reglab/statecodes huggingface dataset:
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.16-027 - NPI-16, Ther 1-16, DDTCS 1-16, Rehabhsp 1-16, ARKids 2-16, PHYS 2-16, Hospital 1-16, CHMS 1-16 and "SPA-2016-TBD? Draft only"

Current through Register Vol. 49, No. 6, June, 2024
Section II ARKids First-B
222.600 Occupational, Physical and Speech
			 Therapy Benefits 7-1-17
Occupational, physical and speech therapy services are
				available to beneficiaries in the ARKids First-B program and must be performed
				by a qualified, Medicaid participating Occupational, Physical or Speech
				Therapist. A referral for an occupational, physical or speech therapy
				evaluation and prescribed treatment must be made by the beneficiary's PCP or
				attending physician if exempt from the PCP program. All therapy services for
				ARKids First-B beneficiaries require referrals and prescriptions be made
				utilizing the "Occupational, Physical and Speech Therapy for Medicaid Eligible
				Recipients Under Age 21" form DMS-640.
View
or print form
				DMS-640.
Occupational, physical and speech therapy referrals and covered
				services are further defined in the Physicians and in the Occupational,
				Physical and Speech Therapy Provider Manuals. Physicians and therapists must
				refer to those manuals for additional rules and regulations that apply to
				occupational, physical or speech therapy services for ARKids First-B
				beneficiaries.
Arkansas Medicaid applies the following daily therapy benefits
				to occupational, physical and speech therapy services in this program:
A. Medicaid will reimburse up to four (4)
			 occupational, physical and speech therapy evaluation units (1 unit = 30
			 minutes) per state fiscal year (July 1 through June 30) without authorization.
			 Additional evaluation units will require an extended therapy request.
B. Medicaid will reimburse up to six (6)
			 occupational, physical and speech therapy units (1 unit = 15 minutes) weekly,
			 per discipline, without authorization. Additional therapy units will require an
			 extended therapy request.
C. All
			 requests for extended therapy services must comply with the guidelines located
			 within the Occupational, Physical and Speech Therapy Provider Manual.
____________
Section II
Developmental Day Treatment Clinic
				Services
__________
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.16-028 - State Plan Amendement #2016-002 & Supplemental Rebate Agreement

Current through Register Vol. 49, No. 6, June, 2024
AMOUNT, DURATION AND SCOPE OF SERVICES
				PROVIDED
ATTACHMENT 3.1-A
12. Prescribed drugs, dentures and prosthetic
			 devices; and eyeglasses prescribed by a physician skilled in diseases of the
			 eye or by an optometrist
a. Prescribed Drugs
(4) The state is in compliance with section
			 1927 of the Social Security Act. The state will cover drugs of Federal rebate
			 participating manufacturers. The state is in compliance with reporting
			 requirements for utilization and restrictions to coverage. Pharmaceutical
			 manufacturers can audit utilization data.
The state will be negotiating supplemental rebates in the
				Medicaid program in addition to the Federal rebates provided for in Title XIX.
				Rebate agreements between the state and pharmaceutical manufacturer(s) will be
				separate from the Federal rebates.
A rebate agreement between the state and a participating drug
				manufacturer for drugs provided to the Medicaid program, submitted to CMS on
May 24, 2016
, and entitled, State of Arkansas Supplemental Rebate
				Agreement, has been authorized by CMS. Any additional versions of rebate
				agreements negotiated between the state and manufacturer(s) after
May 24,
				2016
, will be submitted to CMS for authorization.
Supplemental rebates received by the State in excess of those
				required under the National Drug Rebate Agreement will be shared with the
				Federal government on the same percentage basis as applied under the national
				rebate agreement.
All drugs covered by the program, irrespective of a
				supplemental rebate agreement, will comply with the provisions of the national
				drug rebate agreement.
The supplemental rebate program does not establish a drug
				formulary within the meaning of 1927(d)(4) of the Social Security Act.
The unit rebate amount is confidential and cannot be disclosed
				for purposes other than rebate invoicing and verification, in accordance with
				Section 1927(b)(3)(D) of the Social Security Act.
(5) Pursuant to
			 42 U.S.C. Section
			 1396r-8 the state is establishing a preferred
			 drug list with prior authorization for drugs not included on the preferred drug
			 list. Prior authorization will be provided within a 24-hour turn-around from
			 receipt of request and a 72-hour supply of drugs in emergency
			 situations.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.16-029 - Hospice 1-16

Current through Register Vol. 49, No. 6, June, 2024
240.110 Routine
			 Home Care
A. The Routine Home Care adjusted
			 prospective rate is a daily rate.
B. The Medicaid Program reimburses Hospice
			 providers at the applicable Routine Home Care rate for each day of an
			 authorized election period which is not reimbursed at the applicable
			 prospective rate for another Hospice category of care.
C. Routine Home Care includes core and
			 supplemental services as detailed in the plan of care.
1. Medicaid pays for Routine Home Care
			 regardless of the amount (if less than eight hours in a calendar day), the
			 frequency or the type of service provided on a given day, but only if on that
			 day the Hospice provider is fulfilling the requirements of the beneficiary's
			 authorized Hospice plan of care.
2.
			 Medicaid pays for Routine Home Care as described in subpart C.1 and in
			 accordance with an authorized Hospice plan of care, for a nursing facility or
			 ICF/IID resident who has elected Hospice home care in that setting.
3. Medicaid pays the Hospice provider for
			 Routine Home Care as described in subpart C.1 for a day of the election period
			 during which a patient with an authorized Hospice plan of care receives
			 outpatient services for conditions related or unrelated to his or her terminal
			 illness.
4. Effective January
			 01,2016, Routine Home Care will have a higher base rate for the first 60 days
			 of hospice care and a reduced base payment rate for days 61 and after. A
			 beneficiary may choose to leave or change hospice providers or may be
			 discharged from a provider's care; this is termed a "live discharge." If the
			 beneficiary is readmitted or chooses to come back under care of any hospice
			 provider within 60 days of discharge, or if a provider bills revenue code 0652
			 (continuous home care), the count of days for routine home care will continue
			 from the last date used while under care and not start over.
5. Effective January 01,2016, a new Service
			 Intensity Add-on (SIA) payment can be billed for a home visit by an RN or
			 Clinical Social Worker during the last seven days of life. This is in addition
			 to the Routine Home Care rate. Date of death must be present for the SIA
			 payment to be paid.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.17-007 - Home Health 2-16

Current through Register Vol. 49, No. 6, June, 2024
Section II
Home Health
203.000 Home Health and
			 the Primary Care Physician (PCP) Case Management Program (ConnectCare)
A. Home health care requires a PCP referral
			 except in the following circumstances:
1.
			 Medicaid does not require Medicare beneficiaries to enroll with PCPs;
			 therefore, a PCP referral is not required for home health services for
			 Medicare/Medicaid dual-eligibles.
2. Obstetrician/gynecologists may authorize
			 and direct medically-necessary home health care for postpartum complications
			 without obtaining a PCP referral.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.17-008 - Visual 2-16

Current through Register Vol. 49, No. 6, June, 2024
Section II
Visual Care
214.200 Coverage and
			 Limitations of the Under Age 21 Program
A.
			 One examination and one pair of glasses are available to eligible Medicaid
			 beneficiaries every twelve (12) months.
1. If
			 repairs are needed, the eyeglasses must have been originally purchased through
			 the Arkansas Medicaid Program in order for repairs to be made.
2. If the glasses are lost or broken beyond
			 repair within the twelve (12)-month benefit limit period, one additional pair
			 will be available through the optical laboratory. After the first replacement
			 pair, any additional pair will require prior authorization. There will be no
			 co-payment assessed for replacement glasses requiring prior
			 authorization.
3. All replacements
			 will be made by the optical laboratory and the doctor's office may make repairs
			 only when necessary.
4. EPSDT
			 beneficiaries will have no co-pays. ARKids First-B beneficiaries will be
			 assessed a $10.00 co-pay. All co-pays will be applied to examination codes
			 rather than to tests or procedures.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.17-009 - Patient Centered Medical Home (PCMH) 1-17

Current through Register Vol. 49, No. 6, June, 2024
Section II Patient-Centered Medical Home
220.000 PRACTICE SUPPORT
221.000 Practice Support Scope
Practice support includes both care coordination payments made
				to a PCMH and practice transformation support provided by a Division of Medical
				Services (DMS) contracted vendor and is subject to funding limitations on the
				part of DMS.
Receipt and use of the care coordination payments is not
				conditioned on the PCMH engaging a care coordination vendor, as payment can be
				used to support participating practices' investments (e.g., time and energy) in
				enacting changes to achieve PCMH goals. Care coordination payments are
				risk-adjusted to account for the varying levels of care coordination services
				needed for beneficiaries with different risk profiles.
DMS will contract with a practice transformation vendor on
				behalf of PCMHs that require additional support to catalyze practice
				transformation and retain and use such vendor. PCMHs must maintain
				documentation of the months they have contracted with a practice transformation
				vendor. Practice transformation vendors must report to DMS the level and type
				of service delivered to each PCMH. Payments to a practice transformation vendor
				on behalf of a participating practice may continue for up to 24 months.
However, no practice transformation may extend beyond June 30,
				2018, regardless of the number of months practice support was received by a
				practice.
DMS may pay, recover or offset overpayment or underpayment of
				care coordination payments.
DMS will also support PCMHs through improved access to
				information through the reports described in Section
				244.000.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.17-016 - CHMS & DDTCS Manual and SPA Changes

Current through Register Vol. 49, No. 6, June, 2024
Section
			 II
Child Health Management Services
200.000
CHILD HEALTH MANAGEMENT
			 SERVICES PROGRAM GENERAL INFORMATION
201.000
Arkansas Medicaid Participation
			 Requirements for Child Health
Management Services (CHMS) Providers
Child Health Management Services (CHMS) providers must meet the
				Provider Participation and enrollment requirements contained within Section
				140.000 of this manual as well as the following criteria to be eligible to
				participate in the Arkansas Medicaid Program:
A. CHMS must be provided by an organization
			 that is certified by the Arkansas Medicaid Quality Improvement Organization
			 (QIO) 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 016.06.17-017 - The Provider-led Arkansas Shared Savings Entity Program - Phase 1

Current through Register Vol. 49, No. 6, June, 2024
Click here
				to view image
SECTION II
- PROVIDER-LED ARKANSAS SHARED SAVINGS ENTITY (PASSE) PROGRAM
200.000
DEFINITIONS
Provider-Led Arkansas Shared Savings Entity
				(PASSE)
A Risk Based Provider Organization (RBPO) in Arkansas that has
				enrolled in Medicaid and meets the following requirements:
A. Is 51% owned by participating providers;
			 and
B. Has the following Members
			 or Owners:
1. An Arkansas licensed or
			 certified direct service provider of Developmental Disabilities (DD)
			 services;
2. An Arkansas licensed
			 or certified direct service provider of Behavioral Health (BH)
			 services;
3. An Arkansas licensed
			 hospital or hospital services organizations;
4. An Arkansas licensed physician's practice;
			 and
5. A Pharmacist who is licensed
			 by the Arkansas State Board of Pharmacy.
Risk-based Provider Organization
				(RBPO)
An entity that is licensed by the Insurance Commissioner under
				Act 775 of 2017 and the risk-based provider organization rules.
Participating Provider
An organization or individual that is a member of or has an
				ownership interest in a PASSE and delivers healthcare services to beneficiaries
				attributed to a PASSE.
Direct Service
				Provider
An organization or individual that delivers healthcare services
				to beneficiaries attributed to a PASSE. Participating providers can be direct
				service providers.
The Act
Risk-based Provider Organization
				(RBPO)
Title XIX of the Social Security Act.
Enrollment
A RBPO's successful completion of all requirements to become a
				Medicaid PASSE provider.
Attribution
The method by which DHS assigns a beneficiary to a
				PASSE.
Transition
The movement of a beneficiary from one PASSE to another.
Abeyance
A temporary suspension of PASSE services, due to:
A. A temporary loss of Medicaid
			 eligibility;
B. Placement in a
			 setting excluded from the PASSE; or
C. Loss of contact with the beneficiary or
			 guardian for more than forty-five (45) days.
Closure
A determination by DHS that a beneficiary is no longer eligible
				to receive PASSE services.
Medical/Quality Management
				Committee
A committee developed by the PASSE to oversee Quality Assurance
				of PASSE services.
Referral Network
The Direct Service Providers that join the
				PASSE.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.17-019 - Personal Care Manual

Current through Register Vol. 49, No. 6, June, 2024
ATTACHMENT 3.1-A
AMOUNT, DURATION AND SCOPE OF SERVICES PROVIDED
26. Personal Care
A. Personal care services are provided by a
			 personal care aide to assist with a client's physical dependency needs. The
			 personal care aide must have at least 24 hours classroom training and a minimum
			 of supervised practical training of 16 hours provided by or under the
			 supervision of a registered nurse for a total of no less than 40
			 hours.
B. Personal care services
			 furnished to an individual who is not an inpatient or resident of a hospital,
			 nursing facility, intermediate care facility for
individuals with
			 intellectual disabilities,
or institution for mental disease that are -
1. Authorized for the individual in
			 accordance with a service plan approved by the State;
2. Provided by an individual who is qualified
			 to provide such services and who is not a member of the individual's family,
			 and
3. Furnished in a home, and at
			 the State's option, in another location, including licensed residential care
			 facilities and licensed assisted living facilities.
C. The State defines "a member of the
			 individual's family" as:
1. A
			 spouse,
2. A minor's parent,
			 stepparent, foster parent or anyone acting as a minor's parent,
3. A minor's "guardian of the person" or
			 anyone acting as a minor's "guardian of the person" or
4. An adult's "guardian of the person" or
			 anyone acting as an adult's "guardian of the person".
D. Personal care services are covered for
			 categorically needy individuals only.
E. Personal care services are medically
			 necessary, prescribed services to assist clients with their physical dependency
			 needs.
1. Personal care services involve
			 "hands-on" assistance, by a personal care aide, with a client's physical
			 dependency needs (as opposed to purely housekeeping services).
2. The tasks the aide performs are similar to
			 those that a nurse's aide would normally perform if the client were in a
			 hospital or nursing facility.
F. Prior authorization is required for
			 personal care
pursuant to the Independent Assessment
for
nil
beneficiaries.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.17-026 - Episode of Care Provider Manual

Current through Register Vol. 49, No. 6, June, 2024
(1) a
			 statement of the rule's basis and purpose;
(2) the problem the agency seeks to address
			 with the proposed rule, including a statement of whether a rule is required by
			 statute;
(3) a description of the
			 factual evidence that:
(a) justifies the
			 agency's need for the proposed rule; and
(b) describes how the benefits of the rule
			 meet the relevant statutory objectives and justify the rule's costs;
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.18-001 - Section 1-6-17, Four Visit-No Referrals

Current through Register Vol. 49, No. 6, June, 2024
170.100 Introduction
Arkansas Medicaid's Primary Care Case Management (PCCM) Program
				operates statewide under the authority of the Medicaid State Plan.
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 016.06.18-004 - Section 1 2-18, General Policy, Primary Care Case Management Fee

Current through Register Vol. 49, No. 6, June, 2024
SECTION I - GENERAL
			 POLICY
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.
1. Medicaid
			 pays case management fees quarterly.
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.
I.
			 Reconciliation of care management fees will occur annually in June.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.18-005 - Outpatient Hospital Services State Plan Amendment

Current through Register Vol. 49, No. 6, June, 2024
METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES
				-OTHER TYPES OF CARE ATTACHMENT 4.I9-
2.
a.
Outpatient Hospital Scmccs
(7)
Border City University-Affiliated Pediatric Teaching Hospitals Special
			 consideration is given to border city university-affiliated pediatric teaching
			 hospitals due to the higher costs typically associated with such hospitals.
			 Eflective for claims with dates of service on or after January 1,2018,
			 outpatient hospital facility services provided to patients under the age of 21
			 at border city university-affiliated pediatric teaching hospitals will be
			 reimbursed based on reasonable costs with interim payments and a year-end cost
			 settlement. The State will utilize cost data in a manner approved by CMS
			 consistent with the method used for identifying cost for the private hospital
			 access payments as outlined in this Attachment 4.19-B, Page la.
Arkansas Medicaid will use the lesser of the reasonable
				costs or customary charges to establish cost settlements. The cost settlements
				will be calculated using the methods and standards used by the Medicare
				Program.
A border city university-afTiliated pediatric teaching
				hospital is defined as a hospital located within a bordering city (see
				Attachment 4.19-A page3b) that submits to the Arkansas Medicaid Program a copy
				of a current and effective affiliation agreement with an accredited university,
				and documentation establishing that the hospital is university-affiliated, is
				licensed and designated as a pediatric hospital or pediatric primary hospital
				within its home state, maintains at least five different intern pediatric
				specialty training programs, and maintains at least one-hundred (100) operated
				beds dedicated exclusively for the treatment of patients under the age of
				21.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.18-007 - Medicaid Prosthetics Manual

Current through Register Vol. 49, No. 6, June, 2024
203.100
Documentation in Beneficiary's
			 Case Files
The provider must develop and maintain sufficient written
				documentation to support each service for which billing is made. All entries in
				a beneficiary's file must be signed and dated by the individual who provided
				the service, along with the individual's title. The documentation must be kept
				in the beneficiary's case file.
Documentation should consist of, at a minimum, material that
				includes:
A. An audit trail between
			 the prosthetics provider, the beneficiary, the beneficiary's primary care
			 physician and advanced practice registered nurse and the Division of Medical
			 Services.
B. When applicable,
			 documentation including the request for and approval of prior authorization
			 and/or the request for and approval of extension of benefits for services
			 provided.
C. Prescriptions for
			 prosthetics services, signed and dated by the beneficiary's primary care
			 physician or advanced practice registered nurse within the scope of
			 practice.
D. The prosthetics
			 provider's signed and dated:
1. Certification
			 that used equipment is reconditioned, is in good working order and has no
			 defects in workmanship or material
2. The beneficiary's consent to receive
			 services
3. Notification of
			 termination of prosthetics services
4. Documentation to reflect that necessary
			 training and orientation has been provided to the beneficiary and any other
			 applicable persons
5. Any
			 additional or special documentation, requested in writing, that is needed to
			 provide fair and impartial review of individual cases, requested in
			 writing.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.18-014 - Home Health Provider Manual update

Current through Register Vol. 49, No. 6, June, 2024
200.000
HOME HEALTH GENERAL
			 INFORMATION
201.000 Arkansas
			 Medicaid Participation Requirements for Home Health
Providers
Home Health providers must meet the Provider Participation and
				enrollment requirements contained within Section 140.000 of this manual as well
				as the following criteria to be eligible to participate in the Arkansas
				Medicaid Program:
A. Only home health
			 agencies licensed to operate in Arkansas may participate in the Arkansas
			 Medicaid Home Health Program.
B. A
			 provider participating in the Arkansas Medicaid Home Health Program must be
			 currently licensed by the Division of Health Facility Services, Arkansas
			 Department of Health, as a Class A Home Health Agency.
C. A provider participating in the Arkansas
			 Medicaid Home Health Program must be currently certified by the Arkansas Home
			 Health State Survey Agency as a participant in the Title XVIIi (Medicare)
			 Program.
D. Providers participating
			 in the Arkansas Medicaid Home Health Program must maintain documentation of
			 current licensure and certification in their Medicaid provider enrollment
			 files.
E. _The following
			 individuals employed or contracted with a home health provider must comply with
			 criminal background checks and central registry checks as required by law
			 currently codified at Arkansas Code Annotated §§
									20-33-213
			 and
			 20-38-101
			 et seq.:
1. Owners;
2. Principals;
3. Operators;
4. Employees; and
5. Applicants (prior to the extension of a
			 job offer). Central registry checks under this section must include the:
1. Child Maltreatment Central
			 Registry;
2. Adult and Long-Term
			 Care Facility Resident Maltreatment Central Registry; and
3. Certified Nursing Assistant/Employment
			 Clearance Registry.
Enrolled providers must submit copies of license and
				certification renewals to the Provider Enrollment Unit, Division of Medical
				Services (DMS), within 30 days of the issuance of those documents. View or
				print Provider Enrollment Unit contact information.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.19-005 - ARKDS-4-18, Domiciliary Care-1-18, Section I-5-18, Section III-4-18, and State Plan Amendment #2019-001

Current through Register Vol. 49, No. 6, June, 2024
Section
			 II
ARKids First-B
221.200
Exclusions
Services Not Covered for ARKids First-B
				Beneficiaries:
Adult Developmental Day Treatment (ADDT)
Audiological Services; EXCEPTION, Tympanometry, CPT procedure
				code
92567
, when the diagnosis is within the ICD range.
				(
View ICD codes
.)
Child Health Services/Early and Periodic Screening, Diagnosis
				and Treatment (EPSDT)
Diapers, Underpads and Incontinence Supplies
Early Intervention Day Treatment (EIDT)
End Stage Renal Disease Services
Hearing Aids
Hospice
Hyperalimentation
Non-Emergency
Transportation
Nursing Facilities
Orthotic Appliances and Prosthetic Devices
Personal Care
Private Duty Nursing Services
Rehabilitation Therapy for Chemical Dependency
Rehabilitative Services for Children
Rehabilitative Services for Persons with Physical Disabilities
				(RSPD)
Targeted Case Management
Ventilator Services
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.19-014 - ARKids First-B

Current through Register Vol. 49, No. 6, June, 2024
222.750
Health Education
Health education is a required component of screening services
				and includes anticipatory guidance. The developmental assessment,
				comprehensive, physical examination, and the visual, hearing or dental
				screening provide the initial opportunity for providing health education.
				Health education and counseling to parents (or guardians) and children are
				required. Health education and counseling are designed to assist in
				understanding what to expect in terms of the child's development and to provide
				information about the benefits of healthy lifestyles and practices, as well as
				accident and disease prevention. See Section
				262.130 for procedure
				codes.
Health education can include but isn't limited to tobacco
				cessation counseling services to the parent/legal guardian of the child.
A. Counseling Visits (two (2) per SFY):
Current Procedure Code
Current Modifier
Arkansas Medicaid Description
99406*
SE
*** (Smoking and tobacco use cessation counseling
						  visit; intermediate, 15-minutes)
99406*
CG
*** (Smoking and tobacco use cessation counseling
						  visit, intermediate, 15-minutes provided to parents of children birth through
						  twenty (20) years of age)
99407*
SE
*** (Smoking and tobacco use cessation counseling
						  visit; intensive, 30-minutes)
99407*
CG
*** (Smoking and tobacco use cessation counseling
						  visit, intensive, 30-minutes provided to parents of children birth through
						  twenty (20) years of age)
* Exempt from PCP referral requirements.
*** (...) This symbol, along with text in parentheses,
				indicates the Arkansas Medicaid description of the service. When using a
				procedure code with this symbol, the service must meet the indicated Arkansas
				Medicaid description.
B.
			 Referral of patient to an intensive tobacco cessation referral
			 program.
C. These counseling
			 sessions can be billed in addition to an office visit or EPSDT.
D. If the beneficiary is under the age of
			 eighteen (18), and the parent/legal guardian smokes, he or she can be counseled
			 as well, and the visit billed under the minor's beneficiary Medicaid number.
			 The provider cannot prescribe meds for the parent under the child's Medicaid
			 number. A parent/legal guardian session will count towards the four (4)
			 counseling sessions limit described in section C above.
E. Tobacco cessation sessions do NOT require
			 a PCP referral.
F. The provider
			 must complete the counseling checklist and place in the patient records for
			 audit.
View or Print the Arkansas Be Well Referral
			 Form
.
Refer to Section
				257.000 and Section 292.900 of
				the Primary Care Physician manual for more information.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.19-021 - DHS Policy 1088 Participant Exclusion Rule

Current through Register Vol. 49, No. 6, June, 2024
1088.0
DHS PARTICIPANT EXCLUSION
			 RULE
1088.1
Purpose-Intent
(a)
(1) The Arkansas Department of Human Services
			 (DHS) shall conduct business only with responsible participants.
(2) Participants will be excluded from
			 participation in DHS programs to protect public funds, the integrity of
			 publicly funded programs, and public confidence in those programs.
(3) It is also the intent of this policy to
			 prevent excluded participants from substituting others in their place, usually
			 accomplished through related parties, as surrogates to continue the practices
			 that caused DHS or the Office of Medicaid Inspector General (OMIG) to exclude
			 the participant.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.20-003 - Technical Corrections Removal of References to Provider Electronic Solutions (PES) Software & Updating Outdated Terminology in Arkansas Medicaid Provider Manuals

Current through Register Vol. 49, No. 6, June, 2024
Section II
Adult Developmental Day Treatment
241.000
Introduction to Billing
Adult Developmental Day Treatment service providers use form
				CMS-1500 to bill the Arkansas Medicaid Program for services provided to
				Medicaid beneficiaries. Each claim may contain charges for only one (1)
				beneficiary.
Section III of this manual contains information about available
				options for electronic claim submission.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.20-004 - SPA # 2020-0007 Durable Medical Equipment Rate Adjustment

Current through Register Vol. 49, No. 6, June, 2024
ATTACHMENT 4.19-B
METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES
				-OTHER TYPES OF CARE
April 1, 2020
7. Home Health Services (Continued)
c. Medical Supplies, Equipment and Appliances
			 Suitable for Use in the Home (continued)
(2)
			 Durable Medical Equipment (DME) - Reimbursement is based on amount billed not
			 to exceed the Title XIX maximum.
Effective for claims with dates of service on or after
				April 1, 2020, the reimbursement rate maximums for codes subject to Section
				1903(i)(27) of the Social Security Act will be set annually at the January 1
				Medicare non-rural rate for the State of Arkansas. All rates are published on
				the agency's website
(http://medicaid.mmis.arkansas.gov/)
.
				Except as otherwise noted in the plan, state developed fee schedule rates are
				the same for both governmental and private providers.
For all other DME claims not covered by Section
				1903(i)(27) of the Social Security Act, rates will be set as follows.
Purchase: The Title XIX maximum for new equipment is based on
				Medicare's 1990 DME Fee Schedule. For those items which Medicare did not have a
				rate, the lowest manufacturer cost plus 10% was used. Arkansas Medicaid is
				following Medicare's policy of purchasing any item that costs $150.00 or
				less.
Rental or Capped Rental: Capped Rental equipment may not be
				rented for more than 455 consecutive days. The reimbursement rates for capped
				rental items will be established by dividing the purchase price by 455 days to
				arrive at a daily rental rate. Once the 455 day rental maximum is reached,
				Arkansas Medicaid will cease to pay rent on the equipment, however the
				equipment will remain in the recipient's home as long as determined medically
				necessary by the recipient's physician. The equipment will remain the property
				of the DME company.
A provider may bill for maintenance. However, this maintenance
				fee may not be billed until either 182 days have elapsed after the 455 day
				rental period or 182 days have elapsed from the end of the period the item is
				no longer covered under the suppliers or manufacturer's warranty, whichever is
				later. Maintenance will continue to be paid at six-month intervals if equipment
				is determined to be medically necessary. Reimbursement of the maintenance is
				the lesser of the amount billed or the Title XIX maximum. The Title XIX maximum
				was established by arraying all the Title XIX monthly maximums for capped
				rental items and utilizing the 50th
				percentile.
For those items which are rental only, the Medicare 1990 DME
				Fee Schedule monthly rental rate was used to calculate the Medicaid daily
				rental rate. The Medicare monthly rental rate was multiplied by 12 to determine
				the one-year rental amount and divided by 365 to arrive at the Medicaid daily
				rental amount.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.20-005 - SPA-2020-0001-Self-Direction Budget Calculation Methodology and IC Provider Manual

Current through Register Vol. 49, No. 6, June, 2024
ATTACHMENT 4.19-B
METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES
				-OTHER TYPES OF CARE
Revised: July 1, 2020
28. For self-directed personal assistance
			 services under 1915(j) (see Supplement 4 to Attachment 3.1-A for a full
			 description) the rate will be determined as follows:
Arkansas's methodology for determining the participant's budget
				is based on the assessment of needs for the participant and the development of
				the service plan. The cost of providing the services included in the service
				plan is calculated based on the expected reimbursement for personal care under
				the state plan referenced in Supplement 4 to Attachment 3.1-A, Page 1, and are
				adjusted to account for the self-directed service delivery model. Based on
				historical utilization patterns and differences in set-up and oversight, the
				State will use an adjustment factor of
73.0%
of the expected
				waiver/state plan service reimbursement to calculate the participant's service
				budget for self- directed personal assistance services.
260.200
Method of Reimbursement
The Cash Allowance will be quoted as a Monthly Cash Allowance,
				using thirty (30) as the days in a typical month. However, the amount of the
				allowance awarded will be based on the actual number of days in each month. The
				Monthly Cash Allowance shall be calculated based on a maximum hourly rate of
				73.00% of the personal care rate.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.20-006 - SPA #2020-0005 Vaccine Administration Fee Rate Increase

Current through Register Vol. 49, No. 6, June, 2024
ATTACHMENT 4.19-B
METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES
				-OTHER TYPES OF CARE
Revised: July 1, 2020
5.
Physician Services
Effective for dates of service on or after July 1, 2020,
				the immunization administration fee for influenza will be based on the 2020
				Medicare flu vaccine administration fee. All other immunization administration
				fees will be based on Medicare's 2020 physician fee schedule for the State of
				Arkansas. The rate is paid to all governmental and non-governmental providers,
				unless otherwise specified in the state plan. All rates are published at the
				agency's website,
(http://medicaid.mmis.arkansas.gov/)
.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.20-008 - Methods and Standards for Establishing Payment Rates- Other Types of Care

Current through Register Vol. 49, No. 6, June, 2024
ATTACHMENT 4.19-B
April 1, 2020
7. Home Health Services (Continued)
c. Medical Supplies, Equipment and Appliances
			 Suitable for Use in the Home (continued)
(2)
			 Durable Medical Equipment (DME) - Reimbursement is based on amount billed not
			 to exceed the Title XIX maximum.
Effective for claims with dates of service on or after April 1,
				2020, the reimbursement rate maximums for codes will be set subject to Section
				1903(i)(27) of the Social Security Act. All rates are published on the agency's
				website (
http://medicaid.mmis.arkansas.gov/
).
				Except as otherwise noted in the plan, state developed fee schedule rates are
				the same for both governmental and private providers.
Purchase: The Title XIX maximum for new equipment is based on
				Medicare's 1990 DME Fee Schedule. For those items which Medicare did not have a
				rate, the lowest manufacturer cost plus 10% was used. Arkansas Medicaid is
				following Medicare's policy of purchasing any item that costs $150.00 or
				less.
Rental or Capped Rental: Capped Rental equipment may not be
				rented for more than four hundred and fifty-five (455) consecutive days. The
				reimbursement rates for capped rental items will be established by dividing the
				purchase price by four hundred and fifty-five (455) days to arrive at a daily
				rental rate. Once the four hundred and fifty-five (455) day rental maximum is
				reached, Arkansas Medicaid will cease to pay rent on the equipment, however the
				equipment will remain in the recipient's home as long as determined medically
				necessary by the recipient's physician. The equipment will remain the property
				of the DME company.
A provider may bill for maintenance. However, this maintenance
				fee may not be billed until either one hundred and eighty-two (182) days have
				elapsed after the four hundred and fifty-five (455) day rental period or one
				hundred and eighty-two (182) days have elapsed from the end of the period the
				item is no longer covered under the suppliers or manufacturer's warranty,
				whichever is later. Maintenance will continue to be paid at six-month intervals
				if equipment is determined to be medically necessary. Reimbursement of the
				maintenance is the lesser of the amount billed or the Title XIX maximum. The
				Title XIX maximum was established by arraying all the Title XIX monthly
				maximums for capped rental items and utilizing the
				50th percentile.
For those items which are rental only, the Medicare 1990 DME
				Fee Schedule monthly rental rate was used to calculate the Medicaid daily
				rental rate. The Medicare monthly rental rate was multiplied by twelve (12) to
				determine the one-year rental amount and divided by three hundred and
				sixty-five (365) to arrive at the Medicaid daily rental
				amount.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.21-002 - DMS COVID-19 Response Manual

Current through Register Vol. 49, No. 6, June, 2024
200.000
OVERVIEW
201.000
Authority
The following rules are duly adopted and promulgated by the
				Division of Medical Services (DMS) of the Arkansas Department of Human Services
				(DHS) under the authority of Arkansas Code Annotated §§
										20-76-201
										20-77-107,
				and
				25-10-129.
202.000
Purpose
In response to the COVID 19 pandemic, DHS identified programs
				and services that required additional flexibility or changes to adapt to
				ensuring the health and safety of our clients. This manual details them so that
				DHS may render uninterrupted assistance and services to our clients.
203.000
Appeals
Appeal requests for the COVID-19 response policies must adhere
				to the policy set forth in the Medicaid Provider Manual Section 160.000
				Administrative Reconsideration and Appeals which can be accessed at
https://medicaid.mmis.arkansas.gov/Provider/Docs/all.aspx
.
203.000
Severability
Each section of this manual is severable from all others. If
				any section of this manual is held to be invalid, illegal, or unenforceable,
				such determination shall not affect the validity of other sections in this
				manual and all such other sections shall remain in full force and effect. In
				such an event, all other sections shall be construed and enforced as if this
				section had not been included therein.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.21-005 - Pharmacy 1 -21 Add Place of Service

Current through Register Vol. 49, No. 6, June, 2024
262.200
National Place of Service Codes
			 for Influenza Virus, Pneumococcal Polysaccharide Vaccines, and Any Other
			 Services Provided in the Pharmacy Location 8-1-21
Electronic and paper claims now require the same national place
				of service code.
Place of Service (POS)
POS Code
Pharmacy
01
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.21-006 - Technical Corrections-Vendor Name Removal from Medicaid Provider Manuals

Current through Register Vol. 49, No. 6, June, 2024
215.120
Benefit Extension Requests 8-1-21
A. Requests to extend benefits for outpatient
			 visits and laboratory and x-ray services, including those for fetal ultrasounds
			 and fetal non-stress tests, must be submitted to DHS or its designated vendor.
			 View or print contact information for how to obtain information regarding
			 submission processes. Benefit extension requests are considered only after a
			 claim has been filed and denied because the benefit is exhausted.
B. Submit with the request a copy of the
			 Medical Assistance Remittance and Status Report reflecting the claim's denial
			 for exhausted benefits. Do not send a claim.
C. Additional information will be requested
			 as needed to process a benefit extension request. Failures to timely provide
			 requested additional information within the specified timeline will result in
			 technical denials. Reconsiderations for technical denials are not
			 available.
D. Benefit extension
			 requests must be received within ninety (90) calendar days of the date of the
			 benefits-exhausted denial.
E.
			 Correspondence regarding benefit extension requests and requests for
			 reconsideration of denied benefit extension requests does not constitute
			 documentation or proof of timely claim filing.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.22-006 - Arkansas Independent Assessment (ARIA) Manual, 1915 i

Current through Register Vol. 49, No. 6, June, 2024
Methods amd Standards for Establishing Payment
						  Rates
1.
Services
			 Provided Under Section 1915(i) of tlie Social Security Act.
For each
			 optional service, describe tlie methods and standards used to set tlie
			 associated payment rate.
(Check each that applies, aftd describe
			 methods and standards to set rates):
Click here to view
				image
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.72-035 - Personnel Management Evaluation Report

Current through Register Vol. 49, No. 6, June, 2024
10500
Employee Performance
			 Evaluation
Under the rules for the Merit System of Personnel
				Administration, an appraisal of an employee's performance is required as a
				condition preliminary to:
1. Permanent
			 appointment of a probationary employee;
2. In-grade step or salary increase of a
			 permanent employee;
3.
			 Promotion.
4. Annual assessment of
			 competency of agency staff.
The employee performance evaluation is intended to do the
				following:
1. To help supervisors
			 counsel on ways to strengthen job performance.
2. To indicate whether or not an employee is
			 performing satisfactorily.
3. To
			 identify employees with potential for assuming greater levels of
			 responsibilities.
4. To provide a
			 tool for discussing unsatisfactory performance with employees and written
			 documentation of specific deficiencies.
Every effort should be made to correct deficiencies and
				additional non-scheduled reports may be desirable before recommendation for
				demotion or dismissal are made.