Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 28 - Division of County Operations › Rule 016.28.20-001 - MS Policy Sections A-100; B-300; C-200; E-400; F-100; H-400; I-300; I-500; I-600; SPA# 2019-0007 to Update Income Offsets pursuant to Acts 2017, No. 892

Current through Register Vol. 49, No. 6, June, 2024
Medical Services Policy Manual, Section A
A-100
General Program
			 Information
MS Manual 07/01/20
The Medicaid Program is a Federal-State Program designed to
				meet the financial expense of medical services for eligible individuals in
				Arkansas. The Department of Human Services, Divisions of County Operations and
				Medical Services have the responsibility for administration of the Medicaid
				Program. The purpose of Medical Services is to provide medical assistance to
				low income individuals and families and to insure proper utilization of such
				services. The Division of County Operations will accept all applications,
				verification documents, etc. and will make eligibility determinations.
Benefits for the Arkansas Medicaid and ARKids Programs include,
				but are not limited to the following:
* Emergency Services
* Home Health and Hospice
* Hospitalization
* Long Term Care
* Physician Services
* Prescription Drugs
* Transportation-Refer to Appendix B for a description of
				Transportation Services
Generally, there is no limit on benefits to individuals under
				age 21 who are enrolled in the Child Health Services Program (EPSDT). There may
				be benefit limits to individuals over age 21. Consult "Arkansas Medicaid,
				ARKids First & You, Arkansas Medicaid Beneficiary Handbook" (PUB-040) for
				specific information and covered services.
The Adult Expansion Group coverage for most individuals will be
				provided through a private insurance plan, i.e., a Qualified Health Plan (QHP).
				QHP coverage will include:
* Outpatient Services
* Emergency Services
* Hospitalization
* Maternity and Newborn Care
* Mental Health and Substance Abuse
* Prescription Drugs
* Rehabilitative and Habilitative Services
* Laboratory Services
* Preventive and Wellness Services and Chronic Disease
				Management
* Pediatric Services, including Dental and Vision Care
Exception:
Individuals
				eligible for the Adult Expansion Group who have health care needs that make
				coverage through a QHP impractical, overly complex, or would undermine
				continuity or effectiveness of care, will not enroll in a private QHP plan but
				will remain in Medicaid.
A-115
Cost Sharing for Workers with
			 Disabilities
MS Manual 07/01/20
Recipients of Medicaid for Workers with Disabilities with gross
				income under 100 percent (100%) of the Federal Poverty Level for their family
				size will be subject to the usual Medicaid co- pays. Recipients with gross
				income equal to or greater than 100 percent (100%) of the FPL will be assessed
				co-payments at the point of service for medical visits and prescription drugs
				according to the following schedule:
1. Physician's visits - $10.00 per
			 visit;
2. Prescription drugs -
			 $10.00 for generic, $15.00 for brand name;
3. Inpatient Hospital - 25% of the first
			 day's Medicaid per diem rate;
4.
			 Orthotic appliances, prosthetic devices and augmentative communication devices
			 - 10% of the Medicaid maximum allowable amount;
5. Durable medical equipment - 20% of
			 Medicaid maximum allowable amount per item;
6. Occupational, physical and speech therapy,
			 & private duty nursing - $10.00 per visit, with a cap of $10.00 per
			 day.