reglab/statecodes huggingface dataset:
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.08-013 - Sections I & III of all Medicaid Provider Manuals

Current through Register Vol. 49, No. 6, June, 2024
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. The intent
				of Section I is to provide users with an understanding of Medicaid Program
				objectives and regulations. Additionally it contains details providers may need
				to answer questions often asked about the Medicaid Program. Six 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 administered 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
			 additional 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 section defines the scope of the Primary Care Case Management
			 Program (PCCM) and regulations regarding provider and enrollee participation.
			 It lists the categories of eligibility that are exempt from primary care
			 physician (PCP) referral requirements and it itemizes the services that do not
			 require PCP referral. PCP enrollment and enrollment transfer procedures are
			 explained, as are PCP referral requirements and procedures.
E. Administrative Remedies and Sanctions-This
			 area describes the rules for imposing sanctions.
F. Provider Due Process-This area describes
			 how a provider may request an administrative reconsideration of an adverse
			 decision/action within 30 calendar days after the notice of the
			 decision/action.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.08-015 - Hospital/Critical Access Hospital/End Stage Renal Disease Update Transmittal #140

Current through Register Vol. 49, No. 6, June, 2024
213.231
			 Non-Emergency Services in Emergency Departments and
Outpatient Clinic Services
A. Non-emergency services in the emergency
			 department and outpatient hospital clinic services are not covered separately
			 on the same date of service as an inpatient admission.
B. Coverage of outpatient surgeries and
			 treatment/therapy services include the coverage of outpatient hospital clinic
			 services (room) and basic non-emergency services (room) in the emergency
			 department that occur on the same date of service.
C. See sections
			 172.100 and
			 172.200 for exceptions to the PCP
			 referral requirement.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.08-022 - Hospital/Critical Access Hospital/End-Stage Renal Disease Update #139; Rehabilitative Hospital Update #99; Child Health Management Service Update #105; Developmental Day Treatment Clinic Services (DDTCS) Update #107; Occupational, Physical, Speech Therapy Services Update #96; Physician / Independent Lab / CRNA / Radiation Therapy Center Update #155

Current through Register Vol. 49, No. 6, June, 2024
Section
			 II
Hospital/Critical Access Hospital (CAH)/End
			 Stage Renal Disease (ESRD)
218.120
Accepted Tests for
			 Occupational Therapy 9-1-08
Tests 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 that is not listed below, the provider must
				include documentation in the evaluation to support the reliability and validity
				of the test. This additional information will be used as reference information
				if the chart is selected by Medicaid for review. An explanation of why a test
				from the approved list could not be used to evaluate the patient must also be
				included. The
Mental Measurement Yearbook
(
MMY)
is the standard reference for determining the reliability and validity
				of tests administered in an evaluation. Providers should refer to the MMY for
				additional information regarding specific tests. The following definitions of
				terms are applied to the lists of accepted tests:
*
Standard
: Evaluations that are used to determine
				deficits.
*
Supplemental
: Evaluations that are used to
				identify deficits and support other results. Supplemental tests may not
				supplant standard tests.
*
Clinical observations
: Clinical observations
				have a supplemental role in the evaluation and should always be included.
				Detail, precision and comprehensiveness of clinical observations are especially
				important when standard scores do not qualify the patient for therapy and the
				clinical notes constitute the primary justification of 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. Bruininks-Oseretsky Test of Motor
			 Proficiency, Second Edition (BOT-2)
5. Test of Infant Motor Performance
			 (TIMP)
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.08-023 - Section I and Section V Provider Manual Update

Current through Register Vol. 49, No. 6, June, 2024
105.100
Alternatives for Adults with
			 Physical Disabilities
The Alternatives for Adults with Physical Disabilities (APD)
				waiver program is for disabled individuals age 21 through 64 who receive
				Supplemental Security Income (SSI) or who are Medicaid eligible by virtue of
				their disability and who, but for the services provided by the waiver program,
				would require a nursing facility level of care.
APD eligibility requires a determination of categorical
				eligibility, a level of care determination, the development of a plan of care,
				and a cost comparison to determine the cost-effectiveness of the plan of care.
				The beneficiary must be notified that he/she may choose either home and
				community-based services or institutional services.
The services offered through the waiver are:
A. Environmental
			 accessibility/adaptations/adaptive equipment
B. Attendant care
These services are available only to individuals who are
				eligible under the waiver's conditions. Detailed information is found in the
				APD provider manual.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.08-025 - 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 $178.78 for dates of service beginning
			 July 1, 2008. This 3.94% increase in per diem rate is based on the most
			 currently available CPI-U inflation data applied as an inflation adjustment to
			 the previous rate.
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 016.06.08-027 - Podiatrist Provider Manual Update Transmittal #102

Current through Register Vol. 49, No. 6, June, 2024
201.100
Participation Requirements for
			 Individual Podiatrists
Podiatrists must meet the following criteria to be eligible to
				participate in the Arkansas Medicaid Program.
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. A provider
			 must be licensed to practice podiatry services in his or her state.
1. A copy of the current state license must
			 accompany the provider application and Medicaid contract.
2. 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.
3. Failure to timely submit
			 verification of license renewal will result in termination of enrollment in the
			 Arkansas Medicaid Program.
4.
			 Podiatrists must be enrolled and accept assignment in the Title XVIII -Medicare
			 Program (see section
			 202.000 ).
D. The provider must submit Clinical
			 Laboratory Improvement Amendments (CLIA) certification, if applicable. (Section
			 205.000 contains information
			 regarding CLIA certification.)
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.08-033 - Vaccines for Children Program Official Notice

Current through Register Vol. 49, No. 6, June, 2024
This notice is to inform Arkansas Medicaid providers of
				coverage of the following vaccines under the Vaccines for Children (VFC)
				program:
90681 "Rotavirus vaccine, human, attenuated, 2 dose schedule,
				live, for oral use."
90681 will be covered under the VFC program for beneficiaries
				ages 6-32 weeks with an effective date of 08/15/2008.
90696 "Diphtheria, tetanus toxoids, acellular pertussis vaccine
				and poliovirus vaccine, inactivated (DTaP-IPV), when administered to children 4
				years through 6 years of age, for intramuscular use."
90696 will be covered under the VFC program for beneficiaries
				ages 4-6 years, for dates of service on or after 08/15/2008.
90698 "Diphtheria, tetanus toxoids, acellular pertussis
				vaccine, haemophilus influenza Type B, and poliovirus vaccine, inactivated
				(DTaP-Hib-IPV), for intramuscular use."
90698 will be covered under the VFC program for beneficiaries
				ages 0-4 years, for dates of service on and after 08/07/2008.
Billing instructions forVFC for these procedure codes:
ARKids First-A
ARKids First-B
For Ages
90681-
EP, TJ modifiers
90681
-TJ modifier
6-32 weeks
90696-EP,
TJ modifiers
90696-TJ
modifier
4-6 years
90698-EP,
TJ modifiers
90698-TJ
modifier
0-4 years
For information about participation as a Vaccines for Children
				provider, contact the Arkansas Department of Health at 501-661-2170 and
				reference your provider manual.
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
				501-682-8323 (Local); 1-800-482 -5850, extension 2-8323 (Toil-Free) or to
				obtain access to these numbers through voice relay, 1-800-877 -8973 (TTY
				Hearing Impaired).
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 016.06.08-035 - Physician/CRNA/Independent Lab/Radiation Therapy Center Provider Manual Update Transmittal #154

Current through Register Vol. 49, No. 6, June, 2024
Section II
			 Physician/Independent Lab/CRNA/Radiation Therapy Center
TOC required
203.170
Physician's Role in Hospital
			 Services
A. Medicaid covers medically
			 necessary hospital services, within the constraints of the Medicaid Utilization
			 Management Program (MUMP) and applicable benefit limitations.
B. The care and treatment of a patient must
			 be under the direction of a licensed physician or dentist with hospital staff
			 affiliation. Most inpatient admissions require a PCP referral. (Refer to
			 Section I of this manual.)
C.
			 Arkansas Foundation for Medical Care, Inc., (AFMC) is the Medicaid agency's
			 Quality Improvement Organization (QIO) for physician's and hospital services.
1. AFMC reviews for the Medicaid Utilization
			 Management Program, all inpatient hospital transfers and all inpatient stays
			 longer than four days.
2. The QIO
			 also performs post-payment reviews of hospital stays of any length for medical
			 necessity determinations.
D. Hospital claims are also subject to review
			 by the Medical Director for the Medicaid Program.
1. If Medicaid denies a hospital's claim for
			 lack of medical necessity, payments to practitioners for evaluation and
			 management services incidental to the hospitalization are subject to recoupment
			 by the Medicaid agency.
2.
			 Practitioners and hospitals may not bill a Medicaid beneficiary for a service
			 Medicaid has declared not medically necessary.
3. Practitioners and hospitals may not bill
			 as outpatient services, inpatient services previously denied for lack of
			 medical necessity.
4. Refer to
			 Sections I and III of this manual for Medicare deductible and coinsurance
			 information.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.08-036 - Rehabilitative Services for Persons with Mental Illness Update #99

Current through Register Vol. 49, No. 6, June, 2024
202.000
Arkansas Medicaid Participation Requirements for RSPMI
In order to ensure quality and continuity of care, all mental
				health providers approved to receive Medicaid reimbursement for services to
				Medicaid recipients must meet specific qualifications for their services and
				staff. Providers with multiple service sites must enroll and bill for each site
				separately.
To enroll as an RSPMI Medicaid provider, the following must
				occur:
A. Providers must be located
			 within the State of Arkansas.
B. A
			 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), Medicaid
			 contract (form DMS-653) and Request for Taxpayer Identification Number and
			 Certification (Form W-9).
C. A provider must be certified by the
			 Division of Behavioral Health Services (DBHS). (See section 202.100 for
			 certification requirements.)
D. A
			 copy of the current DBHS certification as an RSPMI provider must accompany the
			 provider application and Medicaid contract. Subsequent certifications must be
			 provided when issued.
E. Enrollment
			 as a Medicaid provider is conditioned upon approval of a completed provider
			 application and the execution of a Medicaid Provider Contract.
DMS shall exclude providers for the reasons stated in
				42
				U.S.C. §
											1320a-7(a) and
				implementing regulations and may exclude providers for the reasons stated in
				42
				U.S.C. §
											1320a-7(b) and
				implementing regulations.
The following factors shall be considered by
				DHS in determining whether sanction(s) should be imposed:
A. Seriousness of the offense(s)
B. Extent of violation(s)
C. History of prior violation(s)
D. Whether an indictment or information was
			 filed against the provider or a related party as defined in DHS Policy 1088,
			 titled DHS Participant Exclusion Rule.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.08-037 - Ambulatory Surgical Centers Provider Manual Update Transmittal #108

Current through Register Vol. 49, No. 6, June, 2024
Section II
Ambulatory Surgical Center
230.100
Reimbursement
Covered outpatient surgical procedures are assigned to one of
				four groups for reimbursement purposes. Billing instructions are in Section
				242.110.
A. Medicaid has established a maximum
			 allowable fee for each surgical group.
1.
			 Reimbursement is the lesser of the billed charge or the maximum allowable fee
			 for the applicable surgical group.
2. The maximum allowable fees are global fees
			 that include all of the covered ASC facility services listed in section
			 210.200.
3. Lab, X-ray and machine tests that are not
			 directly related to the surgery are covered separately.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.08-038 - State Plan Amendment #2008-005

Current through Register Vol. 49, No. 6, June, 2024
ATTACHMENT 4.43
STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT
State/Territory:
ARKANSAS
Citation
1902(a)(69) of the Act,
P.L.
				109-171 (section 6034)
4.43
Cooperation with Medicaid
			 Integrity Program Efforts
. The Medicaid agency assures it complies
			 with such requirements determined by the Secretary to be necessary for carrying
			 out the Medicaid Integrity Program established under section 1936 of the Act.
The Medicaid agency assures that it complies with § 1936
				of the Act, and with determinations of the Secretary that are entitled to
				enforcement under 7 U.S.C. § 706.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.08-039 - State Plan Amendment #2008-004 - Air Ambulance

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
(1)
A.
Ground Ambulance Services
For transportation of recipient when medically necessary as
				certified by a physician to a hospital, to a nursing home from the hospital or
				patient's home, to the patient's home from the hospital or nursing home, from a
				hospital (after receiving emergency outpatient treatment) to a nursing home if
				a patient is bedridden, and from a nursing home to another nursing home if
				determined necessary by the Office of Long Term Care. Emergency service is
				covered only through licensed emergency ambulance companies. Services not
				allowed by Title XVIII but covered under Medicaid will be paid for
				Medicare/Medicaid recipients.
These services will be equally available to all
				recipients.
B. Air
			 Ambulance Services
Air ambulance services are provided to Arkansas Medicaid
				beneficiaries only in emergencies.
Air ambulance providers must be licensed by the Arkansas
				Ambulance Boards and enrolled as a Title XV1H, Medicare Provider.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.08-040 - State Plan Amendment #2008-013 - Personal Care Rate Increase

Current through Register Vol. 49, No. 6, June, 2024
AMOUNT, DURATION AND SCOPE OF SERVICES PROVIDED
ATTACHMENT 3.1-A
25.
			 Home and Community Care for Functionally Disabled Elderly Individuals, as
			 defined, described and limited in Supplement 2 to Attachment 3.1-A, and
			 Appendices A-G to Supplement 2 to Attachment 3.1-A.
Not provided.
1.
Personal Care
A.
Personal
			 care services are provided by a personal care aide to assist with a client's
			 physical dependency needs. The personal care aide must have at least 24 hours
			 classroom training and a minimum of supervised practical training of 16 hours
			 provided by or under the supervision of a registered nurse for a total of no
			 less than 40 hours.
B.
			 Personal care services furnished to an individual who is not an inpatient or
			 resident of a hospital, nursing facility, intermediate care facility for the
			 mentally retarded, or institution for mental disease that are -
1. Authorized for the individual by a
			 physician in accordance with a plan of treatment or (at the option of the
			 State) otherwise authorized for the individual in accordance with a service
			 plan approved by the State;
2.
			 Provided by an individual who is qualified to provide such services and who is
			 not a member of the individual's family, and
3. Furnished in a home, and at the State's
			 option, in another location.
C. The State defines "a member of the
			 individual's family" as:
1. A
			 spouse,
2. A minor's parent,
			 stepparent, foster parent or anyone acting as a minor's parent,
3. A minor's "guardian of the person" or
			 anyone acting as a minor's "guardian of the person" or
4. An adult's "guardian of the person" or
			 anyone acting as an adult's "guardian of the person".
D. Personal care services are covered for
			 categorically needy individuals only.
E. Personal care services are medically
			 necessary, prescribed services to assist clients with their physical dependency
			 needs.
1. Personal care services involve
			 "hands-on" assistance, by a personal care aide, with a client's physical
			 dependency needs (as opposed to purely housekeeping services).
2. The tasks the aide performs are similar to
			 those that a nurse's aide would normally perform if the client were in a
			 hospital or nursing facility.
F. Prior authorization is required for
			 personal care for beneficiaries under age 21.
G. Effective for dates of service on or after
			 April 1, 2002, for services beyond 64 hours per calendar month per beneficiary
			 aged 21 or older, the provider must request a benefit extension. Extensions of
			 the personal care benefit will be provided for beneficiaries aged 21 and older
			 when extended benefits are determined to be medically necessary.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.08-042 - State Plan Amendment #2007-018

Current through Register Vol. 49, No. 6, June, 2024
METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES
				-OTHER TYPES OF CARE
ATTACHMENT 4.19-B
4.
b. Early
			 and Periodic Screening and Diagnosis of Individuals Under 21 Years of Age and
			 Treatment of Conditions Found
(19)
Physical Therapy.
Occupational Therapy and Speech and
			 Language Therapy
Services
Effective for dates of service on or after October
				1,1999, the Arkansas Medicaid maximum rates for physical therapy services,
				occupational therapy services and speech therapy services are based on
				court-ordered rates issued by the United States District Court, Eastern
				District of Arkansas, Western Division and agreed upon by the Division of
				Medical Services and representatives of the Arkansas Physical Therapy
				Association, the Arkansas Occupational Therapy Association and the Arkansas
				Speech-Language-Hearing Association.
The agency's therapy fee schedule rates were set as of
				January 1,2008 and are effective for services on or after that date. All
				therapy fee schedule rates are published on the agency's website
(
www.medicaid.state.ar.us
)
.
				A uniform rate for these services is paid to all governmental and
				nongovernmental providers unless otherwise indicated in the state plan. The
				State assures that physical therapists, occupational therapists and speech
				therapists will meet the requirements contained in
				42
				CFR 440.110.
Therapy Assistants - Effective for dates of service on or
				after October 1,1999, the Arkansas Medicaid maximum for the physical therapy
				assistant, occupational therapy assistant and the speech therapy assistant is
				based on 80% of the amount reimbursed to the licensed therapist.
Fee schedule service
reimbursement is based on the
				lesser of the amount billed or the Arkansas Title XIX (Medicaid) maximum charge
				allowed.
1.
Physical
			 Therapy
Listed below are
covered
physical therapy
services:
Description
Evaluation for physical therapy per 30 minute unit
Individual physical therapy per 15 minute unit
Group physical therapy per 15 minute unit
Individual physical therapy by physical therapy assistant per
				15 minute unit
Group physical therapy by physical therapy assistant per 15
				minute unit
At the beginning of each calendar year, Medicaid officials and
				the Arkansas Physical Therapy Association or it's successor will arrive at
				mutually agreeable increase or decrease in reimbursement rates based on the
				market forces as they impact on access. Any agreed upon increase or decrease
				will be implemented at the beginning of the following state fiscal year, July 1
				with any appropriate State Plan changes.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.08-046 - State Plan Amendment #2007-021 - Private Duty Nursing Services

Current through Register Vol. 49, No. 6, June, 2024
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Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.09-002 - Official Notice for the 2009 CPT Conversion & Official Notice for the 2009 HCPCS Conversion

Current through Register Vol. 49, No. 6, June, 2024
I.
General Information
A review of the 2009 CPT procedure codes has been completed,
				and the Arkansas Medicaid Program will begin accepting CPT 2009 procedure codes
				for dates of service on and after March 1,2009.
Procedure codes that are identified as deletions in CPT 2009
				(Appendix B) are
non-payable
for dates of service on and after
				March 1, 2009.
For the benefit of those programs impacted by the conversions,
				the Arkansas Medicaid website fee schedule will be updated soon after the
				implementation of the 2009 CPT and HCPCS conversions.
II.
Non-Covered 2009 CPT
			 Procedure Codes
A.
			 Effective for dates of service on and after March 1, 2009, the following CPT
			 procedure codes are non-payable.
65757
90650
90738
90951
90952
90953
90954
90955
90956
90957
90958
90959
90960
90961
90962
90963
90964
90965
90966
95803
96360
96361
96373
B. All
			 2009 CPT procedure codes listed in
Category II
and
Category
			 III
are
non-covered.
C. The following new 2009 CPT procedure codes
			 are not payable to
Outpatient Hospitals and Ambulatory Surgical
			 Centers
because these services are covered by another CPT
			 procedure code, another HCPCS code or a revenue code.
43273
61797
61799
61800
63621
96366
96367
96368
96370
96371
96372
96374
96375
96376
D.
			 Effective on and after March 1, 2009, the following currently payable procedure
			 code has a
revised
description and is no longer payable to
Outpatient Hospitals and Ambulatory Surgical Centers
because this service is covered by another CPT procedure code, another HCPCS
			 code or a revenue code.
63035
E. The following 2009 CPT procedure codes are
			 not payable to
Physicians
because these services are
			 covered by another CPT procedure code, another HCPCS code, or another revenue
			 code.
96372 99462
F. The following 2009 CPT procedure code is
			 not payable to
Nurse Practitioners
because this
			 service is covered by another CPT procedure code, another HCPCS code or a
			 revenue code.
99462
G. The following 2009 CPT procedure code is
			 not payable to
Certified Nurse Midwives
because this
			 service is covered by another CPT procedure code, another HCPCS code or a
			 revenue code.
99462
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.09-005 - Child Health Services/Early Periodic Screening Diagnosis and Treatment (EPSDT) Update #116

Current through Register Vol. 49, No. 6, June, 2024
Section II Child
			 Health Services/Early and Periodic Screening, Diagnosis, and Treatment
212.100
Recordkeeping Requirements
A. Providers must contemporaneously
			 establish and maintain records that completely and accurately explain all
			 evaluations, care, diagnoses and other activities in connection to the delivery
			 of medical assistance to any Medicaid beneficiary.
B. Providers furnishing any Medicaid-covered
			 good or service for which a prescription, admission order, physician's order,
			 care plan or other order for service initiation, authorization or continuation
			 is required by law, by Medicaid rule, or both, must obtain a copy of the
			 prescription, care plan or order within five (5) business days of the date it
			 is written. Providers must maintain a copy of each prescription, care plan or
			 order in the beneficiary's medical record and follow all prescriptions, care
			 plans, and orders as required by law, by Medicaid rule, or both.
C. All records must be kept for a period of
			 five (5) years from the ending date of service or until all audit questions,
			 appeal hearings, investigations or court cases are resolved, whichever is
			 longer. Failure to furnish medical records upon request may result in sanctions
			 being imposed.
D. Each provider
			 must furnish all original records in its possession regarding the furnishing or
			 billing of Medicaid goods or services, upon request, to authorized
			 representatives of the Division of Medical Services of their designated
			 representatives, state Medicaid Fraud Control Unit of the Arkansas Office of
			 the Attorney General, the U. S. Secretary of the Department of Health and Human
			 Services, or their designated agents. The request may be made in writing or in
			 person. No advance notice is required for an in-person request.
E. When records are stored off-premise or are
			 in active use, the audited provider may certify, in writing, that the records
			 in question are in active use or off-premise storage and set a date and hour
			 within three (3) working days, at which time the records will be made
			 available. However, the provider will not be allowed to delay for matters of
			 convenience, including availability of personnel.
For more information regarding conditions related to
				recordkeeping, see Section
				142.300 of this provider
				manual.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.09-006 - Prosthetics Provider Manual Update Transmittal #129

Current through Register Vol. 49, No. 6, June, 2024
Section II
Prosthetics
212.100
Diapers and Underpads for
			 Individuals Age 3 and Older
Diapers and underpads are covered by the Arkansas Medicaid
				Program but are benefit limited and must be medically necessary.
A. Medical Necessity
Diaper services must be medically necessary and the medical
				condition that prohibits the ability to potty train must be documented. Only
				patients with a medical condition that results in incontinence of the bladder
				and/or bowel may receive diapers through the Home Health and Prosthetics
				Programs. This coverage does not apply to infants who would be in diapers
				regardless of their medical condition. Medicaid does not cover underpads or
				diapers for beneficiaries under the age of 3 years.
B. Benefit Limit
The benefit limit for diapers and underpads is $130.00 per
				month, per beneficiary, for diapers of any size and underpads. The benefit
				limit applies to any diaper or underpad, or any combination, whether provided
				through the Prosthetics Program, the Home Health Program or both. The limit on
				diapers and underpads is separate from the limit established for home health
				and durable medical equipment (DME) medical supplies.
The benefit may be extended with proper documentation.
C. Extension of Benefits for
			 Diapers and Underpads
To obtain an extension of benefits for diapers and underpads,
				the following information must be submitted to the Prosthetics Services
				Reviewer, DMS Utilization Review. View or print the DMS Utilization Review
				contact information.
1. A completed
			 Medicaid Form DMS-699, titled Request for Extension of Benefits for the
			 requested time period prior to the delivery of the product. View or print form
			 DMS-699.
2. Documentation supported
			 by the medical record substantiating the medical necessity of an extension of
			 benefits, including the prescription(s) for all prescribed incontinence
			 products.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.09-007 - Rural Health Manual Update #99

Current through Register Vol. 49, No. 6, June, 2024
Section
			 II Rural Health Clinic
211.000
Scope
The Medical Assistance (Medicaid) Program is designed to assist
				eligible Medicaid beneficiaries in obtaining medical care within the guidelines
				specified in this manual. All Medicaid benefits are based on medical necessity.
				See the Glossary for the definition of medical necessity.
A. A provider-based rural health clinic is
			 one which is an integral part of a hospital, skilled nursing facility or home
			 health agency that participates in Medicare and which is licensed, governed and
			 supervised with other departments of the facility.
B. An independent (free-standing) rural
			 health clinic is one that participates in Medicare and is not provider
			 based.
C. Visit is defined as a
			 face-to-face encounter between a clinic patient and a physician, physician
			 assistant, nurse practitioner, nurse midwife or other specialized nurse
			 practitioner whose services are reimbursed under the rural health clinic
			 payment method. Encounters with more than one health care professional and
			 multiple encounters with the same health care professional that take place on
			 the same day and at a single location constitute a single visit, except when
			 the patient, after the first encounter, suffers illness or injury requiring
			 additional diagnosis or treatment.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.09-009 - Visual Care Transmittal Update #120

Current through Register Vol. 49, No. 6, June, 2024
Section
			 II Visual Care
214.200
Coverage and Limitations of the Under Age 21 Program
A. One examination and one pair of glasses
			 are available to eligible Medicaid beneficiaries every twelve months.
1. If repairs are needed, the eyeglasses must
			 have been originally purchased through the Arkansas Medicaid Program in order
			 for repairs to be made.
2. If the
			 glasses are lost or broken beyond repair within the twelve month benefit limit
			 period, one additional pair will be available through the optical laboratory.
			 After the first replacement pair, any additional pair will require prior
			 authorization.
3. All replacements
			 will be made by the optical laboratory and the doctor's office may make repairs
			 only when necessary.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.09-011 - State Plan Amendment #2008-018; Nurse Practitioner Update #77 and Section V - Provider Application Form (DMS-652)

Current through Register Vol. 49, No. 6, June, 2024
200.000.
NURSE PRACTITIONER GENERAL
			 INFORMATION
201.000
The Arkansas Medicaid Program enrolls registered nurse
				practitioners or advanced practice nurses for participation in the Nurse
				Practitioner Program. To participate in the Arl[LESS THAN]ansas Medicaid
				Program, providers must adhere to all applicable professional standards of care
				and conduct and meet all enrollment requirements listed below.
A. The provider must be licensed by the state
			 authority in the state in which sen/ices are furnished.
B. The provider must complete a provider
			 application (form DMS-652), a Medicaid contract (fonn 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
			 Gertification (Form W-9).
C. The following documents must be submitted
			 with the provider application and Medicaid contract:
1. A copy of all certifications and licenses
			 verifying compliance with enrollment criteria for the specialty to be
			 practiced. (See section 201.300 of this manual.)
2. Providers have the option of enrolling in
			 tiie Title XVlll (Medicare) Program. If enrolled in Title XVlll, the provider
			 must iflfoiirn the Medicaid Provider Enrollment Unit of iis|qt;|he| Medicare
			 number. Out-of-state providers must submit a copy of their Title XVlll
			 (Medicare) certification.
3.
			 jPjnoyldere who have prescriptive authority must furnish documentation of their
			 prescriptive authority certification. Any changes in prescriptive authority
			 must be immediately reported to Arl[LESS THAN]ansas Medicaid.
4. Certifications and licenses received
			 subsequent to enrollment must be submitted to the Arkansas Medicaid Program
			 within 30 days of issue. If the renewal documents have not been received within
			 this 30-day period, the provider will have an additional and final 30 days to
			 comply.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.09-012 - Alternatives for Adults with Physical Disabilities Wavier Update #85

Current through Register Vol. 49, No. 6, June, 2024
SECTION II
-
			 ALTERNATIVES FOR ADULTS WITH PHYSICAL DISABILITIES WAIVER
211.000 Scope
The Arkansas Medicaid Program offers certain home and
				community-based outpatient services as an alternative to nursing home
				placement. These services are available to disabled individuals age 21 through
				64 who have received a determination of physical disability by SSI/SSA or DHS
				Medical Review Team (MRT) and who, without the provision of home and
				community-based services, would require a nursing facility (NF) level of care.
				The participant's income must be equal to or less than 300% of the SSI
				eligibility limit.
The community-based services offered through the Alternatives
				for Adults with Physical Disabilities Home and Community-Based Waiver,
				described herein as Alternatives, are as follows:
1. Environmental Accessibility
			 Adaptations/Adaptive Equipment
2.
			 Agency Attendant Care - Consumer-Directed
3. Agency Attendant Care - Traditional and
			 Consumer-Directed
4. Case
			 Management/Counseling Support
These services are designed to maintain Medicaid eligible
				beneficiaries at home in order to preclude or postpone institutionalization of
				the individual.
Please note that in accordance with
				42 CFR
				441.301(b)(l)(ii),
				alternatives services are not covered for inpatients of nursing facilities,
				hospitals or other inpatient institutions.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.09-013 - Rules for Conducting Criminal Record Checks for Employees of Long Term Care Facilities

Current through Register Vol. 49, No. 6, June, 2024
100
DEFINITIONS
As used in these regulations the following definitions shall
				apply unless the policy clearly states otherwise.
Bureau
- The Identification Bureau of
				the Department of the Arkansas State Police.
Care
- The treatment, services,
				assistance, education, training, instruction or supervision for which the
				service provider is compensated either directly or indirectly.
Determination
- The determination made
				by the licensing agency that a service provider, operator, applicant for
				employment with, or employee of a service provider is or is not disqualified
				from licensure, exemption from licensure, any other operating authority, or
				employment based on the criminal history of the service provider, operator,
				applicant or employee.
Elderly
- Persons aged 65 years or
				older.
Employee
-
1. A person who:
(i) Has unsupervised access to residents
			 (clients) of a service provider except as provided in subsection 2
			 below;
(ii)
(a) Provides care to residents (clients) of a
			 service provider on behalf of, under supervision of, or by arrangement with the
			 service provider; or
(b) Is
			 employed by a service provider to provide care to residents (clients) of the
			 service provider; or
(c) Is a
			 temporary employee placed by an employment agency with a service provider to
			 provide care to residents (clients) of the service provider; or
(d) Resides in an alternative living home in
			 which services are provided to individuals with developmental
			 disabilities.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.09-014 - ICF/MR Provider Fee Administrative Procedures

Current through Register Vol. 49, No. 6, June, 2024
DEFINITIONS
A.
"Director"
means the director of the
			 division;
B.
"Division
"
means the Division of
			 Medical Services of the Department of Human Services;
C.
"Medicaid
'
means the Medical
			 Assistance Program established by Title XIX of the Social Security Act,
			 42 U.S.C §
									1396 et seq., as it existed on January 1,
			 2009, and administered by the Division;
D.
"Gross
			 Receipts
"
means all compensation paid to intermediate
			 care facilities for individuals with developmental disabilities for services
			 provided to residents including, without limitation, client participation.
			 Gross receipts does not include charitable contributions;
E.
"intermediate care
			 facility for individuais with developmental disabilities"
\
(hereafter referred to as "Facility" or "Facilities") means a
			 residential I institution maintained for the care and training of persons with
			 developmental | disabilities, including without limitation mental retardation;
			 '
"Intermediate care facility for individuals with developmental
				disabilities" has the same meaning as "intermediate care facility for the
				mentally retarded" or "ICF/MR" under federal law;
"Intermediate care facility for individuals with developmental
				disabilities" does not include:
(i)
			 Offices of private physicians and surgeons;
(ii) Residential care facilities;
(iii) Assisted living facilities;
(iv) Hospitals;
(v) Institutions operated by the federal
			 government;
(vi) Life care
			 facilities; j
(vii) Nursing
			 facilities; or
(viii) A facility
			 which is conducted by and for those who rely exclusively upon treatment by
			 prayer for healing in accordance with tenets or practices of a recognized
			 religious denomination;
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.09-017 - Independent Choices Update # 11

Current through Register Vol. 49, No. 6, June, 2024
Section
			 II IndependentChoices
200.200
Eligibility
8-1-09
To be eligible for IndependentChoices, a participant
				must:
A. Be 18 years of age or
			 older
B. Be eligible for Medicaid,
			 as determined by the DHS Division of County Operations, in a category that
			 covers personal care, or be eligible for Supplemental Security Income (SSI)
			 through the Social Security Administration, or be eligible for ElderChoices and
			 determined in need of Adult Companion Services or personal care by the DAAS
			 Registered Nurse (RN)
C. Be
			 receiving personal assistant services or be medically eligible to receive
			 personal assistant services. Personal assistant services include state plan
			 personal care or ElderChoices adult companion services.
1.
Personal Care:
In determining
			 eligibility and level of need for personal care, IndependentChoices follows
			 policy found in the Arkansas Medicaid Personal Care Provider Manual.
2.
Adult Companion Services:
The
			 ElderChoices RN must determine and authorize adult companion services based on
			 ElderChoices policy.
D.
			 Not be living in a home or property owned, operated or controlled by a provider
			 of services unless the provider is related by blood or marriage to the
			 participant. This includes single family homes, group homes, adult family
			 homes, congregate settings, a living situation sponsored or staffed by an
			 agency provider, etc.
E. Be willing
			 to participate in IndependentChoices and understand the rights, risks and
			 responsibilities of managing his or her own care with an allowance; or, if
			 unable to make decisions independently, have a willing representative
			 decisionmaker who understands the rights, risks and responsibilities of
			 managing the care of the participant with an allowance.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.09-019 - Occupational, Physical and Speech Therapy Services Provider Manual Update #113, Developmental Day Treatment Clinic Services Provider Manual Update #124, Physician/Independent Lab/CRNA/Radiation Therapy Center Provider Manual Update #170, Nurse Practitione Provider Manual Update Trarismittal-#115, Hospital/Critical Access Hospital/ End Stage Renal Disease Provider Manual Update #157, Child Health Management Services Provider Manual Update #121, Rehabilitative Hospital Provider Manual Update #113

Current through Register Vol. 49, No. 6, June, 2024
Section II
			 Occupational, Physical, Speech Therapy Services
214.300 Occupational and Physical Therapy
			 Guidelines for Retrospective Review
A.
			 Occupational and physical therapy services are medically prescribed services
			 for the-diagnosis and treatment of movement dysfunction, which-results in
			 functional disabilities,
Occupational and physical therapy services must be medically
				necessary to the treatment of the individual's illness or injury. To be
				considered medically necessary, the following conditions must be met:
1 The services must be
			 considerediunder-accepted-standards oipractice to be a specific and effective
			 treatment for the patient's condition.
2. The services must be of such a level of
			 complexity or the patient's condition must be such that the services required
			 can be safely and effectively performed only by or under the supervision of a
			 qualified physical or occupational therapist.
3. There must-be-reasonable expectation
			 that-therapy will result in-a-meaningful , improvement or a reasonable
			 expectation that therapy will prevent a worsening of the condition. (See
			 tbe-medical-necessity definition in the Glossary of-this-manual.)
A diagnosis alone is not sufficient documentation to support
				the medical necessity of therapy. Assessment for physical and/or occupational
				therapy includes a comprehensive evaluation of the patient's physical deficits
				and functional limitations, treatment planned and goals to address each
				identified problem.