Arkansas Administrative Code
Agency 016 - DEPARTMENT OF HUMAN SERVICES
Division 06 - Medical Services
Rule 016.06.05-043 - Developmental Rehabilitation Services Update Transmittal #14
Universal Citation: AR Admin Rules 016.06.05-043
Current through Register Vol. 49, No. 9, September, 2024
Section II Developmental Rehabilitation Services
201.000
Arkansas
Medicaid Participation Requirements for Developmental Rehabilitation
Services
Providers of developmental rehabilitation services must meet the following requirements to be eligible to participate in the Arkansas Medicaid Program:
A. Providers must be
certified as First Connections Program participants by the Arkansas Division of
Developmental Disabilities Services (DDS) to provide early intervention
services.
B. A provider must
complete and submit to the Medicaid Provider Enrollment Unit a provider
application (form DMS-652), a Medicaid contract (form DMS-653) and a Request
for Taxpayer Identification Number and Certification (Form W-9).
View or print a provider application (form DMS-652), a
Medicaid contract (form DMS-653) and a Request for Taxpayer Identification
Number and Certification (Form W-9).
C. Verification of current certification from
DDS must accompany the provider application and the Medicaid contract.
The Arkansas Department of Health and Human Services must approve the provider application and the Medicaid contract as a condition of participation in the Medicaid program.
D. Subsequent certifications must be
forwarded to the Medicaid Provider Enrollment Unit within 30 days of issuance.
If the renewal document(s) have not been received within this timeframe, the
provider will have an additional and final 30 days to comply.
E. Failure to timely submit verification of
certification renewals will result in termination of enrollment in the Arkansas
Medicaid Program.
Disclaimer: These regulations may not be the most recent version. Arkansas may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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