reglab/statecodes huggingface dataset:
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.09-022 - Provider Manual Update Transmittal #123 - Transportation

Current through Register Vol. 49, No. 6, June, 2024
Section
			 IITransportation
251.100
Ground Ambulance Mileage
Ground ambulance providers must use procedure code A0425 to
				claim mileage for ground ambulance transportation, regardless of licensure
				level of the provider or transporting ambulance. Mileage must be rounded to the
				nearest mile. Actual ground ambulance mileage should be documented on the
				ambulance provider's patient care report.
252.100
Ambulance Procedure Codes
A0382
A0390
A0398
A0422
A0425
A0426
A0427
A0429
J0150*
J0170*
J0280*
J0460*
J1094*
J1100*
J1160*
J1200*
J1265
J1940*
J2060*
J2175*
J2270*
J2310*
J2550*
J2560*
J3360*
J3410*
J3475*
J3480*
J3490*
93041*
*Procedure code can be billed
only
in
				conjunction with procedure code
A0427.
Procedure Code
Required Modifier
Description
A0422
U1
Emergency, oxygen, helicopter air ambulance
A0425
Ground mileage per statute mile.
A0428
Ambulance service, ILS intermediate transport, mileage
						  and disposable supplies billed separately
A0431
Ambulance service, emergency, basic pick-up,
						  helicopter, one unit per day
A0434
Air Ventilator/Respiratory Therapist, one unit equals
						  one hour (Round to the nearest hour.)
A0435
U1, UB
Piston propelled fixed wing air ambulance per
						  mile
U2, UB
Turboprop fixed wing air ambulance per mile
U3, UB
Jet (fixed wing) one unit equals one mile
U4, UB
Piston propelled fixed wing air ambulance per hour
						  (Round to the nearest hour.)
U5, UB
Turboprop fixed wing air ambulance per hour (Round to
						  the nearest hour.)
U6, UB
Jet (fixed wing) one unit equals one hour (Round to the
						  nearest hour.)
A0436
Emergency, per mile, loaded, helicopter air
						  ambulance
T2002**
Non-emergency ground ambulance transportation, hospital
						  to nursing facility
"Procedure code must be billed on a paper CMS-1500 claim form
				with the supporting documentation listed in section
				213.100.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.09-024 - Official Notice DMS-2009-A-1, DMS-2009-X-1, DMS-2009-II-1, DMS-2009-L-1, DMS-2009-R-1 - Billing for Essure Procedure and Device

Current through Register Vol. 49, No. 6, June, 2024
I.
Background
CPT procedure code
58565
(Essure) is a covered
				family planning sterilization procedure for both family planning only
				beneficiaries (Aid Category 69) and regular Medicaid beneficiaries. However,
effective for dates of service on and after August 31, 2009,
billing protocols are changed to allow providers to bill and be
				reimbursed for the portion of the service that they provide when this method of
				sterilization is chosen. Billing may be for the procedure, provision of the
				device, or both.
II.
Billing Protocol
All providers are to separate their charges when billing
				for:
1)
Performance
			 of the "procedure"
,
"Hysteroscopy, surgical; with bilateral
			 fallopian tube cannulation to induce occlusion by placement of permanent
			 implants-PROCEDURE ONLY" (CPT procedure code 58565). This service includes all
			 supplies except provision of the device. Claims must be billed on paper with a
			 correct DMS-615 attached.
2)
Provision of the implant "device"
for:
			 "Hysteroscopy, surgical; with bilateral fallopian tube cannulation to induce
			 occlusion by placement of permanent implants-DEVICE ONLY" Claims may be billed
			 electronically or on paper. NOTE: Payment of the claim for the "device" will
			 not be made without a paid or pending Essure "procedure" claim.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.09-025 - Official Notice DMS-2009-W-1 - FFY 2010 ICD-9-CM Diagnosis Codes

Current through Register Vol. 49, No. 6, June, 2024
I.
General Information
A review of the 2010 ICD-9-CM diagnosis codes has been
				completed.
Effective for claims with dates of service on or after October
				1, 2009,
the Arkansas Medicaid Program will implement the revisions
				included in the 2010 International Classification of Diseases,
				9th Revision, Clinical Modification (ICD-9-CM).
				Providers must enter the updated diagnosis code, if applicable on
claims
				with dates of service on or after October 1, 2009.
The new diagnosis
				codes will be covered with the exception of those in section II of this
				notice.
II.
Non-covered 2010 ICD-9-CM Diagnosis Codes
V72.60
V72.61
V72.62
V72.69
Thank you for your participation in the Arkansas Medicaid
				Program.
If you need this material in an alternative format, such as
				large print, please contact our Americans with Disabilities Act Coordinator at
				501-682-8323 (Local); 1-800-482 -5850, extension 2-8323 (Toll-Free) or to
				obtain access to these numbers
If you have questions regarding this
				notice, please contact the EDS Provider Assistance Center at In-State WATS 1 -
				800-457-4454, or locally and Out-of-State at (501) 376-2211.
Arkansas Medicaid provider manuals, official notices
				and remittance advice (RA) messages are available for downloading from the
				Arkansas Medicaid website:
www.medicaid.state.ar.us.
through voice relay, 1-800-877 -8973 (TTY Hearing
				Impaired).
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.09-028 - Rate Increase for Under 16 Bed ICF/MR Facilities

Current through Register Vol. 49, No. 6, June, 2024
B.
Intemiediate Care Facilities for the
			 Mentally Retarded - Continued 3. Under 16 Beds:
a.
Small ICF/MR facilities certified as
			 having 15 beds or fewer will be reimbursed on a prospective uniform class rate
			 system. An inflationary adjustment, determined by the Division to be reasonable
			 and adequate, will be applied to the existing rates and will be implemented by
			 State Plan amendment as warranted by analysis of cost report data. Cost reports
			 will be submitted annually for the preceding calendar year (January 1 -
			 December 31) and will be reviewed prior to establishing new rates. The Division
			 has established the per diem rate of $ 182.18 for dates of service beginning
			 July 1,2009. This 1.9% increase in per diem rate is based on the most currently
			 available Skilled Nursing Facility Total Market Basket inflation data applied
			 as an inflation adjustment to the previous rate.
b.
Overpayment/Underpayments
Overpayment/underpayments resulting from Section 1-12 administrative errors
			 shall be handled through the vendor payment by recouping overpayments and
			 reimbursing underpayments.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.09-029 - State Plan Amendment #2009-008 - Personal Care Services Rate Adjustment

Current through Register Vol. 49, No. 6, June, 2024
ATTACHMENT 3.1-A
AMOUNT, DURATION, AND SCOPE OF MEDICAL AND REMEDIAL CARE
				AND SERVICES PROVIDED TO THE CATEGORICALLY NEEDY
25. Home and Community Care for Functionally
			 Disabled Klderly Individuals, as defined, described and limited in Supplement 2
			 to Attachment 3.1 -A. and Appendices A-G to Supplement 2 to Attachment 3.1-A.
_________ provided
X
not
				provided
26. Personal care
			 services furnished to an individual who is not an inpatient or resident of a
			 hospital, nursing facility, intermediate care facility for the mentally
			 retarded, or institution for mental disease that are (A) authorized for the
			 individual by a physician in accordance with a plan of treatment, (B) provided
			 by an individual who is qualified to provide such services and who is not a
			 member of the individual's family, and (C) furnished in a home.
X
Provided:
X
State Approved (Not Physician) Service Plan Allowed
X
Services Outside the Home Also Allowed
X
Limitations
				Described on Attachment
______ Not Provided.
METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES -OTHER
				TYPES OF CARE
ATTACHMENT 4J9-B
5.
			 Personal care furnished in accordance with the requirements at
			 42 CFR §
									440.167 and with regulations promulgated,
			 established and published for the Arkansas Medicaid Personal Care Program by
			 the Division of Medical Services.
(a) Except
			 as otherwise noted in the plan, state developed fee schedule rates are the same
			 for both governmental and private providers of personal care services and the
			 fee schedule and any annual/periodic adjustments to the fee schedule are
			 published on the Medicaid website at www.medicaid.state.ar.us.
(b) Reimbursement for Personal Care Program
			 Services is by fee schedule, at the lesser of the billed charge or the Title
			 XIX (Medicaid) maximum allowable fee per unit of service. Effective for dates
			 of service on and after July 1, 2004, one unit equals fifteen minutes of
			 service.
(c) Effective for dates of
			 service on and after July 1,2007, reimbursement to enrolled Residential Care
			 Facilities (RCFs) for personal care services furnished to Medicaid eligible
			 residents (i.e., clients) is based on a multi-hour rate system not to exceed
			 one day, based on the individual clients' levels of care. A client's level of
			 care is determined from the service units required by his or her service plan.
			 Rates will be recalculated as needed to maintain parity with other Personal
			 Care providers when revisions of the Title XIX maximum allowable fee occur. The
			 effective date of any such revised rates shall be the effective date of the
			 revised fee.
(d) Agencies rates are
			 set as of July 1, 2009 and are effective for services on or after that
			 date.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.09-036 - Hospital Update #165 & Physician Update #178

Current through Register Vol. 49, No. 6, June, 2024
Section II
Hospital/Critical Access
			 Hospital (CAH)/End Stage Renal Disease (ESRD)
217.040
Bariatric Surgery for Treatment
			 of Morbid Obesity
Bariatric surgery for morbid obesity is payable under the
				Medicaid Program with prior authorization. (See Section 241.000 of this manual
				for instructions on obtaining prior authorization.)
Morbid obesity is defined as a condition in which the presence
				of excess weight causes physical trauma; pulmonary and circulatory
				insufficiencies and complications related to treatment of other medical
				conditions.
Requirements for Bariatric Surgery
A. The beneficiary must be between 18 and 65
			 years of age.
B. The beneficiary
			 has a documented body-mass index [GREATER THAN]35 and has at least one
			 comorbidity related to obesity.
C.
			 The beneficiary must be free of endocrine disease as supported by an endocrine
			 study consisting of a T3, T4, blood sugar and a 17-Keto Steroid or Plasma
			 Cortisol.
D. Under the supervision
			 of a physician, the beneficiary has made at least one documented attempt to
			 lose weight in the past. The medically supervised weight loss attempt(s) as
			 defined above must have been at least six months in duration.
E. Medical and psychiatric contraindications
			 to the surgical procedure have been ruled out (and referrals made as necessary)
1. A complete history and physical,
			 documenting the beneficiaries:
a. Height,
			 Weight, and BMI;
b. The exclusion
			 or diagnosis of genetic or syndromic obesity, such as Prader-Willi
			 Syndrome
2. A
			 psychiatric evaluation no more than three months prior to requesting
			 authorization. The evaluation should address the following:
a. Ability to provide, without coercion,
			 informed consent;
b. Family and
			 social support;
c. Patient ability
			 to comply with the postoperative care plan and identify potential psychiatric
			 contraindications.
Note: Documentation that female beneficiaries have
				received counseling regarding potential birth defects from nutritional
				deficiencies if they should become pregnant during the weight stabilization
				period following bariatric surgery. Documentation all beneficiaries have been
				informed of possible adverse events related to the surgery.
Covered Procedures:
*
Open and laparoscopic Roux-en-Y gastric bypass
				(RYGBP)
*
Open and laparoscopic Biliopancreatic Diversion
				with Duodenal Switch (BPD/DS)
*
Laparoscopic Adjustable gastric
				banding(LAGB)
*
Vertical banded gastroplasty
*
Gastric Bypass
Non-Covered
				Procedures:
*
Open adjustable gastric banding
*
Open and laparoscopic sleeve
				gastrectomy
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.09-044 - Official Notice DMS-2009-A-3, DMS-2009-AR-2, DMS-2009-G-2, DMS-2009-II-3, DMS-2009-L-3, DMS-2009-KK-2, DMS-2009-R-3, DMS-2009-OO-2 - Vaccines for Children Program (VFC)

Current through Register Vol. 49, No. 6, June, 2024
I. Background
			 Information
The purpose of this official notice is to inform Arkansas
				Medicaid providers of coverage of the following vaccine under the Vaccines for
				Children (VFC) program effective for dates of service on and after May 26,
				2009.
II. Coverage
90732, "Pneumococcal polysaccharide vaccine, 23-valent, adult
				or immunosuppressed patient dosage, when administered to individuals 2 years or
				older, for subcutaneous or intramuscular use." This vaccine is covered under
				the VFC program for beneficiaries age 2 years to 18 years. Coverage and billing
				for ages 19 years and above is unchanged.
III.
Billing Instructions
Billing of
90732
may be submitted electronically
				or on paper claims. VFC Billing instructions for this procedure code:
ARKids First-A:
ARKids First-B:
For Ages:
90732-EP, TJ modifiers
90732-TJ modifier
2 years -18 years
For information about participation as a Vaccines for Children
				provider, contact the Arkansas Department of Health at
501-661-2170
and reference your provider manual.
Thank you for your participation in the Arkansas Medicaid
				Program.
If you need this material in an alternative format, such as
				large print, please contact our Americans with Disabilities Act Coordinator at
				501-682-8323 (Local); 1-800-482 -5850, extension 2-8323 (Toil-Free) or to
				obtain access to these numbers through voice relay, 1-800-877 -8973 (TTY
				Hearing Impaired).
If you have questions regarding this notice, please
				contact the EDS Provider Assistance Center at In-State WATS 1 - 800-457-4454,
				or locally and Out-of-State at (501) 376-2211.
Arkansas Medicaid provider manuals, official notices
				and remittance advice (RA) messages are available for downloading from the
				Arkansas Medicaid website:
www.medicaid.state.ar.us.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.09-047 - Provider Manual Update Transmittal - Section I & Section V

Current through Register Vol. 49, No. 6, June, 2024
SECTION I
-
			 GENERAL POLICY
171.210
ConnectCare Caseload Maximum and PCP Caseload Limits
A. Each PCP may establish an upper limit to
			 his or her Medicaid caseload, up to the default maximum of 2500.
1. The state may permit higher maximum
			 caseloads in areas the federal government has designated as medically
			 underserved.
2. The state may
			 permit higher maximum caseloads for PCPs who state in writing that the default
			 maximum will create a hardship for them, their patients and/or the community
			 they serve.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.09-048 - Section V - DMS 840 Form

Current through Register Vol. 49, No. 6, June, 2024
Click here
				to view image
If you disagree with our decision, you may ask for an appeal
				from the Office of Appeals and Hearings. To ask for a hearing you must send
				your request in writing within 35 calendar days to P.O. Box 1437, Slot N401,
				Little Rock, AR 72203-1437. You must enclose a copy of the denial letter and a
				copy of the envelope containing that letter or enclose a copy of that letter
				showing the facsimile transmission confirmation with your request. If you do
				not include those copies your appeal will be delayed. All deadlines run from
				the next business day after the postmark on the envelope containing that letter
				or the next business day after the date on the facsimile transmission
				confirmation.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.09-050 - Occupational, Physical and Speech Therapy Services Provider Manual Update #108, Physician/Independent Lab/Radiation Therapy Center #165, Rehabilitative Hospital #108, Hospital/Critical Access Hospital (CAH)/End Stage Renal Disease (ESRD) #152, Developmental Day Treatment Clinic Services (DDTCS) #119, Child Health Medical Services #116

Current through Register Vol. 49, No. 6, June, 2024
214.310
Accepted Tests for
			 Occupational Therapy
Tests used must be norm referenced, standardized, age
				appropriate and specific to the therapy provided. The following list of tests
				is not all-inclusive. When using a test that is not listed below, the provider
				must include documentation in the evaluation to support the reliability and
				validity of the test. This additional information will be used as reference
				information if the chart is selected by Medicaid for review. An explanation of
				why a test from the approved list could not be used to evaluate the child
				should be included. The
Mental Measurement Yearbook (MMY)
is
				the standard reference to determine the reliability and validity of the test(s)
				administered in the evaluation. Providers should refer to the MMY for
				additional information regarding specific tests. The following definitions of
				terms are applied to the lists of accepted tests:
* STANDARD: Evaluations that are used to determine
				deficits.
* SUPPLEMENTAL: Evaluations that are used to identify deficits
				and support other results. Supplemental tests may not supplant standard
				tests.
* CLINICAL OBSERVATIONS: Clinical observations have a
				supplemental role in the evaluation and should always be included. Detail,
				precision and comprehensiveness of clinical observations are especially
				important when standard scores do not qualify the patient for therapy and the
				clinical notes constitute the primary justification of medical
				necessity.
A. Fine Motor Skills -
			 Standard
1. Peabody Developmental Motor
			 Scales (PDMS, PDMS2)
2. Toddler and
			 Infant Motor Evaluation (TIME)
3.
			 Bruininks-Oseretsky Test of Motor Proficiency (BOMP)
4. Bruininks-Oseretsky Test of Motor
			 Proficiency, Second Edition (BOT-2)
5. Test of Infant Motor Performance
			 (TIMP)
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.09-051 - Section I Provider Manual Update Transmittal

Current through Register Vol. 49, No. 6, June, 2024
171.230
Primary Care Case Management
			 Fee
A. In addition to reimbursing PCPs
			 on a fee for service basis for physician services, Arkansas Medicaid pays them
			 a monthly case management fee for each enrollee on their caseloads.
B. The amount due for each month is
			 determined by multiplying the established case management fee by the number of
			 enrollees on the PCP's caseload on the last day of the month.
1. Medicaid pays case management fees
			 quarterly-in October, January, April and July.
2. The accompanying Medicaid Remittance and
			 Status Report (RA) itemizes the payments and lists the number of enrollees and
			 each enrollment month.
3. Enrollees
			 are listed alphabetically by name, with their Medicaid identification numbers
			 and addresses also displayed.
C. PCP case management fees are paid
			 according to the PCP's direction. The PCP may choose to have the case
			 management fee paid to his or her individual provider ID number or to the group
			 provider ID number with whom the PCP is affiliated.
D. If the PCP's case management fees are paid
			 to a group and the PCP changes his or her affiliation, the PCP must submit a
			 new PCP Agreement Form to Provider Enrollment within thirty (30) calendar days
			 of changing affiliation. The PCP must also notify the beneficiaries on his or
			 her caseload of the change.
E. If a
			 PCP fails to submit a new PCP Agreement Form, the case management fees will pay
			 to the provider of record until a new PCP Agreement Form is received by
			 Provider Enrollment.
F. If a Group
			 Affiliation Form is received by Provider Enrollment to disassociate a PCP from
			 a group but the PCP Agreement Form is not received, the case management fees
			 will be paid to the individual PCP's provider ID number.
G. If a PCP's case management fees were paid
			 to a group in which the PCP is no longer affiliated, it is the responsibility
			 of that group to reimburse Medicaid the fees they were not entitled to
			 receive.
H.
No
			 case management fees will be back paid to a PCP who has failed to follow
			 the
process described in Paragraph D of this
				Section.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.10-003 - State Plan Amendment #2009-011 - Outpatient Hospital Access Payments

Current through Register Vol. 49, No. 6, June, 2024
ATTACHMENT 3.1-A
AMOUNT, DURATION AND SCOPE OF SERVICES PROVIDED
CATEGORICALLY NEEDY
2.
a.
Outpatient Hospital Services
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.10-004 - 2010 HCPCS and CPT Procedure Code Conversion

Current through Register Vol. 49, No. 6, June, 2024
I.
General
			 Information
A review of the 2010 CPT procedure codes has been completed,
				and the Arkansas Medicaid Program will begin accepting CPT 2010 procedure codes
				for dates of service on and after March 29, 2010.
Procedure codes that are identified as deletions in CPT 2010
				(Appendix B) are
non-payable
for dates of service on and after
				March 29, 2010.
For the benefit of those programs impacted by the conversions,
				the Arkansas Medicaid website fee schedule will be updated soon after the
				implementation of the 2010 CPT and HCPCS conversions.
II.
Non-Covered 2010 CPT
			 Procedure Codes
A.
			 Effective for dates of service on and after March 29, 2010, the following CPT
			 procedure codes are non-payable:
43775
83987
86305
89398
B. All
			 2010 CPT procedure codes listed in
Category II
and Category III
			 are not recognized by Arkansas Medicaid; therefore they are
			 non-covered.
C. The following new
			 2010 CPT procedure codes are not payable to
Outpatient Hospitals
			 and Ambulatory Surgical Centers
because these services are covered
			 by another CPT procedure code, another HCPCS code or a revenue code:
31627
36148
64491
64492
64494
64495
75791
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.10-005 - Hospital Assessment Fee Administrative Procedures

Current through Register Vol. 49, No. 6, June, 2024
ADMINISTRATIVE PROCEDURES HOSPITAL ASSESSMENT FEE
DEFINITIONS
(1) "Division" means the Division of Medical
			 Services of the Department of Human Services;
(2) "Hospital" means a health care facility
			 licensed as a hospital by the Division of Health Facility Services of the
			 Department of Health under Ark Code Ann. §
								20-9-213;
(3) "Medicare Cost Report" means CMS-2552-96,
			 the Cost Report for Electronic Filing of Hospitals, as it existed on January 1,
			 2009;
(4) "Audited Medicare Cost
			 Report" means the most recent audited cost report that specifically includes
			 the audited worksheets, calculations and information related to the Arkansas
			 Medicaid Program. Arkansas Medicaid will use the date of the Medicaid Notice of
			 Provider Reimbursement (NPR) received by the Division of Medical Services from
			 the Medicare Intermediary to determine the most recent audited cost report
			 period for assessment purposes. The most current audited cost report period is
			 used when an earlier period's NPR is finalized after a later period's. In order
			 to be used to calculate the assessment amount, the Medicaid NPR received from
			 the Medicare Intermediary must be dated before July
			 1st of the state fiscal year (SFY) for which the
			 assessment will be collected.
(5)
			 "Net patient revenue" means the amount calculated in accordance with generally
			 accepted accounting principles for hospitals that is reported on Worksheet G-3,
			 Column 1, Line 3, of the Medicare Cost Report adjusted to exclude nonhospital
			 revenue;
(6)
			 "Non-state-government-owned Hospital" means a Hospital in Arkansas that:
(A) Is owned and operated by an agency or a
			 unit of a county or municipal government, including without limitation a
			 hospital owned and operated by:
(i) A county
			 under Ark Code Ann. § 14-263- 101
et seq.
; or
(ii) A city under Ark Code Ann. §
										14-264-101
et seq.;
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.10-008 - Rehabilitative Services for Persons with Mental Illness #129

Current through Register Vol. 49, No. 6, June, 2024
Section II Rehabilitative Services for
			 Persons with Mental Mines:
217.101
Youth Outcome Questionnaire (YOQ®)
The Y-OQ® 2.01, the Y-OQ® SR, the Arkansas Indicators
				and the OQ®-45.2 are instruments for measuring service/treatment
				effectiveness and treatment planning.
The OQ® instruments are user friendly to both the
				beneficiaries and to the provider. For the beneficiary, they are brief and easy
				to understand. For the provider, they are easy to administer.
Frequency
Providers must follow the OQ® Clinician Guide specialized
				for the State of Arkansas located at
https://www.oqarkansas.com/oqa
. At
				a minimum, the OQ® instruments must be administered within 14 days of
				entering care, then every 90 days to coincide with Periodic Review of Treament
				Plans, and at discharge. At a minimum, the Arkansas Indicators must be
				administered every 90 days. Documentation of clinical exceptions to frequencies
				stated in the OQ® Clinical Guide must be included in the clinical
				record.
Documentation Requirements
If the parent or legal guardian for children/adolescents under
				the age of 16 is not available to complete the Y-OQ®2.1 or Arkansas
				Indicators, the provider must have documentation indicating barriers to
				obtaining the Y-OQ®2.1 and Arkansas Indicators. Documentation must include
				attempts to obtain the Y-OQ®2.1, OQ®-45.2 and Arkansas Indicators at
				the scheduled frequency.
If a Y-OQ®2.1 or OQ®-45.2 indicates regression or lack
				of adequate progress, the provider must revise the treatment plan or explain
				the reason for the continuation of the treatment plan in the progress
				notes.
Without documentation of the YOQ, providers' claims are subject
				to recoupment as explained in Section
				228.335.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.10-011 - Official Notice #ON-006-10 - Procedure Code 90662

Current through Register Vol. 49, No. 6, June, 2024
SUBJECT: Medicaid Coverage of Procedure Code 90662
Effective for dates of service on or after October 11, 2010,
				Arkansas Medicaid will reimburse providers for procedure code 90662 for
				eligible beneficiaries as part of a public health initiative.
Providers must bill procedure code 90662: "Influenza virus
				vaccine, split virus, preservative free, enhanced immunogenicity via increased
				antigen content, for intramuscular use". Reimbursement for procedure code 90662
				includes the administration of the vaccine. A PCP referral is not required for
				this service.
Procedure Code
Description
Covered Beneficiaries
90662
Influenza virus vaccine, split virus, preservative
						  free, enhanced immunogenicity via increased antigen content, for intramuscular
						  use
Ages 65 years and older who are Arkansas Medicaid
						  eligible
If you have questions regarding this notice, please contact the
				HP Enterprise Services Provider Assistance Center at In-State WATS 1-800-457
				-4454, or locally and Out-of-State at (501) 376-2211.
If you need this material in an alternative format, such as
				large print, please contact our Americans with Disabilities Act Coordinator at
				501-682-0593 (Local); 1-800-482 -5850, extension 2-0593 (Toil-Free) or to
				obtain access to these numbers through voice relay, 1-800-877 -8973 (TTY
				Hearing Impaired).
Arkansas Medicaid provider manuals, official notices and
				remittance advice (RA) messages are available for downloading from the Arkansas
				Medicaid website: https://www.medicaid.state.ar.us/.
Thank you for your participation in the Arkansas Medicaid
				Program.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.10-013 - State Plan 2010-006 - Rate Increase for Under 16 Bed ICF/MR Facilities

Current through Register Vol. 49, No. 6, June, 2024
B. Intermediate
			 Care Facilities for the Mentally Retarded
3.
			 Under 16 Beds:
a. Small ICF/MR facilities
			 certified as having 15 beds or fewer will be reimbursed on a prospective
			 uniform class rate system. An inflationary adjustment, determined by the
			 Division to be reasonable and adequate, will be applied to the existing rates
			 and will be implemented by State Plan amendment as warranted by analysis of
			 cost report data. Cost reports will be submitted annually for the preceding
			 calendar year (January 1 - December 31) and will be reviewed prior to
			 establishing new rates. The Division has established the per diem rate of
$186.01
for dates of service beginning July 1,
2010
.
			 This
2.1
% increase in per diem rate is based on the most
			 currently available Skilled Nursing Facility Total Market Basket inflation data
			 applied as an inflation adjustment to the previous rate.
b. Provider Fee
Act 433 of 2009 established the levy of a provider fee on
				Intermediate Care Facilities for Individuals with Developmental Disabilities.
				The reimbursement rate paid Under 16 Beds facilities will include a Provider
				Fee component. The Provider Fee component will be reimbursed at the amount
				established as the multiplier for the date of service billed.
The Provider Fee component is paid in addition to the rate
				identified in paragraph a. above.
c. Enhanced Care Add-On
The Department recognizes that the current class rate structure
				limits the providers' ability to invest additional monies for the purpose of
				improving the quality of care. Additionally the recent increase in the minimum
				wage (an unfunded federal mandate) will make it difficult for providers to
				maintain current standards much less improve the quality of care. Therefore the
				Department will implement an enhanced care add-on in the amount of $7.02 per
				day. This enhanced payment will provide additional funds for wage adjustments
				in the base salaries for new hires and incumbent salaries to address the
				increase of the federal minimum wage in July 2009. This will also directly
				increase benefits related to these salary increases such as FICA, LTD, Life
				insurance, retirement, etc. This add-on will also provide funding for
				additional initiative
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.10-014 - State Plan 2010-007 - Medicare Improvements for Patients and Providers Act (MIPPA) Estate Recovery Provisions

Current through Register Vol. 49, No. 6, June, 2024
STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT
(b)
Adjustments or
			 Recoveries
The State complies with the requirements of section 1917(b) of
				the Act and regulations at
				42 CFR 433.36(h) -
				(i).
Adjustments or recoveries for Medicaid claims correctly paid
				are as follows:
(1) For permanently
			 institutionalized individuals, adjustments or recoveries are made from the
			 individual's estate or upon sale of the property subject to a lien imposed
			 because of medical assistance paid on behalf of the individual for services
			 provided in a nursing facility, ICF/MR, or other medical institution.
X
Adjustments or recoveries are made
				for all other medical assistance paid on behalf of the
				individual.
(2)
X
The State determines "permanent institutional
			 status" of individuals under the age of 55 other than those with respect to
			 whom it imposes liens on real property under §1917(a)(1)(B) (even if it
			 does not impose those liens).
(3)
			 For any individual who received medical assistance at age 55 or older,
			 adjustments or recoveries of payments are made from the individual's estate for
			 nursing facility services, home and community-based services, and related
			 hospital and prescription drug services.
__
In addition to adjustment or
				recovery of payments for services listed above, payments are adjusted or
				recovered for other services under the State plan as listed below:
None
4.17(b) Adjustments or Recoveries
(3)
Limitations on Estate Recovery - Medicare Cost Sharing:
(i) Medical assistance for Medicare cost
			 sharing is protected from estate recovery for the following categories of dual
			 eligibles: QMB, SLMB, QI, QDWI, QMB+, SLMB+. This protection extends to medical
			 assistance for four Medicare cost sharing benefits: (Part A and B premiums,
			 deductibles, coinsurance, co-payments) with dates of service on or after
			 January 1, 2010. The date of service for deductibles, coinsurance, and
			 co-payments is the date the request for payment is received by the State
			 Medicaid Agency. The date of service for premiums is the date the State
			 Medicaid Agency paid the premium.
(ii) In addition to being a qualified dual
			 eligible the individual must also be age 55 or over. The above protection from
			 estate recovery for Medicare cost sharing benefits (premiums, deductibles,
			 coinsurance, co-payments) applies to approved mandatory (i.e., nursing
			 facility, home and community-based services, and related prescription drugs and
			 hospital services) as well as optional Medicaid services identified in the
			 State plan, which are applicable to the categories of duals referenced
			 above.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.10-016 - State Plan Amendment #2010-005 - Levonorgestrel-Releasing Intrauterine Contraceptive System (Mirena)

Current through Register Vol. 49, No. 6, June, 2024
METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES
				OTHER TYPES OF CARE
ATTACHMENT 4.19-B
4.c. Family Planning Services
Reimbursement is based on the lesser of the amount billed or
				  the maximum Title XIX (Medicaid) charge allowed.
State developed fee
				  schedule rates are the same for both public and private
				  providers.
1. The Title XIX
				(Medicaid) maximum for Family Planning services is 100% of the current
				physician Medicaid maximum.
At the beginning of each calendar year, the State Agency will
				  negotiate with the affected provider group representatives to arrive at a
				  mutually acceptable increase or decrease from the maximum rate. Market forces,
				  such as private insurance rate, medical and general inflation figures, changes
				  in practice costs and changes in program requirements, will be considered
				  during the negotiation process. Any agreed upon increase or decrease will be
				  implemented at the beginning of the following State Fiscal Year, July 1, with
				  any appropriate State Plan changes.
2.
Intrauterine Devices (IUDs)
Reimbursement for the intrauterine device (IUD) is based on
				  100% of the manufacturer's list price as of July 1,2003.
Effective for
				  claims with dates of service July 1,2010 and after,
the levongestrel
				  releasing IUD is reimbursed based on
100%
of the
manufacturer's list price as of May 5, 2010.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.10-017 - Official Notice ON-004-10: CMS-1500 Replaces DMS-694 for EPSDT Screenings or Services

Current through Register Vol. 49, No. 6, June, 2024
Health Care Providers - Child Health Services (EPSDT),
				Certified Nurse- Midwife, Dental, Hearing, Licensed Mental Health Practitioner,
				Nurse Practitioner, Physician, Visual Care,December 1, 2010,CMS-1500 Replaces
				DMS-694 for EPSDT Screenings or Services
Effective for dates of service on or after 12/1/10, form
				DMS-694 is discontinued and will no longer be available for EPSDT screenings or
				services. Form CMS-1500 will capture the EPSDT screenings or services for paper
				claims in the following manner:
* For all EPDST paper claim submissions, please enter the
				letters EPSDT in BOX 10-D on the CMS-1500 claim form.
* If the EPSDT screening/service resulted in a referral or
				prescription for additional services, enter the appropriate Reason Code listed
				below in the upper shaded part of the detail line 24-H.
* EPSDT Reason Codes are required when billing for EPSDT
				screenings/services. The code should indicate actions taken as a result of the
				screening. Please enter the appropriate 2-byte Reason Code in the upper shaded
				part of the detail line 24-H.
If a Y is entered instead of the required Reason Code indicated
				below, the claim will deny.
o AV - Available - Not Used (patient refused referral)
o NU - Not Used (used when no EPSDT patient referral was
				given)
o S2 - Under Treatment (patient is currently under treatment
				for referred diagnostic or corrective health problem)
o ST - New Service Requested (referral to another provider for
				diagnostic or corrective treatment/scheduled for another appointment with
				screening provider for diagnostic or corrective treatment for at least one
				health problem identified during an initial or periodic screening service, not
				including dental referrals.)
Non-EPSDT screening services, i.e., sick visits, cannot
				be billed on the same claim form as EPSDT services.
If you have questions regarding this notice, please contact the
				HP Enterprise Services Provider Assistance Center at In-State WATS 1-800-457
				-4454, or locally and Out-of-State at (501) 376-2211.
If you need this material in an alternative format, such as
				large print, please contact our Americans with Disabilities Act Coordinator at
				501-682-0593 (Local); 1-800-482 -5850, extension 2-0593 (Toil-Free) or to
				obtain access to these numbers through voice relay, 1-800-877 -8973 (TTY
				Hearing Impaired).
Arkansas Medicaid provider manuals, official notices
				and remittance advice (RA) messages are available for downloading from the
				Arkansas Medicaid website:
www.medicaid.state.ar.us.
Thank you for your participation in the Arkansas Medicaid
				Program.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.10-018 - Prior Authorization for Procedure Codes 87901, 87903, 87904

Current through Register Vol. 49, No. 6, June, 2024
Health Care Provider - Hospital/Critical Access Hospital
				(CAH)/End-Stage Renal Disease (ESRD) and Physician/Independent
				Lab/CRNA/Radiation Therapy Center , July 1, 2011 , Prior Authorization for
				Procedure Codes 87901, 87903, and 87904
Effective for claims with dates of service on or after July 1,
				2011, the following procedure codes will no longer require a prior
				authorization when the primary (ICD-9-CM) diagnosis is 042, Human
				Immunodeficiency Virus (HIV) disease:
Procedure Code
Description
Limitations
87901
Infectious agent genotype analysis by nucleic acid (DNA
						  or RNA); HIV-1, reverse transcriptase and protease regions
A maximum of 12 units per 12 month period
87903
Infectious agent phenotype analysis by nucleic acid
						  (DNA or RNA) with drug resistance tissue culture analysis, HIV-1; first through
						  ten drugs tested
A maximum of 1 unit per year
87904
Each additional drug tested (List separately in
						  addition to code for primary procedure)
This procedure code is an add-on code.
If you have questions regarding this notice, please contact the
				HP Enterprise Services Provider Assistance Center at In-State WATS 1-800-457
				-4454, or locally and Out-of-State at (501) 376-2211.
If you need this material in an alternative format, such as
				large print, please contact our Americans with Disabilities Act Coordinator at
				501-682-0593 (Local); 1-800-482 -5850, extension 2-0593 (Toil-Free) or to
				obtain access to these numbers through voice relay, 1-800-877 -8973 (TTY
				Hearing Impaired).
Arkansas Medicaid provider manuals, official notices and
				remittance advice (RA) messages are available for downloading from the Arkansas
				Medicaid website: www.medicaid.state.ar.us.
Thank you for your participation in the Arkansas Medicaid
				Program.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.10-019 - State Plan Amendment #2010-003 - Developmental Day Treatment Clinic Services (DDTCS) Rate Increase

Current through Register Vol. 49, No. 6, June, 2024
METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES
				-
OTHER TYPES OF CARE
8. Private Duty Nursing Services
Refer to Attachment 4.19-B, Item 4.b.(5) for reimbursement
				information for private duty nursing services for high technology
				non-ventilator recipients in the Child Health Services (EPSDT) Program.
9. Clinic Services
(1) Developmental Day Treatment Clinic
			 Services (DDTCS)
Reimbursement is based on the lesser of the amount billed or
				the maximum Title XIX (Medicaid) charge allowed. The Title XIX maximum was
				established based on a 1980 survey conducted by Developmental Disabilities
				Services (DDS) of 85 Arkansas DDTCS providers of their operational costs
				excluding their therapy services. An average operational cost was derived for
				each service. Then an average number of units was derived for each service. The
				average operational cost for each service was divided by the average units for
				that particular service to arrive at a maximum rate.
For dates of service occurring on or after
February 1,
				2010
, the maximum per unit rate for PreSchool Services is increased to
				$
16.46
and the maximum per unit rate for Adult Development
				Services is increased to $
10.60
. These new rates were calculated
				based on analysis of the current 2005 cost to provide quality services in
				compliance with governing regulations. The rates have been demonstrated to be
				consistent with the Clinic Upper Payment Limit at
				42
				CFR 447.321.
For Pre-School Services, 1 unit of service equals 1 hour of
				service with a maximum of 5 units per day. For Adult Development Services, 1
				unit of service equals 1 hour of service with a maximum of 5 units per
				day.
Services for beneficiaries under age 21 can be extended with
				prior authorization due to medical necessity. State developed fee schedule
				rates are the same for both public and private providers of DDTCS
				services.
Occupational, physical and speech therapy services under the
				DDTCS Program are reimbursed as is described in Item 4.b.(19).
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.10-020 - State Plan Amendment #2010-001 - Reimbursement Rate Increases for Selected Specialized Rehabilitative Equipment

Current through Register Vol. 49, No. 6, June, 2024
7. Home Health Services
c. Medical Supplies, Equipment and Appliances
			 Suitable for Use in the Home
(11)
Specialized Rehabilitative Equipment
Effective for claims with dates of service occurring on
				and after May 1, 2010, the reimbursement rate maximums for the following listed
				Medicaid covered specialized rehabilitative equipment will be 85% of the
				February 1, 2009 retail price.
Reimbursement for this specialized rehabilitative
				equipment is by fee schedule, at the lesser of the billed charge or the Title
				XIX (Medicaid) maximum allowable. Except as otherwise noted in the plan, state
				developed fee schedule rates are the same for both governmental and private
				providers of this specialized rehabilitative equipment and the fee schedule is
				published on the Medicaid website at
www.medicaid.state.ar.us
.
Bath chair 56"
Commode chair, extra wide and/or heavy
						  duty
Tray for Gait Trainer
Corner chair w tray & casters, small
Standing frame syst., any size, w/wo
						  wheels
Corner chair w tray & casters, large
Low back activity chair
Transition toddler chair, small
Supine stander 51", small
Gait trainer, ped size, posterior support,
w/all Accessories
Supine stander 71", large
Prone stander 35"
Prone stander 42"
Adjustable abduction wedge w/hip
						  stabilizer
Prone stander 50"
Tray for stander, prone
Up-rite stander, small
Tray for stander, supine
Up-rite stander, medium
Foot sandals for standers
Up-rite stander, large
Caster base for up-rite stander, small
Tumble form feeder seat, small
Caster base for up-rite stander, medium
Tumble form feeder seat, medium
Caster base for up-rite stander, large
Tumble form feeder seat, large
Tumble form tri stander w/tray, small
Seat & back pad for toddler chairs
Tumble form tri stander w/tray, large
T&S high back w/support activity chair,
						  14"
Mobile floor sitter, medium/large
Tray for toddler chair
T&S high back w/support activity chair,
						  16"
Wrap around back support, small
Wrap around bath support, large
Toilet seat reducer ring (padded)
Toilet support w/high back, small
4 wheel reverse walker
Toilet support w/high back, large
4 wheel front swivel reverse walked
Adult gait trainer
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.10-021 - Dental-3-10 and Section V-8-10

Current through Register Vol. 49, No. 6, June, 2024
Section
			 II Dental
212.300
Dental
			 Services Provided by a Mobile Dental Facility 1-1-11