Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.09-004 - ARKids First-B Provider Manual Update #79

Current through Register Vol. 49, No. 6, June, 2024
Section II ARKids First-B
221.000
Scope
Covered services provided to ARKids First-B beneficiaries are
				within the same scope of services provided to Arkansas Medicaid ARKids First -A
				beneficiaries. However, some services are subject to different levels of
				benefits and cost sharing amounts are applied. Refer to the appropriate
				Arkansas Medicaid provider manual for the scope of each service covered under
				the ARKids First Program. See section
				221.100 of this manual for a
				listing of ARKids First-B Medical Care Benefits that indicate restrictions and
				required co-payment/co-insurance or cost-sharing amounts for covered
				services.
ARKids First-B beneficiaries receive preventive health care
				screens and treatment options within covered benefits. ARKids First-B
				beneficiaries are not entitled to the same benefits as children under the
				Arkansas Medicaid Child Health Services (EPSDT) Program and may not be billed
				as an EPSDT screen.
221.100
ARKids First-B Medical Care Benefits
Listed below are the covered services for the ARKids-B program.
				This chart also includes benefits, whether Prior Authorization or a Primary
				Care Physician (PCP) referral is required and specifies the cost-sharing
				requirements.
Program Services
Benefit Coverage and
						  Restrictions
Prior
Authorization/ PCP Referral
Co-payment/ Coinsurance/ Cost-Sharing
						  Requirement
Ambulance (Emergency Only)
Medical Necessity
None
$10 per trip
Ambulatory Surgical Center
Medical Necessity
PCP Referral
$10 per visit
Certified Nurse-Midwife
Medical Necessity
PCP Referral
$10 per visit
Chiropractor
Medical Necessity
PCP Referral
$10 per visit
Dental Care (No Orthodontia)
Routine dental care
None - PA for inter-periodic screens
$10 per visit
Durable Medical Equipment
Medical Necessity $500 per state fiscal year (July 1
						  through June 30) minus the coinsurance/cost-share. Covered items are listed in
						  section 262.120
PCP Referral and Prescription
20% of Medicaid allowed amount per DME item
						  cost-share
Emergency Dept. Ser
vices
Emergency
Medical Necessity
None
$10 per visit
Non-Emergency
Medical Necessity
PCP Referral
$10 per visit
Assessment
Medical Necessity
None
$10 per visit
Family Planning
Medical Necessity
None
None
Federally Qualified Health Center (FQHC)
Medical Necessity
PCP Referral
$10 per visit
Home Health
Medical Necessity
(10 visits per state fiscal year
(July 1 through June 30)
PCP Referral
$10 per visit
Hospital, Inpatient
Medical Necessity
PA on stays over 4 days if age 1 or over
20% of first inpatient day
Hospital, Outpatient
Medical Necessity
PCP referral
$10 per visit
Immunizations
All per protocol
PCP or
Administered by ADH
None
Laboratory & X-Ray
Medical Necessity
PCP Referral
$10 per visit
Medical Supplies
Medical Necessity Benefit of $125/mo. Covered supplies
						  listed in section
						  262.110
PCP Prescriptions
PA required on supply amounts exceeding
						  $125/mo
None
Mental and Behavioral Health, Outpatient
Medical Necessity
PCP Referral PA on treatment services
$10 per visit
Nurse Practitioner
Medical Necessity
PCP Referral
$10 per visit
Physician
Medical Necessity
PCP referral to specialist and inpatient professional
						  services
$10 per visit
Podiatry
Medical Necessity
PCP Referral
$10 per visit
Prenatal Care
Medical Necessity
None
None
Prescription Drugs
Medical Necessity
Prescription
$5 per prescription (Must use generic and rebate
						  manufacturer, if available)
Preventive Health Screenings
All per protocol
PCP Administration or PCP Referral
None
Rural Health Clinic
Medical Necessity
PCP Referral
$10 per visit
Speech Therapy
Medical Necessity
4 evaluation units (1 unit =30 min) per state fiscal
						  year
4 therapy units (1 unit=15 min) daily
PCP Referral
Authorization required on extended benefit of
						  services
$10 per visit
Vision Care
Eye Exam
One (1) routine eye exam (refraction) every 12
						  months
None
$10 per visit
Eyeglasses
One (1) pair every 12 months
None
None
Refer to your Arkansas Medicaid specialty provider manual for
				prior authorization and PCP referral procedures.
ARKids First-B beneficiary cost-sharing is capped at 5% of the
				family's gross annual income.
221.200
Exclusions
Services Not Covered for ARKids First-B
				Beneficiaries:
Audiological Services; EXCEPTION, Tympanometry, CPT procedure
				code
92567,
when the diagnosis is within the ICD-9-CM range of
				381.0 through 382.9
Child Health Management Services (CHMS)
Child Health Services/Early and Periodic Screening, Diagnosis
				and Treatment (EPSDT)
Developmental Day Treatment Clinic Services (DDTCS)
Diapers, underpads and incontinence Supplies
Domiciliary Care
End Stage Renal Disease Services
Hearing aids
Hospice
Hyperalimentation
Inpatient Psychiatric Services for Under Age 21
Non-Emergency transportation
Nursing facilities
Occupational and Physical Therapies
Orthodontia
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)
School-Based Mental Health Services
Targeted Case Management
Ventilator Services