Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.18-002 - Chiropracitc Services, 172.000, 211.000, 242.300

Current through Register Vol. 49, No. 6, June, 2024
Section I
172.100 Services not Requiring a PCP Referral
The services listed in this section do not require a PCP
				referral.
A. ARChoices waiver
			 services
B. Anesthesia services,
			 excluding outpatient pain management
C. Assessment (including the physician's
			 assessment) in the emergency department of an acute care hospital to determine
			 whether an emergency condition exists. The physician and facility assessment
			 services do not require a PCP referral {rf the Medicaid beneficiary Is enrolled
			 with a PCP)
D. Chiropractic
			 Services
E. Dental
			 services
F. DDS Alternative
			 Community Services (ACS) Waiver services
G. Developmental Day Treatment Clinic
			 Services (DDTCS) core services
H.
			 Disease control services for communicable diseases, including testing for and
			 treating sexually transmitted diseases such as HIV/AIDS
I. Domiciliary care
J. Emergency services in an acute care
			 hospital emergency department, including emergency physician services
K. Family Planning services
L. Gynecological care
M. Inpatient hospital admissions on the
			 effective date of PCP enrollment or on the day after the effective date of PCP
			 enrollment
N. Mental health
			 services, as follows:
1. Psychiatry for
			 services provided by a psychiatrist enrolled in Arkansas Medicaid and
			 practicing as an individual practitioner.
2. Rehabilitative services for persons with
			 mental illness (RSPMI Program) ages 21 or older, or for specified procedures
			 for persons under age 21 as listed in the RSPMI provider manual, Section
			 216.000.
3. Rehabilitative Services for Youth and
			 Children (RSYC) Program.
O. Obstetric (antepartum, delivery and
			 postpartum) services.
1. Only
			 obstetric-gynecologic services are exempt from the PCP referral
			 requirement.
2. The obstetrician or
			 the PCP may order home health care for antepartum or postpartum
			 complications.
3. The PCP must
			 perform non-obstetric, non-gynecologic medical services for a pregnant woman or
			 refer her to an appropriate provider.
P. Nursing facility services and intermediate
			 care facility for individuals with
			 I ntellectual disabilities
			 (ICF/IID) services
Q. Ophthalmology
			 services, including eye examinations, eyeglasses, and the treatment of diseases
			 and conditions of the eye
R.
			 Optometry services
S. Pharmacy
			 services
T. Physician services for
			 inpatients in an acute care hospital. This includes:
1. Direct patient care (initial and
			 subsequent evaluation and management services, surgery, etc.), and
2. Indirect care (pathology, Interpretation
			 of X-rays, etc.)
U.
			 Hospital non-emergency or outpatient clinic services on the effective date of
			 PCP enrollment or on the day after the effective date of PCP
			 enrollment
V. Physician visits
			 (except consultations) In the outpatient departments of acute care hospitals:
1. Medicaid will cover these services without
			 a PCP referral only If the Medicaid beneficiary is enrolled with a PCP and the
			 services are within applicable benefit limitations.
2. Consultations require PCP
			 referral.
W.
			 Professional components of diagnostic laboratory, radiology and machine tests
			 In the outpatient departments of acute care hospitals. Medicaid cavers these
			 services without a PCP referral only:
1. If
			 the Medicaid beneficiary is enrolled with a PCP and
2. The services are within applicable benefit
			 limitations.
X. Targeted
			 Case Management services provided by the Division of Youth Services or the
			 Division of Children and Family Services under an inter-agency agreement with
			 the Division of Medical Services
Y.
			 Transportation (emergency and non-emergency) to Medfcaid-covered services
Z. Other services, such as sexual
			 ebuse examinations, when the Medicaid Program determines that restricting
			 access to care would be detrimental to the patient's welfare or to program
			 Integrity, or would create unnecessary hardship.
Section tl
Chiropractic