reglab/statecodes huggingface dataset:
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 27 - Department of Medical Services › Rule 016.27.20-002 - Ambulatory Surgical Center Manual (ASC-1-19)

Current through Register Vol. 49, No. 6, June, 2024
Section II
Ambulatory Surgical Center
222.000
ASC Procedures That Require
			 Medical Review, Prior Authorization, and Diagnosis Code Restriction
A. The procedure codes found in the following
			 link require medical review, prior authorization, or diagnosis restriction as
			 of the effective date indicated.
View or print the procedure
			 codes for ASC services
.
B. For dates of service on or after November
			 1, 2017 the following procedure codes require prior authorization.
Outpatient Surgery Abortion Codes That Require
						  Prior Authorization
59840 59841 59866
1. Refer to
			 Section 216.110, "Abortion When Life of Mother Would Be Endangered If the Fetus
			 Were Carried to Term," for the prior authorization process.
2. Refer to Section 216.120, "Abortion When
			 the Pregnancy Is a Result of Rape or Incest," for the prior authorization
			 process.
3. Abortion claims must be
			 billed on a paper CMS-1450 (UB-04) claim form with the DMS-2698 form
			 (Certification Statement for Abortion), history and physical, and operative
			 report attached.
View a sample CMS-1450 (UB-04) claim form.
			 View or print form DMS-2698.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 27 - Department of Medical Services › Rule 016.27.20-008 - SPA #2020-0003 EIDT/ADDT Rate Increase

Current through Register Vol. 49, No. 6, June, 2024
ATTACHMENT 3.1-A
STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT
				MEDICAL ASSISTANCE PROGRAM
AMOUNT, DURATION AND SCOPE OF SERVICES PROVIDED
Revised: January 1, 2020
CATEGORICALLY NEEDY
9. Clinic Services
(1) Adult Developmental Day Treatment (ADDT)
			 Services
Limited to comprehensive day treatment centers offering the
				following
core
services to beneficiaries age 18 and above:
a. Assessments, 1 unit per year
b. Adult
Day Habilitation
Services, 5 units per day, 1 hour each
c. Provision of noon meal
Optional Services available through ADDT in conjunction with
				core services are as follows:
a.
			 Physical therapy - Services must be prescribed by a physician and provided by
			 or under the supervision of a qualified physical therapist.
b. Speech therapy - Services must be referred
			 by a physician and provided by or under the supervision of a qualified speech
			 pathologist.
c. Occupational
			 therapy - Services must be prescribed by a physician and provided by or under
			 the supervision of a qualified occupational therapist.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 27 - Department of Medical Services › Rule 016.27.20-009 - Ambulance Services SPA 2020-0009 and Transportation Provider Manual

Current through Register Vol. 49, No. 6, June, 2024
201.100
Ground Ambulance Providers
Ground Ambulance Transportation providers must meet the
				Provider Participation and enrollment requirements contained within Section
				140.000 of the Arkansas Medicaid provider manual as well as the following
				criteria in order to be eligible for participation in the Arkansas Medicaid
				Program:
A. A current copy of the
			 ambulance license issued by the Arkansas Department of Health (instate
			 providers) or the applicable licensing authority (out-of-state and bordering
			 state providers) must accompany the provider application and Medicaid contract.
			 Medicaid will accept approved electronic signatures provided the signatures
			 comply with Arkansas Code §
									25-31-103 et seq.
B. Ambulance transportation providers who
			 wish to be reimbursed for Advanced Life Support services must submit a current
			 copy of the ambulance license that reflects Paramedic or Advanced Emergency
			 Medical Technician (EMT) licensure from the Arkansas Department of Health (for
			 in-state providers) or the applicable licensing authority (out-of-state
			 providers). Please refer to Section 252.410 for special billing instructions
			 regarding Advanced Life Support.
C.
			 The ambulance company must be enrolled in the Title XVIII (Medicare)
			 Program.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 27 - Department of Medical Services › Rule 016.27.20-010 - SPA #20-0013 Medication Assisted Treatment

Current through Register Vol. 49, No. 6, June, 2024
Section II
Federally Qualified Health
			 Center
212.220
Services
			 Furnished in Collaboration with a Physician
Nurse practitioner services
			 are performed in collaboration with a physician or physicians.
A. Collaboration is a process in which a
			 nurse practitioner works with one (1) or more physicians to deliver health care
			 services within the scope of the practitioner's expertise, with medical
			 direction, and appropriate supervision as provided for in jointly developed
			 guidelines or other mechanisms as provided by State law.
B. The collaborating physician does not need
			 to be present with the nurse practitioner when the services are furnished or to
			 make an independent evaluation of each patient who is seen by the nurse
			 practitioner.
C. Medication
			 Assisted Treatment (MAT) for Opioid Use Disorders: Effective dates of service
			 on and after
September 1, 2020
, Medication Assisted Treatment for
			 Opioid Use Disorders is available to all qualifying Medicaid beneficiaries when
			 provided by providers who possess an X-DEA license on file with Arkansas
			 Medicaid Provider Enrollment for billing purposes. All rules and regulations
			 promulgated within the Physician's provider manual for provision of this
			 service must be followed.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 27 - Department of Medical Services › Rule 016.27.20-011 - Episode 1-19; SectionI 3-19; and State Plan # 20-0002

Current through Register Vol. 49, No. 6, June, 2024
SECTION I
- GENERAL POLICY
			 CONTENTS
180.000
EPISODES OF
			 CARE
The Episodes of Care program will gradually conclude over the
				two (2) state fiscal years 2020 and 2021. State fiscal year 2020 will be the
				final payment reporting period year for each episode's performance period. In
				State fiscal year 2021, the final reconciliation report will be generated. The
				reconciliation report period allows Principal Accountable Providers the
				opportunity to improve their gain share/risk share or incentive
				position.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 27 - Department of Medical Services › Rule 016.27.20-014 - Electronic Visit Verification (EVV) Implementation

Current through Register Vol. 49, No. 6, June, 2024
Section I
131.000
Charges that Are Not the
			 Responsibility of the Beneficiary
Except for cost sharing responsibilities outlined in Sections
				133.000 - 135.000, a beneficiary is not liable for the following
				charges:
A. A claim or portion of a
			 claim denied for lack of medical necessity.
B. Charges in excess of the Medicaid maximum
			 allowable rate.
C. A claim or
			 portion of a claim denied due to provider error.
D. A claim or portion of a claim denied
			 because of errors made by DMS or the Arkansas Medicaid fiscal agent.
E. A claim or portion of a claim denied due
			 to changes made in state or federal mandates after services were
			 performed.
F. A claim or portion of
			 a claim denied because a provider failed to obtain prior, concurrent, or
			 retroactive authorization for a service.
G. A claim or portion of a claim denied
			 because the claim did not meet Electronic Visit Verification (EVV) requirements
			 (see 145.000).
H. The difference
			 between the beneficiary Medicaid cost sharing responsibility, if any, and the
			 Medicare or Medicare Advantage co-payments.
I. Medicaid pays the difference, if any,
			 between the Medicaid maximum allowable fee and the total of all payments
			 previously received by the provider for the same service. Medicaid
			 beneficiaries are not responsible for deductibles, co-payments, or coinsurance
			 amounts to the extent that such payments, when added to the amounts paid by
			 third parties, equal or exceed the Medicaid maximum for that service, even if
			 the Medicaid payment is zero. The beneficiary is responsible for paying
			 applicable Medicaid cost share amounts.
J. The beneficiary is not responsible for
			 insurance cost share amounts if the claim is for a Medicaid-covered service by
			 a Medicaid-enrolled provider who accepted the beneficiary as a Medicaid
			 patient. Arkansas Medicaid pays the difference between the amount paid by
			 private insurance and the Medicaid maximum allowed amount. Medicaid will not
			 make any payment if the amount received from the third party insurance is equal
			 to or greater than the Medicaid allowable rate.
If an individual who makes payment at the time of service is
				later found to be Medicaid eligible and Medicaid is billed, the individual must
				be refunded the full amount of his or her payment for the covered service(s).
				If it is agreeable with the individual, these funds may be credited against
				unpaid non-covered services and Medicaid cost-sharing amounts that are the
				responsibility of the beneficiary.
The beneficiary may not be billed for the completion and
				submission of a Medicaid claim form.
Exception: Medicaid does not cover the deductible,
				co-payments, or other cost share amounts levied to Medicare Part D
				drugs.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 27 - Department of Medical Services › Rule 016.27.20-015 - Medication Assisted Treatment Including the Following Provider Manuals: Federally Qualified Health Center 1-19, Hospital 5-19, Nurse Practitioner 3-19, Outpatient Behavorial Health Services 1-19, Physician 4-19, and Rural Health Clinic 1-19; Pharmacy 2-19; Section I 4-19; State Plan Amendmetn #2020-0013

Current through Register Vol. 49, No. 6, June, 2024
Section II
Federally Qualified Health Center
212.220
Services Furnished in
			 Collaboration with a Physician
Nurse practitioner services are performed in collaboration with
				a physician or physicians.
A.
			 Collaboration is a process in which a nurse practitioner works with one (1) or
			 more physicians to deliver health care services within the scope of the
			 practitioner's expertise, with medical direction, and appropriate supervision
			 as provided for in jointly developed guidelines or other mechanisms as provided
			 by State law.
B. The collaborating
			 physician does not need to be present with the nurse practitioner when the
			 services are furnished or to make an independent evaluation of each patient who
			 is seen by the nurse practitioner.
C. Medication Assisted Treatment (MAT) for
			 Opioid Use Disorders: Effective dates of service on and after
September
			 1, 2020
, Medication Assisted Treatment for Opioid Use Disorders is
			 available to all qualifying Medicaid beneficiaries when provided by providers
			 who possess an X-DEA license on file with Arkansas Medicaid Provider Enrollment
			 for billing purposes. All rules and regulations promulgated within the
			 Physician's provider manual for provision of this service must be
			 followed.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 27 - Department of Medical Services › Rule 016.27.20-016 - Community Support System Provider Standards

Current through Register Vol. 49, No. 6, June, 2024
Rules for the Division of Medical Services Licensure
				Manual for Community Support System Providers
LAST UPDATED: January 1, 2021
Subchapter 1.
General
.
101.
Authority.
(a) These standards are promulgated under the
			 authority of Ark. Code Ann. §§
										20-38-101 to -113, Ark. Code Ann.
			 §§
										20-48-101 to 1108, Ark. Code Ann.
			 §
										25-10-102, and Ark. Code Ann.
			 §
										25-15-217.
(b) The Division of Provider Services and
			 Quality Assurance (DPSQA) shall perform all regulatory functions regarding the
			 licensure and monitoring of Community Support System
			 Providers.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 27 - Department of Medical Services › Rule 016.27.20-019 - Hospital Acute Crisis Units

Current through Register Vol. 49, No. 6, June, 2024
STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT
				MEDICAL ASSISTANCE PROGRAM STATE ARKANSAS
AMOUNT, DURATION AND SCOPE OF SERVICES
				PROVIDED
ATTACHMENT 3.1-A
Page 1a(1)
July 1, 2021
CATEGORICALLY NEEDY
1. Inpatient Hospital Services (continued)
Acute Crisis Unit
Effective for dates of service on or after July 1, 2021,
				Hospital Acute Crisis Units are covered for eligible Medicaid clients who are
				experiencing a psychiatry or substance use disorder, or both, crisis that does
				not meet the need for inpatient hospitalization. These units provide hospital
				diversion and step-down services in a safe environment with psychiatry and
				substance use disorder services available on-site, as well as on-call
				psychiatry available 24 hours per day. They must ensure the following services
				are available at a minimum:
A.
ongoing assessment and observation;
B.
crisis
			 intervention;
C.
psychiatric, substance, and co-occurring treatment; and
D.
initiation of referral mechanisms
			 for independent assessment and care planning.
Services are available for up to 96 hours per encounter.
				Providers must initiate an extension of benefits request for medical necessity
				approval prior to providing services beyond 96 hours.
This expenditure is being paid as inpatient hospital
				because the definition of outpatient limits services to less than a 24-hour
				period. (42
				CFR 440.2)
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 27 - Department of Medical Services › Rule 016.27.20-020 - ARChoices 1-20, LCAL 1-20, PERSCARE 3-20, ARChoices and Living Choices Waiver Amendments, and Medical Services Policy C-265, I-630, I-640, L-120

Current through Register Vol. 49, No. 6, June, 2024
Section II
ARChoices In Homecare Home and Community-Based 2176
				Waiver
212.000
Eligibility
			 for the ARChoices Program 1-1-21
A. To
			 qualify for the ARChoices Program, a person must be age twenty-one (21) through
			 sixty-four (64) and have been determined to have a physical disability through
			 the Social Security Administration or the Department of Human Services (DHS)
			 Medical Review Team (MRT) and require an intermediate level of care in a
			 nursing facility, or be sixty-five (65) years of age or older and require an
			 intermediate level of care in a nursing facility. Persons determined to meet
			 the skilled level of care, as determined by the Office of Long Term Care
			 (OLTC), are not eligible for the ARChoices Program.
The ARChoices Program processes for beneficiary intake,
				assessment and service plan development include:
1. Determination of categorical
			 eligibility;
2. Determination of
			 financial eligibility;
3.
			 Determination of nursing facility level of care;
4. Development of a person-centered service
			 plan (PCSP);
5. Development of an
			 individual services budget (ISB);
6. Notification to the beneficiary of his or
			 her choice between home- and community-based services and institutional
			 services; and,
7. Choice by the
			 beneficiary among certified providers.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 27 - Department of Medical Services › Rule 016.27.20-021 - SPA 20-0022- Medicaid Personal Care Rate

Current through Register Vol. 49, No. 6, June, 2024
ATTACHMENT 4.19-B
METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES -
				OTHER TYPES OF CARE
26.
			 Personal care is furnished in accordance with the requirements at 42 CFR §
			 440.167 and with regulations promulgated, established and published for the
			 Arkansas Medicaid Personal Care Program by the Division of Medical Services.
(a) Except as otherwise noted in the plan,
			 state developed fee schedule rates are the same for both governmental and
			 private providers of personal care services and the fee schedule and any
			 annual/periodic adjustments to the fee schedule are published on the Medicaid
			 website at www.medicaid.state.ar.us.
(b) Reimbursement for Personal Care Program
			 Services is by fee schedule, at the lesser of the billed charge or the Title
			 XIX (Medicaid) maximum allowable fee per unit of service. Effective for dates
			 of service on and after July 1, 2004, one unit equals fifteen minutes of
			 service.
(c) Effective for dates of
			 service on and after July 1, 2007, reimbursement to enrolled Residential Care
			 Facilities (RCFs) for personal care services furnished to Medicaid eligible
			 residents (i.e., clients) is based on a multi-hour rate system not to exceed
			 one day, based on the individual clients' levels of care. A client's level of
			 care is determined from the service units required by his or her service plan.
			 Rates will be recalculated as needed to maintain parity with other Personal
			 Care providers when revisions of the Title XFX maximum allowable fee occur. The
			 effective date of any such revised rates shall be the effective date of the
			 revised fee.
(d) Reimbursement to
			 enrolled Assisted Living Facilities (ALF) for personal care services furnished
			 to Medicaid eligible residents (i.e., clients) is based on a multi-hour rate
			 system not to exceed one day, based on the individual clients' level of care. A
			 client's level of care is determined from the service units required by his or
			 her service plan. Rates will be recalculated as needed to maintain parity with
			 other Personal Care providers when revisions of the Title XFX maximum allowable
			 fee occur. The effective date of such revised rates shall be the effective date
			 of the revised fee.
(e) Agencies
			 rates are set as of January 1,2021 and are effective for services on or after
			 that date. All rates are published at the agency's website, (
http://www.medicaid.state.ar.us/
).
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 27 - Department of Medical Services › Rule 016.27.20-022 - SPA #2020-23 Physicians? Evaluation & Management Code Rate Increase

Current through Register Vol. 49, No. 6, June, 2024
ATTACHMENT 4.19-B
METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES
				-OTHER TYPES OF CARE
5.
Physician Services (Continued)
F.
For dates of service beginning January 1, 2021, the maximum reimbursement
			 rate for evaluation and management codes are increased by 3 percent of the
			 7/1/2020 fee-for-service rate for each of these codes. Except as otherwise
			 noted in the plan, state-developed fee schedule rates are the same for both
			 governmental and private providers of evaluation and management services. The
			 agency's fee schedule rate was set as of January 1,2021 and is effective for
			 services provided on or after that date. All rates are published on the
			 agency's website, (
http://medicaid.mmis.arkansas.gov/
).
Effective for dates of service on or after July 1, 2020, the
				immunization administration fee for influenza will be based on the 2020
				Medicare flu vaccine administration fee. All other immunization administration
				fees will be based on Medicare's 2020 physician fee schedule for the State of
				Arkansas. The rate is paid to all governmental and non-governmental providers,
				unless otherwise specified in the state plan. All rates are published at the
				agency's website, (
http://medicaid.mmis.arkansas.gov/
).
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 27 - Department of Medical Services › Rule 016.27.21-003 - State Plan Amendment 2021-0004 Long-Acting Reversible Contraceptives (LARCs); Physician 1-21

Current through Register Vol. 49, No. 6, June, 2024
Rural Health Clinic Section
				II
TOC Required
217.220
Other Contraceptive Methods
			 12-01-21
Additional contraceptive methods covered by Medicaid
				are:
A. Contraceptive implant systems,
			 their implantations and removal,
B.
			 Intrauterine devices (IUD) and
C.
			 Depo-Provera injections
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 27 - Department of Medical Services › Rule 016.27.21-008 - SPA 21-0011; FQHC 2-21; FQHC Mental Health Clinicians added

Current through Register Vol. 49, No. 6, June, 2024
212.200
FQHC
			 Core Services
1-1-22
Covered FQHC core services are:
A. Physician services;
B. Services and supplies incidental to
			 physician services (including drugs and biologicals that cannot be
			 self-administered);
C. Pneumococcal
			 vaccine and its administration and influenza vaccine and its
			 administration;
D. Services
			 provided by physician assistants, nurse practitioners, clinical psychologists,
			 clinical social workers, licensed certified social workers, licensed
			 professional counselors, licensed mental health counselors, and licensed
			 marriage and family therapists;
E.
			 Services and supplies incidental to physician assistant, nurse practitioner,
			 clinical psychologist, clinical social worker, licensed certified social
			 worker, licensed professional counselor, licensed mental health counselor, and
			 licensed marriage and family therapist services as would otherwise be covered
			 if furnished by or incidental to physician services; and
F. Part-time or intermittent nursing care and
			 related medical supplies to a homebound individual, in the case of those FQHCs
			 that are located in an area in which the Secretary of the Department of Health
			 and Human Services has determined there is a shortage of home health
			 agencies.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 27 - Department of Medical Services › Rule 016.27.21-010 - Continuous Glucose Monitors

Current through Register Vol. 49, No. 6, June, 2024
212.208
Continuous Glucose Monitors
1-1-22
A. The Arkansas Medicaid Program provides
			 coverage for a continuous glucose monitor (CGM) for the treatment of a Medicaid
			 client if the client has:
1. Either:
a. A presence of type 1 diabetes or any other
			 type of diabetes with the use of insulin more than two (2) times daily;
			 or
b. A presence of type 1 diabetes
			 or any other type of diabetes with evidence of Level 2 or Level 3 hypoglycemia;
			 or
c. Diagnosis of glycogen storage
			 disease type 1a; or
d. Use of an
			 insulin pump; and
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 27 - Department of Medical Services › Rule 016.27.22-003 - PCP Visits and Act 569 of 2021

Current through Register Vol. 49, No. 6, June, 2024
Section
			 II
Nurse Practitioner
214.210
Advanced Practice Registered
			 Nurse (APRN) Services Benefit Limits 7-1-22
A. For clients twenty-one (21) years of age
			 or older, APRN services provided in a physician office, an APRN office, a
			 patient's home, or nursing home are limited to sixteen (16) visits per state
			 fiscal year (SFY) (July 1 through June 30).
The following services are counted toward the Service Benefit
				Limits established for the state fiscal year:
1. APRN services in the office, patient's
			 home, or nursing facility
2.
			 Physician services in the office, patient's home or nursing facility
3. Rural health clinic (RHC)
			 encounters
4. Medical services
			 furnished by a dentist
5. Medical
			 services furnished by an optometrist
6. Certified nurse-midwife services
7. Federally qualified health center (FQHC)
			 encounters
The established benefit limit does not apply to clients under
				age twenty-one (21).
Global obstetric fees are not counted against the -visit limit.
				Itemized obstetric office visits are not counted in the limit.
Extensions of the benefit limit will be considered for services
				beyond the established benefit limit when documentation verifies medical
				necessity. Refer to Section 214.900 of this manual for procedures for obtaining
				extension of benefits.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 27 - Department of Medical Services › Rule 016.27.22-005 - Act 886 - Outpatient Behavioral Health Services (OBHS) and School Based Mental Health Services (SBMHS) Manuals

Current through Register Vol. 49, No. 6, June, 2024
Section
			 II
School-Based Mental Health
				Services
211.300
Primary Care Physician (PCP) Referral
Each beneficiary who receives School-Based Mental Health
				Services can receive a limited amount of services. Once those limits are
				reached, a Primary Care Physician (PCP) referral or Patient-Centered Medical
				Home (PCMH) approval will be necessary to continue treatment. This referral or
				approval must be retained in the beneficiary's medical record.
A beneficiary can receive ten (10) School-Based Mental Health
				Services before a PCP/PCMH referral is necessary. No services will be allowed
				to be provided without appropriate PCP/PCMH referral. The PCP/PCMH referral
				must be kept in the beneficiary's medical record.
The Patient-Centered Medical Home (PCMH) will be responsible
				for coordinating care with a beneficiary's PCP or physician for School-Based
				Mental Health Services. Medical responsibility for beneficiaries receiving
				School-Based Mental Health Services shall be vested in a physician licensed in
				Arkansas.
The PCP referral or PCMH authorization for School-Based Mental
				Health Services will serve as the prescription for those services.
See Section I of this manual for the PCP procedures. A PCP
				referral is generally obtained prior to providing service to Medicaid-eligible
				children. However, a PCP is given the option of providing a referral after a
				service is provided. If a PCP chooses to make a referral after a service has
				been provided, the referral must be received by the SBMH provider no later than
				45 calendar days after the date of service. The PCP has no obligation to give a
				retroactive referral.
The SBMH provider may not file a claim and will not be
				reimbursed for any services provided that require a PCP referral unless the
				referral is received.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 28 - Division of County Operations › Rule 016.28.20-002 - Medical Services Policy Manual Section E-200

Current through Register Vol. 49, No. 6, June, 2024
E-200
Determining Financial Eligibility
			 Under the MAGI Methodology
E-210
What is MAGI?
MS Manual
MAGI is a federal income tax term meaning
M
odified
A
djusted
G
ross
I
ncome. For purposes of
				determining Medicaid eligibility, MAGI is a methodology for determining how
				income is counted and how household composition and family size are determined.
				It is based on federal tax rules, but it is not an amount on a specific line on
				an individual federal tax return. In addition to being used to determine
				Medicaid eligibility for certain eligibility groups, the MAGI methodology is
				also used to determine eligibility for and the amount of Advance Premium Tax
				Credits (APTC) and cost-sharing reductions available to individuals and
				families who are eligible to purchase health insurance through the Federally
				Facilitated Health Insurance Marketplace (FFM).
For tax purposes, the modified adjusted gross income reflects
				annual income for a specific tax year. For Medicaid purposes, however, current
				monthly income is used to determine eligibility. This is true even when using
				MAGI methodologies. Detailed information on determining whether income is
				"current" and converting income amounts to monthly amounts can be found in
MS E-265.
E-220
Families and Individuals (MAGI)
			 Groups
MS Manual
MAGI methodologies are used to determine financial eligibility
				for the following groups:
1. Infants
			 and children under age 19 (ARKids A & B);
2. Pregnant women;
3. Parents and caretaker relatives;
4. Adults age 19 through 64 who do not fall
			 into another adult group, such as the Adult Expansion Group; or
5. Transitional Medicaid.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 28 - Division of County Operations › Rule 016.28.20-004 - Transitional Employment Assistance Policy Manual 1,000 and 10,000

Current through Register Vol. 49, No. 6, June, 2024
10,000 Arkansas Work Pays
Arkansas Act 1705 of 2005 established the Arkansas Work Pays
				Program. Arkansas Work Pays is a n incentive program designed to encourage
				working Transitional Employment Assistance (TEA) participants to remain
				employed after closure of the TEA case while increasing their hours of work or
				hourly wage. Families participating in Arkansas Work Pays will receive a
				monthly cash assistance payment in the amount of two hundred and four dollars
				($204) for up to twenty-four (24) months, provided they meet the Arkansas Work
				Pays eligibility requirements. The twenty-four (24) months will count toward
				the federal sixty-month time limit, but not the state's TEA twenty-four
				(24)-month limit. This work incentive program may be limited to three thousand
				(3,000) families.
The eligibility worker will explain the Arkansas Work Pays
				program to the applicant during the initial interview for TEA cash assistance.
				The Department of Workforce Services (DWS) Workforce Specialist will discuss
				the Arkansas Work Pays program with the participant during ongoing case
				management activities. When the TEA case closes due to employment, the
				participant will receive additional information about Arkansas Work Pays ,
				including an Arkansas Work Pays application.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 28 - Division of County Operations › Rule 016.28.20-006 - Elderly Simplified Application Project (ESAP)

Current through Register Vol. 49, No. 6, June, 2024
SNAP Certification Manual - Section 8000
8100
Initial Application Process -
			 Summary
8981
Processing Application when Child Abuse has occurred
SNAP Manual 01/01/2021
The following applications are initial applications:
* An application from a household that has never received
				Supplemental Nutrition Assistance Program (SNAP) benefits.
* An application from a household whose certification period
				expired if the household does not reapply within thirty (30) days of the last
				day of the last month of certification.
* An application from a household whose SNAP case closed if the
				household does not reapply within thirty (30) days from the last day of the
				month of closure.
The initial application process begins the day an application
				is submitted to the agency in person, by mail, or electronically and ends when
				the application is approved or denied. The date of application is the date the
				application is logged as received by the agency. Eligible households that
				complete the application process will participate in the Program as soon as
				possible, but no later than thirty (30) calendar days from the application
				date. Applications not approved or denied by the thirtieth day must be
				evaluated to determine if the household or the agency was at fault for the
				delay in processing the application. If the agency is at fault, the application
				will continue to be processed. If the household is at fault, the application
				will be denied. See SNAP 8530.
The application process consists of the following
				actions:
1. Registering the
			 application using as the date of application the day Department of Human
			 Services (DHS) received the application. Electronic applications received after
			 the close of business will use the following workday as the application
			 date.
2. Providing each adult
			 household member with assistance completing voter registration application as
			 explained in the Voter Registration Appendix.
3. Interviewing the applicant (face-to-face,
			 telephone, or virtual).
4. Ensuring
			 declared household composition is correct and that all members are
			 eligible.
5. Registering members
			 not exempt from work requirements.
6. Determining that all members have declared
			 or applied for a Social Security number (SSN).
7. Determining if the household is eligible
			 based on income and resources.
8.
			 Obtaining all necessary verification.
9. Completing all necessary forms, routing
			 them as required by the agency, and scanning into the electronic case file as
			 specified.
10. Issuing forms and
			 notices to the household as specified.
SNAP 8000 explains the process of filing an application,
				registering an application, interviewing a household, and determining fault
				when an application is delayed. The eligibility determination process for
				income and resources is covered in SNAP 7100.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 28 - Division of County Operations › Rule 016.28.21-002 - Division of County Operations (DCO) COVID-19 Response Manual

Current through Register Vol. 49, No. 6, June, 2024
200.000
OVERVIEW
201.000
Authority
The following rules are duly adopted and promulgated by the
				Division of County Operations (DCO) of the Arkansas Department of Human
				Services (DHS) under the authority of Arkansas Code Annotated §§
										20-76-201,
				20-76-401,
				20 77-107, and
				25-10-129.
Applicable Guidance:
Families First Coronavirus Response Act (
				Public Law
				116-127 - March 18, 2020)
CMS Families First Coronavirus Response Act - Increased FMAP
				FAQ (question 6):
https://www.medicaid.gov/state-resource-center/downloads/covid-19-section-6008-faqs.pdf
Coronavirus Aid, Relief, and Economic Security (CARES) Act
				(Public Law No. 116-136 - March 27, 2020)
42
				C.F.R. §
											433.400; 45 C.F.R. §
				260-265, § 286; and TANF-ACF-PI-2007-08
202.000
Purpose
In response to the COVID-19 pandemic, DHS identified programs
				and services that required additional flexibility or changes to adapt to
				ensuring the health and safety of our clients. This manual details them so that
				DHS may render uninterrupted assistance and services to our clients.
203.000
Appeals
Appeal requests for the COVID-19 response policies must adhere
				to the policy set forth in the Medicaid Provider Manual Section 160.000
				Administrative Reconsideration and Appeals which can be accessed at
https://medicaid.mmis.arkansas.gov/Provider/Docs/all.aspx
.
204.000
Severability
Each section of this manual is severable from all others. If
				any section of this manual is held to be invalid, illegal, or unenforceable,
				such determination shall not affect the validity of other sections in this
				manual and all such other sections shall remain in full force and effect. In
				such an event, all other sections shall be construed and enforced as if this
				section had not been included therein.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 28 - Division of County Operations › Rule 016.28.21-005 - Updates to TEA Policy 2000 - 2013

Current through Register Vol. 49, No. 6, June, 2024
Transitional Employment Assistance Policy Manual, Section
				2000
2000
TEA Application
01/01/22
DHS County Offices will accept and process applications for
				Transitional Employment Assistance (TEA).
A TEA application must be disposed of by either approval or
				denial as quickly as possible but no later than thirty (30) calendar days from
				the date the application was received by DHS, unless the eligibility worker
				determines that the applicant needs more time in order to establish their
				eligibility for services.
The TEA eligibility requirements are:
1. Personal Responsibility Agreement
			 Requirement
2. Social Security
			 Number (SSN) Enumeration
3. Minor
			 Parent Requirements
4. Children's
			 Age and Relationship to Parent or Adult Caretaker Requirement
5. Citizenship or Alienage
			 Requirement
6. State Residence
			 Requirement
7. Time Limit
			 Requirement
8. Resource
			 Requirement
9. Income
			 Requirement
10. Work Participation
			 Requirement
11. Child Support
			 Requirement
Each requirement above is discussed in detail in the section of
				the manual that deals with that specific requirement.
Information, to establish whether a family meets the above
				requirements, is obtained from the application form and during the application
				interview.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 28 - Division of County Operations › Rule 016.28.21-006 - SNAP 9000 Expedited Case Actions

Current through Register Vol. 49, No. 6, June, 2024
SNAP Certification Manual - Section 9000
9100
Expedited Case Actions -
			 Summary
9200
Households Entitled to Expedited Service
9100
Expedited Case Actions -
			 Summary
SNAP Manual 10/01/97
Certain eligible households are entitled to receive
				Supplemental Nutrition Assistance Program benefits within seven calendar days
				of application. Households entitled to expedited service are identified through
				a screening process.
The following section of policy identifies the households
				entitled to expedited service and describes the procedures under which
				applications from these households are processed.
9200
Households Entitled to Expedited
			 Service
SNAP Manual 04/01/2022
The following households are entitled to expedited
				service:
1. All households with one
			 hundred dollars ($100) or less in countable liquid resources (i.e., cash on
			 hand, checking or savings accounts, savings certificates, and lump sum
			 payments) and less than one hundred and fifty ($150) in gross monthly
			 income;
2. Eligible households
			 whose total combined gross monthly income and liquid resources are less than
			 the amount incurred by the household for its utilities and rent or mortgage
			 payment; or
3. Destitute households
			 with one hundred dollars ($100) or less in countable liquid resources (i.e.,
			 cash on hand, checking or savings accounts, savings certificates, and lump sum
			 payments). Only households that contain migrant or seasonal farm-worker members
			 in the job stream may be considered destitute (See SNAP 9600 for a full
			 explanation).
Sometimes a household disqualified for failure to cooperate
				with a quality assurance (QA) reviewer will reapply and be entitled to
				expedited service. Any such household reapplying within ninety-five (95) days
				of the end of the QA annual review period must cooperate with the QA reviewer
				prior to certification.
Any such household, reapplying more than ninety-five (95) days
				after the end of the annual QA review period, has to provide verification of
				all eligibility requirements before certification. However, if the household is
				entitled to expedited service, only identity must be verified before the first
				month's benefits are issued. The household must provide verification of all
				eligibility requirements before its next certification period begins.
There is no limit to the number of times a household may be
				certified under the expedited service provisions. However, prior to each
				subsequent expedited certification, the household must either complete the
				verification requirements that were postponed or be certified under normal
				processing standards. See SNAP 9441.1 for additional information.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 28 - Division of County Operations › Rule 016.28.22-001 - SNAP Policy 3502.2 and SNAP 3502.3 - Act 419

Current through Register Vol. 49, No. 6, June, 2024
SNAP Certification Manual - Section 3000
3500 The SNAP Requirement to Work (RTW)
Voluntary Quit
3502.2
			 Discretionary Exemptions
SNAP Manual 05/01/2022
FNS provides the State Agency an allotted number of
				discretionary exemptions equal to twelve percent of the State's SNAP
				participation caseload. The State agency may use these exemptions to extend
				SNAP eligibility to individuals no longer eligible to participate in SNAP due
				to the three (3) month Able-Bodied Adult RTW time limit. Discretionary
				exemptions are granted to one Able-Bodied Adult for one month. The decision to
				exempt an individual from RTW must be documented in the case record.
The Division of County Operations is required to track and
				report the number of discretionary exemptions used each quarter via the FNS-583
				form. The report must include the total number of exemptions used and the name
				and SSN of the individual that was granted the exemption. Discretionary
				exemptions do not expire and any unused exemptions from the previous fiscal
				year can carry over from year to year.
3502.3 Assignment of Discretionary Exemptions
SNAP Manual 05/01/2022
Discretionary exemptions allow certain individuals an
				opportunity to establish or re-establish themselves into the community.
				Discretionary exemptions may be assigned to the following groups:
* Individuals who are currently in Foster Care
* Individuals who are in Battered Women's Shelters
Individuals who are currently in Foster Care or Battered
				Women's Shelters may be exempt from the RTW until they exit Foster Care or the
				Battered Women's Shelter.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 28 - Division of County Operations › Rule 016.28.22-003 - SNAP Updates Pursuant to Act 780

Current through Register Vol. 49, No. 6, June, 2024
8000
Initial Application Process
8100
Initial Application Process -
			 Summary
SNAP Manual 05/01/2022 The following applications are initial
				applications:
* An application from a household that has never received
				Supplemental Nutrition Assistance Program (SNAP) benefits.
* An application from a household whose certification period
				expired if the household does not reapply within thirty (30) days of the last
				day of the last month of certification.
* An application from a household whose SNAP case closed if the
				household does not reapply within thirty (30) days from the last day of the
				month of closure.
The initial application process begins the day an application
				is submitted to the agency in person, by mail, or electronically and ends when
				the application is approved or denied. The date of application is the date the
				application is logged as received by the agency. Eligible households that
				complete the application process will participate in the Program as soon as
				possible, but no later than thirty (30) calendar days from the application
				date. Applications not approved or denied by the thirtieth day must be
				evaluated to determine if the household or the agency was at fault for the
				delay in processing the application. If the agency is at fault, the application
				will continue to be processed. If the household is at fault, the application
				will be denied. See SNAP 8530.
The application process consists of the following
				actions:
1. Registering the
			 application using the date of application as the day the Department of Human
			 Services (DHS) received the application. Electronic applications received after
			 the close of business will use the following workday as the application
			 date.
2. Providing each adult
			 household member with assistance completing voter registration application as
			 explained in the Voter Registration Appendix.
3. Interviewing the applicant (face-to-face,
			 telephone, or virtual).
4. Ensuring
			 declared household composition is correct and that all members are
			 eligible.
5. Work registering
			 members who are not exempt from work requirements.
6. Determining that all members have declared
			 or applied for a Social Security number (SSN).
7. Determining if the household is eligible
			 based on income and resources.
8.
			 Obtaining all necessary verification and assisting the household to obtain
			 verification when needed.
9.
			 Completing all necessary forms, routing them as required by the agency, and
			 scanning into the electronic case file as specified.
10. Issuing forms and notices to the
			 household as specified.
SNAP 8000 explains the process of filing an application,
				registering an application, interviewing a household, and determining fault
				when an application is delayed. The eligibility determination process for
				income and resources is covered in SNAP 7100.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 28 - Division of County Operations › Rule 016.28.22-004 - Medical Services Policy Section A-116, H-100, H-400, H-600 and H-700

Current through Register Vol. 49, No. 6, June, 2024
Medical Services Policy Manual, Section X
A-116
Premiums For The Adult Expansion
			 Group
A program participant who has income of at least 100% of the
				federal poverty level will pay a premium of no more than 2% of their income to
				a health insurance carrier.
Individuals who are medically frail and receiving traditional
				Medicaid will not be required to pay a premium.
Medical Services Policy Manual, Section H
H-100
Long-Term Services and
			 Supports
The policies located in Section H of this manual describe
				programs and procedures that are unique to the Long Term Services and Supports
				eligibility groups. These sections include:
1. Income Trusts (MS H-110-116);
2. Spousal Impoverishment Rules (MS
			 H-200);
3. Transfer of Resources
			 (MS H-300);
4. Post-Eligibility
			 rules (MS H-400);
5. Long-Term Care
			 Insurance Partnership Program (MS H-500);
6. Estate Recovery (MS H-600); and
7. Undue Hardship Waiver (MS H-700).
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 28 - Division of County Operations › Rule 016.28.22-006 - Support Act Changes for Former Foster Care Youth

Current through Register Vol. 49, No. 6, June, 2024
B-200
Families and Individuals Group
			 (MAGI)
B-260
Former
			 Foster Care Adults
MS Manual 01/01/23
This group consists of adults up to twenty-six (26) years of
				age who aged out of foster care in Arkansas. There is no income or resource
				test. Other than the general Health Care eligibility requirements that all
				Health Care eligibles must meet (MS D-100), the requirements for eligibility in
				this group are that the adult was in foster care in Arkansas, was enrolled in
				Health Care when aging out of foster care at eighteen (18) to twenty-one (21)
				years of age depending on the individual circumstances and is currently under
				twenty-six (26) years of age.
Individuals in this group receive the full range of Health Care
				benefits.
Note:
If an individual
				has aged out of foster care in one state, and they move to another state, they
				are eligible for Former Foster Coverage if all other general Health Care
				eligibility requirements are met. This applies only to youth who reach eighteen
				(18) years of age on or after January 01, 2023.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 28 - Division of County Operations › Rule 016.28.22-007 - TEA Income Limit Increase

Current through Register Vol. 49, No. 6, June, 2024
2100
TEA Application Process
01/01/2023
2101
Preliminary Income and Resource Eligibility Screening
The income and resource sections of the application will be
				reviewed with the applicant to determine whether the family may be eligible for
				assistance. If the income or resources are above the maximums of $513/month for
				income (TEA 2351) or $3000 for resources (TEA 2272), it is not necessary to
				continue the application interview. The TEA application will be denied. If it
				appears that the family may be eligible for assistance, the interview process
				will continue.