CFO Provider Enrollment Acceptable ... - State of Louisiana



Chapter 13: Provider Qualifications in EarlySteps

|Specialty |Qualifications |Verification Requirement |Supervision Requirement |

|Applied Behavior Analysis|High School Diploma |Valid diploma or transcript indication award of diploma |Supervised by qualified Behavior Consultant enrolled|

|(ABA) Implementer | |AND |in EarlySteps |

| | |Documentation of supervision arrangement with supervisor’s | |

| | |name/qualifications | |

|Audiologist |Master’s in Audiology |Valid Louisiana License in Audiology |None |

| |AND | | |

| |Licensed by the LA Board of Examiners for | | |

| |Speech-Language Pathology and Audiology | | |

|Assistive Technology |Licensed OT, PT, MD, SLP, Audiologist, or Durable |Valid Louisiana License |None |

|Equipment Provider |Medical Equipment (DME) vendor |Verification of enrollment as DME vendor | |

|Behavior Consultant |Master’s or PhD degree in human service field |Transcript indicating achievement of graduate level degree in|None |

| |AND at least one of the following: |human service field | |

| |National Certification in Applied Behavior Analysis |AND | |

| |(BCBA) |Copy of National or State Certification in Applied Behavior | |

| |Applied Behavior Analysis Certification from another |Analysis | |

| |state | | |

|Counselor, Licensed |Master’s in Counseling or Marriage and Family Therapy|Valid Louisiana License as a Licensed Professional Counselor |None |

|Professional | |(LPC) | |

| |AND |OR | |

| |Licensed by the Louisiana Licensed Professional |Valid Louisiana License as a Licensed Marriage and Family | |

| |Counselors Board of Examiners as either an LPC or |Therapist (LMFT) | |

| |LMFT | | |

|Counselor, School setting|Masters in School Counseling |Transcript indicating achievement of Master’s Degree |Employment by a Local Education Agency (LEA) |

| |AND |AND | |

| |Certification by the Department of Education as a |Valid Louisiana DOE Certification in Counselor in School | |

| |Counselor in a School Setting or Professional |Setting | |

| |Counselor in a School Setting; must be employed by a |AND | |

| |local education agency |Proof of employment by LEA | |

|Dietitian |Bachelor’s Degree in Dietetics or Nutrition with |Valid Louisiana License in Dietetics and Nutrition |None |

| |internship | | |

| |AND | | |

| |Licensed by the Louisiana Board of Examiners in | | |

| |Dietetics and Nutrition | | |

|Early Intervention |Master’s degree in one of the following: early |Personnel Documentation Requirement at SPOE: |Supervision required by employing/contract agency |

|Consultant-SPOE |childhood education, child development, certification|Application/resume | |

| |in non-categorical preschool or early intervention; |Driver’s license | |

|(This position does not |occupational therapy, physical therapy; speech |Proof of auto insurance | |

|enroll with the CFO) |language pathology; nursing; psychology; social |Diploma/Transcript | |

| |work; or Master’s degree in education with Early |Verification of experience | |

| |Intervention Certificate |Verification of EarlySteps training | |

| |AND |Employment begin/end date(s) | |

| |3 years experience as an early intervention provider,|Annual evaluations by supervisor | |

| |working in a developmental service delivery model for|Salary documentation | |

| |early intervention with children ages birth to five |Background Check | |

| |with disabilities | | |

| |AND | | |

| |Employed or contracted by an EarlySteps System Point | | |

| |of Entry | | |

|Evaluation and Assessment|Master’s Degree |Copy of appropriate transcript/license |None |

|Provider |AND |AND | |

| |Educational Diagnostician Certification by the |Verification of BDI-2 training and Autism Screening Training | |

| |Louisiana Department of Education | | |

| |AND | | |

| |3 years experience evaluating children ages birth to | | |

| |five years | | |

| |OR | | |

| |Specialist meeting the personnel qualifications of | | |

| |Audiology, Behavior Consultant, Licensed Professional| | |

| |Counselor, Early Intervention Consultant, Registered | | |

| |Nurse, Occupational Therapy, Physical Therapy, | | |

| |Physician, Psychology, School Psychology, Social | | |

| |Work, Speech Language Pathology, Special Instructor, | | |

| |Special Instructor for Children with Sensory | | |

| |Impairments, Vision Specialist | | |

| |AND | | |

| |Completion of BDI-2 Training and Autism Screening | | |

| |Training | | |

| |Please note: assistant-level professionals are not | | |

| |qualified to enroll as Evaluation and Assessment | | |

| |Providers | | |

|Foreign Language |Statement of fluency in foreign language |Proof of Identification |None |

|Interpreter | |AND | |

| | |Tax ID number | |

|Interpreter for the deaf |High School Diploma or GED |Copy of diploma or GED certificate |None |

|or hard of hearing |AND |AND | |

| |Certification by and registered with the Commission |Valid Commission for the Deaf Certification as an Interpreter| |

| |for the Deaf | | |

|Nurse, RN |Associate’s or Bachelor’s in Nursing |Valid Louisiana License in Registered Nursing |None |

| |OR, | | |

| |Diploma in Nursing from a Nurse Diploma Program | | |

| |AND | | |

| |License by the State Board of Registered Nursing | | |

|Nurse, LPN |Graduate of a State Certified School of Practical |Valid Louisiana License in Practical Nursing |Supervision required by licensing board (including |

| |Nursing | |any updates not represented below) by supervisor |

| |AND |Documentation of Supervision Arrangement with licensed |knowledgeable about and enrolled in EarlySteps. |

| |Licensed by the Louisiana Board of Practical Nurse |physician, optometrist, dentist, psychologist, or registered |Authorizations are issued to supervisor/licensed |

| |Examiners |from the Service Matrix, no independent enrollment as LPN |May perform duties (with appropriate training) |

| | | |authorized by the Board when directed to do so by |

| | |Please note: |appropriate supervisees. |

| | |May not participate in eligibility determination | |

| | |May not participate in decision-making at a team meeting that|Information available at |

| | |results in changes to early intervention services | |

| | |May not enroll as or provide evaluation and assessment | |

| | |May perform duties consistent with educational preparation | |

|Occupational Therapist |Bachelors or Master’s Degree in Occupational Therapy |Valid Louisiana License in Occupational Therapy |None |

| |AND | | |

| |Licensed by the Louisiana Board of Examiners for | | |

| |Occupational Therapy | | |

|Occupational Therapy, |Graduate of an Accredited Occupational Therapy |Valid Louisiana License as a Certified Occupational Therapy |Supervision required by licensing board (including |

|Certified Assistant |Assistant Program |Assistant |any updates not represented below) by supervisor |

|(COTA) |AND | |knowledgeable about and enrolled in EarlySteps. |

| |Licensed by the Louisiana Board of Examiners of |Documentation of Supervision Arrangement with OT Supervisor |Authorizations are issued to supervisor/licensed OT |

| |Occupational Therapy |from the Service Matrix, no independent enrollment as | |

| | |assistant |For “home health” settings—must practice under |

| | | |direction of licensed OT as follows: |

| | |Please note: |No less than 2 years prior experience in OT |

| | |COTA implements treatment plan developed by licensed OT |Supervisor has conducted an assessment of the client|

| | |Attends IFSP meetings to provide input |and established the goals and treatment plan |

| | |May not participate in decision making at team meeting that |Supervisor re-evaluates or treats the client no less|

| | |results in changes to early intervention services |than once every 2 weeks or every 6th session |

| | | |Face-to-face client care conference for each client |

| | |May not enroll as or conduct evaluations and assessments |no less frequently than once every 2 weeks. |

| | | |Treatment provided by COTA is documented and signed |

| | | |by supervisor. |

| | | |Requirements available at: lsbme. |

|Ophthalmologist |Doctor of Medicine or Board Certified or Board |Valid Louisiana License in Ophthalmology |None |

| |eligible in Ophthalmology | | |

| |AND | | |

| |Licensed by Louisiana Board of Ophthalmology | | |

|Optometrist |Graduate of Approved School of Optometry (which is |Valid Louisiana License in Optometry |None |

| |accredited by the Council of Optometric Education of | | |

| |the American Optometric Association and recommended | | |

| |to state board in Optometry as worthy of approval in | | |

| |Louisiana) | | |

| |AND | | |

| |Licensed by the Louisiana State Board of Optometry | | |

| |Examiners | | |

|Orientation and Mobility |Bachelor’s Degree in Orientation and Mobility |Transcript indicating Bachelor’s in Orientation and Mobility | |

|Specialists |Training |Training | |

| |AND |AND | |

| |Certification by the Association for Education and |Valid Association for Education and Rehabilitation of the | |

| |Rehabilitation of the Blind and Visually Impaired |Blind and Visually Impaired Certificate | |

| | |OR | |

| | |Proof of eligibility for receipt of a valid certificate from | |

| | |the Association for Education and Rehabilitation of the Blind| |

| | |and Visually Impaired | |

|Physical Therapist |Bachelor’s or Master’s Degree in Physical Therapy |Valid Louisiana License in Physical Therapy |None |

| |AND | | |

| |Licensed by state Board of Physical Therapy Examiners| | |

|Physical Therapist |Graduate of an Accredited Physical Therapy Assistant |Valid Louisiana License as a Physical Therapist Assistant |Supervision required by licensing board (including |

|Assistant |Program | |any updates not represented below) by supervisor |

| |AND |Written supervision arrangement by physical therapy |knowledgeable about and enrolled in EarlySteps. |

| |Licensed by state Board of Physical Therapy Examiners|supervisor on the Service Matrix, no independent provider |Authorizations are issued to supervisor/licensed PT |

| |AND |enrollment |Supervisor responsibilities-- |

| |One year of work experience | |In nursing/outpatient settings: |

| | |Letter from previous employer verifying employment dates of |Supervisor must be on premises for at least ½ of the|

| | |one year of work experience |treatment hours provided by PTA |

| | | |Evaluate and set up treatment plan for each patient |

| | |Please note: |prior to treatment |

| | |Implements treatment plan (IFSP) developed by licensed PT |Be accessible (beeper/phone) within 25 miles and 30’|

| | |Attends IFSP meeting to provide input |travel time of facility |

| | |May not participate in Eligibility Determination |Assess final treatment and write discharge summary |

| | |May not Participate in decision-making at team meeting that |In home health/school settings: |

| | |results in changes to early intervention services |Be readily accessible by beeper/phone |

| | |May not enroll as or perform evaluation and assessments |Evaluate and set up treatment plan on each client |

| | | |prior to treatment |

| | | |Treat and assess on at least every 6th visit, not |

| | | |less than 1 x month |

| | | |Conduct 1x week face-to-face conference with PTA to |

| | | |review and modify treatment plan |

| | | |Assess final treatment and write discharge summary |

| | | | |

| | | |Information available at |

| | | | |

|Physician |Doctor of Medicine and either Board Eligible or Board|Valid Louisiana License as a Physician |None |

| |Certified in an appropriate medical specialty | | |

| |AND | | |

| |Licensed by the Louisiana Board of Medical Examiners | | |

| |as a Physician | | |

|Psychologist |Doctorate in Psychology |Valid Louisiana License in Psychology |None |

| |AND | | |

| |Licensed by the State Board of Examiners in | | |

| |Psychology | | |

|Specialty |Qualifications |Verification Requirement |Supervision Requirement |

|School Psychologist |Master’s Degree in School Psychology |Transcript indicating achievement of Master’s Degree in | |

| |AND |School Psychology | |

| |Louisiana Department of Education Level B |AND | |

| |Certification in School Psychology |Valid Louisiana Department of Education Level B Certification| |

| | |in School Psychology | |

| | |AND | |

| | |Proof of LEA employment | |

|Associate to a |Master’s Degree in Psychology |Transcript indicating Master’s Degree in Psychology | |

|Psychologist (ATAP) |AND |AND | |

| |Must be employed by a state agency (such as the |Verification of employment with OCDD | |

| |Office for Citizens with Developmental Disabilities) | | |

| |which also employs and/or contracts with a licensed | | |

| |psychologist for required supervision. The licensed | | |

| |psychologist must also enroll as an EarlySteps | | |

| |provider. | | |

|Intake Coordinator |Bachelor’s or Master’s Degree in one of the following|Transcript indicating Bachelor’s or Master’s in Human Service|SPOE Agency must provide required supervisor with |

|Supervisor |human service fields, from an field-specific |Field as listed |activities documented according to EarlySteps and |

| |accredited institution: |AND/OR |Medicaid requirements if supervisor also carries a |

|(This position does not |Social Work |License as appropriate to discipline |caseload. |

|enroll with the CFO) |Nursing (RN currently licensed—one year paid |AND | |

| |experience will substitute for degree) |Employment Documentation |Supervision meets requirements of DHH Health |

| |Psychology |Application/resume |Standards: |

| |Education |Driver’s license |Individual, face-to-face supervision at least 1 time|

| |Counseling |Proof of auto insurance |per week for minimum of 1 hour |

| |Child life/family studies, child development |Diploma/transcript |Face-to-face sessions with all case management staff|

| |Family and Consumer sciences |Employment begin/end dates verifying paid post-degree case |to problem-solve, provide feedback and support |

| |Criminal Justice |management experience |Sessions in which supervisor accompanies case |

| |Social services or sociology |Training verification according to EarlySteps and Medicaid |manager are required |

| |Philosophy |requirements prior to case assignment |Review of at least 10% of each case manager’s |

| |Substance abuse |Annual evaluation by supervisor |records conducted each month. |

| |Vocational rehabilitation |Salary documentation | |

| |OR |Background check | |

| |Bachelor’s degree in liberal arts or general studies | | |

| |with 16 hours on a field listed above. | | |

| |AND | | |

| |Two years of paid post-degree experience in providing| | |

| |case management services | | |

| | | | |

| | | | |

| | | | |

| | | | |

|Specialty |Qualifications |Verification Requirement |Supervision Requirement |

|Family Support |Bachelor’s or Master’s degree in a human services |Transcript indicating Bachelor’s in Human Service Field as |FSC Agency must provide required supervisor that |

|Coordinator |field, from a field-specific accredited institution |listed |meets qualifications with supervision activities |

| |including: |AND/OR |documented according to EarlySteps and Medicaid |

| |Social Work |License as appropriate to discipline |requirements |

| |Nursing (RN currently licensed—one year paid |AND | |

| |experience will substitute for degree) |Employment Documentation | |

| |Psychology |Application/resume | |

| |Education |Driver’s license | |

| |Counseling |Proof of auto insurance | |

| |Child life/family studies, child development |Diploma/transcript | |

| |Family and consumer sciences |Employment begin/end dates | |

| |Social services or sociology |Training verification according to EarlySteps and Medicaid | |

| |Philosophy |requirements prior to case assignment | |

| |Substance abuse |Annual evaluation by supervisor | |

| |Vocational rehabilitation |Salary documentation | |

| |OR |Background check | |

| |Bachelor’s degree in liberal arts or general studies | | |

| |with 16 hours on a field listed above. | | |

|Family Support |Bachelor’s or Master’s Degree in one of the following|Transcript indicating Bachelor’s or Master’s in Human Service|FSC Agency must provide required supervisor with |

|Coordinator Supervisor |human service fields, from an field-specific |Field as listed |activities documented according to EarlySteps and |

| |accredited institution: |AND/OR |Medicaid requirements if supervisor also carries a |

| |Social Work |License as appropriate to discipline |caseload. |

| |Nursing (RN currently licensed—one year paid |AND | |

| |experience will substitute for degree) |Employment Documentation | |

| |Psychology |Application/resume | |

| |Education |Driver’s license | |

| |Counseling |Proof of auto insurance | |

| |Child life/family studies, child development |Diploma/transcript | |

| |Family and Consumer sciences |Employment begin/end dates verifying paid post-degree case | |

| |Criminal Justice |management experience | |

| |Social services or sociology |Training verification according to EarlySteps and Medicaid | |

| |Philosophy |requirements prior to case assignment | |

| |Substance abuse |Annual evaluation by supervisor | |

| |Vocational rehabilitation |Salary documentation | |

| |OR |Background check | |

| |Bachelor’s degree in liberal arts or general studies | | |

| |with 16 hours on a field listed above. | | |

| |AND | | |

| |Two years of paid post-degree experience in providing| | |

| |case management services | | |

|Specialty |Qualifications |Verification Requirement |Supervision Requirement |

|Social Worker |Master’s Degree in Social Work |Valid Louisiana License in Social Work |Supervision required by licensing board (including |

| |AND |OR |any updates not represented below) by supervisor |

| |Licensed by the Louisiana Board of Social Work |Transcript indicating graduate degree in Social Work |knowledgeable about and enrolled in EarlySteps-- |

| |Examiners as a LCSW |AND |1. GSW seeking LCSW credential: Minimum of 24 |

| |OR |Proof of employment (i.e., notarized letter from employer, |accumulated calendar months of supervised fulltime |

| |GSW employed by an agency and working under |W-2 forms, etc.) |postgraduate social work practice under |

| |supervision |AND/OR |Board-Approved Clinical Supervisor |

| | |Documentation of supervision arrangement with licensed social|Face-to-face supervision for licensure must total at|

| | |worker (LCSW) on Service Matrix |least 96 hours |

| | | |4 hours per calendar month with at least two |

| | |GSW level: |different supervision contacts per month |

| | |Must be employed by an agency |one-half (48 hrs. maximum) may be met through group |

| | |May perform practice activities allowable by license |supervision in no more than 2 hours per group with |

| | |May not enroll as Evaluation and Assessment provider or |no more than 5 supervisees in group. |

| | |participate in eligibility determination |2. GSW not pursuing LCSW or fulfilling experience |

| | |May not participate in decision-making at team meeting that |requirement toward licensure may deliver clinical |

| | |results in changes to early intervention services. |services which constitute psychotherapy only under |

| | | |the supervision of an LCSW as follows: |

| | | |Minimum of 2 hours supervision/month in increments |

| | | |no fewer than 30 minutes for the duration of time |

| | | |providing psychotherapeutic services |

| | | |Supervisor is not required to have BACS designation |

| | | |GSW may independently secure LCSW supervision, |

| | | |supervisor is enrolled in EarlySteps |

| | | |On-site supervision is preferred |

| | | |Supervision activities may include individual, |

| | | |group, telephone, secure electronic media |

| | | |Requirements available at |

|Specialty |Qualifications |Verification Requirement |Supervision Requirement |

|Speech/Language |Master’s Degree in Speech-Language Pathology or |Valid Louisiana License in Speech Language Pathology |None |

|Pathologist |Communication Disorders | | |

| |AND | | |

| |Licensed by the Louisiana Board of Examiners for | | |

| |Speech-Language Pathology and Audiology | | |

|Speech/Language |Bachelor’s Degree in Speech/Language Pathology |Valid License issued by the Louisiana Board of Examiners for |Supervision according to license requirements for |

|Pathologist Assistant |AND |Speech-Language Pathology and Audiology |provisional SLP, provisional/restricted SLP, and |

| |Licensed by the Louisiana Board of Examiners for | |provisional SLP Assistants (including any updates |

| |Speech-Language Pathology and Audiology |Documentation of Supervision arrangement by licensed SLP on |not represented below). Supervisor must be |

| | |the Service Matrix in EarlySteps work setting, no independent|knowledgeable about and enrolled as EarlySteps SLP. |

| | |enrollment |The supervisor and supervisee must maintain |

| | | |supervision records for a period of 3 years. |

| | |Please note: |Provisional/Restricted SLP |

| | |May not participate in eligibility determination |Minimum 4 on-site, in-view (allows live video or web|

| | |May not participate in decision-making at a team meeting |cam) activities and |

| | |resulting in changes to early intervention services. |Alternate activities for a total of 12 per year |

| | |May not enroll as or provide evaluation and assessment. | |

| | |May conduct hearing screening limited to pass/fail |SLP Assistant |

| | |determination |1 clock hour of on-site, in-view supervision (allows|

| | | |live video and web cam) and |

| | | |1 clock hour of alternative methods each week. |

| | | |Information available at |

| | | | |

|Specialty |Qualifications |Verification Requirement |Supervision Requirement |

|Special Instructor |Bachelor’s or Master’s degree |Transcript indicating achievement of Bachelor’s or Master’s |None or as required by school system employer |

| |AND |Degree | |

| |Certification by the Louisiana Department of |AND | |

| |Education in at least one of the following: |Valid Certification by the Louisiana Department of Education | |

| |Noncategorical Preschool |as listed | |

| |Early Intervention | | |

| |Adapted Physical Education with add-on in Early | | |

| |Intervention | | |

| |Pre-K through 3 with add-on in Early Intervention | | |

| | | | |

| | | | |

|Special Instructor for |Bachelor’s or Master’s degree |Transcript indicating achievement of a Bachelor or Masters |None or as required by school system employer |

|Children with Sensory |AND |degree | |

|Impairments |Certification by the Louisiana Department of |AND | |

| |Education in at least one of the following: |Valid Certification in Visually Impaired or Hearing Impaired | |

| |Visually Impaired | | |

| |Hearing Impaired | | |

|Transportation Provider |Valid driver’s license |Valid driver’s license number with expiration date | |

| |AND |AND | |

| |Proof of current liability insurance |Copy of current insurance card indicating liability coverage | |

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