Current through Register Vol. 49, No. 9, September, 2024
201.000
Arkansas Medicaid Participation Requirements
Individual and group providers of occupational therapy,
physical therapy and speech-language pathology services must meet the following
criteria to be eligible to participate in the Arkansas Medicaid Program.
A. A provider of therapy services must meet
the enrollment criteria for the type of therapy to be provided as established
and outlined in section
202.000 of this manual.
B. A provider of therapy services has the
option of enrolling in the Title XVIII (Medicare) Program. When a beneficiary
is dually eligible for Medicare and Medicaid, providers must bill Medicare
prior to billing Medicaid. The beneficiary may not be billed for the charges.
Providers enrolled to participate in the Title XVIII (Medicare) Program must
notify the Arkansas Medicaid Program of their Medicare provider number. Claims
filed by Medicare "nonparticipating" providers do not automatically cross over
to Medicaid for payment of deductibles and coinsurance.
C. The 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), Medicaid contract (form DMS-653) and Request for
Taxpayer Identification Number and Certification (Form
W-9).
D. The
following documents must accompany the provider application and the Medicaid
contract.
1. A copy of all certifications and
licenses verifying compliance with enrollment criteria for the therapy
discipline to be practiced. (See section
202.000 of this
manual.)
2. If enrolled in the
Title XVIII (Medicare) Program, an out-of-state provider must submit a copy of
verification that reflects current enrollment in that program.
E. 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.
F. A copy of subsequent state license renewal
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.
G. Failure to timely submit
verification of license renewal will result in termination of enrollment in the
Arkansas Medicaid Program.
201.100
Group Providers of Therapy
Services
Group providers of therapy services must meet the following
criteria to be eligible for participation in the Arkansas Medicaid
Program.
A. In situations where a
therapist, a therapy assistant, a speech-language pathologist or a
speech-language pathology assistant is a member of a group of therapy service
providers, each individual therapist, speech-language pathologist, or assistant
and the group must both enroll.
1. Each individual in the group must enroll
following the participation requirements in section
201.000 and by meeting the
enrollment criteria established in section
202.000 for the applicable
therapy disciplines.
2. The group
must also enroll in the Arkansas Medicaid Program by completing and submitting
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), Medicaid contract (form DMS-653) and 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.
3. The group has the option of enrolling in
the Title XVIII (Medicare) program. (See subpart B of section
201.000 of this
manual.)
4. The group must also
comply with subsequent certifications and license renewals as outlined in
section 201.000, subparts F and
G.
B. Group providers
are "pay to" providers only. The service must be performed and
billed by the performing licensed and Medicaid-enrolled therapist,
speech-language pathologist, therapy assistant or speech-language pathology
assistant with the group.
216.300
Procedures for Obtaining
Extension of Benefits for Therapy
Services
A. Requests for extension of benefits for
therapy services for beneficiaries under age 21 must be mailed to the Arkansas
Foundation for Medical Care, Inc. (AFMC).
View or print the
Arkansas Foundation for Medical Care, Inc., contact
information. A request for extension of benefits must meet
the medical necessity requirement, and adequate documentation must be provided
to support this request.
1. Requests for
extension of benefits are considered only after a claim is denied because the
patient's benefit limits are exhausted.
2. The request for extension of benefits must
be received by AFMC within 90 calendar days of the date of the
benefits-exhausted denial.
3.
Submit with the request a copy of the Medical Assistance Remittance and Status
Report reflecting the claim's denial for exhausted benefits. Do not send a
claim.
4. AFMC will not accept
extension of benefits requests sent via electronic facsimile (FAX).
B. Form DMS-671, Request for
Extension of Benefits for Clinical, Outpatient, Laboratory, and X-Ray Services,
must be utilized for requests for extension of benefits for therapy services.
View or print form DMS-671 .
Consideration of requests for extension of benefits requires correct completion
of all fields on this form. The instructions for completion of this form are
located on the back of the form. The provider's signature (with his or her
credentials) and the date of the request are required on the form. Stamped or
electronic signatures are accepted. All applicable records that support the
medical necessity of the extended benefits request should be
attached.
C. AFMC will approve or
deny an extension of benefits request - or ask for additional information
-within 30 calendar days of their receiving the request. AFMC reviewers will
simultaneously advise the provider and the beneficiary when a request is
denied.
216.310
Reconsideration of Extension of Benefits Denial
A request for reconsideration of an extension of benefits
denial must be in writing and must include a copy of the denial letter as well
as additional supporting documentation. The written reconsideration request
must be received by AFMC within 31 calendar days from the next business day
following the date of the postmark on the denial notice envelope.
216.315
Documentation
Requirements
A. To request an
extension of benefits for any benefit-limited service, all applicable records
that support the medical necessity of extended benefits are required.
B. Documentation requirements are as follows.
Clinical records must:
1. Be legible and
include records supporting the specific request
2. Be signed by the performing
provider
3. Include the physician
referral and prescription for additional therapy based on clinical records and
progress reports furnished by the performing provider
262.400
Special Billing
Procedures
Services may be billed according to the care provided and to
the extent each procedure is provided. Occupational, physical and speech
therapy services do not require prior authorization.
Extension of benefits may be provided for all therapy services
if medically necessary for beneficiaries under age 21. Refer to sections
216.000 through
216.315 of this manual for more
information.
