with Arkansas Code § 25-31-103.

Date and actual beginning and ending time of services performed
Specific ADDT covered services furnished daily
Name(s) and title(s) of person(s) providing the service(s)
Relationship of services to goals and objectives in the beneficiary's IPP
Weekly or more frequent progress notes signed or initialed
Records must support medical necessity and contain the IPP
Electronic signatures accepted per Arkansas Code § 25-31-103

Documentation Required

Therapy student supervision

Therapies performed by unlicensed therapy students are covered only when the licensed therapist is present and engaged in oversight for the entirety of the encounter and the services are provided under the direction of the licensed therapist; otherwise the services are not covered.

Licensed therapist must be present and engaged in student oversight during the entire encounter
Services must be under the direction of the licensed therapist

Defined Terms

Key definitions

Adult Developmental Treatment (ADDT)Assessments, as well as habilitative, supervised living, prevocational, therapeutic, and educational services provided by a licensed adult treatment clinic.

Individual Program Plan (IPP)A written, individualized plan to improve or maintain the beneficiary's condition based upon evaluation and containing a written description of treatment objectives; must be authorized by the physician determining medical necessity.

Adult Habilitative ServicesInstruction in cognition, communication, social/emotional, motor, and adaptive (including self-care) skills or to reinforce skills learned in occupational, physical, or speech therapy; based on IPP goals.

Assessment ServicesTests and evaluations reimbursed per unit (1 unit = 1 hour), including administration, scoring, and report time; covered once per calendar year if medically necessary.

Prevocational ServicesHabilitation preparing a beneficiary for employment (goals like compliance, task completion); not job-task oriented, for persons not expected to join general workforce within one year; compensation must be <50% of minimum wage.

Clinical and Administrative Background

Adult Developmental Treatment (ADDT) provides habilitative, supervised living, prevocational, therapeutic, and educational services delivered by licensed adult treatment clinics for outpatients aged 21 years and older with developmental disabilities. These ADDT core and optional services are furnished by DPSQA‑licensed comprehensive adult developmental day treatment centers and include assessments, adult habilitative services, and optional occupational, physical and speech therapies and nursing when medically necessary and prescribed by the beneficiary's primary care or attending physician. [[3]] [[6]]

For each beneficiary who enters the ADDT program an Individual Program Plan (IPP) must be developed. The IPP is a written, individualized plan based on evaluation that describes treatment objectives, a schedule for service delivery (frequency and duration), job titles/credentials of personnel furnishing services, and a tentative schedule for reevaluations and IPP updates. The IPP must be authorized by the physician determining that ADDT services are medically necessary and must bear the physician's original personal signature (delegated or stamped signatures are not permitted; electronic signatures are acceptable when compliant with Arkansas Code § 25‑31‑103). [[2]] [[11]] [[9]]

Assessment services are reimbursed per unit with one unit = one hour (including administration, scoring, and report writing) and are covered once per calendar year if medically necessary. Adult habilitative services are provided based on IPP goals, billed in one‑hour units with a maximum of five units per day, and prevocational services are available only under specified conditions (must not be job‑task oriented, intended for persons not expected to join the general workforce within one year, and trainee compensation must be less than 50% of minimum wage). Documentation requirements for daily service records include date, actual start/end times, services provided, provider names/titles, relation to IPP goals, and weekly or more frequent progress notes signed or initialed. [[6]] [[8]] [[11]]

Therapies in the ADDT program are optional but are covered only when they are included in the beneficiary's IPP and after referral and prescription by the PCP or attending physician; a copy of the prescription must be maintained in the beneficiary's record. Group therapy is limited to no more than four persons per session. Services that do not meet program definitions or minimum unit lengths (for example, assessment or habilitative services under 1 hour), supervised living, educational services, or services to inpatients are not covered under ADDT. [[10]] [[6]] [[9]] [[5]]

Policy Summary

PayerCareSource

PolicyAdult Developmental Treatment (ADDT) Services - AR PASSE

Policy CodePolicy N/A

Change TypeArchived

Effective DateNov 1, 2022

Next Review Date

Key ActionEnsure the beneficiary's IPP is authorized with the physician's original personal signature and maintain daily documentation supporting medical necessity and IPP goals.

SourceLink

On This Page

OpenPayer

Adult Developmental Treatment (ADDT) Services - AR PASSE

Medically Necessary / Eligibility for ADDT

Service Limits and Conditions of Coverage

Non-covered Services

Diagnoses / Code Guidance

What Providers Must Do

Defined Terms

Clinical and Administrative Background

Policy Update Changes