Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.06-052 - Section I - Provider Manual Update Transmittal

Current through Register Vol. 49, No. 6, June, 2024
Provider Manual
Transmittal Number
Alternatives for Adults with Physical Disabilities
						  Waiver...........................................
............ 42
Ambulatory Surgical
						  Center......................................................................................
............ 74
ARKids
						  First-B..........................................................................................................
............ 41
Certified
						  Nurse-Midwife.............................................................................................
............ 77
Child Health Management
						  Services..........................................................................
............ 74
Child Health Services/Early and Periodic Screening,
						  Diagnosis and Treatment.......
............ 82
Children's Services Targeted Case
						  Management.....................................................
............ 26
Chiropractic...............................................................................................................
............ 70
DDS Alternative Community Services
						  Waiver...........................................................
............ 67
Dental........................................................................................................................
............ 93
Developmental Day Treatment Clinic
						  Services.........................................................
............ 76
Developmental Rehabilitation
						  Services.....................................................................
............ 26
Division of Youth Services and Division of Children and
						  Family Services
Targeted Case
						  Management........................................................................
............ 18
Domiciliary
						  Care........................................................................................................
............ 54
ElderChoices Home and Community-Based 2176
						  Waiver........................................
............ 68
Federally Qualified Health
						  Center.............................................................................
............ 63
Hearing
						  Services.......................................................................................................
............ 67
Home
						  Health.............................................................................................................
............ 84
Hospice.....................................................................................................................
............ 57
Hospital/End-Stage Renal
						  Disease...........................................................................
............
102
Hyperalimentation.....................................................................................................
............ 82
Inpatient Psychiatric Services for Under Age
						  21.......................................................
............ 74
Licensed Mental Health
						  Practitioners........................................................................
............ 58
Living Choices Assisted
						  Living..................................................................................
............ 24
Medicare/Medicaid Crossover
						  Only..........................................................................
............ 51
Nurse
						  Practitioner.....................................................................................................
............ 73
Occupational, Physical, Speech Therapy
						  Services...................................................
............ 66
Personal
						  Care...........................................................................................................
............ 79
Pharmacy..................................................................................................................
............ 92
Physician/Independent Lab/CRNA/Radiation Therapy
						  Center..................................
............
120
Podiatrist............................................................................................................
................... 71
Portable X-Ray
						  Services....................................................................................
................... 61
Private Duty Nursing
						  Services...........................................................................
................... 73
Program of All-inclusive Care for the Elderly
						  (PACE)........................................
................... 4
Prosthetics.........................................................................................................
................... 86
Rehabilitative
						  Hospital........................................................................................
................... 69
Rehabilitative Services for Persons with Mental
						  Illness.....................................
................... 73
Rehabilitative Services for Persons with Physical
						  Disabilities............................
................... 46
Rehabilitative Services for Youth and
						  Children..................................................
................... 28
Rural Health Clinic
						  Services...............................................................................
................... 63
School-Based Mental Health
						  Services...............................................................
................... 32
Targeted Case
						  Management.............................................................................
................... 65
Transportation....................................................................................................
................... 84
Ventilator
						  Equipment..........................................................................................
................... 65
Visual
						  Care........................................................................................................
................... 83
SECTION I -
			 GENERAL POLICY
161.300
Administrative
			 Appeals of Adverse Actions that are not Sanctions
In addition to sanction reconsiderations and appeal as provided
				in sections
				160.000 -169.000, providers may
				appeal any other decision by the Department of Health and Human Services or its
				reviewers or contractors that adversely affects a Medicaid provider or
				beneficiary in regard to receipt of and payment of Medicaid claims and
				services, referred to as "non-sanction adverse action."
Within 30 calendar days of receiving notice of non-sanction
				adverse action the provider may appeal. A notice of appeal must be in writing
				and state with particularity all findings, determinations, and adverse
				decisions/actions that the provider alleges are not supported by applicable
				laws (including state and federal laws and rules and applicable professional
				standards) or both. The appeal should be mailed or delivered to the Office of
				Appeals and Hearings, Arkansas Department of Health and Human Services, P.O.
				Box 1437, Slot N401, Little Rock, AR 72203-1437.
161.400
Sanction Appeals
Within 30 calendar days of receiving notice of adverse
				decision/action, or 10 calendar days of receiving an administrative
				reconsideration decision that upholds all or part of any adverse
				decision/action, whichever is later, the provider may appeal.
A notice of appeal must be in writing and state with
				particularity all findings, determinations, and adverse decisions/actions that
				the provider alleges are not supported by applicable laws (including state and
				federal laws and rules and applicable professional standards) or both. The
				appeal should be mailed or delivered to the Director, Division of Medical
				Services, P.O. Box 1437, Slot S401, Little Rock, AR 72203-1437. No appeal is
				allowed if the adverse decision/action is due to loss of licensure,
				accreditation or certification.
162.000
Notice of the Appeal
			 Hearing
When an appeal hearing is scheduled, the Office of Hearings and
				Appeals shall notify the provider or; if the provider is represented by an
				attorney, the provider's attorney, in writing, of the date, time and place of
				the hearing. Notice shall be mailed not less than 10 calendar days before the
				scheduled date of the hearing. Hearings shall be conducted in accordance with
				DHHS Policy 1098. The decision of the Office of Appeals and Hearings is the
				final agency determination.
162.400
Appearance in Representative
			 Capacity
A person appearing in a representative capacity shall file a
				written notice of appearance on behalf of a provider identifying himself by
				name, address and telephone number; identifying the party represented and shall
				have a written authorization to appear on behalf of the provider. The Division
				of Medical Services shall notify the provider in writing of the name and
				telephone number of the Division's representative.