reglab/statecodes huggingface dataset:
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.11-002 - Official Notices ON-002-11 & ON-003-11- 2011 Conversions - 2011 CPT and HCPCS Procedure Code Conversion

Current through Register Vol. 49, No. 6, June, 2024
I.
General
			 Information
A review of the 2011 Current Procedural Terminology (CPT®)
				procedure codes has been completed, and the Arkansas Medicaid Program will
				begin accepting CPT 2011 procedure codes for dates of service on and after
				March 15, 2011.
Procedure codes that are identified as deletions in CPT 2011
				(Appendix B) are
non-payable
for dates of service on and after
				March 15, 2011.
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 2011 CPT and Healthcare Common Procedural Coding System
				Level II (HCPCS) conversions.
II.
Non-Covered 2011 CPT
			 Procedure Codes
A.
			 Effective for dates of service on and after March 15, 2011, the following CPT
			 procedure codes are non-covered.
64566
90644
90654
90664
90666
90667
90668
90867
90868
95800
95801
99224
99225
99226
B. All
			 2011 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
			 2011 CPT procedure codes are not payable to
Outpatient Hospitals
because these services are covered by another CPT procedure code,
			 another HCPCS code or a revenue code.
11045
11046
11047
22552
37222
37223
37232
37233
37234
37235
38900
43283
43338
49327
49412
61781
61782
61783
90460
90461
90470
92227
92228
93462
93463
93563
93564
93565
93566
93567
93568
D. The
			 following new 2011 CPT procedure codes are not payable to
Ambulatory Surgical Centers
because these services are
			 covered by another CPT procedure code, another HCPCS code or a revenue code.
11045
11046
11047
22552
37222
37223
37232
37233
37234
37235
38900
43283
43338
49327
49412
61781
61782
61783
90460
90461
90470
92227
92228
E. The
			 following new 2011 CPT procedure codes are not payable to
Physicians
because these services are covered by
			 another CPT procedure code, another HCPCS code or a revenue code.
90460
90461
90470
92227
92228
F. The
			 following new 2011 CPT procedure codes are not payable to
Vision
			 Service
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.11-006 - Provider Manual Update Transmittal Transportation - #TRANSP-1-11

Current through Register Vol. 49, No. 6, June, 2024
261.000 Arkansas
			 Medicaid Participation Requirements for DDTCS
Transportation Providers
All non-emergency medical transportation will be provided by
				the transportation broker for the region in which the beneficiary lives with
				the exception of transportation to and from a Developmental Day Treatment
				Clinic Services (DDTCS) center when the transportation is provided by the
				center.
The DDTCS provider may choose to provide transportation
				services for the developmentally disabled (DD) population as a fee-for-service
				provider to and from a DDTCS facility. A transportation broker must provide
				transportation to and from medical providers.
The DDTCS transportation providers must meet the following
				criteria to be eligible for participation in the Arkansas Medicaid
				Program:
A. The provider must complete
			 a provider application (Form DMS-652), a Medicaid contract (Form DMS-653, an
			 Ownership and Conviction Disclosure (Form DS-675), a Disclosure of Significant
			 Business Transactions (Form DMS-689) and a Request for Taxpayer Identification
			 Number and Certification (Form W-9) with the Arkansas Medicaid Program.
View or print a provider application (Form DMS-652). Medicaid
			 contract (Form DMS-653). Ownership and Conviction Disclosure (Form DMS-675),
			 Disclosure of Significant Business Transactions (Form DMS-689) and Request for
			 Taxpayer Identification Number and Certification (Form
			 W-9).
B. The
			 provider application and Medicaid contract must be approved by the Arkansas
			 Medicaid Program.
C. The provider
			 must submit:
1. A copy of his or her current
			 vehicle registration for each vehicle to be used for DDTCS
			 transportation,
2. A copy of the
			 driver's current commercial and/or non-commercial driver's license(s)
			 appropriate for the operation of any motor vehicle(s) the driver will be
			 operating/driving to transport DDTCS beneficiaries,
3. Proof of automobile insurance for each
			 vehicle with minimum liability coverage of $50,000.00 per person per
			 occurrence,
4. Consent for Release
			 of Information, Form DMS-619, completed by each driver.
.View
			 or print Consent for Release of Information Form
			 DMS-619.
5.
			 Provider agreement.
D.
			 The provider must subsequently submit upon receipt, proof of the periodic
			 renewal of each of the following:
1. Vehicle
			 registration
2. Commercial and/or
			 non-commercial driver's license(s) appropriate for the operation of any motor
			 vehicle(s) the driver will be operating/driving to transport DDTCS
			 beneficiaries
3. Required liability
			 insurance
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.11-008 - Hearing-1-11 and Section V-3-11

Current through Register Vol. 49, No. 6, June, 2024
Section
			 IIHearing Services
202.110
School Districts and Education Service Cooperatives 10-15-11
If a school district or an education service cooperative (ESC)
				contracts with an individual qualified audiologist, the participation criteria
				for group providers of audiology services apply. (Refer to Section
				202.100.)
If a school district or ESC employs a qualified audiologist,
				the following participation criteria apply:
A. The school district or ESC must complete
			 and submit to the Medicaid Provider Enrollment Unit a provider application
			 (form DMS-652), a Medicaid contract (form DMS-653), a certification letter from
			 the Arkansas Department of Education (ADE) and a Request for Taxpayer
			 Identification Number and Certification (form W-9) with the Arkansas Medicaid
			 Program.
View or print a provider application (form DMS-652),
			 Medicaid contract (form DMS-653) and Request for Taxpayer Identification Number
			 and Certification (form W-9).
The Local Education Agency
			 (LEA) number must be used as the license number for the school district or
			 ESC.
B. Enrollment as a Medicaid
			 provider is conditioned upon approval of a completed provider application and
			 the execution of a Medicaid provider contract. Persons and entities that are
			 excluded or debarred under any state or federal law, regulation or rule are not
			 eligible to enroll, or to remain enrolled, as Medicaid providers.
C. The school district or ESC must maintain a
			 copy of each employed audiologist's current state license.
D. A Medicaid-enrolled audiologist who
			 exclusively performs services as an employee of a school district or ESC must
			 complete and submit form DMS-7782
(view or print form
			 DMS-7782)
on an annual basis so that the audiologist's
			 individual enrollment with Arkansas Medicaid remains active.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.11-010 - Manual of Cost Reimbursement Rules for Long Term Care Facilities Estate Recovery Address Update

Current through Register Vol. 49, No. 6, June, 2024
4. If possible the
			 resident or his representative should sign the authorization for expenditures
			 column of the participant's ledger account. If the resident has already left,
			 or in the case where the resident is deceased, write the address where you sent
			 the check in the "Description" column.
5-4
Treatment of Deceased Resident Personal Trust Fund
In the event of the death of a resident, the facility
				administrator shall within 30 days of the resident's death provide an
				accounting and shall return all refunds and funds held in trust as detailed
				below. The administrator must determine if a personal representative has been
				appointed for the resident. If one has been appointed, then the personal trust
				funds shall be disbursed to that personal representative. If no such personal
				representative exists, then the facility administrator should disburse the
				funds to the named beneficiary designated by the resident on the form provided
				by the long term care facility or surviving spouse. If a personal
				representative, surviving spouse, or named beneficiary does not exist or cannot
				be located at the time of disbursement, the facility administrator shall
				deposit the funds into an interest bearing account in a bank, savings and loan
				association, trust company, or credit union located in this state and if
				possible, located within the same county in which the facility is located. The
				long term care facility needs to maintain only one account in which the trust
				funds amounting to less than one hundred dollars ($100) of deceased residents
				are placed. However, it shall be the obligation of the long term care facility
				to maintain adequate records to permit compilation of interest due each
				individual resident's account. Separate accounts shall be maintained with
				respect to trust funds of deceased residents equal to or in excess of $100. The
				facility shall maintain such account until such time as the trust funds are
				disbursed pursuant to the provisions of Arkansas' Probate Code.
At the time the funds are disbursed the nursing facility should
				notify DHS of the account on the DECEASED RESIDENT PERSONAL TRUST FUND FORM
(Page 5-9)
. If the resident trust fund is disbursed to a personal
				representative, a surviving spouse or a named beneficiary a BENEFICIARY RECEIPT
				FORM
(Page 5-10)
should be completed and a copy submitted along
				with the DECEASED RESIDENT PERSONAL TRUST FUND FORM.
These forms should be completed and submitted to:
Arkansas Department of Human Services
Third Party Liability
Estate Recovery
P.O. Box 1437 Slot 296
Little Rock, AR 72203-1437
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.11-013 - Rehabilitative Services for Persons with Mental Illness (RSPMI) Update No. 1-11 - Youth Outcomes Questionaire (YOQ)

Current through Register Vol. 49, No. 6, June, 2024
217.001
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 Treatment Plans and at discharge. At a minimum, the
				Arkansas Indicators must be administered every 90 days. The
				OQ® instruments and Arkansas Indicators are
				required for all beneficiaries ages 4 through 17. The instruments must be
				administered to beneficiaries ages 18 to 21 unless they have a documented
				certification of Serious Mental Illness (SMI). 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®2.01 or Arkansas Indicators, the provider
				must have documentation indicating barriers to obtaining the
				Y-OQ®2.01 and Arkansas Indicators. Documentation
				must include attempts to obtain the Y-OQ®2.01,
				OQ®-45.2 and Arkansas Indicators at the
				scheduled frequency.
If a Y-OQ®2.01 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 016.06.11-018 - Provider Manual Update Transmittal THERAPY-1-11

Current through Register Vol. 49, No. 6, June, 2024
Section II
Occupational, Physical,
			 Speech Therapy Services
203.000
Supervision
The Arkansas Medicaid Program uses the following criteria to
				determine when supervision occurs within the Occupational, Physical, and Speech
				Therapy Services Program.
A. The
			 person who is performing supervision must be a paid employee of the enrolled
			 Medicaid provider of therapy or speech-language pathology services who is
			 filing claims for services.
B. The
			 qualified therapist or speech-language pathologist must monitor and be
			 responsible for the quality of work performed by the individual under his or
			 her supervision.
1. The qualified therapist
			 or speech-language pathologist must be immediately available to provide
			 assistance and direction throughout the time the service is being performed.
			 Availability by telecommunication is sufficient to meet this
			 requirement.
2. When therapy
			 services are provided by a licensed therapy assistant or speech-language
			 pathology assistant who is supervised by a licensed therapist or
			 speech-language pathologist, the supervising therapist or speech-language
			 pathologist must observe a therapy session with a child and review the
			 treatment plan and progress notes at a minimum of every 30 calendar
			 days.
C. The qualified
			 therapist or speech-language pathologist must review and approve all written
			 documentation completed by the individual under his or her supervision prior to
			 the filing of claims for the service provided.
1. Each page of progress note entries must be
			 signed by the supervising therapist with his or her full signature, credentials
			 and date of review.
2. The
			 supervising therapist must document approval of progress made and any
			 recommended changes in the treatment plan.
3. The services must be documented and
			 available for review in the beneficiary's medical record.
D. The qualified therapist or speech-language
			 pathologist may not be responsible for the supervision of more than 5
			 individuals.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.11-019 - Provider Manual Update Transmittal HOSPITAL-2-11

Current through Register Vol. 49, No. 6, June, 2024
Section II Hospital/Critical Access Hospital
			 (CAH)/End Stage Renal Disease (ESRD)
272.450
Special Billing Requirements for Laboratory and X-Ray Services
The following table lists other services covered by Medicaid
				that are not restricted to the malignant neoplasm or HIV diagnoses:
Radiation Therapy
National Code
Required Modifier
Local Code Description
77417*
U2
Localization/verification - Film 1 port
77417*
U3
Localization/verification - Film 2 port
77417*
U1
Localization/verification - Film 3 port
77417*
U2
Localization/verification - Film 4 port
* Arkansas Medicaid Description
The following codes have special billing requirements for
				laboratory and X-ray procedures.
A. OPT and HCPCS Lab Procedure Codes with
			 Diagnosis Restrictions
The following CPT and procedure codes will be payable with a
				primary diagnosis as is indicated below.
Procedure Code
Required Primary Diagnosis
83951
571.5
88720
227.4, 774.2,774.6, or 782.4
88740
986
88741
289.7 or 791.2
B.
			 Genetic Testing
Procedure Code
Payment Method
S3831
Manually priced with no age or diagnosis
						  restrictions
S3835
S3837
S3840
S3843
S3844
S3846
S3847
S3848
S3849
S3850
S3851
S3853
S3860
S3861
S3862
S3800
Manually priced with no age or diagnosis restrictions;
						  requires Prior Authorization. This procedure code requires prior authorization
						  by AFMC based on the following criteria: (1) an ICD-9-CM diagnosis code of
						  335.20 and symptoms of muscle weakness, (2) documentation of muscle testing
						  must be provided and (3) a completed evaluation by a neurologist to rule out
						  other causes of muscle weakness.
(See Section 241.00 regarding procedures for obtaining
						  prior authorization by AFMC.)
C.
Procedure Code
Description
S3620
Newborn Metabolic Screening Panel
Arkansas Code §
											20-15-302
				states that all newborn infants shall be tested for phenylketonuria,
				hypothyroidism, galactosemia, cystic fibrosis and sickle cell anemia. Arkansas
				Medicaid shall reimburse the enrolled Arkansas Medicaid hospital provider that
				performs the tests required for the cost of the tests. Newborn Metabolic
				Screenings performed inpatient are included in the interim per diem
				reimbursement rate and facility cost settlement. For Newborn Metabolic
				Screenings performed in the outpatient setting (due to retesting or as an
				initial screening), Arkansas Medicaid will reimburse the hospital directly. For
				the screenings performed in the outpatient hospital setting, the provider will
				submit a claim using procedure code S3620. All positive test results shall be
				sent immediately to the Arkansas Department of
				Health.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.11-021 - Official Notice 001-11 and Section V-1-11 - Dental

Current through Register Vol. 49, No. 6, June, 2024
DIVISION OF MEDICAL SERVICES
MEDICAL ASSISTANCE PROGRAM
PROVIDER APPLICATION
As a condition for entering into or renewing a provider
				agreement, all applicants must complete this provider application. A true,
				accurate and complete disclosure of all requested information is required by
				the Federal and State Regulations that govern the Medical Assistance Program.
				Failure of an applicant to submit the requested information or the submission
				of inaccurate or incomplete information may result in refusal by the Medical
				Assistance program to enter into, renew or continue a provider agreement with
				the applicant. Furthermore, the applicant is required by Federal and State
				Regulations to update the information submitted on the Provider
				Application.
Whenever changes in this information occur, please submit the
				change in writing to:
Medicaid Provider Enrollment Unit
HP Enterprise Services
P.O. Box 8105
Little Rock, AR 72203-8105
All dates, except where otherwise specified, should be written
				in the month/day/year (MMDDYY) format. Please print all information.
This information is divided into sections. The following
				describes which sections are to be completed by the applicant:
Section I - All providers
Section II - Facilities Only
Section III
-
Pharmacists/Registered Respiratory Therapist Only
Section IV - Dental Providers Only
Section V - Provider Group Affiliations
Electronic Fund Transfer - All Providers (optional)
Managed Care Agreement - Primary Care Physician
W-9 Tax Form - All Providers
Contract - All Providers
Ownership and Conviction
Disclosure - All Providers
Disclosure of Significant
Business Transactions - All Providers
Click here
				to view image
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.11-029 - Long Term Care Facility Nursing Assistant Training Program

Current through Register Vol. 49, No. 6, June, 2024
Section I
AUTHORITY
1. The
			 following rules and regulations for the Long Term Care Facility Nursing
			 Assistant Training Program are duly adopted and promulgated by the Department
			 of Human Services pursuant to Arkansas Code
			 20-10-701 et
			 seq.
2. This initiative is pursuant
			 to the Federal mandates of Public Law 100-203 (the Nursing Home Reform Act,
			 Subtitle C of the Omnibus Budget and Reconciliation Act of 1987 and technical
			 amendments of OBRA 1989 and 1990) concerning the training and competency
			 evaluation of nursing assistants employed in long term care facilities and the
			 registry of certified nursing assistants.
3. The Federal Omnibus Budget Reconciliation
			 Act of 1987, 1989, and 1990 (OBRA) and regulations issued by the U.S.
			 Department of Health and Human Services -Centers for Medicare and Medicaid
			 Services (formerly Health Care Financing Administration, or HCFA) established
			 the minimum requirements for nursing assistant training and competency
			 evaluation programs in Section 1819(a) - (f) and 1919(a) - (f) of the Social
			 Security Act.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.11-030 - Official Notice #008-11 - 2012-ICD-9-CM Diagnosis Codes

Current through Register Vol. 49, No. 6, June, 2024
Effective for claims with dates of service on or after October
				1, 2011, the Arkansas Medicaid Program will implement the revisions included in
				the 2012 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, 2011.
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 016.06.12-001 - Rehabilitative Services for Persons with Mental Illness (RSPMI) - Update Transmittal RSPMI 7-11

Current through Register Vol. 49, No. 6, June, 2024
Section II
			 Rehabilitative Services for Persons with Mental Illness (RSPMI)
202.000
Arkansas Medicaid
			 Participation Requirements for RSPMI
In order to ensure quality and continuity of care, all mental
				health providers approved to receive Medicaid reimbursement for services to
				Medicaid beneficiaries must meet specific qualifications for their services and
				staff. Providers with multiple service sites must enroll each site separately
				and reflect the actual service site on billing claims.
RSPMI 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. Providers must be
			 located within the State of Arkansas.
B. A provider must be certified by the
			 Division of Behavioral Health Services (DBHS). (See Section 202.100 for
			 certification requirements.)
C. A
			 copy of the current DBHS certification as an RSPMI provider must accompany the
			 provider application and Medicaid contract.
D. The provider must give notification to the
			 DMS Program Integrity Unit on or before the tenth day of each month of all
			 covered health care practitioners who perform services on behalf of the
			 provider. The notification must include the following information for each
			 covered health care practitioner:
1.
			 Name/Title
2. Enrolled site(s)
			 where services are performed
3.
			 Social Security Number
4. Date of
			 Birth
5. Home Address
6. Start Date
7. End Date (if applicable)
Notification is not required when the list of covered health
				care practitioners remains unchanged from the previous notification.
DMS shall exclude providers for the reasons stated in
				42
				U.S.C. §
												1320a-7(a) and
				implementing regulations and may exclude providers for the reasons stated in
				42
				U.S.C. §
												1320a-7(b) and
				implementing regulations.
The following factors shall be considered by
				DHS in determining whether sanction(s) should be imposed:
A. Seriousness of the offense(s)
B. Extent of violation(s)
C. History of prior violation(s)
D. Whether an indictment or information was
			 filed against the provider or a related party as defined in DHS Policy 1088,
			 titled DHS Participant Exclusion Rule.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.12-004 - Healthcare Common Procedure Coding System (HCPCS) and Current Procedure Terminology (CPT) procedure codes

Current through Register Vol. 49, No. 6, June, 2024
I.
General Information
A review of the 2012 Current Procedural Terminology
				(CPT®) procedure codes has been completed, and
				the Arkansas Medicaid Program will begin accepting
				CPT® 2012 procedure codes for dates of service
				on and after May 11, 2012.
Procedure codes that are identified as deletions in
				CPT® 2012 (Appendix B) are
non-payable
for dates of service on and after May 11, 2012.
For the benefit of those programs impacted by the conversions,
				the Arkansas Medicaid Web site fee schedule will be updated soon after the
				implementation of the 2012 CPT® and Healthcare
				Common Procedural Coding System Level II (HCPCS) conversions.
II.
Non-Covered 2012
			 CPT
®
Procedure
			 Codes
A. Effective for
			 dates of service on and after May 11, 2012, the following
			 CPT® procedure codes are non-covered.
20527
26341
81200
81205
81206
81207
81208
81209
81210
81211
81212
81213
81214
81215
81216
81217
81220
81221
81222
81223
81224
81225
81226
81227
81228
81229
81240
81241
81242
81243
81244
81245
81250
81251
81255
81256
81257
81260
81261
81262
81263
81264
81265
81266
81267
81268
81270
81275
81280
81281
81282
81290
81291
81292
81293
81294
81295
81296
81297
81298
81299
81300
81301
81302
81303
81304
81310
81315
81316
81317
81318
81319
81330
81331
81332
81340
81341
81342
81350
81355
81370
81371
81372
81373
81374
81375
81376
81377
81378
81379
81380
81381
81382
81383
81400
81401
81402
81403
81404
81405
81406
81407
81408
90869
92618
B. All
			 2012 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 2012
			 CPT® procedure codes are not payable to
Outpatient Hospitals
because these services are
			 covered by another CPT® procedure code, another
			 HCPCS code or a revenue code.
15272
15274
15276
15278
15777
22634
32506
32507
32667
32668
32674
64634
64636
94780
94781
D. The
			 following new 2012 CPT® procedure codes are not
			 payable to
Ambulatory Surgical Centers
because these
			 services are covered by another CPT® procedure
			 code, another HCPCS code or a revenue code.
15272
15274
15276
15278
15777
22634
32506
32507
32667
32668
32674
64634
64636
94780
94781
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.12-006 - Medicaid Provider Manual - Section 142.900

Current through Register Vol. 49, No. 6, June, 2024
NOTICE
OF
RULE MAKING
The Director of the Division of Medical Services hereby issues
				the following proposed medical assistance rule(s) under one or more of the
				following chapters or sections of the Arkansas Code:
				20-10-211(a),
				20-10-203(b),
				20-76-433,
				25-10-129,
				and Title 20, Chapter 77.
Section I
of each Medicaid Provider Manual is amended to add a new Section
			 142.900:
For these five episodes. Attention Deficit
				and Hyperactivity Disorder (ADHD), Ambulatory Upper Respiratory Infection (UKO,
				Congestive Heart Failure (CHF), Hip/Knee Replacement, and Pregnancy, the
				following provider types are eligible to be Principle Accountable Providers
				(PAPst;
ADHD; physicians, licensed clinical
				psychologists, and RSPMI provider organizations (depending on pathway of
				care)
Ambulatory URI; providers seeing patients for
				in-person URI consultations (e.g., physicians, nurse practitioners) CHF;
				hospitals
Hip/Knee Replacement; hospitals and
				orthopedic surgeons Pregnancy; providers offering prenatal care services or
				performing delivery Beginning July 1,2012. eligible PAPs may submit a limited
				set of data (currently unavailable through claims) for ADHD, Hip/Knee, and
				Pregnancy, and receive reports on costs and quality metrics for their episodes
				through the Provider Portal.
If you need this material in a different format, such as large
				print, 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 through voice relay: 1-800-877 -8973 (TTY Hearing
				Impaired).
The Arkansas Department of Human Services is in compliance with
				Titles VI and VII of the Civil Rights Act and is operated, managed and delivers
				services without regard to religion, disability, political affihation, veteran
				status, age, race, color or national origin.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.12-007 - State Plan Amendment #2012-002 & Personal Care 4-11

Current through Register Vol. 49, No. 6, June, 2024
AMOUNT, DURATION AND SCOPE OF SERVICES
				PROVIDED
ATTACHMENT 3.1-A
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 the mentally retarded, or
			 institution for mental disease that are -
1.
			 Authorized for the individual by a physician in accordance with a plan of
			 treatment or (at the option of the State) otherwise 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,
			 andatthe 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 for beneficiaries under age 21.
G. Effective for dates of service on or after
			 April 1, 2002, for services beyond 64 hours per calendar month per beneficiary
			 aged 21 or older, the provider must request a benefit extension. Extensions of
			 the personal care benefit will be provided for beneficiaries aged 21 and older
			 when extended benefits are determined to be medically necessary.
METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES
				OTHER TYPES OF CARE
ATTACHMENT 4.19-B
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.12-009 - Autism Waiver and Manual

Current through Register Vol. 49, No. 6, June, 2024
Section
			 I
105.120 Autism Waiver 10-1-12
The purpose of the Autism waiver is to provide one-on-one,
				intensive early intervention treatment for young children ages eighteen (18)
				months through six (6) years with a diagnosis of autism. The waiver
				participants must meet the ICF/MR level of care and have a diagnosis of
				autism.
The community-based services offered through the Autism waiver
				are as follows:
1. Individual
			 Assessment, Program Development and Training
2. Provision of Therapeutic Aides
3. Plan Implementation and Monitoring of
			 Intervention Effectiveness
4. Lead
			 Therapy Intervention
5. Line
			 Therapy Intervention
6.
			 Consultative Clinical and Therapeutic Services
The waiver program is operated by the University of Arkansas
				for Medical Sciences (UAMS) Partners under the administrative authority of the
				Division of Medical Services.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.12-012 - Provider Manual Update Transmittal Prosthetics 1-12 and Provider Manual Update Transmittal Section V 1-12

Current through Register Vol. 49, No. 6, June, 2024
212.600
Orthotic Appliances and
			 Prosthetic Devices, All Ages
A. The
			 Arkansas Medicaid Program covers orthotic appliances and prosthetic devices for
			 beneficiaries under age 21 in the Child Health Services (EPSDT) Program.
			 Providers of orthotic appliances and prosthetic devices may be reimbursed by
			 the Arkansas Medicaid Program when the items are prescribed by a physician and
			 documented as medically necessary for beneficiaries under age 21 participating
			 in the Child Health Services (EPSDT) Program.
1. No prior authorization is required to
			 obtain these services for beneficiaries under age 21.
2. No benefit limits apply to orthotic
			 appliances and prosthetic devices for beneficiaries underage 21.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.12-013 - Rehabilitative Services for Persons with Mental Illness Update 2-12 and State Plan Amendment #2012-006

Current through Register Vol. 49, No. 6, June, 2024
Section II
Rehabilitative Services for Persons with Mental Illness
224.201
Psychiatric Diagnostic
			 Assessment - Initial
The purpose of this service is to determine the existence,
				type, nature and most appropriate treatment of a mental illness or emotional
				disorder as defined by DSM-IV or ICD-9. This face-to-face psychodiagnostic
				assessment must be conducted by one of the following:
*
an Arkansas-licensed physician, preferably one
				with specialized training and experience in psychiatry (child and adolescent
				psychiatry for beneficiaries under age 18)
*
an Adult Psychiatric Mental Health Advanced
				Nurse Practitioner/Family Psychiatric Mental Health Advanced Nurse Practitioner
				(PMHNP-BC)
The PMHNP-BC must meet all of the following
				requirements:
*
Licensed by the Arkansas State Board of
				Nursing
*
Practicing with licensure through the American
				Nurses Credentialing Center
*
Practicing under the supervision of an
				Arkansas-licensed psychiatrist who has an affiliation with the RSPMI program
				and with whom the PMHNP-BC has a collaborative agreement. Prior to the
				initiation of the treatment plan, the findings of the Psychiatric Diagnostic
				Assessment - Initial conducted by the PMHNP-BC must be discussed with the
				supervising psychiatrist. The collaborative agreement must comply with all
				Board of Nursing requirements and must spell out, in detail, what the nurse is
				authorized to do and what age group they may treat.
*
Practicing within the scope of practice as
				defined by the Arkansas Nurse Practice Act
*
Practicing within a PMHNP-BC's experience and
				competency level The initial Psychiatric Diagnostic Assessment must
				include:
A. An interview with the
			 beneficiary, which covers the areas outlined below. The initial Psychiatric
			 Diagnostic Assessment may build on information obtained through other
			 assessments reviewed by the physician or the PMHNP-BC and verified through the
			 physician's or the PMHNP-BC's interview. The interview should obtain or verify
			 all of the following:
1. The beneficiary's
			 understanding of the factors leading to the referral
2. The presenting problem (including symptoms
			 and functional impairments)
3.
			 Relevant life circumstances and psychological factors
4. History of problems
5. Treatment history
6. Response to prior treatment
			 interventions
7. Medical history
			 (and examination as indicated)
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.12-014 - AAPD-1-11; ASC-2-11; DDSACS-1-11; DDTCS-1-11; FQHC-1-11; Hospital-4-11; INCHOICE-2-11; INPPSYCH-1-11; LCAL-1-11; MEDX-1-11; PERSCARE-3-11; PHYSICN-3-11; PORTX-1-11; RURLHLTH-1-11; TRANSP-3-11; SECI-4-11 and SECV-12-1 - Special Language

Current through Register Vol. 49, No. 6, June, 2024
211.000
Scope
The Arkansas Medicaid Program offers certain home and
				community-based outpatient services as an alternative to nursing home
				placement. These services are available to individuals with physical
				disabilities age 21 through 64 who have received a determination of physical
				disability by SSI/SSA or DHS Medical Review Team (MRT) and who, without the
				provision of home and community-based services, would require a nursing
				facility (NF) level of care. The participant's income must be equal to or less
				than 300% of the SSI eligibility limit.
The community-based services offered through the Alternatives
				for Adults with Physical Disabilities Home and Community-Based Waiver,
				described herein as Alternatives, are as follows:
1. Environmental Accessibility
			 Adaptations/Adaptive Equipment
2.
			 Agency Attendant Care - Consumer-Directed
3. Agency Attendant Care - Traditional and
			 Consumer-Directed
4. Case
			 Management/Counseling Support
These services are designed to maintain Medicaid eligible
				beneficiaries at home in order to preclude or postpone institutionalization of
				the individual.
Please note that in accordance with
				42 CFR
				441.301(b)(l)(ii),
				alternatives services are not covered for inpatients of nursing facilities,
				hospitals or other inpatient institutions.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.12-016 - Visual Care Update 1-12

Current through Register Vol. 49, No. 6, June, 2024
Section II
Visual Care
215.000
Eyeglasses Covered by Medicaid
Brand
Frame
Gender
Size
Colors
Europa
ALT-07
Men's
52 and 54
Brown, Gold and Grey
Kerry
Unisex
48 and 50
Bronze, Black, Chrome
Kip
Women's
48
Black and Crystal
MM-01
Children's
38,40 and 42
Brown, Blue, Violet and Pink
MM-02
Children's
39, 41 and 43
Bronze, Blue, Gunmetal and Wine
MM-03
Unisex
46, 48 and 50
Bronze, Black, Gunmetal and Light Copper
MM-04
Unisex
44, 46 and 48
Brown, Blue, Violet and Red
MM-05
Women's
45, 47 and 49
Brown, Black, Gunmetal and Blue
NF-3
Unisex
44 and 46
Matte Black and Matte Silver
L-Cable
Children's
36,38 and 40
Brown, Gold and Black
NF-2
Unisex
45 and 47
Matte Black and Matte Blue
MM-06
Men's
50, 52 and 54
Brown, Black, Gunmetal and Gold
Kenmark
Andrea
Women's
49
Rose, Brown and Wine
Shannon
Women's
46 and 48
Sand, Black and Lavender
Sharon
Women's
49
Black Crystal and Brown
Blaire
Women's
50 and 52
Golden Rose, Nutmeg and Dove
Gypsy
Women's
55 and 57
Demi, Black and Lavender
Sam
Men's
49 and 51
Brown, Gunmetal and Black
Gracy
Women's
52 and 54
Brown, Bleu and Rose
Henry
Men's
52, 54, 56 and 58
Gold, Gold/Demi Amber and Gunmetal/Tortoise
Chet
Men's
54 and 56
Brown and Gunmetal
Aimee
Women's
54 and 56
Brown, Purple and Rose
Gwen
Women's
51 and 53
Beige, Blush and Mist
Debbie
Women's
52
Tortoise and Black
Jim
Men's
53, 55 and 59
Brown, Gunmetal and Gold
Bryant
Men's
49 and 51
Black, Brown and Gunmetal
Leya
Women's
45 and 47
Brown, Grape, Black and Plum
United
Destiny
Unisex
47
Coffee, C2 Matte Black and C3 Matte Silver
Steve
Men's
49 and 51
C1 Brown, and C2 Dark Gray
Stella
Women's
51
C1 Light Brown C2 Lilac and C3 Matte Silver
Candy
Unisex
45
C1 Shiny Brown and C2 Matte Black
Modern
Sporty
Kids
44 and 46
Black/Crystal, Blue and Brown
Gift
Women's
47 and 49
Black/Crystal, Brown/Crystal and Purple/Brown
Dazzle
Women's
49, 51 and 53
Brown, Gold And Rose
Judi
Women's
50 and 53
Black/Crystal, Tortoise and Wine/Gray
Dynamite
Girl's
42, 45 and 47
Antique Brown and Black Silver
Ralph
Men's
52, 54 and 56
Black, Brown and Gray
Ninja
Unisex
44 and 46
Blue, Brown and Lilac
Zimco
Attitudes #3
Women's
50
Brown/Crystal and Black
Retro#1
Women's
48
Gold, Gunmetal Blue and Matte Brown
Hart
Hart-9756
Women's
48
Brown, Gold and Gunmetal Silver
3766
Women's
52
Brown and Lilac
Hart-8112
Unisex
48
Matte Black, Matte Burgundy and Matte Coffee
Reality-Hart
Women's
51
Onyx-Brown and Onyx-Burgundy
3714
Women's
52
Black-Burgundy and Tortoise
Hart-3712
Men's
52
Black-Brown and Gunmetal
7206
Girl's
52
Brown and Graphite
Hart-9751
Women's
48 and 50
Brown, Silver and Lilac
Hart-9509
Boy's
38, 41 and 44
Gold Brown, Satin Blue and Shiny Brown
MiraFlex
Mini Baby
Children
Various
Various Colors
Baby Lux
Children
Various
Various Colors
New Baby 2
Children
Various
Various Colors
LBI
Woman Day
Women's
55
Gold, Rose and Gray
LBI--915
Women's
53
Gold/Silver, Silver/Gold and Brown/Gold
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.12-017 - State Plan Amendment #2011-013 - CPMH

Current through Register Vol. 49, No. 6, June, 2024
1. Inpatient Hospital Services
All inpatient admissions to an acute care/general hospital or
				rehabilitative hospital will be allowed up to four (4) days of service per
				admission when determined inpatient care is medically necessary. On the fifth
				day of hospitalization, if the physician determines the patient should not be
				discharged on the fifth day of hospitalization, the hospital may contact the
				Quality Improvement Organization (Arkansas Foundation for Medical Care, Inc.)
				and request an extension of inpatient days. The Quality Improvement
				Organization (QIO) will then determine medically necessary days. Calls for
				extension of days may be made at any point from the fourth day of stay through
				discharge. However the provider must accept the financial liability should the
				stay not meet the necessary medical criteria for inpatient services. Medically
				necessary inpatient days are available to individuals under age 1 without
				regard to the four day limit and extension procedures required under the plan.
				Additionally, effective for dates of service on or after November 1, 2001, a
				benefit limit of 24 days per State Fiscal Year (July 1 through June 30) is
				imposed for recipients age 21 and older. No extensions will be authorized. The
				benefit limit does not apply to recipients under age 21 in the Child Health
				Services (EPSDT) Program
or beneficiaries, regardless of age, who meet the
				following criteria:
I.
Diagnosis (one of the following)
a.
the presence of two or more
			 diagnoses on Axis I and/or II is indicative of a serious emotional
			 disorder
b.
the
			 presence of a diagnosis on Axis I or II
and
a
			 diagnosis on Axis III
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.12-020 - Rehabilitative Services for Mental Illness (RSPMI) - Update 4-12

Current through Register Vol. 49, No. 6, June, 2024
Section II
Rehabilitative Services for Persons with Mental Illness
226.200
Documentation
The RSPMI provider must develop and maintain sufficient written
				documentation to support each medical or remedial therapy, service, activity or
				session for which Medicaid reimbursement is sought. This documentation, at a
				minimum, must consist of:
A. Must be
			 individualized to the beneficiary and specific to the services provided,
			 duplicated notes are not allowed.
B. The date and actual time the services were
			 provided (Time frames may not overlap between services. All services must be
			 outside the time frame of other services.),
C. Name and credentials of the person, who
			 provided the services,
D. The
			 setting in which the services were provided. For all settings other than the
			 provider's enrolled sites, the name and physical address of the place of
			 service must be included,
E. The
			 relationship of the services to the treatment regimen described in the plan of
			 care and
F. Updates describing the
			 patient's progress and
G. For
			 services that require contact with anyone other than the beneficiary, evidence
			 of conformance with HIPAA regulations, including presence in documentation of
			 Specific Authorizations, is required.
Documentation must be legible and concise. The name and title
				of the person providing the service must reflect the appropriate professional
				level in accordance with the staffing requirements found in Section
				213.000.
Every individual receiving Rehabilitative Day Services must
				have both daily notes and a weekly summary documented in the medical
				record.
The weekly summary must be signed by a Mental Health
				Professional (MHP) and include a description of therapeutic activities provided
				and the beneficiary's progress or lack of progress in achieving the treatment
				plan goal(s) and established outcomes to be accomplished. Additionally, if a
				Mental Health Paraprofessional (MHPP) documents and signs the daily notes, the
				supervising MHP must sign the weekly summary. The supervising MHP's signature
				indicates that the MHP has supervised and approves of the daily services
				provided by the MHPP.
All documentation must be available to representatives of the
				Division of Medical Services at the time of an audit by the Medicaid Program
				Integrity Unit. All documentation must be available at the provider's place of
				business. No more than thirty (30) days will be allowed after the date on the
				recoupment notice in which additional documentation will be accepted.
				Additional documentation will not be accepted after the 30-day period.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.12-026 - Health Insurance Premium Payment (HIPP)

Current through Register Vol. 49, No. 6, June, 2024
I. Introduction: The Arkansas Division of
			 Medical Services (DMS) may pay for health insurance premiums for Medicaid
			 eligible individuals if such payments are cost effective. This chapter contains
			 the rules governing premium payments under the Arkansas Health Insurance
			 Premium Payment (HIPP) program.
II.
			 Definitions
a. Cost Effectiveness: Health
			 insurance premium payments are cost effective if the premiums, coinsurance,
			 deductibles and other cost sharing obligations under a health plan, plus an
			 amount for administrative costs are likely to be less than the amount paid for
			 equivalent Medicaid services. HIPP is
not
cost effective when:
(1) Private insurance premiums are used to
			 meet a spend down obligation under the medically needy program;
(2) The client's eligibility category is
			 "aged."Covered Benefits: Medical assistance as defined in § 1905 of the
			 Social Security Act that is covered under the State Medicaid Plan and any
			 additional services covered under a waiver approved by the Secretary of the
			 Department of Health and Human Services.