Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 20 - Division of County Operations › Rule 016.20.18-001 - Medical Services Policy sections A-210, B-500, D-372, D-373

Current through Register Vol. 49, No. 6, June, 2024
A-200 Medicaid Coverage Periods
A-200 Medicaid Coverage Periods
MS Manual 05/01/18
The State is required to provide retroactive eligibility for up
				to three full months prior to the date of application to applicants who:
1. Received medical services in the
			 retroactive period; and
2. Were
			 eligible in the month the medical services were received.
Retroactive eligibility will be provided to applicants who were
				otherwise eligible in the month services were received regardless of whether
				they were ineligible at other times during the retroactive period. Retroactive
				eligibility is separate and apart from current eligibility, i.e., applicants
				not eligible for the current period may be eligible for the retroactive period.
				Retroactive eligibility determinations are required for all categories, except
				ALF, ARChoices, Autism, DDS Waiver, QMB and PACE.
Note:
Retroactive coverage for
				Newborns will not be given prior to the date of birth.
Note:
Beginning May 1, 2018, Adult
				Expansion Group recipients may be eligible for retroactive coverage 30 days
				prior to the date of application. Retroactive coverage for the Adult Expansion
				Group is date specific.
Example:
James is approved for
				coverage in the Adult Expansion Group with an application date of September 15.
				He asks for retroactive coverage for a doctor bill with a service date of
				August 1. He is not eligible for retroactive coverage because his bill Is for
				August 1 and retroactive coverage can only begin August 16.
Example:
James is approved for
				coverage in the Adult Expansion Group with an application date of December 31.
				He asks for retroactive coverage for a doctor bill with a service date of
				December 1. His regular coverage will begin December 1. As the 30* day is
				included in his regular coverage period, no coverage will be given for the
				previous month.
An application for retroactive eligibility may be made on
				behalf of deceased persons and eligibility will be provided if they were
				eligible when the services were received.
For cases in which an applicant has not resided in Arkansas for
				three full months prior to the date of application, the retroactive period
				begins with the date the individual established residency in Arkansas. The
				"previous state" is responsible for the retroactive period prior to the time
				the applicant established residency in Arkansas. The caseworker is responsible
				for
Medical Services Policy Manual, Section B
B-500 Emergency Medicaid Services for
				Aliens
MSManual 05/01/18
This group consists of:
* Nonqualified aliens living in the I or
* Qualified aliens living in the U.S. for less than 5
				years.
Medicaid benefits are available to pay for the cost of
				emergency services for aliens who do not meet the Medicaid citizenship or alien
				status requirements or Social Security Number requirements. However, they must
				meet the financial and categorical eligibility requirements and state residency
				requirements for the category in which they apply, such as Parent Caretaker
				Relative, Medically Needy, Adult Expansion, ARKids A or B.
*f
NOTE: Emergency Medicaid applicants,
				if eligible in the Adult Expansion Group may be approved for retroactive
				coverage 30 days prior to the date of application. Retroactive coverage for the
				Adult Expansion Group is date specific.
Example:
James applies for
				Emergency Medicaid coverage on October 20 and requests coverage for September
				15 through September 17. He is not eligible for retroactive coverage
because his bill is for S
eptember 15 through 17 which
				is more than 30 days prior to the application date. Retroactive coverage cannot
				begin prior to September 20.
Example:
James applies for
				Emergency Medicaid coverage on October 30 and is found to be medically eligible
				for the Adult Expansion Group on October 1 through October 2. He asks for
				retroactive coverage for a medical bill with a service date of October 1. He is
				eligible for retroactive coverage because his bill for October 1 is within the
				30 days prior to the application
				date.1
To be eligible for emergency Medicaid, the applicant must
				have, or must have had within the last 3 months, an emergency medical
				condition. For the exception, see NOTE above. Labor and delivery is considered
				an emergency medical condition.
Emergency medical condition is defined as a medical
				condition, including labor and delivery, manifesting itself by acute symptoms
				of such severity, including severe pain, such that the absence of immediate
				medical attention could reasonably be expected to result in at least one of the
				following:
* Placing the patient's health in serious
				jeopardy
* Serious impairment of bodily function
* Serious dysfunction of any bodily part or
				organ
To qualify as an emergency, the medical condition must be
				acute. It must have a sudden onset, a sharp rise and last a short time. If the
				individual's condition is chronic (ongoing), such as cancer, AIDS, end-stage
				renal disease, etc., it is not considered acute and does not meet the
				definition of an emergency. If the chronic condition worsens, it is still not
				acute and does not qualify for emergency services. Federal policy specifically
				identifies care and services related to an organ transplant procedure as not
				qualifying under emergency services.
Before eligibility can be determined, the existence of an
				emergency medical condition must be verified by a physician's statement that
				the alien met the conditions shown above. A physician's statement that the
				individual will die without medical treatment does not in and of itself,
				constitute an emergency. The eligibility determination must include a
				determination of whether the condition is acute or chronic. Verification that
				medical expenses were incurred for treatment of the condition must also be
				presented.
Payment for emergency services is limited to the day
				treatment was initiated and the following period of time in which the necessity
				for emergency services existed. The date the alien first sought treatment is
				considered the first day of the emergency, regardless of the length of time the
				condition exists. The period of eligibility will be a fixed retroactive period,
				with the Medicaid begin and end dates entered in the system.
Emergency services are defined as services provided in a
				hospital, clinic, office or other facility equipped to furnish the required
				care after the onset of an emergency medical condition. Labor and delivery
				services are covered, including normal deliveries.
To determine if an applicant's doctor visit, emergency
				room visit or hospital stay was considered an emergency, the discharge summary
				for the medical visit will be sent to OPPD, S333 for an emergency medical
				determination.
6.
Publically operated community residences that serve no more than 16
			 residents are facilities that provide some services beyond food and shelter
			 such as social services, help with personal living activities, or training in
			 socialization and life skills. They cannot be on the grounds of or immediately
			 adjacent to any large institution or multiple purpose complexes such as
			 educational or vocational training institutions, correctional or holding
			 facilities, or hospitals, nursing facilities or intermediate care facilities
			 for Individuals with intellectual disabilities.
D-371
Inmates Being Released from Custody
MS Manual 08/01/15
Individuals in the custody of the Arkansas Department of
				Correction (ADC), Arkansas Department of Community Correction (ADCC), county
				jail, city jail, juvenile detention facility or Division of Youth Services
				(DYS) will be allowed to submit an application for Medicaid up to 45 days prior
				to the individual's scheduled release date. Applications will be submitted
				online at
www.access.arkansas.gov
,
or by paper application, DCO-151, Application for Health Coverage Single
				Adults, which will be submitted to the local DHS county office.
If eligible, Medicaid will not start until the individual
				is released from custody. The authorized representative from the facility wilt
				notify DHS of the actual release date.
D-372
Inmates Being Released for Inpatient
				Treatment
MS Manual 05/01/18
An individual in the custody of ADC, ADCC, or a local
				correctional facility who has been admitted and received treatment at an
				inpatient facility may be eligible for Medicaid payment provided all
				eligibility requirements are met. Eligibility will be determined in accordance
				with MS Sections D, E and F. Only the inmate will be included in the Medicaid
				household. The coverage period will begin on the hospital admission date and
				end on the hospital discharge date.
M
NOTE:
Inmates
				may be approved for retroactive coverage 30 days prior to the date of
				application in the Adult Expansion Group, if eligible. Retroactive coverage for
				the Adult Expansion Group is date specific.
Example:
James applies for
				medical coverage on September 15. He asks for retroactive coverage for a
				medical bill with an inpatient hospital begin date of August 1. He is not
				eligible for retroactive coverage on this date because his bill is for August 1
				and retroactive coverage can only begin August 16, thirty (30) days prior to
				the September 15 application date.
Example:
James applies for
				medical coverage or September 20. He asks for retroactive coverage for a
				medical bill with an inpatient hospital begin date of September 15. He is
				eligible for retroactive coverage on September 15, as this date is within the
				30 days prior to the application date.
D-373
Suspension of Medicaid Coverage for an
				Inmate
MS Manual 05/01/18
The appropriate correctional facility will notify DHS
				when a Medicaid or Adult Expansion Group recipient enters the ADC, ADCC, the
				county Jail, city jail, or a juvenile detention facility. When this
				notification is received, DHS will place that individual's Medicaid coverage in
				suspended status for up to twelve (12) months from the initial approval or most
				recent renewal.
When an individual with suspended Medicaid eligibility
				receives eligible medical treatment off the grounds of the detention facility
				or is released from custody, the individual's case will be reinstated if the
				reinstatement date is within the twelve (12) month period from the individual's
				initial approval or most recent renewal. For those individuals receiving
				eligible treatment while off the correctional facility grounds, Medicaid will
				be reinstated for a fixed eligibility period from the date of hospitalization
				to the date of hospital discharge. The case will be re suspended following the
				fixed eligibility period.
D-380
Child(ren) Entering Custody of Division of Youth
				Services (DYS)
MS Manual 04/29/16
The appropriate juvenile detention facility will notify
				the designated DYS staff when a Medicaid recipient enters the facility. When
				this notification is received, DYS designated staff will place that child's
				Medicaid coverage in suspended status for up to twelve (12) months from the
				initial approval or most recent renewal.
When a child with suspended Medicaid eligibility receives
				eligible medical treatment off the grounds of the juvenile detention facility
				or is released from custody, the child's case will be reinstated if the
				reinstatement date is within the twelve (12) month period from the individual's
				initial approval or most recent renewal. For those children receiving eligible
				treatment while off the correctional facility grounds, Medicaid will be
				re-instated for a fixed eligibility period from the date of hospitalization to
				the date of hospital discharge. The case will be re-suspended following the
				fixed eligibility period.