reglab/statecodes huggingface dataset:
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.05-066 - Home Health Provider Manual Update Transmittal #62

Current through Register Vol. 49, No. 6, June, 2024
205.000
Record Retention Requirements
The record retention requirements in this section apply to the
				home health records of beneficiaries of all ages. Special documentation and
				record retention requirements apply to beneficiaries under the age of 21. See
				sections 218.000 through 218.165 for those additional requirements.
A. All required records must be kept for a
			 period of 5 years from the ending date of service or until all audit questions,
			 appeal hearings, investigations or court cases are resolved, whichever period
			 is longer.
B. Providers are
			 required, upon request, to furnish their records to authorized representatives
			 of the Arkansas Division of Medical Services (DMS), the Medicaid Fraud Control
			 Unit of the Office of the Attorney General and representatives of the
			 Department of Health and Human Services.
C. Furnishing records on request to
			 authorized individuals and agencies is a contractual obligation of providers
			 enrolled in the Medicaid Program. Sanctions will be imposed for failure to
			 furnish medical records upon request.
D. When the Medicaid Field Audit Unit
			 conducts an audit of a provider's records, all documentation must be made
			 available to authorized DMS personnel at the provider's place of business
			 during normal business hours. Requested documentation that is stored off-site
			 must be made available to DMS personnel within three business days.
E. If an audit determines that recoupment of
			 Medicaid payments is necessary, DMS will accept additional documentation for
			 only thirty days after the date of the notification of recoupment. Additional
			 documentation will not be accepted later.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.05-068 - State Plan Amendment #2005-009

Current through Register Vol. 49, No. 6, June, 2024
8.
			 Private Duty Nursing Services
Refer to Attachment 4.19-B, Item 4.b.(5) for reimbursement
				information for private duty nursing services for high technology
				non-ventilator recipients in the Child Health Services (EPSDT) Program.
9. Clinic Services
(1) Developmental Day Treatment Clinic
			 Services (DDTCS)
Reimbursement is based on the lesser of the amount billed or
				the maximum Title XIX (Medicaid) charge allowed. The Title XIX maximum was
				established based on a 1980 survey conducted by Developmental Disabilities
				Services (DDS) of 85 Arkansas DDTCS providers of their operational costs
				excluding their therapy services. An average operational cost was derived for
				each service. Then an average number of units was derived for each service. The
				average operational cost for each service was divided by the average units for
				that particular service to arrive at a maximum rate.
For dates of service occurring on or after September 27,
				2005, the maximum per unit rate for Pre-School Services is increased to
				$15.57and the maximum per unit rate for Adult Development Services is increased
				to $9.99. These new rates were calculated based on analysis of the current 2005
				cost to provide quality services in compliance with governing regulations. The
				rates have been demonstrated to be consistent with the Clinic Upper Payment
				Limit at
				42
				CFR 447.321.
For Pre-School Services, 1 unit of service equals 1 hour
				of service with a maximum of 5 units per day. For Adult Development Services, 1
				unit of service equals 1 hour of service with a maximum of 5 units per
				day.
Services for beneficiaries under age 21 can be extended
				with prior authorization due to medical necessity. State developed fee schedule
				rates are the same for both public and private providers of DDTCS
				services.
Occupational, physical and speech therapy services under the
				DDTCS Program are reimbursed as is described in Item 4.b.(19).
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.05-074 - Rate Increase for Under 16 Bed ICF/MR Facilities

Current through Register Vol. 49, No. 6, June, 2024
B. Intermediate Care Facilities for the
			 Mentally Retarded - Continued 3. Under 16 Beds:
a. Small ICF/MR facilities certified as
			 having 15 beds or fewer will be reimbursed on a prospective uniform class rate
			 system. An inflationary adjustment, determined by the Division to be reasonable
			 and adequate, will be applied to the existing rates and will be implemented by
			 State Plan amendment as warranted by analysis of cost report data. Cost reports
			 will be submitted annually for the preceding calendar year (January 1 -
			 December 31) and will be reviewed prior to establishing new rates. The Division
			 has established the per diem rate of $166.83 for dates of service beginning
			 July 1, 2005. This 3.1% increase in per diem rate is based on the CMS Market
			 Basket forecast for nursing home index as an inflation factor.
b. Overpayment/Underpayments
Overpayment/underpayments resulting from Section 1-12
				administrative errors shall be handled through the vendor payment by recouping
				overpayments and reimbursing underpayments.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.05-075 - Developmental Rehabilitation Services Provider Manual Update Transmittal #17

Current through Register Vol. 49, No. 6, June, 2024
Section II
Developmental Rehabilitation Services
201.000
Arkansas Medicaid
			 Participation Requirements for Developmental Rehabilitation Services
Providers of developmental rehabilitation services must meet
				the following requirements to be eligible to participate in the Arkansas
				Medicaid Program:
A. Providers must be
			 certified as First Connections Program participants by the Arkansas Division of
			 Developmental Disabilities Services (DDS) to provide early intervention
			 services.
B. A provider must
			 complete and submit to the Medicaid Provider Enrollment Unit a provider
			 application (form DMS-652), a Medicaid contract (form DMS-653) and a Request
			 for Taxpayer Identification Number and Certification (Form W-9).
View or print a provider application (form DMS-652), a
			 Medicaid contract (form DMS-653) and a Request for Taxpayer Identification
			 Number and Certification (Form W-9).
C. 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.
D. Verification of current certification from
			 DDS must accompany the provider application and the Medicaid
			 contract.
E. Subsequent
			 certifications must be forwarded to the Medicaid Provider Enrollment Unit
			 within 30 days of issuance. If the renewal document(s) have not been received
			 within this timeframe, the provider will have an additional and final 30 days
			 to comply.
F. Failure to timely
			 submit verification of certification renewals will result in termination of
			 enrollment in the Arkansas Medicaid Program.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.05-078 - Prescription Drug Coverage for Dual Eligibles Covered By Medicare - DMS-2005-O-1, DMS-2005-G-2, DMS-2005-II-3, DMS-2005-L-3, DMS-2005-KK-2, DMS-2005-Q-2, DMS-2005-R-3, DMS-2005-OO-2

Current through Register Vol. 49, No. 6, June, 2024
Effective January 1, 2006, due to the change in federal law,
				Arkansas Medicaid will no longer cover prescription drugs for the dual eligible
				population. Dual eligibles are those persons with Medicare who receive
				prescription drug coverage through Medicaid. Medicare will begin to pay for
				their prescription drugs through a Medicare approved prescription drug plan
				(PDP).
A claim submitted to Arkansas Medicaid with a date of service
				on or after January 1, 2006 for a Medicare eligible patient will deny at point
				of sale indicating the drug is non-covered (edit Y700).
A small number of drugs are excluded from Medicare coverage
				under the new federal law. For excluded select drugs only, to which a reference
				is listed on back of this page, Arkansas Medicaid will be required to reimburse
				if a PDP does not.
When a claim is submitted by the pharmacy for a covered drug in
				the category on the back of this page, the pharmacy will receive edit
Y701
with an error message requiring
				the pharmacy to bill Medicare first. If a claim is denied by Medicare and the
				PDP does not pay for an equivalent drug in the class, the claim will be paid by
				Arkansas Medicaid. The pharmacy will be required to enter the Medicare denial
				date into the Third Party Liability (TPL) denial date field (443-E8 Other Payer
				Date).
The following excluded drugs are covered, as set forth on the
				Arkansas Medicaid Website at www.medicaid.state.ar.us under the following link,
				"Medicare Part D Excluded -- Allowed by Arkansas Medicaid":
a. select agents when used for weight gain b.
			 select agents when used for the symptomatic relief of cough and colds c. select
			 prescription vitamins and mineral products, except prenatal vitamins and
			 fluoride d. select nonprescription drugs e. select agents when used to promote
			 smoking cessation f. barbiturates g. benzodiazepines Coverage of these drugs by
			 Arkansas Medicaid for the dual eligibles will be subject to any criteria as
			 established for the regular Medicaid population.
Thank you for your participation in the Arkansas Medicaid
				Program.
Roy Jeffus, Director
If you need this material in an alternative format, such as
				large print, please contact our Americans with Disabilities Act Coordinator at
				(501) 682-6789 and 1-877-708 -8191. Both telephone numbers are voice and
				TDD.
If you have questions regarding this notice, please contact the
				EDS Provider Assistance Center at In-State WATS 1-800-457 -4454, or locally and
				Out-of-State at (501) 376-2211.
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
.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.05-082 - Physician/Independent Lab/CRNA/Radiation Therapy Center Update #105

Current through Register Vol. 49, No. 6, June, 2024
201.100
Arkansas Medicaid
			 Participation Requirements for Physicians
All physicians are eligible for participation in the Arkansas
				Medicaid Program if they meet the following criteria:
A. A provider of physician's services must be
			 licensed to practice in his or her state.
B. A provider of physician's services (with
			 the exception of a pediatrician) must be enrolled in the Title XVIII (Medicare)
			 Program.
C. A provider of
			 physician's services must complete a provider application (form DMS-652),
			 Medicaid contract (form DMS-653), Request for Taxpayer Identification Number
			 and Certification (Form W-9) and Arkansas Medicaid Primary Care Physician
			 Managed Care Program Primary Care Physician Participation Agreement (form
			 DMS-2608).
View or print form DMS-652, form DMS-653, Form W-9
			 and form DMS-2608.
D. A copy of the following documents must
			 accompany the application and contract:
1.
			 The physician must submit a copy of his or her current license to practice in
			 his or her state.
2. Out-of-state
			 physicians must submit a copy of verification that reflects current enrollment
			 in the Title XVIII (Medicare) Program.
3. Subsequent licensure and certifications
			 must be forwarded to Provider Enrollment within 30 days of issuance. If the
			 renewal document(s) have not been received within this timeframe, the provider
			 will have an additional 30 and final days to comply.
E. Enrollment as a Medicaid provider is
			 conditioned upon approval of a completed provider application and the execution
			 of a Medicaid Provider Agreement.
F. 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.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.05-083 - Visual Care Update Transmittal #70 and State Plan Transmittal #2005-011

Current through Register Vol. 49, No. 6, June, 2024
ATTACHMENT 4.19-B
METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES
				-OTHER TYPES OF CARE
4.
b. Early and Periodic Screening and Diagnosis
			 of Individuals Under 21 Years of Age and Treatment of Conditions Found
(13)
Rye Prostheses
and
			 Cleaning
Reimbursement is based on the lesser of the amount billed or
				the Title XIX (Medicaid) maximum charge allowed. The Medicaid maximum rates
				were established using the
2005 Medicare fee schedule. The State
				developed fee schedule rates are the same for both public and private providers
				of the service and the fee schedule and any annual/periodic adjustments to the
				fee schedule are published.
(14)
Rar Molds
Reimbursement is based on the lesser of the amount billed or
				68% of the dealer invoice.
(15)
Pesensitization
			 Injections
Medicaid will pay a physician's fee up to the Title XIX
				(Medicaid) maximum for administering the injection and up to the Title XIX
				(Medicaid) maximum per vial of antigen. Refer to Attachment 4.19-B, Page 2,
				Item 5.
Effective for claims with dates of service on or after July 1,
				1992, the Title XIX maximum rates were decreased by 20%.
SUBJECT: Provider Manual Update Transmittal #70
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.05-085 - Occupational, Physical and Speech Therapy Services Provider Manual Update Transmittal #52

Current through Register Vol. 49, No. 6, June, 2024
262.110
Occupational, Physical, Speech Therapy Procedure Codes
The following occupational, physical and speech-language
				pathology procedure codes are payable when billed using type of service (TOS)
B
.
A.
OCCUPATIONAL
			 THERAPY
Procedure Code
Required Modifiers
Description
97003
-
Evaluation for Occupational Therapy
(30-minute unit; maximum of 4 units per state fiscal
						  year, July 1 through June 30)
97530
-
Individual Occupational Therapy (15-minute unit;
						  maximum of 4 units per day)
97150
U2
Group Occupational Therapy
(15-minute unit; maximum of 4 units per day, maximum of
						  4 clients per group)
97530
UB
Individual Occupational Therapy by Occupational Therapy
						  Assistant
(15-minute unit; maximum of 4 units per day)
97150
UB, U1
Group Occupational Therapy by Occupational Therapy
						  Assistant
(15-minute unit; maximum of 4 units per day, maximum of
						  4 clients per group)
B.
PHYSICAL THERAPY
Procedure Code
Required Modifier
Description
97001
-
Evaluation for Physical Therapy
(30-minute unit; maximum of 4 units per state fiscal
						  year, July 1 through June 30)
97110
-
Individual Physical Therapy
(15-minute unit; maximum of 4 units per day)
97150
-
Group Physical Therapy
(15-minute unit; maximum of 4 units per day, maximum of
						  4 clients per group)
97110
UB
Individual Physical Therapy by Physical Therapy
						  Assistant (15-minute unit; maximum of 4 units per day)
97150
UB
Group Physical Therapy by Physical Therapy
						  Assistant
(15-minute unit; maximum of 4 units per day, maximum of
						  4 clients per group)
C.
SPEECH-LANGUAGE PATHOLOGY
Procedure Code
Required Modifier
Description
92506
-
Evaluation for Speech Therapy
(30-minute unit; maximum of 4 units per state fiscal
						  year, July 1 through June 30)
92507
-
Individual Speech Session
(15-minute unit; maximum of 4 units per day)
92508
-
Group Speech Session
(15-minute unit; maximum of 4 units per day, maximum of
						  4 clients per group)
92507
UB
Individual Speech Therapy by Speech-Language Pathology
						  Assistant
(15-minute unit; maximum of 4 units per day)
92508
UB
Group Speech Therapy by Speech-Language Pathology
						  Assistant
(15-minute unit; maximum of 4 units per day, maximum of
						  4 clients per group)
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.05-087 - Home Health Provider Manual Update Transmittal #70; Hospital/Critical Access Hospital (CAH)/End-Stage Renal Disease (ESRD) Provider Manual Update Transmittal #70; Rehabilitative Hospital Provider Manual Update Transmittal #54

Current through Register Vol. 49, No. 6, June, 2024
Section II
Home Health
242.120
Home Health Physical
			 Therapy
Procedure Code
Modifier
Description
97110
UB
Home Health Physical Therapy by a Qualified Physical
						  Therapy Assistant
97110
Home Health Physical Therapy by a Qualified Licensed
						  Physical Therapist
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.05-089 - Rehabilitative Services for Youth and Children Provider Manual Update Transmittal #19; Licensed Mental Health Practitioner Provider Manual Update Transmittal #49; ARKids First-B Provider Manual Update Transmittal #28; School-Based Mental Health Services Provider Manual Update Transmittal #22

Current through Register Vol. 49, No. 6, June, 2024
Section II
Rehabilitative Services for Youth and Children
262.100
Division of Youth Services
			 (DYS) Special Billing Codes
The following pages contain a listing of Arkansas Medicaid
				Rehabilitative Services for Youth and Children (RSYC) Codes that pertain to
				services covered by the Division of Youth Services (DYS). It is important to
				use the Medicaid code listing. All codes must have five digits.
NOTE: Effective for claims received on or after December
				5, 2005, modifier UB must be used as described below.
Procedure Code
Required Modifier
Description
96100
UB
PSYCHOLOGICAL TESTING BATTERY
This code will only be used for the retroactive billing
						  period.
1 unit = test battery
H2020
-
EMERGENCY SHELTER 1 unit = 1 day
H2020
U1
THERAPEUTIC FOSTER CARE 1 unit = 1 day
H2020
U2
THERAPEUTIC GROUP HOME 1 unit = 1 day
H2020
U4
RESIDENTIAL TREATMENT SERVICES 1 unit = 1 day
90801
-
DIAGNOSIS AND EVALUATION 1 unit = 15 minutes
90804
-
INDIVIDUAL PSYCHOTHERAPY 1 unit = 15 minutes
90853
-
GROUP PSYCHOTHERAPY 1 unit = 15 minutes
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.05-090 - DMS-2005-CA-2, DMS-2005-II-2; DMS-2005-L-2; DMS-2005-R-2; DMS-2005-OO-1 - 2006 ICD-9-CM Diagnosis Codes

Current through Register Vol. 49, No. 6, June, 2024
I.
General Information
A review of the 2006 ICD-9-CM diagnosis codes has been
				completed. The Arkansas Medicaid Program will begin accepting the new diagnosis
				codes effective for claims received on and after December 1, 2005. Most of the
				new diagnosis codes will be covered with the exception of those in section II
				of this notice.
II.
Non-covered 2006 ICD-9-CM Diagnosis Codes
V59.70
V59.71 V59.72 V59.73 V59.74
If you need this material in an alternative format, such as
				large print, please contact our Americans with Disabilities Act Coordinator at
				(501) 682-6789 or 1-877-708 -8191. Both telephone numbers are voice and
				TDD.
If you have questions regarding this transmittal, please
				contact the EDS Provider Assistance Center at 1-800-457 -4454 (toll-free)
				within Arkansas or locally and out-of-state at (501) 376-2211.
Arkansas Medicaid provider manuals (including update
				transmittals), 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 016.06.05-091 - ElderChoices Home and Community-Based 2176 Waiver Provider Manual Update Transmittal #56

Current through Register Vol. 49, No. 6, June, 2024
Section II
ElderChoices Home and Community-Based 2176
				Waiver
201.000
Arkansas
			 Medicaid Certification Requirements for ElderChoices
H&CB Waiver Program
All ElderChoices home and community-based (H&CB) waiver
				providers must meet the following criteria to be eligible to participate in the
				Arkansas Medicaid Program:
A.
			 ElderChoices H&CB Waiver providers must be certified by the Division of
			 Aging and Adult Services (DAAS) as having met all Centers for Medicare and
			 Medicaid Services (CMS) approved provider criteria for the service(s) they wish
			 to enroll to provide.
B. The
			 provider must complete and submit to the Medicaid Provider Enrollment Unit a
			 provider application (form DMS-652), a Medicaid contract (form DMS-653) and a
			 Request for Taxpayer Identification Number and Certification (Form W-9). A copy
			 of the current certification must accompany the provider application and
			 Medicaid contract. Subsequent certification renewals must be submitted upon
			 receipt.
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).
Certification by the Division of Aging and Adult Services
				does not guarantee enrollment in the Medicaid program.
C. 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.
All providers must maintain their provider files at the
				Division of Medical Services (DMS) by submitting current certification,
				licensure, etc.,
all DAAS-issued certification renewals and any
				other renewals affecting their status as a Medicaid-eligible
				provider
. Failure to submit required documents will result in
				termination of the provider's eligibility for reimbursement of services.
				Providers may avoid a cancellation of provider eligibility by timely submission
				of required materials to the Medicaid Provider Enrollment Unit.
View or print the Provider Enrollment Unit contact
				information.
Copies of certifications and renewals required by DAAS must be
				maintained by DAAS to avoid loss of provider certification. These copies must
				be submitted to DAAS ElderChoices Provider Certification.
View or print the Division of Aging and Adult Services
				ElderChoices Provider Certification contact
				information.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.05-093 - Section I - All Arkansas Medicaid Provider Manuals

Current through Register Vol. 49, No. 6, June, 2024
190.001
The Medicaid Fairness Act
The Medicaid Fairness Act, Ark. Code Ann. §§
									20-77-1601
				- 20-77-1615, requires that the Department of Health and Human Services and its
				outside contractors treat providers with fairness and due process.
190.002
Definitions
A.
Adverse decision/adverse action
means any decision or action 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 for Medicaid claims
			 and services including but not limited to decisions as to:
1. Appropriate level of care or
			 coding,
2. Medical
			 necessity,
3. Prior
			 authorization,
4. Concurrent
			 reviews,
5. Retrospective
			 reviews,
6. Least restrictive
			 setting,
7. Desk audits,
8. Field audits and onsite audits,
			 and
9. Inspections.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.05-100 - Section I Provider Manual Update Transmittal

Current through Register Vol. 49, No. 6, June, 2024
SECTION I - GENERAL POLICY
100.000
GENERAL INFORMATION
100.100
Introduction
Section I imparts general program information about the
				Arkansas Medicaid Program. It includes information about beneficiary
				eligibility and explains the provider's role and responsibilities in utilizing
				the program. The Primary Care Case Management (PCCM) Program is explained in
				detail. The information conveyed will provide users with an understanding of
				Medicaid Program policy. It also contains information the provider may need to
				answer questions often asked about the Medicaid Program.
Four major areas are covered in Section I.
A. General information about the program -
			 This area contains information regarding the background, history and scope of
			 the Medicaid Program, including information about Medicaid waivers and/or
			 programs covered by the Division of Medical Services.
B. Beneficiary eligibility - This area
			 contains information about Medicaid beneficiary aid categories, beneficiaries'
			 eligibility for benefits, and an explanation of the Medicaid identification
			 card, the beneficiaries' responsibilities and other beneficiary
			 information.
C. Provider
			 participation - This area specifies the provider enrollment procedures, the
			 general conditions that must be met by providers to begin and to maintain
			 program participation and remedies and sanctions that the Division of Medical
			 Services may employ in the administration and regulation of the Arkansas
			 Medicaid Program.
D. Primary Care
			 Case Management Program (PCCM) - This area defines the scope of the Primary
			 Care Case Management program and provider and enrollee participation. It lists
			 the categories of eligibility that are exempt from primary care physician (PCP)
			 referral requirements and itemizes the services that do not require PCP
			 referral. PCP enrollment and enrollment transfer procedures are explained, as
			 are PCP referral requirements and procedures.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.05-102 - Flu Vaccine Rate Increase

Current through Register Vol. 49, No. 6, June, 2024
Arkansas Medicaid Budget Impact and Justification
* Increase in rate paid for flu vaccine (split virus with
				preservative) for ages nineteen and older
* Current reimbursement rate is $9.75 (includes
				administration)
* Proposed new rate of $12.06 (includes
				administration)
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.05-111 - Alternatives for Adults with Physical Disabilities Waiver Provider Manual Update #31

Current through Register Vol. 49, No. 6, June, 2024
SECTION II
-
			 ALTERNATIVES FOR ADULTS WITH PHYSICAL DISABILITIES WAIVER
200.000
ALTERNATIVES FOR ADULTS WITH
			 PHYSICAL DISABILITIES WAIVER GENERAL INFORMATION
201.000 Arkansas Medicaid Enrollment
			 Requirements for Alternatives for
Adults with Physical Disabilities (Alternatives Waiver)
Provider participation in the Arkansas Medicaid Alternatives
				for Adults with Physical Disabilities Waiver Program (Alternatives Waiver)
				requires the following:
A. Providers
			 of Alternatives Waiver attendant care and environmental
			 accessibility/adaptation services must be certified by the Division of Aging
			 & Adult Services (DAAS) as having met all CMS approved provider criteria
			 for the service(s) to be provided.
1. It is
			 the responsibility of all providers of Alternatives Waiver services to maintain
			 current Division of Aging and Adult Services (DAAS) certification to avoid loss
			 of provider eligibility. Required materials must be submitted to the Division
			 of Aging and Adult Services.
View or print the Division of
			 Aging and Adult Services contact information.
2. Effective December 26, 2005, DAAS
			 certification of attendant care providers is contingent upon participation in
			 the financial management services process as required by federal guidelines for
			 consumer-directed programs. Participation in the financial management services
			 process does not change the procedure for filing claims. Claims will continue
			 to be submitted to EDS and are processed by EDS. Prior to payment the fiscal
			 intermediary deducts appropriate withholdings and mails the Medicaid payment to
			 the provider.
B.
			 Providers must complete a provider application (form DMS-652) a Medicaid
			 contract, (form DMS-653) and a Request for Taxpayer Identification Number and
			 Certification (W-9) for submission to 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).
1. A copy of the current DAAS certification,
			 licensure, etc., must accompany the provider application and Medicaid contract.
a. Subsequent renewals of certification must
			 be forwarded to Provider Enrollment within 30 days of issuance.
View or print DMS Provider Enrollment Unit contact
			 information.
b.
			 If the renewal document(s) have not been received within thirty (30) days, the
			 provider will have an additional, and final, thirty (30) days to
			 comply.
2. Enrollment as
			 a Medicaid provider is conditioned upon approval of a completed provider
			 application and the execution of a Medicaid Provider Agreement.
3. 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 enroll, as Medicaid providers.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.06-006 - Podiatrist Services Provider Manual Update Transmittal #62

Current through Register Vol. 49, No. 6, June, 2024
Section II
Podiatrist
201.400
Podiatrists in States Not Bordering Arkansas
A. Podiatrists in states not bordering
			 Arkansas are called limited services providers because they may enroll in
			 Arkansas Medicaid only after they have treated an Arkansas Medicaid beneficiary
			 and have a claim to file, and because their enrollment automatically expires.
1. A non-bordering state provider may send a
			 claim to Provider Enrollment and Provider Enrollment will forward by return
			 mail a provider manual and a provider application and contract.
View or print Medicaid Provider Enrollment Unit contact
			 information.
2.
			 Alternatively, a non-bordering state provider may download the provider manual
			 and provider application materials from the Arkansas Medicaid website,
			 www.medicaid.state.ar.us, and then submit its application and claim to the
			 Medicaid Provider Enrollment Unit.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.06-007 - Dental Provider Manual Update Transmittal #83

Current through Register Vol. 49, No. 6, June, 2024
Section II
Dental
201.210
Individual Limited Services Providers in Non-Bordering States
A. Providers in states not bordering Arkansas
			 are called limited services providers because they may enroll in Arkansas
			 Medicaid only after they have treated an Arkansas Medicaid beneficiary and have
			 a claim to file, and because their enrollment automatically expires.
1. A non-bordering state provider may send a
			 claim to Provider Enrollment and Provider Enrollment will forward by return
			 mail a provider manual and a provider application and contract.
View or print Provider Enrollment Unit Contact
			 information.
2.
			 Alternatively, a non-bordering state provider may download the provider manual
			 and provider application materials from the Arkansas Medicaid website,
			 www.medicaid.state.ar.us, and then submit its application and claim to the
			 Medicaid Provider Enrollment Unit.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.06-010 - Medicaid Alternatives for Adults with Physical Disabilities Waiver Provider Manual Update Transmittal #32

Current through Register Vol. 49, No. 6, June, 2024
SECTION
			 II
- ALTERNATIVES FOR ADULTS WITH PHYSICAL DISABILITIES
			 WAIVER
200.000
ALTERNATIVES FOR
			 ADULTS WITH PHYSICAL DISABILITIES WAIVER GENERAL INFORMATION
201.100
Providers of Alternatives for
			 Adults with Physical Disabilities Waiver Services in Arkansas and Bordering
			 States
Providers of Alternatives for Adults with Physical Disabilities
				Waiver services in Arkansas and the six bordering states (Louisiana,
				Mississippi, Missouri, Oklahoma, Tennessee and Texas) may be enrolled as
				routine services providers if they meet all Arkansas Medicaid participation
				requirements outlined in Section
				201.000.
A routine services provider may be enrolled in the program as a
				provider of routine Alternatives services to eligible Arkansas Medicaid
				beneficiaries. Reimbursement may be available for all attendant care and
				environmental accessibility adaptation/adaptive equipment services covered in
				the Arkansas Medicaid Program. Claims must be filed according to Section
				240.000 of this
				manual.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.06-011 - Occupational, Physical and Speech Therapy Services Update Transmittal #56

Current through Register Vol. 49, No. 6, June, 2024
Section II
Occupational, Physical, Speech Therapy Services
201.300
Providers in States Not
			 Bordering Arkansas
A. Providers in
			 states not bordering Arkansas are called limited services providers because
			 they may enroll in Arkansas Medicaid only after they have treated an Arkansas
			 Medicaid beneficiary and have a claim to file, and because their enrollment
			 automatically expires.
1. A non-bordering
			 state provider may send a claim to Provider Enrollment and Provider Enrollment
			 will forward by return mail a provider manual and a provider application and
			 contract.
View or print Medicaid Provider Enrollment Unit
			 contact information.
2. Alternatively, a non-bordering state
			 provider may download the provider manual and provider application materials
			 from the Arkansas Medicaid website, www.medicaid.state.ar.us, and then submit
			 its application and claim to the Medicaid Provider Enrollment Unit.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.06-014 - 2006 National CPT and HCPCS Procedure Codes.

Current through Register Vol. 49, No. 6, June, 2024
2006 CPT Procedure Code Conversion
II.
Non-Covered 2006 CPT
			 Procedure Codes
A. The following
			 2006 CPT procedure codes are non-covered for all providers.
43770
43771
43772
43773
43774
43886
43887
43888
83037
90649
90736
90760
90761
90773
95251
96102
96103
96116
96119
96120
97760
97761
98960
98961
98962
99324
99325
99326
99327
99328
99334
99335
99336
99337
99339
99340
B. The
			 following 2006 CPT procedure codes are not payable to outpatient hospital and
			 ambulatory surgical centers because these services are covered by another CPT
			 procedure code, another HCPCS code, or a revenue code.
15111
15116
15131
15136
15151
15152
15156
15157
15171
15176
15301
15321
15331
15336
15341
15361
15366
15421
15431
22525
33768
33884
37185
37186
44213
58110
61641
61642
75956
75957
75958
75959
90766
90767
90768
90774
90775
C.
			 Effective for dates of service on and after March 1, 2006, the following
			 currently payable CPT procedure codes will become non-payable because the
			 services are covered by another CPT procedure code or another HCPCS code for
			 physicians, osteopaths and AHECS.
99050
99056
99058
Effective for dates of service on and after March 1, 2006, the
				following 2006 CPT procedure codes will be non-payable because the services are
				covered by another CPT procedure code or HCPCS code for physicians, osteopaths
				and AHECS.
90772
99051
99053
99060
D. All
			 2006 CPT procedure codes listed in
Category II
and
Category
			 III
are non-
covered.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.06-015 - Ambulatory Surgical Center Provider Manual Update Transmittal #66

Current through Register Vol. 49, No. 6, June, 2024
Section II
Ambulatory Surgical Center
201.100
Ambulatory Surgical Centers
			 (ASCs) in States Not Bordering Arkansas
A. ASCs in states not bordering Arkansas are
			 called limited services providers because they may enroll in Arkansas Medicaid
			 only after they have treated an Arkansas Medicaid beneficiary and have a claim
			 to file, and because their enrollment automatically expires.
1. A non-bordering state ASC may send a claim
			 to Provider Enrollment and Provider Enrollment will forward by return mail a
			 provider manual and a provider application and contract.
View
			 or print Provider Enrollment Unit Contact
			 information.
2.
			 Alternatively, a non-bordering state ASC may download the provider manual and
			 provider application materials from the Arkansas Medicaid website,
			 www.medicaid.state.ar.us, and then submit its application and claim to the
			 Medicaid Provider Enrollment Unit.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.06-016 - Hospital/Critical Access Hospital (CAH)/End Stage Renal Disease (ESRD) Provider Manual Update Transmittal #89 - Hospital Update #89

Current through Register Vol. 49, No. 6, June, 2024
Section II
Hospital/Critical Access Hospital (CAH)/End Stage Renal Disease
			 (ESRD)
201.220
Hospitals in States Not Bordering Arkansas
A. Hospitals in states not bordering Arkansas
			 are called limited services providers because they may enroll in Arkansas
			 Medicaid only after they have treated an Arkansas Medicaid beneficiary and have
			 a claim to file, and because their enrollment automatically expires.
1. A non-bordering state hospital may send a
			 claim to Provider Enrollment and Provider Enrollment will forward by return
			 mail a provider manual and a provider application and contract.
View or print Provider Enrollment Unit Contact
			 information.
2.
			 Alternatively, a non-bordering state hospital may download the provider manual
			 and provider application materials from the Arkansas Medicaid website,
			 www.medicaid.state.ar.us, and then submit its application and claim to the
			 Medicaid Provider Enrollment Unit.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.06-018 - State Plan Transmittal #2005-010

Current through Register Vol. 49, No. 6, June, 2024
ATTACHMENT 3.1-A
23. Any other medical care and any other type
			 of remedial care recognized under State law, specified by the Secretary.
a. Transportation
(3) Non-Emergency
(a) Public Transportation
Effective for dates of service on or after December 1, 2001,
				public transportation services are available when provided by an enrolled
				Medicaid public transportation provider to an eligible Medicaid
beneficiary
being transported to or from a medical facility to
				receive medical care services covered by the Arkansas Medicaid Program.
				Transportation will be covered from the point of pick-up to the medical
				facility or from the medical facility to the point of delivery. The following
				benefit limits are established. One unit of service = 1 mile. The benefit
				limits do not apply to EPSDT beneficiaries.
Effective for dates of service on or after January
				1,2006, public transportation services are available when provided by an
				enrolled Medicaid public transportation provider to a full benefit dual
				eligible being transported to or from a pharmacy to receive prescriptions
				covered under the Medicare Prescription Drug Benefit- Part D.
X Public Transportation, Taxi, Intra-City, One Way - may be
				billed once per day, per
beneficiary
for a maximum of 15 units.
				Extensions of the established benefit limits will be considered if medically
				necessary. The provider must request an extension.
X Public Transportation, Taxi, Intra-City, Round Trip - may be
				billed once per day, per
beneficiary
for a maximum of 30 units.
				Extensions of the established benefit limits will be considered if medically
				necessary. The provider must request an extension.
X Public Transportation, City-to-City - may be billed once per
				day, per
beneficiary
for a maximum of 50 units. Extensions
				of the established benefit limits will be considered if medically necessary.
				The provider must request an extension.
X Public Transportation, ADA Accessible Van, Intra-City, One
				Way - may be billed once per day, per
beneficiary
for a maximum of
				15 units. The provider may request an extension of the benefit limit if
				medically necessary by submitting documentation including the purpose of the
				trip and the provider=s name and address.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.06-020 - Chiropractic Provider Manual Update Transmittal #61; Dental Provider Manual Update Transmittal #82; ElderChoices Provider Manual Update Transmittal #60; Federally Qualified Health Center Provider Manual Update Transmittal #55; Nurse Practitioner Provider Manual Update Transmittal #62; Physician/CRNA/Independent Lab/Radiation Therapy Center Provider Manual Update Transmittal #108; Podiatrist Provider Manual Update Transmittal #63; Portable X-Ray Provider Manual Update Transmittal #52; Rehabilitative Services for Persons with Mental Illness Provider Manual Update Transmittal #65

Current through Register Vol. 49, No. 6, June, 2024
SECTION II Rehabilitative Services for
			 Persons with Mental Illness
252.200
Place of Service and Type of Service Codes
Place of Service
Paper Claims
Electronic Claims
Outpatient Hospital
2
22
Office
3
11
Patient's Home
4
12
Nursing Facility
7
32
Skilled Nursing Facility
8
31
Other Locations
0
99
RSPMI Clinic (Telemedicine)
H
99
Emergency Services in ER
X
23
Type of Service
R-
RSPMI - (age 21 and older for services requiring
						  PA)
9-
RSPMI - (under age 21 and adults age 21 and older for
						  services not requiring PA)
V-
Telemedicine
SUBJECT: Provider Manual Update Transmittal #61
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.06-021 - Program of All-Inclusive Care for the Elderly Provider Manual and State Plan Amendment #2004-001

Current through Register Vol. 49, No. 6, June, 2024
SECTION II -
			 PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE)
200.000
PROGRAM OF ALL-INCLUSIVE CARE
			 FOR THE ELDERLY (PACE) GENERAL INFORMATION
201.000
Arkansas Medicaid
			 Participation Requirements for Providers of the Program of All-inclusive Care
			 for the Elderly (PACE)
The Program of All-inclusive Care for the Elderly (PACE) is an
				innovative model that enables individuals who are 55 years of age or older and
				certified by the state to need nursing facility care, to live as independently
				as possible. Through PACE, fragmented health care financing and delivery system
				comes together to serve the unique needs of the enrolled individual with
				chronic care needs. The population served by PACE is historically very frail.
				The PACE organization must provide all needed services to the PACE
				participant.
201.100
PACE
			 Provider Enrollment Requirements
In order to ensure quality and continuity of care, all PACE
				providers approved to receive Medicaid reimbursement for services provided must
				meet specific qualifications.
Prior to enrollment of an applicant as a PACE Provider, the
				following must occur:
A. A provider
			 application (Form DMS-652) and a contract (Form DMS-653) with the Arkansas
			 Medicaid Program must be completed and submitted.
View or
			 print a provider application (Form DMS-652), Medicaid contract (Form DMS-653)
			 and Request for Taxpayer Identification Number and Certification
			 (W-9).
B. A
			 PACE application must be submitted to the Division of Aging and Adult Services
			 (DAAS).
C. A PACE provider
			 application must be approved by the Centers for Medicare and Medicaid Services
			 (CMS) and DAAS.
D. A three-way
			 Provider Agreement must be signed by the DAAS, CMS, and the provider.
E. The PACE Organization must be licensed by
			 the Arkansas Department of Health and Human Services, Long Term Care Section,
			 as an Adult Day Health Care.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.06-025 - Section I - All Arkansas Medicaid Provider Manuals

Current through Register Vol. 49, No. 6, June, 2024
171.000
Primary Care Physician
			 Participation
171.100
PCP-Qualified Physicians and Single-Entity Providers
A. Obstetricians and gynecologists may choose
			 whether or not to be PCPs.
B. All
			 other PCP-qualified physicians and clinics must enroll as PCPs, except for
			 physicians who certify in writing that they are employed exclusively by an Area
			 Health Education Center (AHEC), a Federally Qualified Health Center (FQHC), a
			 Medical College Physicians Group, or a hospital (i.e., they are
			 "hospitalists").
C. PCP-qualified
			 physicians are those whose sole or primary specialty is
1. Family Practice
2. General Practice
3. Internal Medicine
4. Obstetrics and gynecology
5. Pediatrics and Adolescent
			 Medicine
D. Physicians
			 with multiple specialties may elect to enroll as PCPs if a secondary or
			 tertiary specialty in their Medicaid provider file is listed in part C
			 above.
E. PCP-qualified clinics and
			 health centers (single-entity PCPs) are
1.
			 AHECs
2. FQHCs
3. The family practice and internal medicine
			 clinics at the University of Arkansas for Medical Sciences
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.06-027 - Prosthetics Update #81 and Certified Nurse Midwife Update #74

Current through Register Vol. 49, No. 6, June, 2024
Section II
Prosthetics
242.200
Place of Service, Type of
			 Service and Modifier Codes
Place of Service
Paper Claims
Electronic Claims
Inpatient Hospital
1
21
Outpatient Hospital
2
22
Doctor's Office
3
11
Patient's Home
4
12
Day Care Facility
5
52
Night Care Facility
6
52
Nursing Facility
7
32
Skilled Nursing Facility
8
31
Ambulance
9
41
Other Locations
0
99
Independent Laboratory
A
81
Ambulatory Surgical Center
B
24
Residential Treatment Center
C
56
Specialized Treatment Facility
D
56
Comprehensive Outpatient Rehabilitative Facility
E
62
Independent Kidney Disease Treatment Center
F
65
Inpatient Psychiatric Facility
G
51
Type of Service (paper only)
H-Over 21
U-Used Equipment
I-Initial Rental
6-Under 21
Modifiers
EP- Service provided as part of EPSDT Program
KH-Durable Medical Equipment (DME) item, initial claim,
						  first month's rental
NU-New Equipment
RR-Durable Medical Equipment (DME) Rental
U1-Medicaid Level of Care 1 (defined by state)
U2-Medicaid level of Care 2 (defined by state)
U3-Medicaid level of care 3 (defined by state)
Modifiers
U4-Medicaid level of care 4 (defined by state)
U5-Medicaid level of care 5 (defined by state)
UE-Used durable medical equipment (DME)
52-Reduced Services