reglab/statecodes huggingface dataset:
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.05-024 - Rehabilitative Services for Youth and Children (RSYC) Update Transmittal #14

Current through Register Vol. 49, No. 6, June, 2024
Section II
Rehabilitative Services for Youth and Children
201.000
Introduction
Medicaid (Medical Assistance) is designed to assist eligible
				Medicaid recipients in obtaining medical care within the guidelines specified
				in Section
				I of this manual. Reimbursement
				may be made for Rehabilitative Services for Youth and Children (RSYC) when
				provided to eligible Medicaid recipients by qualified providers.
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.
262.100
Division of Youth Services
			 (DYS) Special Billing Codes
The following pages contain a listing of Arkansas Medicaid
				Rehabilitative Services for Youth and Children (RSYC) Codes that pertain to
				services covered by the Division of Youth Services (DYS). It is important to
				use the Medicaid code listing. All codes must have five digits.
Procedure Code
Required Modifier
Description
96100
UB
PSYCHOLOGICAL TESTING BATTERY
This code will only be used for the retroactive billing
						  period.
1 unit = test battery
H2020
-
EMERGENCY SHELTER 1 unit = 1 day
H2020
U1
THERAPEUTIC FOSTER CARE 1 unit = 1 day
H2020
U2
THERAPEUTIC GROUP HOME 1 unit = 1 day
H2020
U4
RESIDENTIAL TREATMENT SERVICES 1 unit = 1 day
90801
-
DIAGNOSIS AND EVALUATION 1 unit = 15 minutes
90804
-
INDIVIDUAL PSYCHOTHERAPY 1 unit = 15 minutes
90853
-
GROUP PSYCHOTHERAPY 1 unit = 15 minutes
262.200
Division of Children and
			 Family Services (DCFS) Special Billing Codes
The following pages contain a listing of Arkansas Medicaid
				Rehabilitative Services for Youth and Children (RSYC) codes that pertain to
				services covered by the Division of Children and Family Services (DCFS). It is
				important to use the Medicaid code listing. All codes must have five
				digits.
Procedure Code
Required Modifier
Description
90801
-
PSYCHIATRIC DIAGNOSTIC INTERVIEW EXAMINATION 1 unit = 1
						  visit
T1023
U1
ASSESSMENT, REASSESSMENT AND PLAN OF CARE
DEVELOPMENT
1 unit = 1 visit
H0032
U1
PERIODIC REVIEW OF PLAN OF CARE
1 unit = 15 minutes. Maximum of 2 units per day.
H2020
U1
THERAPEUTIC FOSTER CARE 1 unit = 1 day
H2020
U1
RESIDENTIAL TREATMENT SERVICES 1 unit = 1 day
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.05-025 - Licensed Mental Health Practitioners (LMHP) Update Transmittal #44

Current through Register Vol. 49, No. 6, June, 2024
201.000
Arkansas Medicaid Participation Requirements for Licensed Mental
Health Practitioners - Licensed Certified Social Worker
				(LCSW), Licensed Marriage and Family Therapist (LMFT), Licensed Professional
				Counselor (LPC) and Psychologist
In order to ensure quality and continuity of care, all mental
				health providers approved to receive Medicaid reimbursement for services
				provided to the under age 21 Medicaid population must meet specific
				qualifications for their services and staff.
In order to be enrolled as a Medicaid Licensed Mental Health
				Practitioner provider, the following must occur:
A. A provider application (Form DMS-652) and
			 a contract (Form DMS-653) with the Arkansas Medicaid Program must be completed
			 and submitted.
View or print a provider application (Form
			 DMS-652), Medicaid contract (Form DMS-653) and Request for Taxpayer
			 Identification Number and Certification (W-9).
B. For the LCSW, LMFT and LPC, a copy of the
			 certification letter from the Division of Mental Health Services (DMHS) must
			 accompany the provider application. Any changes or subsequent certifications
			 must be furnished to Arkansas Medicaid when received. See Sections
			 201.100 through
			 201.130 for the DMHS
			 certification requirements.
C. In
			 order to be enrolled as a Medicaid provider, the psychologist must:
1. Be licensed as a psychologist by the
			 Arkansas Board of Examiners in Psychology.
2. Provide a copy of the current license to
			 the Arkansas Medicaid Program with the psychologist's provider application and
			 Medicaid contract. Subsequent licensure must be provided when issued.
D. The provider application and
			 Medicaid contract must be approved by the Arkansas Medicaid Program. 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.
Providers of Licensed Mental Health Practitioner services have
				the
option
of enrolling in the Title XVIII (Medicare)
				Program. When a recipient is dually eligible for Medicare and Medicaid and is
				provided services that are reimbursable under both programs, the Medicare
				Program must be billed first. Medicaid will not reimburse for services that
				have not been submitted to Medicare prior to being billed to Medicaid. The
				recipient may not be billed for the charges.
Providers who have agreements with Medicaid to provide other
				services to Medicaid recipients must submit a separate provider application and
				Medicaid contract to provide Licensed Mental Health Practitioner services. A
				separate provider number is assigned.
An LCSW may not be enrolled in both the Targeted Case
				Management (TCM) and the Licensed Mental Health Practitioner Medicaid Programs.
				He or she must choose the program in which he or she wishes to
				enroll.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.05-026 - Physician/Independent Lab/CRNA/Radiation Therapy Center Provider Manual Update #94

Current through Register Vol. 49, No. 6, June, 2024
Section II
Physician/Independent Lab/CRNA/Radiation
				Therapy Center
201.100
Arkansas Medicaid Participation
			 Requirements for Physicians 7-1-05
All physicians are eligible for participation in the Arkansas
				Medicaid Program if they meet the following criteria:
A. A provider of physician's services must be
			 licensed to practice in his or her state.
B. A provider of physician's services (with
			 the exception of a pediatrician) must be enrolled in the Title XVIII (Medicare)
			 Program.
C. A provider of
			 physician's services must complete a provider application (form DMS-652) ,
			 Medicaid contract (form DMS-653), Request for Taxpayer Identification Number
			 and Certification (Form W-9) and Arkansas Medicaid Primary Care Physician
			 Managed Care Program Primary Care Physician Participation Agreement (form
			 DMS-2608).
View or print form DMS-652, form DMS-653, Form W-9
			 and form DMS-2608.
D. A copy of the following documents must
			 accompany the application and contract:
1.
			 The physician must submit a copy of his or her current license to practice in
			 his or her state.
2. Out-of-state
			 physicians must submit a copy of verification that reflects current enrollment
			 in the Title XVIII (Medicare) Program.
E. The provider application and Medicaid
			 contract must be approved by the Arkansas Medicaid Program as a condition of
			 participation in the Medicaid Program. 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.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.05-028 - Section I of All Arkansas Medicaid provider manuals

Current through Register Vol. 49, No. 6, June, 2024
170.000
THE ARKANSAS MEDICAID PRIMARY
			 CARE CASE MANAGEMENT PROGRAM
170.100
Introduction
Arkansas Medicaid's Primary Care Case Management (PCCM)
				Program,
ConnectCare,
operates statewide under the waiver
				authority of Section 1915(b) of the Social Security Act.
A. Most Medicaid beneficiaries and all ARKids
			 First-B participants must enroll with a primary care physician (PCP), also
			 known as a primary care case manager (PCCM).
1. PCPs provide primary care services and
			 health education.
2. PCPs make
			 referrals for medically necessary specialty physician's services, hospital care
			 and other services.
3. PCPs assist
			 their enrollees with locating medical services.
4. PCPs coordinate and monitor their
			 enrollees' prescribed medical and rehabilitation services.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.05-029 - Home Health Update Transmittal #69

Current through Register Vol. 49, No. 6, June, 2024
Section
			 II
Home Health
219.000
Service Logging by Electronic
			 Media
A. Nurses, home health aides,
			 physical therapists and physical therapy assistants may log the times that they
			 begin and end services, as well as the services themselves, by electronic
			 media, such as telephony.
B.
			 Electronic signatures, as permitted under Arkansas law and as defined in
			 Section IV of this manual, are allowed in the Home Health Program.
C. All Arkansas Medicaid documentation
			 requirements must be met, regardless of documentation media.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.05-030 - Rule for Licensure of Residential Long Term Care Facilities: Section 310 - Incident Reporting

Current through Register Vol. 49, No. 6, June, 2024
The facility must develop and implement written policies and
				procedures to ensure that incidents, including:
*
alleged or suspected abuse or neglect of
				residents;
* accidents, including accidents resulting in
				death;
* unusual deaths or deaths from violence;
* unusual occurrences; and,
* exploitation of residents or any misappropriation of
				resident property,
are prohibited, reported, investigated and documented as
				required by these regulations.
A facility is not required under this regulation to report
				death by natural causes. However, nothing in this regulation negates, waives or
				alters the reporting requirements of a facility under other regulations or
				statutes.
Facility policies and procedures regarding reporting, as
				addressed in these regulations, must be included in orientation training for
				all
new
employees, and must be addressed at least
annually
during in-service training for
all
facility staff.
310.1
NEXT-BUSINESS-DAY REPORTING OF
			 INCIDENTS
The following events shall be reported to the Office of Long
				Term Care by facsimile transmission to telephone number 501-682-8551 of the
				completed Incident & Accident Intake Form (Form DMS-7734) no later than
				11:00 a.m. on the next business day following discovery by the facility.
a. Any alleged, suspected or witnessed
			 occurrences of abuse or neglect to residents.
b. Any alleged, suspected or witnessed
			 occurrence of misappropriation of resident property, or exploitation of a
			 resident.
c. Any alleged, suspected
			 or witnessed occurrences of verbal abuse. For purposes of this regulation,
			 "verbal abuse" means the use of oral, written, or gestured language that
			 willfully includes disparaging and derogatory terms to residents, or within
			 their hearing distance, regardless of their age, ability to comprehend, or
			 disability. Examples of verbal abuse include, but are not limited to: threats
			 of harm; saying things to frighten a resident, such as telling a resident that
			 he or she will never be able to see his or her family again.
d. Any alleged, suspected or witnessed
			 occurrences of sexual abuse to residents by any individual.
RCF INCIDENT REPORTING
In addition to the requirement of a facsimile report by the
				next business day on Form DMS-7734, the facility shall complete a Form DMS-762
				in accordance with Section 310.2.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.05-034 - Rehabilitative Services for Persons with Mental Illness (RSPMI) Provider Manual Update Transmittal # 48

Current through Register Vol. 49, No. 6, June, 2024
202.000
Arkansas Medicaid Participation Requirements for RSPMI
In order to ensure quality and continuity of care, all mental
				health providers approved to receive Medicaid reimbursement for services to
				Medicaid recipients must meet specific qualifications for their services and
				staff.
To enroll as an RSPMI Medicaid provider, the following must
				occur:
A. Providers must be located
			 within the State of Arkansas.
B. A
			 provider must complete a provider application (form DMS-652), a Medicaid
			 contract (form DMS-653) and a Request for Taxpayer Identification Number and
			 Certification (Form W-9) with the Arkansas Medicaid Program.
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).
C. A provider must be certified by the
			 Division of Behavioral Health Services (DBHS). (See section 202.100 for
			 certification requirements.)
D. A
			 copy of the current DBHS certification as an RSPMI provider must accompany the
			 provider application and Medicaid contract. Subsequent certifications must be
			 provided when issued.
Enrollment as a Medicaid provider is conditioned upon approval
				of a completed provider application and the execution of a Medicaid Provider
				Contract.
DMS shall exclude providers for the reasons stated in
				42
				U.S.C. §
												1320c-7(a) and
				implementing regulations and may exclude providers for the reasons stated in
				42
				U.S.C. §
												1320c-7(b) and
				implementing regulations.
The following factors shall be considered by DHS in determining
				whether sanction(s) should be imposed:
A. Seriousness of the offense(s)
B. Extent of violation(s)
C. History of prior violation(s)
D. Whether an indictment or information was
			 filed against the provider or a related party as defined in DHS Policy 1088,
			 titled DHS Participant Exclusion Rule.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.05-043 - Developmental Rehabilitation Services Update Transmittal #14

Current through Register Vol. 49, No. 6, June, 2024
Section II
Developmental Rehabilitation
			 Services
201.000
Arkansas
			 Medicaid Participation Requirements for Developmental Rehabilitation
			 Services
Providers of developmental rehabilitation services must meet
				the following requirements to be eligible to participate in the Arkansas
				Medicaid Program:
A. Providers must be
			 certified as First Connections Program participants by the Arkansas Division of
			 Developmental Disabilities Services (DDS) to provide early intervention
			 services.
B. A 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), a
			 Medicaid contract (form DMS-653) and a Request for Taxpayer Identification
			 Number and Certification (Form W-9).
C. Verification of current certification from
			 DDS must accompany the provider application and the Medicaid contract.
The Arkansas Department of Health and Human Services must
				approve the provider application and the Medicaid contract as a condition of
				participation in the Medicaid program.
D. Subsequent certifications 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.
E. Failure to timely submit verification of
			 certification renewals will result in termination of enrollment in the Arkansas
			 Medicaid Program.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.05-046 - Section II: Occupational, Physical, Speech Therapy Services - Provider Manual Update Transmittal No. 41

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. When a beneficiary
			 is dually eligible for Medicare and Medicaid, Medicare must be billed 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 Medicare provider number. Claims filed by
			 Medicare "nonparticipating" providers do not automatically cross over to
			 Medicaid for payment of deductibles and coinsurance.
C. The provider must complete and submit to
			 the 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. The Arkansas Medicaid Program
			 must approve the provider application and the Medicaid contract as a condition
			 of participation in the Medicaid Program. 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 Provider Enrollment 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.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.05-047 - Certified Nurse-Midwife Update Transmittal #59

Current through Register Vol. 49, No. 6, June, 2024
202.000
Arkansas Medicaid
			 Participation Requirements for Certified Nurse-
Midwife Providers
All providers of certified nurse-midwife services must meet the
				following criteria in order to be eligible for participation in the Arkansas
				Medicaid Program:
A. The provider must
			 complete a provider application (DMS-652), a Medicaid contract (DMS-653) and a
			 Request for Taxpayer Identification Number and Certification (W-9).
View or print a provider application (DMS-652), a Medicaid
			 contract (DMS-653) and a Request for Taxpayer Identification Number and
			 Certification (W-9).
B. A current copy of the certified
			 nurse-midwife license from the Arkansas State Board of Nursing must accompany
			 the provider application and Medicaid contract. Subsequent renewals of license
			 must be provided when issued.
C.
			 The certified nurse-midwife who provides intrapartum care must have a
			 consulting agreement with a Medicaid enrolled physician and must furnish the
			 name of the consulting physician with the provider application and the Medicaid
			 contract. The consulting physician must be available within thirty (30) minutes
			 of the hospital admitting the certified nurse-midwife's laboring patients or
			 within thirty (30) minutes of the alternative birth site if the patient is not
			 transported to the hospital.
D.
			 Subsequent changes in the name of the consulting physician must be immediately
			 provided to Arkansas Medicaid.
E.
			 The certified nurse-midwife who has prescriptive authority must furnish the
			 Certificate of Prescriptive Authority Number issued by the Arkansas State Board
			 of Nursing with the provider application and Medicaid contract. Any changes in
			 prescriptive authority must be immediately reported to Arkansas
			 Medicaid.
F. The provider
			 application and the Medicaid contract must be approved by the Arkansas Medicaid
			 Program as a condition of participation in the Medicaid Program. 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.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.05-048 - DDS Alternative Community Services (ACS) Waiver - Provider Manual Update Transmittal #54

Current through Register Vol. 49, No. 6, June, 2024
210.000
PROGRAM COVERAGE
211.000
Scope
The Arkansas Medical Assistance Program (IVIedicaid) offers
				certain home and community based services as an alternative to
				institutionalization. These services are available for eligible individuals
				with a developmental disability who would otherwise require an intermediate
				care facility for the mentally retarded (ICF/MR) level of care. The home and
				community based services to be provided through this waiver are described
				herein as the DDS Alternative Community Services Waiver Renewal, hereafter
				referred to as DDS ACS Waiver.
42 CFR §
											441.301(b)(1)(ii) states
				that home and community based waiver services are available
only
to individuals who are
not inpatients
(residents) of a
				hospital, nursing facility (NF) or intermediate care facility for the mentally
				retarded (ICF/MR) only if payment to the hospital, nursing facility or ICF/MR
				is being made through private pay or private insurance.
Services provided under this program are as follows:
A. ACS Supportive Living
B. Community Experiences
C. ACS Respite Care
D. ACS Non-Medical Transportation
E. ACS Waiver Coordination
F. Supported Employment
G. Adaptive Equipment
H. Environmental Modifications
I. ACS Specialized Medical Supplies
J. Supplemental Support Service
K. Case Management Services
L. Consultation Services
M. Crisis Intervention Services
N. Crisis Center
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.05-049 - Rules for the Arkansas Long Term Care Facility Nursing Assistant Traning Program

Current through Register Vol. 49, No. 6, June, 2024
Section I
AUTHORITY
The following rules and regulations for the Long Term Care
				Facility Nursing Assistant Training Program are duly adopted and promulgated by
				the Department of Health and Human Services pursuant to Arkansas Code
				20-10-701 et
				seq.
This initiative is pursuant to the Federal mandates of Public
				Law 100-203 (the Nursing Home Reform Act, Subtitle C of the Omnibus Budget and
				Reconciliation Act of 1987 and technical amendments of OBRA 1989 and 1990)
				concerning the training and competency evaluation of nursing assistants
				employed in long term care facilities and the registry of certified nursing
				assistants.
The Federal Omnibus Budget Reconciliation Act of 1987, 1989,
				and 1990 (OBRA) and regulations issued by the Department of Health and Human
				Services - Health Care Financing Administration (HCFA) established the minimum
				requirements for nursing assistant training and competency evaluation programs
				in Section 1819(a) - (f) and 1919(a) - (f) of the Social Security Act.
Section II
PURPOSE
To develop and approve training and competency evaluation
				programs for individuals who provide nursing or nursing-related services to
				residents in long term care facilities and who are not licensed health
				professionals or volunteers who provide services without monetary
				compensations.
These requirements are designed to assist long term care
				facilities and other educational institutions with training and competency
				programs for nursing assistants. The objective of the Nursing Assistant
				Training Program is the provision of quality services to residents by nursing
				assistants who are able to:
1. perform
			 uncomplicated nursing procedures and to assist licensed practical nurses or
			 registered nurses in direct resident care;
2. form a relationship, communicate and
			 interact competently on a one-to-one basis with the residents as part of the
			 team implementing resident care objectives;
3. demonstrate sensitivity to residents'
			 emotional, social, and mental health needs through skillful, directed
			 interactions;
4. assist residents
			 in attaining and maintaining functional independence;
5. exhibit behavior in support and promotion
			 of residents' rights;
6.
			 demonstrate observational and documenting skills needed in support of the
			 assessment of residents' health, physical condition and well-being.
The training program must teach the attitudes and behaviors
				(which reflect attitudes) which promote the healthy functioning of residents
				both physically and emotionally, and focus on the restoration and maintenance
				of the resident in an independent as possible status. These attitudes and
				behaviors of staff are demonstrable in the day-to-day care environment in the
				facility.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.05-051 - Child Health Management Services (CHMS) Provider Manual Update Transmittal #57

Current through Register Vol. 49, No. 6, June, 2024
Section II
Child Health Management Services
201.000
Arkansas Medicaid
			 Participation Requirements for Child Health Management Services (CHMS)
			 Providers
Providers of Child Health Management Services (CHMS) must meet
				the following criteria in order to be eligible to participate in the Arkansas
				Medicaid Program:
A. CHMS must be
			 provided by an organization that is certified by Arkansas Foundation for
			 Medical Care, Inc. (AFMC) to be in full compliance with one of the two
			 conditions described below:
1. An academic
			 medical center program specializing in Developmental Pediatrics that is
			 administratively staffed and operated by an academic medical center and under
			 the direction of a boarded or board-eligible developmental pediatrician. An
			 academic medical center consists of a medical school and its primary teaching
			 hospitals and clinical programs. In order to be eligible for CHMS
			 reimbursement, the academic medical center must:
a. Be located in the state of
			 Arkansas;
b. Provide
			 multi-disciplinary diagnostic, evaluation and treatment services to children
			 throughout Arkansas;
c. Serve as a
			 large multi-referral program as well as a referral source for other
			 non-academic CHMS providers with the state and
d.Be staffed to provide training of pediatric
			 residents and other professionals in the multi-disciplinary diagnostics,
			 evaluation and treatment of children with special health care needs. For an
			 academic medical center CHMS program, services may be provided at different
			 sites operated by the academic medical center as long as the CHMS program falls
			 under one administrative structure within the academic medical center.
OR
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.05-052 - School-Based Mental Health Provider Manual Update Transmittal # 17

Current through Register Vol. 49, No. 6, June, 2024
211.300 Primary
			 Care Physician (PCP) Referral
A primary care physician (PCP) referral is required for each
				Medicaid recipient under age twenty-one for outpatient mental health services.
				See Section
				I of this manual for the PCP
				procodures. A PCP referral is generally obtained prior to providing service to
				Mcdicaid-eligiblo children. However, a PCP is given the option of providing a
				referral after a service is provided. If a PCP chooses to make a referral after
				a service has been provided, the referral must be received by the SBMH provider
				no later 45 calendar days after the date of service. The PCP has no obligation
				to give a retroactive referral.
The SBMH provider may not file a claim and will not be
				reimbursed for any services provided that require a PCP referral unless the
				referral is received.
211.310 When a Child is Ineligible for
			 Medicaid at Time of Service
A. When a child
			 who is not eligible for Medicaid receives an outpatient mental health service,
			 an application for Medicaid eligibility may be filed by the child or his or her
			 representative.
B. If the
			 application for Medicaid coverage is approved, a PCP referral is not required
			 for the period prior to the Medicaid authorization date. This period is
			 considered retroactive eligibility and does not require a referral.
C. A PCP referral is required no later than
			 forty-five calendar days after the authorization date. If the PCP referral is
			 not obtained within forty-five calendar days of the Medicaid authorization
			 date, reimbursement will begin, if all other requirements are met, the date the
			 PCP referral is received. To verify the authorization date, a provider may call
			 EDS or the local DHS Office.
However. a PCP is giwn 1hf: option ol providing a referral
				after a service is provided. If a PCP chooses to makt; a referral after a
				service has been provided, the referral must bo received by the SBMH provider
				no later 45 calendar days after the date of authorisation. The PCP has no
				obligation to give a ri-'troactivfi relerral.
The- SBMH piovidor may not file a claim and will not hn
				reimbursed for any services provided that require a PCP n.-forrui unless the
				rofnrral is received.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.05-054 - State Plan Transmittal #2003-001

Current through Register Vol. 49, No. 6, June, 2024
ATTACHMENT 4.19-B
METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES
				-OTHER TYPES OF CARE
2.
a. Outpatient Hospital Services
(1)
Acute
			 Care/General
Reimbursement is based on the lesser of the amount billed or
				the maximum Title XIX (Medicaid) charge allowed. The Title XIX (Medicaid)
				maximum was established utilizing 80% of the
Blue Cross/Blue
				Shield
customary as reflected in their 10/90 publication.
For those procedures which Blue Shield did not have a
				comparable code, the rates were increased by 35%. The 35% represents the
				average overall increase for all services.
Effective for claims with dates of service on or after July 1,
				1992, the Title XIX maximum rates were decreased by 20%.
Effective April 1, 2003, all Arkansas non-state
				government-owned or operated acute care/ general hospitals (that is, all acute
				care government hospitals within the State of Arkansas that are neither owned
				nor operated by the State of Arkansas) shall qualify for an annual upper
				payment limit (UPL) reimbursement adjustment. Psychiatric hospitals, pediatric
				hospitals, rehabilitative hospitals and critical access hospitals are not
				eligible for an adjustment. Payment shall be made before the end of the State
				Fiscal Year (SFY). The adjustment will be calculated and based on each
				hospital's previous SFY outpatient Medicare-related upper payment limit (UPL as
				specified in
				42
				CFR 447.321 ) for Medicaid reimbursed
				outpatient services. The adjustments will be calculated as
				follows:
1.
For each
			 qualifying hospital, Arkansas Medicaid will annually identify the total
			 Medicaid outpatient expenditures during the most recent completed
			 SFY.
2.
For each
			 qualifying hospital, the total Medicaid expenditures, as determined in step 1,
			 are divided by 80% to estimate the amount that would have been paid using
			 Medicare reimbursement principles.
3.
The difference between step 1
			 identified Medicaid expenditures and step 2 estimated Medicare amounts is the
			 UPL annual adjustment amount that will be reimbursed.
Eligible hospitals that were not licensed and providing
				services throughout the most recent completed SFY shall receive a pro-rated
				adjustment based on the partial year data.
4.
Payment for SFY 2003 shall be
			 prorated proportional to the number of days between April 1, 2003 and June 30,
			 2003 to the total number of days in SFY 2003.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.05-057 - Child Health Management Services Provider Manual Update Transmittal #63

Current through Register Vol. 49, No. 6, June, 2024
245.000
Guidelines for Retrospective Review of Occupational, Physical and Speech
			 Therapy Services
Arkansas Medicaid conducts retrospective review of
				occupational, physical and speech therapy services. The purpose of
				retrospective review is to promote effective, efficient and economical delivery
				of health care services.
The Quality Improvement Organization (QIO), Arkansas Foundation
				for Medical Care, Inc. (AFMC), under contract to the Arkansas Medicaid Program,
				performs retrospective reviews of medical records to determine if services
				delivered and reimbursed by Medicaid meet medical necessity
				requirements.
For the provider's information specific guidelines have been
				developed for occupational, physical and speech therapy retrospective reviews.
				These guidelines may be found in sections
				245.100 through
				245.220.
245.100
Occupational and Physical
			 Therapy Guidelines for Retrospective Review
A. Occupational and physical therapy services
			 are medically prescribed services for the diagnosis and treatment of movement
			 dysfunction that results in functional disabilities.
Occupational and physical therapy services must be medically
				necessary for the treatment of the individual's illness or injury. To be
				considered medically necessary, the following conditions must be met:
1. The service must be considered under
			 accepted standards of practice to be a specific and effective treatment for the
			 patient's condition.
2. The service
			 must be of such a level of complexity or the patient's condition must be such
			 that the services required can be safely and effectively performed only by or
			 under the supervision of a qualified physical or occupational
			 therapist.
3. There must be
			 reasonable expectation that therapy will result in a meaningful improvement or
			 a reasonable expectation that therapy will prevent a worsening of the
			 condition. (See the mecf/ca/necess/Yy definition in the Glossary of this
			 manual.)
A diagnosis alone is not sufficient documentation to support
				the medical necessity of therapy. Assessment for physical and/or occupational
				therapy includes a comprehensive evaluation of the patient's physical deficits
				and functional limitations, treatment planned and goals to address each
				identified problem.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.05-060 - Hospital/Critical Access Hospital (CAH)/End Stage Renal Disease (ESRD) Provider Manual Update Transmittal #68

Current through Register Vol. 49, No. 6, June, 2024
218.000
Guidelines for Retrospective Review of Occupational, Physical and Speech
			 Therapy Services
The Quality Improvement Organization (QIO), Arkansas Foundation
				for Medical Care, Inc. (AFMC), under contract with the Arkansas Medicaid
				Program, performs retrospective reviews of medical records to determine the
				medical necessity of services paid for by Medicaid.
AFMC has developed guidelines for retrospective review of
				occupational, physical and speech-language therapy services furnished to
				Medicaid beneficiaries under the age of 21. Those guidelines are included in
				this manual to assist providers in determining and documenting the medical
				necessity of occupational, physical and speech-language therapy
				services.
218.100
Guidelines for Retrospective Review of Occupational and Physical Therapy for
			 Beneficiaries Under the Age of 21
A.
			 Occupational and physical therapy services are services prescribed by a
			 physician for the diagnosis and treatment of movement dysfunction.
B. Occupational and physical therapy services
			 must be medically necessary to the treatment of the individual's illness or
			 injury. To be considered medically necessary, the following conditions must be
			 met:
1. The services must be considered under
			 accepted standards of practice to be a specific and effective treatment for the
			 patient's condition.
2. The
			 services must be of such a level of complexity or the patient's condition must
			 be such that the services required can be safely and effectively performed only
			 by or under the supervision of a qualified physical or occupational
			 therapist.
3. There must be
			 reasonable expectation that therapy a. Will result in a meaningful improvement
			 of a condition or b. Will prevent a worsening of the condition.
C. A diagnosis alone is not
			 sufficient documentation to support the medical necessity of therapy.
D. Assessment for physical or occupational
			 therapy includes
1. A comprehensive evaluation
			 of the patient's physical deficits and functional limitations,
2. The treatment(s) planned to address each
			 identified problem and
3. Treatment
			 goals and objectives.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.05-061 - Prosthetics Provider Manual Update Transmittal #72

Current through Register Vol. 49, No. 6, June, 2024
Section II
Prosthetics
201.000
Arkansas Medicaid Participation
			 Requirements for Prosthetics Providers
Prosthetics providers must meet the following criteria in order
				to be eligible for participation in the Arkansas Medicaid Program:
A. The provider must complete 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 the provider application (form DMS-652), the
			 Medicaid contract (form DMS-653) and the Request for Taxpayer Identification
			 Number and Certification (Form W-9).
B. 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.
C. The provider must be enrolled in the Title
			 XVIII (Medicare) Program as a durable medical equipment/oxygen, orthotic
			 appliances or prosthetic devices provider.
D. A copy of the verification letter that
			 reflects the provider's Medicare supplier number must be submitted with the
			 provider application and Medicaid contract.
E. A separate letter and Medicare supplier
			 number must be submitted for each Medicaid service location.
NOTE: The orthotics/prosthetics provider should maintain
				accreditation by the American Board for Certification in Orthotics and
				Prosthetics. The provider should ensure that staff providing patient care
				(including but not limited to direct care, evaluations, diagnoses, fabrication
				fittings and follow up care) are accredited by the American Board for
				Certification in Orthotics and Prosthetics and meet all national licensing and
				certification requirements and all licensing and certifications required by the
				State of Arkansas.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.05-062 - Hospital/Critical Access Hospital (CAH)/End-Stage Renal Disease (ESRD) Provider Manual Update Transmittal #80

Current through Register Vol. 49, No. 6, June, 2024
Section
			 II
Hospital/Critical Access Hospital (CAH)/End
			 Stage Renal Disease (ESRD)
215.021
Benefit Limit for
			 Occupational, Physical and Speech Therapies
A. Occupational, physical and speech
			 therapies are subject to the benefit limit of 12 outpatient hospital visits per
			 state fiscal year (SFY), as explained in section
			 215.020.
1. Outpatient therapy services furnished by
			 acute care hospitals and rehabilitative hospitals are combined when tallying
			 utilization of this benefit.
2.
			 This limit does not apply to Medicaid beneficiaries under the age of
			 21.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.05-063 - Occupational, Physical, Speech Therapy Services Provider Manual Update Transmittal #49

Current through Register Vol. 49, No. 6, June, 2024
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. 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 Medicare provider number. Claims
			 filed by Medicare "nonparticipating" providers do not automatically cross over
			 to Medicaid for payment of deductibles and coinsurance.
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.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.05-064 - Development Day Treatment Clinic Services Provider Manual Update Transmittal #61

Current through Register Vol. 49, No. 6, June, 2024
SECTION II
			 -DEVELOPMENTAL DAY TREATMENT CLINIC SERVICES (DDTCS)
220.000
Guidelines for Retrospective
			 Review of Occupational, Physical and Speech Therapy Services
Arkansas Medicaid conducts retrospective review of
				occupational, physical and speech therapy services. The purpose of
				retrospective review is to promote effective, efficient and economical delivery
				of health care services.
The Quality Improvement Organization (QIO), Arkansas Foundation
				for Medical Care, Inc. (AFMC), under contract to the Arkansas Medicaid Program,
				performs retrospective reviews of medical records to determine if services
				delivered and reimbursed by Medicaid meet medical necessity
				requirements.
Specific guidelines have been developed for occupational,
				physical and speech therapy retrospective reviews. These guidelines may be
				found in sections
				220.100 through
				220.220.
220.100
Occupational and Physical
			 Therapy Guidelines for Retrospective Review
A. Occupational and physical therapy services
			 are medically prescribed services for the diagnosis and treatment of movement
			 dysfunction, which results in functional disabilities.
Occupational and physical therapy services must be medically
				necessary for the treatment of the individual's illness or injury. To be
				considered medically necessary, the following conditions must be met:
1. The services must be considered under
			 accepted standards of practice to be a specific and effective treatment for the
			 patient's condition.
2. The
			 services must be of such a level of complexity or the patient's condition must
			 be such that the services required can be safely and effectively performed only
			 by or under the supervision of a qualified physical or occupational
			 therapist.
3. There must be
			 reasonable expectation that therapy will result in a meaningful improvement or
			 a reasonable expectation that therapy will prevent a worsening of the condition
			 (See the
medical necessity
definition in the Glossary of this
			 manual).
A diagnosis alone is not sufficient documentation to support
				the medical necessity of therapy. Assessment for physical and/or occupational
				therapy includes a comprehensive evaluation of the patient's physical deficits
				and functional limitations, treatment planned and goals to address each
				identified problem.