Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.07-011 - Occupational, Physical, Speech Therapy Services Provider Manual Update Transmittal # 78

Current through Register Vol. 49, No. 6, June, 2024
Section II
Occupational, Physical, Speech Therapy
			 Services
201.000
Arkansas Medicaid Participation Requirements
Individual and group providers of occupational therapy,
				physical therapy and speech-language pathology services must meet the following
				criteria to be eligible to participate in the Arkansas Medicaid Program.
A. A provider of therapy services must meet
			 the enrollment criteria for the type of therapy to be provided as established
			 and outlined in section
			 202.000 of this manual.
B. A provider of therapy services has the
			 option of enrolling in the Title XVIII (Medicare) Program. Item 1-C. of the
			 Contract To Participate In The Arkansas Medical Assistance Program Administered
			 By The Division Of Medical Services Title XIX (Medicaid) further requires
			 acceptance of assignment under Title XVIII (Medicare) in order to receive
			 payment under Title XIX (Medicaid) for any applicable deductible or coinsurance
			 that may be due and payable under Title XIX (Medicaid). Services furnished to
			 an individual enrolled under Medicare who is also eligible for Medicaid,
			 including Qualified Medicare Beneficiaries (QMB)
may only be
			 reimbursed on an assignment related basis.
When a beneficiary is
			 dually eligible for Medicare and Medicaid, providers must bill Medicare prior
			 to billing Medicaid. The beneficiary may not be billed for the charges.
			 Providers enrolled to participate in the Title XVIII (Medicare) Program must
			 notify the Arkansas Medicaid Program of their National Provider
			 Identifier.
C. The provider must
			 complete and submit to the Medicaid Provider Enrollment Unit a provider
			 application (form DMS-652), a Medicaid contract (form DMS-653) and a Request
			 for Taxpayer Identification Number and Certification (Form W-9).
View or print a provider application (form DMS-652), Medicaid
			 contract (form DMS-653) and Request for Taxpayer Identification Number and
			 Certification (Form W-9).
D. The following documents must accompany the
			 provider application and the Medicaid contract.
1. A copy of all certifications and licenses
			 verifying compliance with enrollment criteria for the therapy discipline to be
			 practiced. (See section
			 202.000 of this
			 manual.)
2. If enrolled in the
			 Title XVIII (Medicare) Program, an out-of-state provider must submit a copy of
			 verification that reflects current enrollment in that program.
E. Enrollment as a Medicaid
			 provider is conditioned upon approval of a completed provider application and
			 the execution of a Medicaid provider contract. Persons and entities that are
			 excluded or debarred under any state or federal law, regulation or rule are not
			 eligible to enroll, or to remain enrolled, as Medicaid providers.
F. A copy of subsequent state license renewal
			 must be forwarded to the Medicaid Provider Enrollment Unit within 30 days of
			 issuance. If the renewal document(s) have not been received within this
			 timeframe, the provider will have an additional and final 30 days to
			 comply.
G. Failure to timely submit
			 verification of license renewal will result in termination of enrollment in the
			 Arkansas Medicaid Program.
H. The
			 provider must adhere to all applicable professional standards of care and
			 conduct.