The Division of Medical Services (Arkansas Medicaid) has made changes to form DMS-640 for Occupational, Physical, and Speech-Language Therapy referrals and prescriptions (see 10/11/04 Official Notices on the Medicaid website).
Effective for dates of services on or after November 1, 2004, form DMS-640 must be used by Primary Care Physicians (PCP) when making referrals for therapy evaluations and when prescribing therapy treatment. Prescriptions and referrals completed prior to that date will not use the revised DMS-640 until it is time for a new referral/prescription.
The revised DMS-640 is available on the Special Education website under the Medicaid link at http://arksped.k12.ar.us. The Form can also be accessed at the Medicaid website at www.medicaid.state.ar.us. At the Medicaid website, select "Provider Information" and then "Provider Manuals, Official Notices, and RA messages" to display a list of Arkansas Medicaid programs. Select the appropriate program and scroll to "Official Notices".
For additional information regarding revised form DMS-640 or other topics on Medicaid in the schools, contact Tony Boaz at (501) 682-4288 or email at tboaz@arkedu.k12.ar.us.