Arkansas Administrative Code › Agency 003 - DEPARTMENT OF COMMERCE › Division 20 - Arkansas Division of Workforce Services › Rule 003.20.21-001 - ARS Policy and Procedure Manual

Current through Register Vol. 49, No. 6, June, 2024
Arkansas Rehabilitation Services, 2020 Rule
				Revisions
1.
Fee
			 Schedules for Payment to Medical Providers
SURGICAL AND HOSPITAL INSURANCE
Insurance benefits must be used first in paying for surgical
				and medical services. ARS will pay a portion of the billed amount after
				comparable services, similar benefits and insurance are applied. The authorized
				payment will be based on the most current Medicare Fee Schedule. If the service
				is not covered by Medicare, payment will be based on the current Arkansas
				Workers' Compensation Commission Fee Schedule (Medical or Laboratory). For
				services covered by neither Medicare nor the Arkansas Workers' Compensation
				Commission, ARS will pay up to 50% of the total charges billed for the surgical
				or medical services. For hospitals or clinics with which ARS has a contract
				establishing an all-inclusive amount for services, ARS will pay the contract
				amount without regard to Medicare or Workers' Compensation-based fee
				schedules.
[VI-16]
PROCEDURES - ASSISTIVE TECHNOLOGY
				SERVICES/
REHABILITATION ENGINEERING
* For assistive technology/rehabilitation engineering services
				associated with a CPT code:
* ARS will issue payment according to the price indicated in
				the current Medicare or Arkansas Workers' Compensation fee schedule, beginning
				with Medicare. For services covered by neither Medicare nor Arkansas Workers'
				Compensation, ARS will pay up to 50% of the total charges billed for the
				assistive technology or rehabilitation technology.
* ARS will issue payment after insurance coverage for the
				assistive technology/ rehabilitation engineering services has been
				applied.
* For assistive technology/rehabilitation engineering services
				with no CPT code associated:
* Access and Accommodations staff will review purchases to
				ensure the price for the recommended technology is reasonable in the market. A
				reasonable price will be obtained through competitive bids, following the
				regulations applicable to ARS as a procurement agency. At least three bids will
				be solicited.
* ARS will generally pay 100% of the lowest responsive bid,
				after accounting for comparable services and benefits, and client
				participation, as appropriate.
[VI-49 to 50]
Payment for Hearing Aids
* ARS will issue payment for new hearing aids and related
				devices according to the current Arkansas Workers' Compensation fee schedule
				for the appropriate L or V code.
* For used hearing aids and related devices, ARS will pay 70%
				of the price indicated for the appropriate L or V code in the Arkansas Workers'
				Compensation fee schedule.
* For hearing aids and related devices (new or used) not
				covered by Arkansas Workers' Compensation, ARS will pay up to 50% of the total
				charges billed.
* For individuals with insurance coverage for hearing aids and
				related devices, ARS will issue payment after that coverage has been
				applied.
[VI-53]
ARS MEDICAL FEES
The applicable cost of procedures, devices, and other medical
				services may be found in the fee schedules maintained by Medicare or the
				Arkansas Workers' Compensation Commission. Links to these schedules are located
				on the ARS network. Before applying the fee schedules, ARS counselors must
				first determine if comparable benefits are available, including all health
				insurance plan coverages.
[Appendix I-1]
3.
RATES OF PAYMENT
When determining rates of payment to third party vendors, ARS
				first requires that the vendors be properly licensed or accredited. For
				example, medical providers must be in good standing with the applicable State
				of Arkansas licensing board or agency. If properly licensed, medical providers
				will be paid using the fee schedules established by (1) Medicare, or (2) the
				Arkansas Workers' Compensation Commission. For services covered by neither
				Medicare nor Arkansas Workers' Compensation, ARS will pay up to 50% of the
				total amount billed by the medical provider. For hospitals or clinics with
				which ARS has a contract establishing an all-inclusive amount for services, ARS
				will pay the contract amount without regard to Medicare or Workers'
				Compensation-based fee schedules.
[Appendix I-4]
5.
MEDICAL REHABILITATION
			 SERVICES
The rate of payment for physician services, dental treatment,
				glasses, optical aids, and artificial eyes, hearing aids, hospitalization,
				nursing services, orthotic devices, physical and occupational therapy,
				prosthetic devices, psychotherapy, speech and hearing therapy, and surgical
				implants/appliances are based on the fee schedules established by (1) Medicare
				or (2) the Arkansas Workers' Compensation Commission. For services covered by
				neither Medicare nor Arkansas Workers' Compensation, ARS will pay up to 50% of
				the total amount billed by the provider.
5.01
Physician Services
Rates of payment for medical services provided by physicians
				are based on the fee schedules established by (1) Medicare or (2) the Arkansas
				Workers' Compensation Commission, updated annually. Services are identified by
				CPT code where possible. For services covered by neither Medicare nor Arkansas
				Workers' Compensation, ARS will pay up to 50% of the total amount billed by the
				provider.
5.02
Dental
			 Treatment
Rates of payment for dental services are based on the fee
				schedules established by (1) Medicare or (2) the Arkansas Workers' Compensation
				Commission, updated annually. Services are identified by CPT code where
				possible. For services covered by neither Medicare nor Arkansas Workers'
				Compensation, ARS will pay up to 50% of the total amount billed by the
				provider.
Insurance benefits must be used first in paying for surgical
				and medical services. The amount authorized by ARS will be followed by the
				statement "Rehabilitation Services will pay only that part of the authorized
				amount not covered by the insurance policy up to the maximum amount allowed by
				the ARS Fee Schedule." (See Appendix I-1.)
The file must document the rational use in price decision:
				previously proposed prices, contracted prices, market research for the same
				items.
5.03
Glasses,
			 Optical Aids, and Artificial Eyes
Rates of payment are based on fee schedules established by (1)
				Medicare or (2) the Arkansas Workers' Compensation Commission for prescription
				glasses, optical aids, and artificial eyes. For devices covered by neither
				Medicare nor Arkansas Workers' Compensation, ARS will pay up to 50% of the
				total amount billed by the provider.
5.04
Hearing Aids
Invoices for hearing aids must be itemized. Each line item must
				correspond to the recommendations for the individual in the audiology/hearing
				aid evaluation.
Line items for devices not recommended for the individual in
				the audiology/hearing aid evaluation may be rejected if inconsistent with the
				individual's Employment Plan. Non-itemized or bundled invoices will be rejected
				and returned to the vendor.
Each line item for a hearing aid or related device must include
				the appropriate billing code from the "L" or "V" sections of the Health Care
				Common Procedures Coding System (HCPCS). ARS may request further documentation
				to support a given L or V code, and may refuse payment if the vendor cannot
				provide the documentation requested.
Used devices, if provided, must be disclosed on the invoice as
				"refurbished," "used," or "rebuilt." Failure to disclose a refurbished device
				or to follow the FDA procedures may result in removal of the vendor from the
				ARS Approved Vendor List.
Counselor will verify that the individual received the device
				and is able to use it. Document in the ECF. Counselor will key required
				information into the case management system for ARS Purchase
				Authorization.
ARS will issue payment for new hearing aids and related devices
				according to the price indicated for the appropriate L or V code in the fee
				schedule established by the Arkansas Workers' Compensation Commission. For used
				hearing aids and related devices, ARS will pay 70% of the price indicated for
				the appropriate L or V code, using the Arkansas Workers' Compensation Fee
				Schedule.
For hearing aids and related devices (new or used) not covered
				by Arkansas Workers' Compensation, ARS will pay up to 50% of the total amount
				billed by the provider.
5.05
Hospitalization
Rates of payment for the first day of inpatient hospital
				services are based on the fee schedules established by (1) Medicare or (2) the
				Arkansas Workers' Compensation Commission. For first-day hospital services
				covered by neither Medicare nor Arkansas Workers' Compensation, ARS will pay up
				to 50% of the total amount billed by the provider.
For hospital services beyond one day, ARS will pay up to 50% of
				the total amount billed by the provider.
For hospitals with which ARS has a contract establishing an
				all-inclusive amount for services, ARS will pay the contract amount.
5.06
Nursing Services
Rates of payment for nursing services are based on the fee
				schedules established by (1) Medicare or (2) the Arkansas Workers' Compensation
				Commission. For nursing services covered by neither Medicare nor Arkansas
				Workers' Compensation, ARS will pay up to 50% of the total amount billed by the
				provider. For hospitals or outpatient clinics with which ARS has a contract
				establishing an all-inclusive amount for services, ARS will pay the contract
				amount.
5.07
Orthotic
			 Devices
Rates of payment for orthotic devices are based on fee
				schedules established by (1) Medicare or (2) the Arkansas Workers' Compensation
				Commission. For orthotics covered by neither Medicare nor Arkansas Workers'
				Compensation, ARS will pay up to 50% of the total amount billed by the
				provider.
5.08
Physical and Occupational Therapy
Rates of payment for physical and occupational therapy services
				are based on fee schedules established by (1) Medicare or (2) the Arkansas
				Workers' Compensation Commission. For physical and occupational therapies
				covered by neither Medicare nor Arkansas Workers' Compensation, ARS will pay up
				to 50% of the total amount billed by the provider.
[Appendix I-5 to 8]
5.10
Prosthetic Devices
Rates of payment for prosthetics are based on the fee schedules
				established by (1) Medicare or (2) the Arkansas Workers' Compensation
				Commission. All prosthetic requests are reviewed by the
Access and Accommodations physical therapist to ensure the
				prosthesis and its components are consistent with the client's expressed
				vocational goal. As part of the report, the physical therapist will document
				the allowable rate for the device. For prosthetics covered by neither Medicare
				nor Arkansas Workers' Compensation, ARS will pay up to 50% of the total amount
				billed by the provider.
5.13
Surgical
			 Implants/Appliances
Rates of payment for surgical implants/appliances are based on
				the fee schedules established by (1) Medicare or (2) the Arkansas Workers'
				Compensation Commission. For implants or appliances covered by neither Medicare
				nor Arkansas Workers' Compensation, ARS will pay up to 50% of the total amount
				billed by the provider. For hospitals or outpatient clinics with which ARS has
				a contract establishing an all-inclusive amount for services, ARS will pay the
				contract amount.
[Appendix I-10]