reglab/statecodes huggingface dataset:
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.06-076 - Transportation Update Transmittal #86

Current through Register Vol. 49, No. 6, June, 2024
252.100
Ambulance Procedure
			 Codes
93041*
A0380
A0382
A0390
A0398
A0422
A0426
A0427
A0429
J0150*
J0170*
J0280*
J0460*
J1094*
J1100*
J1160*
J1200*
J1940*
J2060*
J2175*
J2270*
J2310*
J2550*
J2560*
J3360*
J3410*
J3475*
J3480*
J3490*
Q4076*
*Procedure code can be billed
only
in
				conjunction with procedure code
A0427
.
Procedure Code
Required Modifier
Description
A0436
Emergency, per mile, loaded, helicopter air
						  ambulance
A0422
U1
Emergency, oxygen, helicopter air ambulance
A0431
Ambulance service, emergency, basic pick-up,
						  helicopter, one unit per day
A0428
Ambulance service, ILS intermediate transport, mileage
						  and disposable supplies billed separately
A0380
TF
ILS mileage (per mile)
T2002**
Non-emergency ground ambulance transportation, hospital
						  to nursing facility
A0435
U1, UB
Piston propelled fixed wing air ambulance per
						  mile
U2, UB
Turboprop fixed wing air ambulance per mile
U3, UB
Jet (fixed wing) one unit equals one mile
U4, UB
Piston propelled fixed wing air ambulance per hour
						  (Round to the nearest hour.)
U5, UB
Turboprop fixed wing air ambulance per hour (Round to
						  the nearest hour.)
U6, UB
Jet (fixed wing) one unit equals one hour (Round to the
						  nearest hour.)
A0434
Air Ventilator/Respiratory Therapist, one unit equals
						  one hour (Round to the nearest hour.)
**Procedure code must be billed on a paper CMS-1500 claim form
				with the supporting documentation listed in section
				213.100.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.06-080 - ARKids First Provider Manual Update Transmittal #47

Current through Register Vol. 49, No. 6, June, 2024
Section II
ARKids First-B
TOC not required
222.300
Dental Services Benefit Limit
Dental services for ARKids First-B participants are limited to
				one periodic dental exam, bite-wings, and prophylaxis/fluoride treatments every
				six (6) months plus one (1) day. See section
				262.100 to view the procedure
				code for periodic dental screening exams. Scalings are limited to once per
				State Fiscal Year (SFY).
The procedure codes listed in the table below may be billed for
				the prophylaxis/fluoride.
Procedure Code
Description
D1110
Prophylaxis - adult (ages 10-20)
D1120
Prophylaxis - child (ages 0-9)
D1201
Topical application of fluoride (including prophylaxis)
						  - child (ages 0-9)
D1205
Topical application of fluoride (including prophylaxis)
						  - adult (ages 10-18)
Refer to Section
				II of the Dental Provider Manual
				for a complete listing of covered dental services.
Orthodontia Services
				are not covered for ARKids First-B participants.
Procedure codes for treatment services that are not shown as
				payable may be requested on treatment plans subject to review and approval by
				the Division of Medical Services dental consultants if such treatment is deemed
				medically necessary.
222.310
Preventive Dental Screens
A. Initial/Periodic Preventive Dental
			 Screens
Procedure code
D0120
must be billed for an
				initial/periodic preventive dental screening
.
B. Interperiodic Preventive Dental Screens
ARKids B participants may receive interperiodic preventive
				dental screening. There is no limit on this service. However, prior
				authorization must be obtained in order to receive reimbursement. See Section
				240.200 for prior authorization
				information.
Procedure code
D0140
must be billed for an
				interperiodic preventive dental screen. This service requires prior
				authorization.
240.200
Prior Authorization (PA)
			 Process for Interperiodic Preventive Dental Screens
Prior authorization for procedure code D0140, Interperiodic
				Dental Screening Exam, must be requested on the ADA claim form or online with a
				brief narrative through the Prior Authorization Manipulation (PAM) software.
View or print the Department of Health and Human Services
				Medicaid Dental Unit address.
Refer to Section
				222.310 of this manual for
				coverage and billing information.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.06-081 - Section V Update - All Providers and Prosthetics Update #90

Current through Register Vol. 49, No. 6, June, 2024
Section II
			 Prosthetics
211.100
Condition for
			 Provision of Services
The following conditions must be met for the provision of
				services:
A. The patient must reside
			 in the state of Arkansas.
B. The
			 patient must be an Arkansas Medicaid beneficiary.
C. Services must be medically necessary and
			 prescribed by the beneficiary's primary care physician (PCP) unless the patient
			 is exempt from PCP requirements.
D.
			 Patients are accepted for services on the basis of a reasonable expectation
			 that his or her medical needs can be adequately met by the provider.
E. When applicable, Form DMS-679, titled
			 Medical Equipment Request for Prior Authorization and Prescription, must be
			 utilized when requesting prior authorization for wheelchairs, wheelchair
			 seating systems, wheelchair repairs, for eligible Medicaid beneficiaries.
View or print form DMS-679 and instructions for
			 completion
.
F.
			 When applicable, form AFMC-103, titled Prescription & Prior Authorization
			 Request for Medical Equipment Excluding Wheelchairs & Wheelchair
			 Components, must be utilized when requesting prior authorization for some
			 medical supplies (i.e.: compression burn garments), orthotics appliances,
			 prosthetic devices and durable medical equipment, excluding wheelchairs,
			 wheelchair seating systems or wheelchair repairs, when these items are
			 prescribed for eligible Medicaid beneficiaries.
View or print
			 form AFMC-103 and instructions for completion.
G. When applicable, form DMS-602, titled
			 Request for Extension of Benefits for Medical Supplies for Medicaid Recipients
			 Under Age 21, must be utilized when requesting extension of benefits for
			 medical supplies for beneficiaries under age 21.
View or
			 print form DMS-602 and instructions for
			 completion
.
H.
			 When applicable, form DMS-699, titled Request for Extension of Benefits, must
			 be utilized when requesting extension of benefits for diapers and underpads for
			 eligible beneficiaries ages three and older.
View or print
			 form DMS-699
.
I. The beneficiary must reside in his or her
			 own dwelling, an apartment, relative's or friend's home, boarding home,
			 residential care facility or any other type of supervised living situation that
			 is not required to provide prosthetics services as part of the facility's
			 participation agreement as a service provider.
A beneficiary's place of residence for services may not include
				a hospital, skilled nursing facility, intermediate care facility or any other
				supervised living situation that is required to provide prosthetics services
				under a provider agreement or contract as required by federal, state or local
				regulation.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.06-083 - Child Health Management Services (CHMS) Update #71 and Section V Provider Manual Update

Current through Register Vol. 49, No. 6, June, 2024
Section V
Provider Manual Update Transmittal
Section II
Child Health Management Services
201.000
Arkansas Medicaid Participation
			 Requirements for Child Health 1-1-07
Management Services (CHMS) Providers
Providers of Medicaid services must adhere to all applicable
				professional standards of care and conduct. Providers of Child Health
				Management Services (CHMS) must meet the following criteria in order to be
				eligible to participate in the Arkansas Medicaid Program:
A. CHMS must be provided by an organization
			 that is certified by Arkansas Foundation for Medical Care, Inc. (AFMC) to be in
			 full compliance with one of the two conditions described below:
1. An academic medical center program
			 specializing in Developmental Pediatrics that is administratively staffed and
			 operated by an academic medical center and under the direction of a boarded or
			 board-eligible developmental pediatrician. An academic medical center consists
			 of a medical school and its primary teaching hospitals and clinical programs.
			 In order to be eligible for CHMS reimbursement, the academic medical center
			 must:
a. Be located in the state of
			 Arkansas;
b. Provide
			 multi-disciplinary diagnostic, evaluation and treatment services to children
			 throughout Arkansas;
c. Serve as a
			 large multi-referral program as well as a referral source for other
			 non-academic CHMS providers with the state and
d. Be staffed to provide training of
			 pediatric residents and other professionals in the multi-disciplinary
			 diagnostics, evaluation and treatment of children with special health care
			 needs.
For an academic medical center CHMS program, services may be
				provided at different sites operated by the academic medical center as long as
				the CHMS program falls under one administrative structure within the academic
				medical center.
OR
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.07-001 - 2007 HCPCS & CPT Procedure Code Conversion Official Notices

Current through Register Vol. 49, No. 6, June, 2024
I.
General Information
A review of the 2007 CPT procedure codes has been completed,
				and the Arkansas Medicaid Program will begin accepting
CPT 2007
procedure codes for dates of service on and after March 1, 2007.
				Please add this information to your Medicaid provider manual until revised
				manual sections have been included in future updates.
Procedure codes that are identified as deletions in the
CPT 2007
(Appendix B) are
non-payable
for dates
				of service on and after March 1, 2007.
II.
Non-Covered
CPT 2007
Procedure Codes
A. The
			 following CPT procedure codes are
non-covered for all providers.
22526
22527
43647
43648
43881
43882
58541
58542
58543
58544
70554
70555
94002
94003
94004
94005
94774
94775
94776
94777
96020
96040
99363
99364
B. All
CPT 2007
procedure codes listed in
Category II
and
Category III
are
non-covered.
C. Effective for dates of service on and
			 after March 1, 2007, the following new 2007 CPT procedure codes are not payable
			 to outpatient hospital and ambulatory surgical centers because these services
			 are covered by another CPT procedure code, another HCPCS code or a revenue
			 code.
15003
15005
15847
17312
17314
17315
35306
49326
49435
94645
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.07-002 - State Plan Amendment #2007-007

Current through Register Vol. 49, No. 6, June, 2024
STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT
State/Territory:
ARKANSAS
4.42
Employee Education About False Claims
				Recoveries
.
(a)
The Medicaid agency meets the requirements regarding
				establishment of policies and procedures for the education of employees of
				entities covered by section 1902(a)(68) of the Social Security Act (the Act)
				regarding false claims recoveries and methodologies for oversight of entities'
				compliance with these requirements.
(1)
Definitions.
(A)
An "entity" includes a governmental
			 agency, organization, unit, corporation, partnership, or other business
			 arrangement (including any Medicaid managed care organization, irrespective of
			 the form of business structure or arrangement by which it exists), whether
			 for-profit or not-for-profit, which receives or makes payments, under a State
			 Plan approved under title XIX or under any waiver of such plan, totaling at
			 least $5,000,000 annually.
If an entity furnishes items or services at more than a
				single location or under more than one contractual or other payment
				arrangement, the provisions of section 1902(a)(68) apply if the aggregate
				payments to that entity meet the $5,000,000 annual threshold. This applies
				whether the entity submits claims for payments using one or more provider
				identification or tax identification numbers.
A governmental component providing Medicaid health care
				items or services for which Medicaid payments are made would qualify as an
				"entity" (e.g., a state mental health facility or school district providing
				school-based health services). A government agency which merely administers the
				Medicaid program, in whole or part (e.g., managing the claims processing system
				or determining beneficiary eligibility), is not, for these purposes, considered
				to be an entity.
An entity will have met the $5,000,000 annual threshold
				as of January 1, 2007, if it received or made payments in that amount in
				Federal fiscal year 2006. Future determinations regarding an entity's
				responsibility stemming from the requirements of section 1902(a)(68) will be
				made by January 1 of each subsequent year, based upon the amount of payments an
				entity either received or made under the State Plan during the preceding
				Federal fiscal year.
(B)
An "employee" includes any officer
			 or employee of the entity.
(C)
A "contractor" or "agent" includes
			 any contractor, subcontractor, agent, or other person which or who, on behalf
			 of the entity, furnishes, or otherwise authorizes the furnishing of, Medicaid
			 health care items or services, performs billing or coding functions, or is
			 involved in the monitoring of health care provided by the
			 entity.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.07-003 - State Plan #2006-014; Visual Care Update #82; Section V-DMS-0101

Current through Register Vol. 49, No. 6, June, 2024
Section II Visual
			 Care
201.000
Arkansas Medicaid
			 Participation Requirements for Visual Care
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.07-005 - Hospital Update Number 96 and Arkansas State Plan Amendment #2006-003

Current through Register Vol. 49, No. 6, June, 2024
Section II
			 Hospital/Critical Access Hospital (CAH)/End Stage Renal Disease (ESRD)
250.203
Cost Settlement
A. The Division of Medical Services or its
			 designee audits each hospital's cost report.
1. Allowable costs are determined and
			 validated in accordance with CMS Publication 15-1 (costs and allowable costs)
			 and CMS Publication 15-2 (cost reports).
2. Accounting exceptions specific to Title
			 XIX or to the Arkansas Medicaid Program are noted in this section
			 (Reimbursement, section 250.000) of this provider manual.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.07-006 - Home Health Update Number #82 and Arkansas State Plan Amendment #2006-012

Current through Register Vol. 49, No. 6, June, 2024
6.
d. Other Practitioner's Services
(5) Psychologist Services Refer to Attachment
			 4.19-B, Item 4.b. (17).
(a) Additional
			 Reimbursement for Psychologists Services Associated with UAMS - Refer to
			 Attachment 4.19-B, item 5.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.07-007 - State Plan Transmittal #2007-010 and Section III of all Medicaid Provider Manuals

Current through Register Vol. 49, No. 6, June, 2024
Section III
Provider Manual Update Transmittal
331.000
Introduction
The Medicaid Program is required by federal regulations to
				access all third party payment sources and to seek reimbursement for services
				that have also been paid by Medicaid. "Third party" means an individual,
				institution, association, corporation or public or private agency that is
				liable for payment of all or part of the medical cost of injury, disease or
				disability of a Medicaid beneficiary. Arkansas Code Annotated §
										20-77-306
				incorporates the requirements of the federal Deficit Reduction Act of 2005
				(DRA).
Examples of third party resources are:
A. Medicare (Title XVIII) including Medicare
			 Advantage Programs
B. Railroad
			 Retirement Act
C. Insurance
			 Policies (including insurance carried by an absent parent) such as:
1. Private health
2. Group health
3. Liability
4. Automobile, including casualty, medical
			 payment, uninsured motorist, bodily injury coverage, and underinsured benefits
			 except benefits payable for or limited under the terms of the policy to
			 property damage or wrongful death
5. A Managed Care Organization
6. A Pharmacy Benefit Manager
7. Indemnity
D. Worker's Compensation
E. Veteran's Administration
F. TRICARE (formerly known as
			 CHAMPUS)
G. Social Security
			 Disability Determination
H.
			 Self-insured plans
I. Other parties
			 that are, by statute, contract, or agreement, legally responsible for payment
			 of a claim for a health care item or service
Medicaid regulations concerning dual Medicare/Medicaid
				eligibility (including QMB) and coverage differ from the rules regarding other
				third party payers and coverage. See section
				133.300,
				302.100 and
				331.000 for additional
				information.
Arkansas Rehabilitation Services (ARS) is
not
a third party source. If ARS and Medicaid pay for
				the same service, refund ARS.
Indian Health Services is not a third party
				resource.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.07-008 - Visual Care No. 98 and Arkansas Medicaid State Plan Amendment #2007-012

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
(13)
Rye Prostheses and Cleaning,
			 Enlargpinpnt and RpHiirtinn
Reimbursement is based on the lesser of the amount billed or
				the Title XIX (Medicaid) maximum charge allowed. The Medicaid maximum rates
				were established using the 2005 Medicare fee schedule. The State developed fee
				schedule rates are the same for both public and private providers of the
				service and the fee schedule and any annual/periodic adjustments to the fee
				schedule are published.
(14)
Rar Molds
Reimbursement is based on the lesser of the amount billed or
				68% of the dealer invoice.
(15)
Desensitization
			 Injections
Medicaid will pay a physician's fee up to the Title XIX
				(Medicaid) maximum for administering the injection and up to the Title XIX
				(Medicaid) maximum per vial of antigen. Refer to Attachment 4.19-B, Page 2,
				Item 5.
Rffective for claims with dates of service on or after July 1,
				1992, the Title XIX maximum rates were decreased by 20%.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.07-013 - Child Health Management Services Provider Manual Update Transmittal # 90

Current through Register Vol. 49, No. 6, June, 2024
Section II
Child Health Management Services
245.110
Accepted Tests for
			 Occupational Therapy
Tests used must be norm-referenced, standardized, age
				appropriate and specific to the therapy provided. The following list of tests
				is not all-inclusive. When using a test not listed here, the provider must
				include additional documentation to support the reliability and validity of the
				test. This additional information will be used as reference information if the
				chart is ever selected by Medicaid for audit review. An explanation of why a
				test from the approved list could not be used to evaluate the child must also
				be included. The
Mental Measurement Yearbook (MMY)
is the
				standard reference to determine the reliability and validity of the test(s)
				administered in an evaluation. Providers should refer to the
MMY
for additional information regarding specific tests.
Definitions:
STANDARD: Evaluations that are used to determine
				deficits.
SUPPLEMENTAL: Evaluations that are used to justify deficits and
				support other results. These should not "stand alone."
CLINICAL OBSERVATIONS: All clinical observations are
				supplemental but should be included with every evaluation, especially if
				standard scores do not qualify the child for therapy. They will be considered
				during reviews for medical necessity.
A. Fine Motor Skills - Standard
1. Peabody Developmental Motor Scales (PDMS,
			 PDMS2)
2. Toddler and Infant Motor
			 Evaluation (TIME)
3.
			 Bruininks-Oseretsky Test of Motor Proficiency (BOMP)
4. 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 016.06.07-016 - Physician Services Provider Manual Update Transmittal #140; Hospital/Critical Access Hospital (CAH)/End Stage Renal Disease (ESRD) Provider Manual Update #124; Home Health Provider Manual #103

Current through Register Vol. 49, No. 6, June, 2024
227.210
Accepted Tests for
			 Occupational Therapy
Tests used must be norm referenced, standardized, age
				appropriate and specific to tine tinerapy provided.
The
following list of tests is not all-inclusive. When using a test not
				listed here, the provider must include additional documentation to support the
				reliability and validity of the test. This additional information will be used
				as reference information if the chart is ever selected by Medicaid for review.
				An explanation of why a test from the approved list could not be used to
				evaluate the child must also be included. The
MMY is
the
				standard reference to determine the reliability and validity of the test(s)
				administered in an evaluation. Providers should refer to the
MMY tor
additional information regarding specific tests.
DEFINITIONS:
STANDARD: Evaluations that are used to determine
				deficits.
SUPPLEMENTAL: Evaluations that are used to justify deficits and
				support other results. These should not "stand alone."
CLINICAL OBSERVATIONS: All clinical observations are
				supplemental but should be included with every evaluation, especially if
				standard scores do not qualify the child for therapy. It will be considered
				when reviewing for medical necessity.
A. Fine Motor Skills - Standard
1. Peabody Developmental Motor Scales (PDMS,
			 PDMS2)
2. Toddler and Infant Motor
			 Evaluation (TIME)
3.
			 Bruininks-Oseretsky Test of Motor Proficiency (BOMP)
4. 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 016.06.07-017 - Official Notice DMS-2007-W-2: FFY 2008 ICD-9-CM Diagnosis Codes

Current through Register Vol. 49, No. 6, June, 2024
Effective for claims with dates of service on or after
				October 1, 2007,
the
Arkansas Medicaid Program will implement the revisions included
				in the 2008 International Classification of Diseases,
				9th Revision, Clinical Modification (ICD-9-CM).
				Providers must enter the updated diagnosis code, if applicable, on
claims
				with dates of service on or after October 1, 2007.
Thank you for your participation in the Arkansas Medicaid
				Program.
If you need this material in an alternative format, such as
				large print, please contact our Americans with Disabilities Act Coordinator at
				(501) 682-6789 (TDD only).
If you have questions regarding this notice, please contact the
				EDS Provider Assistance Center at In-State WATS 1 - 800-457-4454, or locally
				and Out-of-State at (501) 376-2211.
Arkansas Medicaid provider manuals, official notices
				and remittance advice (RA) messages are available for downloading from the
				Arkansas Medicaid website:
www, medicaid, state, or.
				us
.
Roy Jeffus, Director
Official Notice
DMS-20
DMS-20
DMS-20
DMS-20
Page 2
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.07-026 - Alternatives for Adults with Physical Disabilities Waiver Provider Manual Update Transmittal #55

Current through Register Vol. 49, No. 6, June, 2024
200.000
			 ALTERNATIVES FOR ADULTS WITH PHYSICAL DISABILITIES WAIVER GENERAL
			 INFORMATION
201.000
Arkansas
			 Medicaid Enrollment Requirements for Alternatives for Adults with Physical
			 Disabilities (Alternatives Waiver)
Provider participation in
the
Arl[LESS
				THAN]ansas IVIedicaid Alternatives for Adults with Physical Disabilities Waiver
				Program (Alternatives Waiver) requires the following:
A.
Consumer-Directed Attendant
			 Care
Consumer-Directed Attendant Care must be certified by the
				Division of Aging and Adult Services (DAAS) as having met all Centers for
				Medicare and Medicaid Services (CMS)-approved provider criteria for the
				services to be provided. Providers of Alternatives Waiver Attendant Care and
				Environmental Accessibility/Adaptation Services must be certified by the
				Division of Aging & Adult Services (DAAS) as having met all CMS approved
				provider criteria for the service(s) to be provided.
DAAS certification of Attendant Care providers is contingent
				upon participation in the financial management services process as required by
				federal guidelines for consumer-directed programs. Participation in the
				financial management services process does not change the procedure for filing
				claims. Claims will continue to be submitted to EDS and are processed by EDS.
				Prior to payment, the fiscal intermediary deducts appropriate withholdings and
				mails the Medicaid payment to the provider.
B.
Consumer-Directed Agency Attendant
			 Care
Consumer-Directed Agency Attendant Care must be certified by
				the Division of Aging and Adult Services (DAAS) as having met all CMS-approved
				provider criteria for the services to be provided.
C.
Traditional Agency Attendant
			 Care
Traditional Agency Attendant Care must be certified by the
				Division of Aging and Adult Services (DAAS) as having met all CMS-approved
				provider criteria for the services to be provided.
D.
Environmental
			 Accessibility/Adaptations/Adaptive Equipment
Environmental Accessibility/Adaptations/Adaptive Equipment must
				be certified by the Division of Aging and Adult Services (DAAS) as having met
				all CMS-approved provider criteria for the services to be provided.
E.
Case
			 Management/Counseling Support
Case Management/Counseling Support must be certified by the
				Division of Aging and Adult Services (DAAS) as having met all CMS-approved
				provider criteria for the services to be provided.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.07-027 - Dental Provider Manual Update Transmittal #99

Current through Register Vol. 49, No. 6, June, 2024
215.000
Child Health Services (EPSDT)
			 Dental Screening
The Child Health Services (EPSDT) periodic and interperiodic
				dental screening exams consist of an inspection of the oral cavity by a
				licensed dentist. The purpose of the dental screening exams is to check for
				obvious dental abnormalities and to assure access to needed dental care.
				Regular screening exams should be performed in accordance with the
				recommendations of the Child Health Service (EPSDT) periodicity
				schedule.
The Child Health Services (EPSDT) periodic dental screening
				exam is limited to two screening exams per every six (6) months plus one (1)
				day for individuals under age 21. These benefits may be extended if
				documentation is provided that verifies medical necessity. See Section
				262.100 to view the procedure
				code for periodic dental screening exams.
Individuals under age 21 enrolled in the EPSDT Program may
				receive an interperiodic dental screening exam as often as is medically
				necessary. Prior authorization from the Division of Medical Services Dental
				Care Unit is required for this service and must be requested on the ADA Claim
				Form.
View or print form ADA-J510
or
				request prior authorization online with a brief narrative through the Provider
				Electronic Solutions (PES) Application Software or other vendor software. See
				Section 262.100 for the interperiodic
				dental screening exam procedure code.
Infant oral health care examinations must be based on the
				recommendations of the American Academy of Pediatric Dentistry. Essential
				elements of an infant oral health care visit are a thorough medical and dental
				history, oral examination, parental counseling, preventive health education and
				determination of appropriate periodic re-evaluation. See Section
				201.500 for information regarding
				the dentist's role in the EPSDT Program.
216.100
Complete Series
			 Radiographs
A complete series of intraoral radiographs is allowable within
				a single state fiscal year (SPY) of July 1 through June 30 only once every five
				years, any limits may be exceeded based on medical necessity (e.g., traumatic
				accident).
A. A complete series must
			 include 10 to 18 intraoral films, including bitewings or a panoramic film
			 including bitewings. Two bitewings are covered when a panoramic X-ray is taken
			 on the same date.
B. Only one
			 complete series is covered. A complete series may be:
1. Intraoral, including bitewings,
			 or
2. Panoramic, including
			 bitewings.
C. When an
			 emergency extraction is done on the day a complete series is taken, no
			 additional X-rays will be covered.
D.
Prior authorization (PA) is required
			 for panoramic radiographs of children under age six.
E. When referrals are made, the patient's
			 X-rays must be sent to the specialist.
F. For instructions when billing for a
			 complete series, see section
			 262.400.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.07-036 - Manufacturer Appeal of Nonconforming State Supplemental Drug Rebate Offers

Current through Register Vol. 49, No. 6, June, 2024
The following information outlines the process for manufacturer
				appeal of nonconforming state supplemental drug rebate offers:
I. Mail that is marked with a Procurement
			 Identification and received by the bid deadline and identified as a drug rebate
			 bid will be routed to a screener designated by the Director of the Division of
			 Medical Services (DMS) to determine, using the criteria set forth in the bid
			 letter, whether the bid conforms to the bid request. This screener shall have
			 no input in any drug rebate decision.
II. Within three business days of identifying
			 a bid that does not conform to all bid requirements, DMS will send one dated
			 written notice of the nonconformity. If the bidder supplies an e-mail address,
			 DMS will notify by e-mail. If the bidder does not supply an e-mail address but
			 does supply a fax number, DMS will notify by fax. If the bidder does not supply
			 an e-mail address or fax number, notice will be by certified mail to the
			 address stated on the bid. DMS will use only the numbers and addresses supplied
			 by the bidders.
III. The party that
			 tendered a nonconforming drug rebate bid may:
A. Submit a written exception to the DMS
			 director or his reviewing designee in accordance with the following:
1. The written exception shall be received by
			 the DMS director or a person designated to review bid nonconformity decisions
			 within seven (7) calendar days from the date of receipt by the tendering party
			 of the DMS notice that the bid is nonconforming. The deadline will be 7 days
			 from the date of receipt, or if the 7th day is a holiday, the next business
			 day. This reviewer shall have no input into the original determination of
			 nonconformity or any drug rebate decision;
2. The written exception shall state, and
			 provide any supporting documentation to establish, how and why the bid
			 conformed to all applicable bid requirements;
3. After the time for filing written
			 exceptions has expired, the DMS director or his reviewing designee shall
			 consider all exceptions. The DMS director or his reviewing designee shall
			 notify the tendering party of the results of the review. If the DMS director or
			 his reviewing designee finds that a bid was conforming, the bidder shall be
			 notified and the bid shall be considered on an equal basis with other bids. The
			 decision of the DMS director or his designee is final.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.07-048 - Hospital/Critical Access Hospital (CAH)/End Stage Renal Disease (ESRD) - Provider Manual Update Transmittal #113

Current through Register Vol. 49, No. 6, June, 2024
Section
			 II
Hospital/Critical Access Hospital (CAH)/End Stage
			 Renal Disease (ESRD)
216.400
Sterilizations
A. Medicaid
			 covers sterilization of men and women.
1. All
			 adult (aged 21 or older) male and female Medicaid beneficiaries who are
			 mentally competent are eligible for therapeutic and non-therapeutic
			 sterilization procedures.
2. Adult
			 (aged 21 or older) women who participate in the Women's Health (Family Planning
			 Waiver) Program (Aid Category 69) and who are mentally competent are eligible
			 for non-therapeutic sterilization procedures approved by CMS for the Women's
			 Health Program and for non-therapeutic sterilizations not performed in
			 conjunction with deliveries of infants.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.07-053 - Provider Manual Update Transmittal #89 - Rehabilitative Hospital

Current through Register Vol. 49, No. 6, June, 2024
Section II
Rehabilitative Hospital
216.121
Fine Motor Skills - Standard
A. Peabody Developmental Motor Scales
			 (PDMS, PDMS2)
B. Toddler and Infant
			 Motor Evaluation (TIME)
C.
			 Bruininks-Oseretsky Test of Motor Proficiency (BOMP)
D. Bruininks-Oseretsky Test of Motor
			 Proficiency, Second Edition (BOT2)
E. Test of Infant Motor Performance
			 (TIMP)
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.07-054 - Section I Provider Manual Update Transmittal

Current through Register Vol. 49, No. 6, June, 2024
171.210
Caseload Maximum and PCP
			 Caseload Limits
A. Each PCP may
			 establish an upper limit to his or her Medicaid caseload, up to the default
			 maximum of 1000.
1. The state may permit
			 higher maximum caseloads in areas the federal government has designated as
			 medically underserved.
2. The state
			 may permit higher maximum caseloads for PCPs who state in writing that a
			 caseload limit of 1000 will create a hardship for them, their patients and/or
			 the community they serve.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.07-055 - Living Choices Assisted Living Provider Manual Update Transmittal #41

Current through Register Vol. 49, No. 6, June, 2024
212.000
Living Choices Assisted Living Services
Medicaid covers Living Choices services on a daily,
				all-inclusive basis, rather than on an itemized per-service basis. A day is a
				covered date of service when a participant receives any of the services
				described in Sections
				212.100 through
				212.500 between midnight on a
				given day and midnight of the following day. A day is not a covered date of
				service when a participant does not receive any Living Choices services between
				midnight of that day and midnight of the following day.
A. Basic Living Choices Assisted Living
			 direct care services are:
1. Attendant care
			 services,
2. Therapeutic social and
			 recreational activities,
3.
			 Periodic nursing evaluations,
4.
			 Limited nursing services,
5.
			 Assistance with medication to the extent that such assistance is in accordance
			 with the Arkansas Nurse Practice Act and interpretations thereto by the
			 Arkansas Board of Nursing,
6.
			 Medication oversight to the extent permitted under Arkansas law and
7. Assistance obtaining non-medical
			 transportation specified in the plan of care.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.07-062 - State Plan Amendment #2007-013 - PASRR

Current through Register Vol. 49, No. 6, June, 2024
ATTACHMENT 4.39-A
STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY
				ACT
State/Territory:
ARKANSAS
CATEGORICAL DETERMINATIONS
Arkansas applies categorical determinations
that
				admission to or residence
in
a NF is normally needed
to
				individuals
who are:
1.
			 terminally ill, comatose, ventilator dependent, or severely ill and
whose
impairment
is
so severe that the individual
			 could not be expected to benefit from specialized services;
or,
2.
admitted from a hospital
			 for convalescent care due to an acute physical illness, for a period not to
			 exceed 90 days, and who are not a danger to self or others.
Arkansas applies categorical determinations that
				specialized services are not needed to individuals with mental retardation, or
				a related condition, and a concurrent diagnosis of dementia.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.07-065 - Targeted Case Management Update Transmittal #62 and State Plan Amendment #2007-008

Current through Register Vol. 49, No. 6, June, 2024
201.000
Arkansas Medicaid Participation Requirements for Providers of Targeted
			 Case Management
To participate in the Arkansas Medicaid Program, providers must
				adhere to all applicable professional standards of care and conduct.
Providers of targeted case management (TCM) services must meet
				the following criteria in order to be eligible for participation in the
				Arkansas Medicaid Program:
Targeted case management provider applicants must complete and
				submit to Provider Enrollment a provider application (form DMS-652), a Medicaid
				contract (form DMS-653) and a Request for Taxpayer Identification Number and
				Certification (Form W-9).
View or print a provider
				application (DMS-652), a Medicaid Contract (DMS-653) and a Request for Taxpayer
				Identification Number and Certification (Form W-9).
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.
Providers must be licensed or certified to serve their
				respective target population(s).
NOTE: Individual employees of the Department of Health
				and Human Services (DHHS) are excluded from enrolling as Medicaid providers for
				the Targeted Case Management Program; however, the Division of Health may
				enroll as a TCM provider agency.
201.100
Participation Requirements for
			 Providers of Targeted Case
Management for Beneficiaries Under the Age of Twenty-One
				(21) Who Are
Not Receiving
Division of Developmental
				Disabilities Services Alternative Community Services (DDS ACS) Waiver Program
				Services
Providers of targeted case management services who are
				restricted to serving beneficiaries under the age of twenty-one (21) who
				participate in the Child Health Services/EPSDT Program and are not receiving
				services from the DDS ACS waiver program must:
A. Have a Master of Social Work degree
			 or
B. Be licensed in the State of
			 Arkansas as a registered nurse or
C. Be licensed in the State of Arkansas as a
			 licensed practical nurse or
D. Be
			 licensed in the State of Arkansas as a licensed social worker or
E. Be licensed in the State of Arkansas as a
			 licensed psychiatric technician nurse or
F. Be certified on the basis of a Master's
			 degree or higher by the Arkansas State Board of Education as a school guidance
			 counselor, school psychology specialist or special education supervisor.
A copy of the applicant's license or certification must
				accompany the provider application and Medicaid contract. Subsequent licensure
				and/or certification renewals must be submitted to Provider Enrollment within
				30 days of issuance in order for the provider to maintain continuous
				enrollment.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.07-066 - State Plan Amendment #2007-004; Section V Providers Manual Update Transmittal; Personal Care Update #75

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 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
. The Title XIX maximum
allowable fee
is
set by statute
.
(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
			 XIX maximum allowable fee occur. The effective date of any such revised rates
			 shall be the effective date of the revised fee.
(d)
Agencies rates are set as of July
			 1, 2007 and are effective for services on or after that date.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.08-008 - 2008 HCPCS & CPT Procedure Code Conversion

Current through Register Vol. 49, No. 6, June, 2024
I.
General
			 Information
A review of the 2008 CPT procedure codes has been completed,
				and the Arkansas Medicaid Program will begin accepting CPT 2008 procedure codes
				for dates of service on and after March 1, 2008. Please add this information to
				your Medicaid provider manual until revised manual sections have been included
				in future updates.
Procedure codes that are identified as deletions in CPT 2008
				(Appendix B) are
non-payable
for dates of service on and after
				March 1, 2008.
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 2008 CPT and HCPCS conversions.
II.
Non-Covered CPT 2008
			 Procedure Codes
A. Effective for
			 dates of service on and after March 1, 2008, the following CPT procedure codes
			 are non-payable
.
Arkansas Medicaid does not cover the services
			 they represent.
21073
34806
90661
90662
90663
93982
96125
98966
98967
98968
98969
99174
99366
99367
99368
99408
99409
99441
99442
99443
99444
99605
99606
99607
B. All
			 CPT 2008 procedure codes listed in
Category II
and
Category
			 III
are
non-covered.
C. Effective for dates of service on and
			 after March 1, 2008, the following new 2008 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.
20985
20986
20987
22208
33257
33258
33259
36591
36592
90770
90771
90776
D.
			 Effective for dates of service on and after March 1, 2008, the following new
			 2008 CPT procedure codes are not payable to physicians and certified nurse
			 midwives because these services are covered by another CPT procedure code,
			 another HCPCS code or a revenue code.
99406
99407
E.
			 Effective for dates of service on and after March 1, 2008, the following
			 currently payable 2008 CPT procedure codes have revised descriptions and are no
			 longer payable to outpatient hospitals and ambulatory surgical centers because
			 these services are covered by another CPT procedure code, another HCPCS code,
			 or another revenue code.
20930
20931
20936
20937
20938
22840
22841
22842
22843
22844
22845
22846
22847
22848
22851
33517
33518
33519
33521
33522
33523
35600
49568
51797
F.
			 Revised CPT Descriptions Affecting Multiple Provider Types
Effective for dates of service on and after March 1, 2008,
				procedure code
90698
will become non-payable for all provider
				types.
Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.08-010 - Podiatrist Provider Manual Update Transmittal #99; Ambulatory Surgical Center Provider Manual Update Transmittal #103; Hospital, Critical Access Hospital (CAH), End-Stage Renal Disease (ESRD) Provider Manual Update Transmittal #138; Physician/Independent Lab/CRNA/Radiation Therapy Center Provider Manual Update Transmittal #153

Current through Register Vol. 49, No. 6, June, 2024
Section
			 II
Podiatrist
213.100
Bilaminate Graft or Skin
			 Substitute Coverage Restriction 5-1-08
Arkansas Medicaid covers bilaminate graft or skin substitute,
				known as dermal and epidermal tissue of human origin, with or without
				bioengineered or processed elements, with metabolically active elements. The
				physician's application procedure is covered separately and must be indicated
				separately on the claim.
This product is designed for treatment of burn injuries and
				non-infected partial and full-thickness skin ulcers caused by venous
				insufficiency and for treatment of full-thickness neuropathic diabetic foot
				ulcers that extend through the dermis, but without tendon, muscle, capsule or
				bone exposure and which are located on the plantar, medial or lateral area of
				the foot (excluding the heel).
A.
Indications and Documentation
:
When the diagnosis is a burn injury, (ICD-9-CM code range 940.0
				through 949.5, indicated on the claim form), no additional medical treatment
				documentation is required.
This modality/product and related procedures will be covered
				for other restricted diagnoses (indicated below) when all of the following
				conditions are met and are documented in the beneficiary's medical
				record:
1. Partial or full-thickness
			 skin ulcers caused by venous insufficiency or full-thickness neuropathic
			 diabetic foot ulcers,
2. Ulcers of
			 greater than three (3) months duration and
3. Ulcers that have failed to respond to
			 documented conservative measures of greater than two (2) months'
			 duration.
4. There must be
			 measurements of the initial ulcer size, the size of the ulcer following
			 cessation of conservative management, and the size at the beginning of skin
			 substitute treatment.
5. For
			 neuropathic diabetic foot ulcers, appropriate steps to off-load pressure during
			 treatment must be taken and documented in the patient's medical
			 record.
6. The ulcer must be free
			 of infection and underlying osteomyelitis; treatment of the underlying disease
			 (e.g., peripheral vascular disease) must be provided and documented in
			 conjunction with skin substitute treatment.