reglab/statecodes huggingface dataset:
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.06-028 - Alternatives for Adults with Physical Disabilities Update #38

Current through Register Vol. 49, No. 6, June, 2024
242.300
Billing Instructions - Paper Only
EDS offers providers several options for electronic billing.
				Providers of environmental accessibility adaptations/adaptive equipment
				services may bill electronically or on paper.
To bill for environmental accessibility adaptations/adaptive
				equipment services, use the CMS-1500 (formerly HCFA-1500). The numbered items
				correspond to numbered fields on the claim form.
View a
				sample CMS-1500 form.
The following instructions must be
				read and carefully followed so that EDS can efficiently process claims.
				Accuracy, completeness and clarity are important. Claims cannot be processed if
				applicable information is not supplied or is illegible. Claims should be typed
				whenever possible.
Completed claim forms should be forwarded to the EDS Claims
				Department.
View or print EDS Claims Department contact
				information
.
NOTE: A provider rendering services without verifying
				eligibility for each date of service does so at the risk of not being
				reimbursed for the services.
243.300
Billing Instructions - Paper
			 Only
EDS offers providers several options for electronic billing.
				Attendant Care service providers may submit claims electronically or on
				paper.
To bill for attendant care services, use the Alternatives
				Attendant Care Provider Claim Form (AAS-9559).
View a sample
				Alternatives Attendant Care Provider Claim Form (Form AAS-9559).
The following instructions must be read and carefully followed so that
				EDS can efficiently process claims. Accuracy, completeness and clarity are
				important. Claims cannot be processed if applicable information is not supplied
				or is illegible. Claims should be typed whenever possible.
NOTE: A provider rendering services without verifying
				eligibility for each date of service does so at the risk of not being
				reimbursed for the services.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.06-030 - Private Duty Nursing Update Transmittal #68

Current through Register Vol. 49, No. 6, June, 2024
Section II
Private Duty Nursing
			 Services
201.100
Private Duty
			 Nursing Services Providers
Providers of Private Duty Nursing Services (PDN) must meet the
				following criteria in order to be eligible for participation in the Arkansas
				Medicaid Program:
A. The PDN provider
			 must have either a Class A or Class B license issued by the Arkansas Division
			 of Health. It must be designated on the license that the PDN agency is a
			 provider of extended care services.
1. A copy
			 of the license must accompany the provider application and Medicaid
			 contract.
2. Subsequent licensure
			 must be provided when issued by the Arkansas Division of Health.
a. Subsequent license renewal must be
			 forwarded to Provider Enrollment within 30 days of issue. If the renewal
			 documents have not been received within the 30-day deadline, the provider will
			 have an additional and final 30 days to comply.
b. Failure to ensure that current licensure
			 is on file with Provider Enrollment will result in termination from the
			 Arkansas Medicaid Program.
3. For purposes of review under the Arkansas
			 Medicaid Program, agencies enrolled as Class B operators providing private duty
			 nursing services must adhere to those standards governing quality of care,
			 skill and expertise applicable to Class A operators.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.06-031 - Certified Nurse Midwife Update Transmittal #60

Current through Register Vol. 49, No. 6, June, 2024
Section II
Occupational,
			 Physical, Speech Therapy Services
201.000
Arkansas Medicaid Participation
			 Requirements
Individual and group providers of occupational therapy,
				physical therapy and speech-language pathology services must meet the following
				criteria to be eligible to participate in the Arkansas Medicaid Program.
A. A provider of therapy services must meet
			 the enrollment criteria for the type of therapy to be provided as established
			 and outlined in section
			 202.000 of this manual.
B. A provider of therapy services has the
			 option of enrolling in the Title XVIII (Medicare) Program. When a beneficiary
			 is dually eligible for Medicare and Medicaid, providers must bill Medicare
			 prior to billing Medicaid. The beneficiary may not be billed for the charges.
			 Providers enrolled to participate in the Title XVIII (Medicare) Program must
			 notify the Arkansas Medicaid Program of their Medicare provider number. Claims
			 filed by Medicare "nonparticipating" providers do not automatically cross over
			 to Medicaid for payment of deductibles and coinsurance.
C. 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).
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).
D. The
			 following documents must accompany the provider application and the Medicaid
			 contract.
1. A copy of all certifications and
			 licenses verifying compliance with enrollment criteria for the therapy
			 discipline to be practiced. (See section
			 202.000 of this
			 manual.)
2. If enrolled in the
			 Title XVIII (Medicare) Program, an out-of-state provider must submit a copy of
			 verification that reflects current enrollment in that program.
E. 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.
F. A copy of subsequent state license renewal
			 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.
G. Failure to timely submit
			 verification of license renewal will result in termination of enrollment in the
			 Arkansas Medicaid Program.
H. The
			 provider must adhere to all applicable professional standards of care and
			 conduct.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.06-035 - Nursing Assistant Training Program - Alzheimer's Tranining

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 Health and 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 016.06.06-039 - Visual Care Transmittal Update #78

Current through Register Vol. 49, No. 6, June, 2024
Section
			 II Visual Care
215.000 Evealasses
			 Covered bv Medicaid
Brand
Frame
Gender
Size
Colors
Europa
M-005
Unisex
44&46
Antique Burgundy, and Gun/Matte Black
Kip
Women's
48
Black and Crystal
NF-1
Women's
44&46
Red, and Antique Dark Green
NF-3
Unisex
44&46
Matte,Black and Mette Silver
NF-5
Children's
39-41-43
Brown, Blue, Gunmetal and Gold
Shannon
Women's
46
Violet, Grey, Gold and Blue
Carmen
Unisex
44-46-48
Matte Brown, Matte Gray, Ant. Gold tort. &
						  Vio.
L-Cable
Children's
36-38-40
Brown, Gold and Black
NF-2
Unisex
45&47
Matte,Black and Mette Blue
NF-4
Children's
38-40-42
Brown, Blue and Light Purple
NF-9
Unisex
46&48
Gray Matte and Brown Metallic
NF-11
Men's
52&54
Brown, Black, and Gunmetal
Ken mark
G531
Unisex
45-47
Brown, Black and Matte Gold
Andrea
Women's
49
Rose, Brown and Wne
Shannon
Women's
46-48
Sand, Black and Lavender
Sharon
Women's
49
Black Crystal and Brown
Blaire
Women's
50-52
Golden Rose, Nutmeg and Dove
Jay
Men's
48-50
Brown, Black and Gray
Sam
Men's
49-51
Brown, Gunmetal and Black
Jamie
Women's
44-46
Black/Yellow, Brown and Eine
Henry
Men's
52-54-56-58
Gold, Gold/Demi Amber &
						  Gunmetal/Tortoise
Chet
Men's
54-56
Brown and Gunmetal
Jed
Men's
51-53
Brown, Black and Gray
Steve
Men's
52-54-56
Gray Fade, Demi Amber, Brown Fade &
						  Black
Gwen
Women's
51-53
Beige, Blush and Mist
Louise
Women's
50-52
Brown, Sky and Violet
United
Destiny
Unisex
47
Coffee, C2 Matte Black and C3 Matte Silver
Steve
Men's
49-51
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
44-46
Black/Crystal, Blue and Brown
Gift
Women's
47-49
Black/Crystal, Brown/Crystal &
						  Purple/Brown
Dazzle
Women's
49-51-53
Brown, Gold And Rose
Judi
Women's
50-53
Black/Crystal, Tortoise and Wne/Gray
Dynamite
Girl's
42-45-47
Antique Brown and Black Silver
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
Hart-8103
Men's
50
Gunmetal, Brown and Black
Hart-8112
Unisex
48
Matte Black, Mattee Burgundy & Matte
						  Coffee
Hart-5634
Women's
47
Black Crystal and Brown Smoke
Hart-5670
Women's
48
Burgundy and Tortoise
Hart-7771
Men's
54
Bordfeaux and Coffee
Hart-5695
Girl's
47
Tortoise, Rose and Black
Hart-5221
Unisex
46
Blue, Brown and Lilac
Hart-9751
Women's
48-50
Brown, Silver and Lilac
Hart 9509
Boy's
38-41-44
Gold Brown,Satin Blue and Shiny Brown
LBI
Woman Day
Woman's
55
Gold, Rose and Gray
LBI-
915
Woman's
53
Gold/Silver, Silver Gold and Brown/Gold
243.400
Special Billing Procedures
Prosthetic providers that bill procedure codes
V2623 or
				V2624
electronically must use a type of service
(TOS)
H
				with an NU modifier. Prosthetic providers billing either of the above procedure
				codes on paper must also use a
TOS
H with an NU
				modifier.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.06-040 - Occupational, Physical, Speech Therapy Services Update Transmittal #63

Current through Register Vol. 49, No. 6, June, 2024
215.000
Augmentative Communication Device (ACD) Evaluation
Arkansas Medicaid covers evaluations for augmentative
				communication devices (ACDs) under the following conditions.
A. Prior authorization by the Division of
			 Medical Services Utilization Review Section is required for approval of the ACD
			 evaluation. (See section
			 231.000 of this manual for prior
			 authorization procedures for ACD evaluations.)
B. A multidisciplinary team must conduct the
			 ACD evaluation. The evaluation team must meet the following requirements:
1. A speech-language pathologist who has
			 earned a Master's Degree in speech-language pathology must lead the team. The
			 individual is also required to have a Certification of Clinical Competence from
			 the American Speech-Language and Hearing Association.
2. The team must also include an occupational
			 therapist who is licensed by the Arkansas State Medical Board.
3. Both the speech-language pathologist and
			 occupational therapist must have verifiable training and experience in the use
			 and evaluation of ACD equipment. Their knowledge must include, but not be
			 limited to, the equipment's use and its working capabilities, mounting and
			 training requirements, warranties and maintenance.
4. A physical therapist may be added to the
			 team if it is determined that there is a need for assistance in the evaluation
			 as it relates to the positioning and seating in utilizing specific ACD
			 equipment.
5. The team may include
			 regular and special educators, caregivers and parents. Vocational
			 rehabilitation counselors may be included for beneficiaries of all
			 ages.
6. The team must use an
			 interdisciplinary approach in the evaluation, incorporating the goals,
			 objectives, skills and knowledge of various disciplines.
7. The team must evaluate at least three ACD
			 systems, with written documentation of each usage included in the ACD
			 assessment.
C. After the
			 team has completed the evaluation, the evaluation report must be submitted to
			 the prosthetics provider who will request prior authorization for the ACD.
The evaluation report must meet the following
				requirements.
1. The report must
			 indicate the medical reason for the ACD.
2. The report must give specific
			 recommendations of the system and justify why one system is more appropriate
			 than another.
3. The
			 speech-language pathologist must sign the ACD evaluation report.
Refer to section
				216.000 of this manual for
				benefit limits and section
				260.000 of this manual for
				procedures code and billing instructions.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.06-044 - Transportation Provider Manual Update Transmittal #82

Current through Register Vol. 49, No. 6, June, 2024
Section II Transportation
201.100
Ground Ambulance Providers
Providers of ground ambulance transportation must meet the
				following criteria in order to be eligible for participation in the Arkansas
				Medicaid Program:
A. Provider must
			 complete a provider application (DMS-652), a Medicaid contract (DMS-653) and a
			 Request for Taxpayer Identification Number and Certification (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).
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. A current
			 copy of the ambulance license issued by the applicable State Ambulance Board
			 must accompany the provider application and Medicaid contract. Subsequent
			 license renewal must be provided when issued.
1. Subsequent license renewal must be
			 forwarded to Provider Enrollment within 30 days of issuance.
2. Failure to ensure that current licensure
			 and/or certification is on file with Provider Enrollment will result in
			 termination from the Arkansas Medicaid Program.
D. Ambulance transportation providers who
			 wish to be reimbursed for Advanced Life Support services must submit a written
			 request and a current copy of the ambulance license that reflects paramedic,
			 intermediate or EBLS (Enhanced Basic Life Support). Please refer to Section
			 252.410 for special billing
			 instructions regarding Advanced Life Support.
E. The ambulance company must be enrolled in
			 the Title XVI II (Medicare)
			 Program.
F. The ambulance
			 transportation provider must adhere to all applicable professional standards of
			 care and conduct.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.06-046 - Hearing Services Provider Manual Update Transmittal #63

Current through Register Vol. 49, No. 6, June, 2024
Section II Hearing
			 Services
SECTION II HEARING
			 SERVICES
201.000
Arkansas
Medicaid Participation Requirements
for
Hearing
Aid
Dealers
Hearing aid dealers must meet the following criteria to
				participate in the Arkansas Medicaid Program.
A. Hearing aid dealers, physicians and
			 audiologists in Arkansas must be licensed as Hearing Aid dealers. Audiologists
			 licensed in Arkansas may provide both audiology service and the dispensing of
			 hearing aids with their audiologist license. Hearing aid dealers, physicians
			 and audiologists outside of Arkansas must be licensed by their states as
			 hearing aid dealers. A current copy of the applicable license must accompany
			 the provider application and Medicaid contract.
1. A copy of subsequent state licensure
			 renewal 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.
2. Failure to timely submit
			 verification of license renewal 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 016.06.06-049 - Pharmacy Provider Manual Update Transmittal #90

Current through Register Vol. 49, No. 6, June, 2024
201.000
Arkansas Medicaid
			 Participation Requirements for Pharmacy Providers
Providers of pharmacy services must meet the following criteria
				in order to be eligible for participation in the Arkansas Medicaid
				Program:
A. The pharmacy must complete
			 a provider application, a Medicaid contract and a Request for Taxpayer
			 Identification Number and Certification 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 (W-9).
B. The pharmacy must have a current retail
			 pharmacy permit issued by the applicable State Board of Pharmacy. A current
			 copy of the pharmacy permit must accompany the provider application and
			 Medicaid contract. Subsequent permits must be provided when renewed.
1. Subsequent retail pharmacy permit renewal
			 must be forwarded to the Medicaid Provider Enrollment Unit within 30 days of
			 issuance.
2. Failure to ensure that
			 current permit and/or certification is on file with the Medicaid Provider
			 Enrollment Unit will result in termination from the Arkansas Medicaid
			 Program.
C. The pharmacy
			 must have a DEA number issued by Drug Enforcement Agency. A current copy of the
			 DEA certificate must accompany the provider application, Request for Taxpayer
			 Identification Number and Certification, and Medicaid contract. Subsequent
			 certificates must be provided when renewed.
1.
			 Subsequent DEA certifications must be forwarded to Provider Enrollment within
			 30 days of issuance.
2. Failure to
			 ensure that current DEA certification is on file with the Medicaid Provider
			 Enrollment Unit will result in termination from the Arkansas Medicaid
			 Program.
D. Indian
			 Health Services (HIS) pharmacy providers enrolled in other states' pharmacy
			 programs will meet Arkansas enrollment criteria if they provide proof of other
			 state enrollment.
E. 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.
F. The Pharmacy
			 provider must adhere to all applicable professional standards of care and
			 conduct.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.06-050 - All Providers Official Notice DMS-2006-W-4 - 2007 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, 2006,
the
Arkansas Medicaid Program will implement the revisions included
				in the 2007 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, 2006.
Thank you for your participation in the Arkansas Medicaid
				Program.
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 (TDD only).
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, or.
				us
.
Official Notice
DMS-20
DMS-20
DMS-20
DMS-20
Page 2
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.06-054 - Hearing Services Provider Manual Update Transmittal #65

Current through Register Vol. 49, No. 6, June, 2024
242.110
Hearing Aid Procedure Codes
Use the following procedure codes for hearing aid equipment for
				beneficiaries under age 21 in the Child Health Services (EPSDT) Program.
				Medicaid covers up to 2 hearing aids per beneficiary each six-months.
HCPCS
Procedure
Codes
V5014*
V5030
V5040
V5050
V5060
V5120
V5130
V5140
V5170
V5180
V5210
V5220
V5267**
V5299
*Repairs require prior authorization **Accessories
HCPCS
Procedure
Code
Modifier
V5008
EP
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.06-055 - Vaccines Available in the Vaccines for Children (VFC) Program

Current through Register Vol. 49, No. 6, June, 2024
The purpose of this Official Notice is to inform providers of
				vaccines available through the VFC Program, conditions of coverage and billing
				instructions.
I. Effective for dates
			 of service on and after July 10, 2006, a new vaccine, "rotavirus vaccine,
			 pentavalent, 3 dose schedule, live, for oral use" (Rota Teq) is available
			 through VFC. This vaccine is covered by Medicaid
only
through
			 the VFC Program for children ages 6 weeks through 32 weeks. When filing claims,
			 procedure code
90680
must be used with modifiers
EP
and
TJ
. For paper claims, providers must enter a type of
			 service code
"6"
and
the modifiers.
For beneficiaries of the
ARKids First-B Program
,
				this procedure must be billed with modifier
TJ
. For paper claims,
				a type of service code
"1"
and
the modifier
TJ
are required.
II. Procedure code
90648
,
			 "hemophilus influenza b vaccine (Hib), PRP-T conjugate (4 dose schedule), for
			 intramuscular use", available through the VFC program, is covered by Medicaid
only
through the VFC program for beneficiaries under age 19.
			 Claims require modifiers
EP
and
TJ
. When filing
			 claims on paper, a type of service code
"6"
is required along with
			 the modifiers.
For beneficiaries of the
ARKids First-B Program
,
				this procedure code must be billed with modifier
TJ
. Paper claims
				require a type of service code
"1"
and the modifier
TJ
.
Thank you for your participation in the Arkansas Medicaid
				Program.
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.
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
.
Roy Jeffus, Director
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.06-057 - DMS-2006-A-4, DMS-2006-O-3, DMS-2006-X-1, DMS-2006-II-4, DMS-2006-L-4, DMS-2006-SS-3, DMS-2006-KK-4, DMS-2006-R-4, DMS-2006-OO-3 - Family Planning Services

Current through Register Vol. 49, No. 6, June, 2024
I.
Introduction
The purpose of this Official Notice is to inform providers of
				changes required by the Centers for Medicare and Medicaid Services (CMS) to be
				implemented
June 28, 2006.
Arkansas Medicaid covers family
				planning services for beneficiaries in full-coverage aid categories ("regular
				Medicaid") and covers many family planning services for women of child-bearing
				age who are Medicaid-eligible only in aid category 69 and who participate in
				the Arkansas Women's Health Program, a research and demonstration project
				approved by CMS.
NOTE: Currently, the system is unable to process claims
				with the newly added family planning procedure codes included in this notice.
				Providers will be notified when the necessary system changes are
				complete.
Please hold affected claims until further
				notice.
II.
Non-Payable Family Planning Procedure Codes
A. Women's Health Program
Effective for dates of service on and after June 28, 2006, the
				procedure codes listed below are no longer payable for Women's Health Waiver
				(Aid category 69) beneficiaries.
58605
58611
58661
58700
S0612
B.
			 Regular Medicaid
Effective for dates of service on and after June 28, 2006,
				procedure code
S0612
is no longer covered as a family planning
				service.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.06-061 - Child Health Management Services (CHMS) Update Transmittal #76; Developmental Day Treatment Clinic Sevices (DDTCS) Transmittal #79; Home Health Update Transmittal #86; Hospital/CAH/End-Stage Renal Disease Update Transmittal #105; Occupational, Physical & Speech Therapy Update Transmittal #68; Physician/Independent Lab/CRNA/Radiation Therapy Center Update Transmittal #122; and Rehabilitative Hospital Update Transmittal #71

Current through Register Vol. 49, No. 6, June, 2024
Section II
Child Health Management Services
TOC required
245.110
Accepted Tests for
			 Occupational Therapy
Tests used must be norm-referenced, standardized, age
				appropriate and specific to the therapy provided. The following list of tests
				is not all-inclusive. When using a test not listed here, the provider must
				include additional documentation to support the reliability and validity of the
				test. This additional information will be used as reference information if the
				chart is ever selected by Medicaid for audit review. An explanation of why a
				test from the approved list could not be used to evaluate the child must also
				be included. The
MMY
is the standard reference to determine
				the reliability and validity of the test(s) administered in an evaluation.
				Providers should refer to the
MMY
for additional information
				regarding specific tests.
Definitions:
STANDARD: Evaluations that are used to determine
				deficits.
SUPPLEMENTAL: Evaluations that are used to justify deficits and
				support other results. These should not "stand alone."
CLINICAL OBSERVATIONS: All clinical observations are
				supplemental but should be included with every evaluation, especially if
				standard scores do not qualify the child for therapy. They will be considered
				during reviews for medical necessity.
A. Fine Motor Skills - Standard
1. Peabody Developmental Motor Scales (PDMS,
			 PDMS2)
2. Toddler and Infant Motor
			 Evaluation (TIME)
3.
			 Bruininks-Oseretsky Test of Motor Proficiency (BOMP)
4. Test of Infant Motor Performance
			 (TIMP)
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.06-062 - Arkansas Medicaid Chiropractic Provider Manual Update #68

Current through Register Vol. 49, No. 6, June, 2024
200.000
			 CHIROPRACTIC GENERAL INFORMATION
201.000
Arkansas Medicaid
			 Participation Requirements for Individual
Chiropractic Providers
To participate in
the
Arl[LESS THAN]ansas
				IVIedicaid Program, providers must adinere to all applicable professional
				standards of care and conduct. Individual providers of chiropractic services
				must meet the following criteria in order to be eligible for participation in
				the Arkansas Medicaid Program.
A. The
			 provider must complete and submit to Provider Enrollment a provider application
			 (form DMS-652), Medicaid contract (form DMS-653) 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)
.
B. The provider must be licensed to practice
			 in his or her state. A copy of the current license must accompany the provider
			 application and Medicaid contract.
1.
			 Subsequent renewals of license must be forwarded to Provider Enrollment within
			 30 days of issuance.
2. If the
			 renewal document(s) have not been received within this time period, the
			 provider will have an additional, and final, 30 days to comply.
C. The provider must be enrolled
			 in the Title XVIII (Medicare) Program.
D. Enrollment as a Medicaid provider is
			 conditioned upon approval of a completed provider application and the execution
			 of a Medicaid Provider Agreement.
E. 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 016.06.06-063 - Medicare/Medicaid Crossover Only Update Transmittal #46

Current through Register Vol. 49, No. 6, June, 2024
Section II
Medicare/Medicaid Crossover
			 Only
201.000
Arkansas Medicaid
			 Participation Requirements for Medicare/Medicaid Crossover Only Providers
			 Located in the State of Arkansas
Providers of Title XVIII (Medicare) covered services who are
				interested in participating in the Title XIX (Medicaid) Program for the payment
				of Medicare coinsurance and deductible amounts for services not covered by
				Medicaid and/or do not meet the enrollment criteria for other Medicaid programs
				must meet the following criteria:
A.
			 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).
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).
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. Provider must be enrolled in the
			 appropriate Title XVIII (Medicare) Program.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.06-064 - Hyperalimentation Update Transmittal #75 & Section V Provider Manual Update Transmittal all manuals

Current through Register Vol. 49, No. 6, June, 2024
Section II
			 Hyperalimentation
TOC required
202.000
Arkansas Medicaid
			 Participation Requirements for
Hyperalimentation Providers
Providers of parenteral and enteral (sole source) nutrition
				therapy services must meet the following criteria in order 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) 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), a Medicaid contract (form DMS-653) and a Taxpayer
			 Identification Number and Certification (Form
			 W-9).
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 provider
			 of parenteral nutrition must be licensed as a retail pharmacy by the Arkansas
			 State Board of Pharmacy. A copy of the provider's current Arkansas Retail
			 Pharmacy Permit must accompany the provider application and Medicaid contract.
			 The provider must maintain a current Arkansas Retail Pharmacy Permit while
			 providing services in this program. Subsequent licensure must be provided when
			 issued.
D. The provider application
			 and Medicaid contract must be approved by the Arkansas Medicaid
			 Program.
E. Providers of both
			 parenteral and enteral nutrition must be enrolled in the Title XVIII (Medicare)
			 Program to provide hyperalimentation services. A copy of the Medicare letter of
			 verification must accompany the application.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.06-065 - Developmental Day Treatment Clinic Services Manual Update Transmittal #78

Current through Register Vol. 49, No. 6, June, 2024
Section II
			 Developmental Day Treatment Clinic Services
201.000
Arkansas Medicaid Participation
			 Requirements for Developmental
Day Treatment Clinic Services (DDTCS) Providers
To participate in
the
Arl[LESS THAN]ansas
				IVIedicaid Program, providers must adinere to all applicable professional
				standards of care and conduct. All providers of DDTCS services must meet the
				following criteria to be eligible for participation in the Arkansas Medicaid
				Program:
A. Each provider of DDTCS
			 services must be licensed as a developmental day treatment clinic by the
			 Division of Developmental Disabilities Services (DDS), Arkansas Department of
			 Health and Human Services.
1. A copy of the
			 current license must accompany the provider application and the Medicaid
			 contract.
2. Copies of renewed
			 licenses must be submitted to the Provider Enrollment Unit of the Division of
			 Medical Services when they are issued.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.06-066 - Portable X-Ray Services Update Transmittal #59

Current through Register Vol. 49, No. 6, June, 2024
201.000
Arkansas Medicaid
			 Participation Requirements for Portable X-Ray
Providers
To participate in the Arkansas Medicaid Program, providers must
				adhere to all applicable professional standards of care and conduct. Providers
				of portable X-ray services are eligible for participation in the Arkansas
				Medicaid Program if the following criteria are met:
A. The provider must complete 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 (DMS-652), a Medicaid
			 contract (DMS-653) and a Request for Taxpayer Identification Number and
			 Certification (W-9).
B. The provider of portable X-ray services
			 must be certified by the Division of Health as a Title XVIII (Medicare)
			 participant. A copy of the current certification must accompany the provider
			 application (form DMS-652) and Medicaid contract (form DMS-653).
1. Subsequent certifications must be
			 forwarded to Provider Enrollment within 30 days of issue.
2. If the certification document is not
			 received within this time period, the provider will have an additional, and
			 final, 30 days to comply.
C. Enrollment as a Medicaid provider is
			 conditioned upon approval of a completed provider application and the execution
			 of a Medicaid Provider Agreement.
D. 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 016.06.06-067 - Private Duty Nursing (PDN) Provider Manual Update Transmittal #71

Current through Register Vol. 49, No. 6, June, 2024
SUBJECT: Provider Manual Update Transmittal
				#71
REMOVE
INSERT
Section
Date
Section
Date
213.000
7-1-06
213.000
225.000
7-1-06
225.000
Explanation of
				Updates
Sections 213.000 and 225.000 are included to clarify that a
				primary care physician (PCP) Child Health Services (EPSDT) screening/ referral
				is required to receive private duty nursing services.
Paper versions of this update transmittal have updated pages
				attached to file in your provider manual. See Section I for instructions on
				updating the paper version of the manual. For electronic versions, these
				changes will be automatically incorporated.
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 (TDD only).
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.
213.000
Coverage of
			 Private Duty Nursing Services for Medicaid-Eligible Beneficiaries Under
			 21
Private Duty Nursing Services (PDN) may be covered for Medicaid
				beneficiaries under 21 who meet the following requirements:
A. Medicaid-eligible beneficiaries under age
			 21 who are:
1.
										I n the Child Health Services
			 (EPSDT) Program, and
2. High
			 technology non-ventilator dependent beneficiary requiring at least two (2) of
			 the following services, unless the beneficiary requires an extremely high level
			 of one (1) service making a home care plan impossible without private duty
			 nursing services:
a. Intravenous Drugs (e.g.
			 chemotherapy, pain relief, or prolonged IV antibiotics)
b. Respiratory - Tracheostomy or Oxygen
			 Supplementation
c. Total Care
			 Support for ADLs and close patient monitoring
d. Hyperalimentation - parenteral or enteral
PDN services may be provided by a registered nurse and/or
				licensed practical nurse as directed by the beneficiary's physician.
Medicaid-eligible beneficiaries under age 21 who are in the
				Child Health Services (EPSDT) program require additional documentation to
				receive private duty nursing services. Refer to section
				225.000 of this manual.
All PDN services require prior authorization by the Medicaid
				Program. Refer to section
				220.000 of this manual for
				information on the prior authorization process.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.06-070 - 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 $172.00 for dates of service beginning
			 July 1, 2006. 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 016.06.06-072 - Title XIX State Plan Amendment 2006-013

Current through Register Vol. 49, No. 6, June, 2024
ATTACHMENT 3.1-A
AMOUNT, DURATION AND SCOPE OF SERVICES
				PROVIDED
2.
a. Outpatient Hospital Services
Non-Emergency Services
Outpatient hospital services other than those which qualify as
				emergency, outpatient surgical procedures and treatment and therapy services
				are covered as non-emergency services.
Benefit Limit
Outpatient hospital services are limited to a total of twelve
				(12) visits a year. This yearly limit is based on the
State Fiscal Year - July 1 through June 30. Outpatient hospital
				services include the following:
* non-emergency outpatient hospital and related physician and
				nurse practitioner services
* outpatient hospital therapy and treatment services and
				related physician and nurse practitioner services
For services beyond the 12 visit limit, an extension of
				benefits will be provided if medically necessary. The following diagnoses are
				considered to be categorically medically necessary and do not require prior
				authorization for medical necessity: Malignant neoplasm; HIV infection; renal
				failure and pregnancy. All other diagnoses are subject to prior authorization
				before benefits can be extended.
Outpatient hospital services are not benefit limited for
				recipients in the Child Health Services (EPSDT) Program.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.06-073 - Medicaid State Plan Amendment #2006-005

Current through Register Vol. 49, No. 6, June, 2024
ATTACHMENT 4.19-B
12. Prescribed drugs, dentures, and
			 prosthetic devices; and eyeglasses prescribed by a physician skilled in
			 diseases of the eye or by an optometrist
c.
			 Prosthetic Devices
(6) Orthotic Appliances
			 and Prosthetic Devices
Reimbursement is based on the lesser of the amount billed
				or the Title XIX (Medicaid) maximum charge allowed. State developed fee
				schedule rates are the same for both public and private providers of orthotic
				appliances and prosthetic devices.
Effective for dates of service occurring on and after
				September 1, 2006, reimbursement rate maximums for Medicaid covered orthotic
				appliances and prosthetic devises are based on 100% of the 2006 DMEPOS Medicare
				rates.
For the following procedure codes not reflecting a rate
				on the 2006 DMEPOS Medicare fee schedule, reimbursement rate maximums for dates
				of service occurring September 1, 2006 and after, will be based on 100% of the
				2006 Arkansas Blue Cross/Blue Shield rate:
A5510 = $30.28, L0452 = $263.81, L3202 = $51.21, L3204 =
				$50.12, L3206 = $51.93, L3207 = $52.67, L3208 = $28.58, L3209 = $39.53, L3211 =
				$42.11, L3215 = $93.94, L3216 = $113.29, L3219 = $105.26, L3221 = $126.00,
				L3222 = $139.22, L3230 = $163.33, L3250 = $331.47, L3253 = $44.64, L3257 =
				$32.95, L3265 = $20.54,L3902 = $1,980.19, L4205 = $35.00, L4210 = $28.27, L7500
				= $67.55, L7520 = $15.00
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.06-074 - State Plan Amendment #2006-001 and Dental Update #85

Current through Register Vol. 49, No. 6, June, 2024
ATTACHMENT 3.1-A
AMOUNT, DURATION AND SCOPE OF SERVICES
				PROVIDED
CATEGORICALLY NEEDY
4.b. Early and Periodic Screening and
			 Diagnosis of Individuals Under 21 Years of Age, and Treatment of Conditions
			 Found.
10. Dental Services
Refer to Attachment 3.1-A, Item 4. b. (16)
for
				information regarding dental services for EPSDT eligible children under age
				21
Dental services are available for Medicaid beneficiaries
				age 21 and over only when provided as a result of a life-threatening medical
				necessity. All adult dental services must be prior authorized.
.
(16)
Dental Services
(1) Services are limited to eligible Medicaid
			 recipients in the Child Health Services (EPSDT) Program.
(2) Procedures which may be provided to
			 recipients in the Child Health Services (EPSDT) Program without prior
			 authorization are:
a. Initial radiographs
			 taken in conjunction with preparation of a treatment plan.
b.
Periodic oral exam,
prophylaxis and topical flouride for children in the Child Health Services
			 (EPSDT) Program.
c. Emergency
			 treatment. One visit without prior authorization is payable for any emergency.
			 Procedures payable without prior authorization when provided as emergency care
			 include:
1. All necessary
			 radiographs.
2. Extraction of up to
			 three teeth for relief of pain or acute infections.
3. Control of bleeding.
4. Treatment for relief of pain resulting
			 from injuries to the oral cavity or related services.
5. Emergency services provided to patients in
			 hospitals or long term care facilities.
All other procedures require prior authorization from the
				Medical Assistance Section. A full mouth radiograph is limited to once every
				five years.
Periodic oral exam, prophylaxis, fluoride treatment, and
				bite-wing X-rays are limited to once per every 6 (six) months plus 1 (one) day.
				Scaling is limited to one per state fiscal year (July 1 through June 30).
Periapical X-rays are limited to four (4) per recall visit.
Any
				limits will be exceeded based on medical necessity.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.06-075 - State Plan Amendment #2006-007 and Hospital Update #104

Current through Register Vol. 49, No. 6, June, 2024
ATTACHMENT 4.19-A
METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES
				-INPATIENT HOSPITAL SERVICES
1.
			 Inpatient Hospital Services
A. In-State Acute
			 Care/General Hospitals, All Bordering City Hospitals and All Out-of-State
			 Hospitals
3.
Other Covered
			 Transplants
Reimbursement for the actual organ to be transplanted (organ
				acquisition) will be at (a) 100% of the submitted organ invoice amount from an
				outside organ provider organization or (b) reasonable cost with interim
				reimbursement and year-end cost settlement. The hospital has the choice of
				using either method. If (a) is used, the provider will submit a copy of the
				invoice for the organ acquired and Medicaid will reimburse 100% of the invoice
				amount and no additional amounts will be reimbursed to the hospital. If (b) is
				used, an interim amount will be reimbursed to the hospital and a year-end cost
				settlement will be calculated. The interim amount reimbursed and the year-end
				cost settlement will be calculated in a manner consistent with the method used
				by the Medicare Program for organ acquisition costs.