Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 05 - Developmental Disabilities Services › Rule 016.05.17-004 - Amendment to the Community and Employment (CES) 1915(c) Waiver; the CES Provider Manual and the CES Certification Standards

Current through Register Vol. 49, No. 6, June, 2024
200.000
DDS COMMUNITY AND EMPLOYMENT
			 SUPPORTS (CES) WAIVER GENERAL INFORMATION
201.000
Arkansas Medicaid Program
			 Participation Requirements for DDS 10-1-17 CES Waiver Program
All Division of Developmental Disabilities Services (DDS)
				Community and Employment Supports (CES) waiver 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:
Medicaid will accept electronic signatures provided the
				electronic signatures comply with Arkansas Code §
									25-31-103
				et seq.
All willing and qualified providers have the opportunity to
				enroll as a waiver provider. DDS provides continuous open enrollment for waiver
				service providers. Potential providers should contact DDS Quality Assurance
				staff for information on the CES certification standards. Once a provider is
				certified by DDS, the provider must contact the DMS Provider Enrollment Unit to
				enroll as a Medicaid provider.
Certified and enrolled providers are allowed to specify the
				maximum number of persons they can serve, the county they can serve, the
				services they can provide and the service levels they can offer based on staff
				availability. Waiver beneficiaries have the freedom of choice of service
				providers. Once a provider is chosen by a beneficiary and meets the
				designations made by the provider, the provider cannot refuse to provide
				services unless the provider cannot assure the health and safety of the
				beneficiary. It is incumbent upon the provider to prove the individual cannot
				be served by the provider. The burden of proof also requires written
				identification of the cause for the failure to provide health and safety
				supported by documentation that attests to that condition.
Before a provider can decrease the maximum number of
				beneficiaries they will serve, drop an existing county they serve, a service,
				or service level, the provider must identify any beneficiary currently being
				served who would be affected. The provider will be required to continue
				providing services to any beneficiary who would be affected by the changes
				until such time as DDS can secure a new provider and services are in place
				under the new provider. If a provider elects to change the existing county
				served or the maximum number of participants served, the change cannot be made
				if it will adversely impact any beneficiary currently receiving services from
				the provider. The provider's maximum number of beneficiaries served may only be
				reduced through ceasing provision of services in a designated county or
				counties, freezing the number of persons they serve at the current number and
				reducing the number through attrition, or ceasing provision of services to
				those beneficiaries they have most recently begun serving. DDS will freeze new
				referrals when a provider requests to make changes in the above items but will
				not approve the changes for existing beneficiaries until such time as the
				transition to a new provider has occurred. Further, when less than an entire
				county is deleted from coverage, the provider must articulate in writing a
				business reason for making the change and demonstrate that the selection
				process is not capricious or arbitrary, does not result in discrimination and
				does not unfairly distinguish between levels of care. The process cannot be
				used to eliminate difficult families or beneficiaries. Other than business
				reasons for closing entire counties or programs, beneficiaries can only be
				discontinued if the provider cannot assure health and safety.
Option: Based on individual choice, a provider may continue to
				serve a beneficiary without serving others in the county when the individual
				served relocates their place of residence.
201.100
Providers of DDS CES Waiver
			 Services in Arkansas and Bordering 10-1-17 States Trade Area Cities
DDS CES waiver services are limited to Arkansas and bordering
				state trade area cities. The DDS must certify providers located in a bordering
				state trade area city as CES waiver providers before services may be provided
				for Arkansas Medicaid beneficiaries.
Bordering state trade area cities are Monroe and Shreveport,
				Louisiana; Clarksdale and Greenville, Mississippi; Poplar Bluff and
				Springfield, Missouri; Poteau and Sallisaw, Oklahoma; Memphis, Tennessee and
				Texarkana, Texas.
201.200
Organized Health Care Delivery System Provider 10-1-17
The DDS CES waiver allows a provider who is licensed and
				certified as a DDS CES care coordination entity or a DDS CES supportive living
				services provider to enroll in the Arkansas Medicaid Program as a DDS CES
				organized health care delivery system (OHCDS) provider.
The option of OHCDS is available to any current or future
				provider through a written agreement between DDS and the provider entity. The
				agreement requires each OHCDS provider to guarantee that any sub-contractor
				will abide by all Medicaid regulations and provides that the OHCDS provider
				assumes all liability for contract noncompliance. The OHCDS provider must also
				have a written contract that sets forth specifications and assurances that work
				will be completed timely, satisfactorily to the beneficiary being served and
				with quality maintained. The OHCDS provider is responsible for ensuring that
				services were delivered and proper documentation, including a signed customer
				satisfaction statement, has been submitted prior to billing.
As long as the OHCDS provider delivers at least one waiver
				service directly utilizing its own employees, an OHCDS provider may provide any
				other DDS CES waiver service via a subcontract with an entity qualified to
				furnish the service. The subcontract must ensure financial accountability and
				that services were delivered, properly documented and billed. The primary use
				of OHCDS is consultation, adaptive equipment, environmental modifications,
				supplemental support and specialized medical supplies.
The OHCDS provider furnishes the services as the beneficiary's
				provider of choice as described in that beneficiary's person-centered service
				plan.
202.000
Documentation Requirements 10-1-17
DDS CES waiver providers must keep and properly maintain
				written records. Along with the required enrollment documentation, which is
				detailed in Section 141.000, the following records must be included in the
				beneficiary's case files maintained by the provider.
202.100
Documentation in Beneficiary's
			 Case Files 10-1-17
DDS CES waiver providers must develop and maintain sufficient
				written documentation to support each service for which billing is made. This
				documentation, at a minimum, must consist of:
A. A copy of the beneficiary's
			 person-centered service plan, including any amendments thereto.
B. The specific services rendered.
C. The date and actual time the services were
			 rendered.
D. The name of the
			 individual who provided the service.
E. The relationship of the service to the
			 treatment regimen of the beneficiary's person-centered service plan.
F. Updates describing the beneficiary's
			 progress or lack thereof. Updates should be maintained on a daily basis or at
			 each contact with or on behalf of the beneficiary. Progress notes must be
			 signed and dated by the provider of the service.
G. Certification statements, narratives and
			 proofs that support the cost-effectiveness and medical necessity of the service
			 to be provided.
Additional documentation and information may be required
				dependent upon the service to be provided.