Current through Register Vol. 49, No. 9, September, 2024
Section II Transportation
201.100
Ground Ambulance Providers
Providers of ground ambulance transportation must meet the
following criteria in order to be eligible for participation in the Arkansas
Medicaid Program:
A. Provider must
complete a provider application (DMS-652), a Medicaid contract (DMS-653) and a
Request for Taxpayer Identification Number and Certification (W-9) with the
Arkansas Medicaid Program. 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).
B.
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.
C. A current
copy of the ambulance license issued by the applicable State Ambulance Board
must accompany the provider application and Medicaid contract. Subsequent
license renewal must be provided when issued.
1. Subsequent license renewal must be
forwarded to Provider Enrollment within 30 days of issuance.
2. Failure to ensure that current licensure
and/or certification is on file with Provider Enrollment will result in
termination from the Arkansas Medicaid Program.
D. Ambulance transportation providers who
wish to be reimbursed for Advanced Life Support services must submit a written
request and a current copy of the ambulance license that reflects paramedic,
intermediate or EBLS (Enhanced Basic Life Support). Please refer to Section
252.410 for special billing
instructions regarding Advanced Life Support.
E. The ambulance company must be enrolled in
the Title XVI II (Medicare)
Program.
F. The ambulance
transportation provider must adhere to all applicable professional standards of
care and conduct.
201.200
Air Ambulance Providers
Providers of air ambulance transportation must meet the
following criteria in order to be eligible for participation in the Arkansas
Medicaid Program:
A. Provider must
complete a provider application (Form DMS-652), a Medicaid contract (Form
DMS-653) and a Request for Taxpayer Identification Number and Certification
(Form W-9) with the Arkansas Medicaid Program. 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).
B.
Enrollment as a Medicaid provider is conditioned upon approval of a completed
provider application and the execution of 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.
C. The
ambulance company must be in enrolled in the Title XVIII (Medicare)
Program.
D. A current copy of the
ambulance license issued by the applicable State Ambulance Board must accompany
the provider application and Medicaid contract. Subsequent license renewal must
be provided when issued.
1. Subsequent license
renewal must be forwarded to Provider Enrollment within 30 days of
issuance.
2. Failure to ensure that
current licensure and/or certification is on file with Provider Enrollment will
result in termination from the Arkansas Medicaid Program.
E. The ambulance transportation provider must
adhere to all applicable professional standards of care and conduct.
203.000
Ambulance Providers
in States Not Bordering Arkansas A.
Ambulance providers in states not bordering Arkansas may enroll as closed-end
providers after they have furnished services to an Arkansas Medicaid
beneficiary and have a claim to file with Arkansas Medicaid.
1. A non-bordering state provider may send a
claim to Provider Enrollment and Provider Enrollment will forward by return
mail a provider manual and a provider application and contract.
View or print Provider Enrollment Unit Contact
information.
2.
Alternatively, a non-bordering state provider may download the provider manual
and provider application materials from the Arkansas Medicaid website,
www.medicaid.state.ar.us, and then submit its application and claim to the
Medicaid Provider Enrollment Unit.
B. Closed-end providers remain enrolled for
one year.
1. If a closed-end provider treats
another Arkansas Medicaid beneficiary during the year of enrollment and bills
Medicaid, the enrollment may continue for one year past the newer claim's last
date of service, if the provider keeps the enrollment file current.
2. During the enrollment period the provider
may file any subsequent claims directly to EDS.
3. Closed-end providers are strongly
encouraged to submit claims through the Arkansas Medicaid website because the
front-end processing of web-based claims ensures prompt adjudication and
facilitates reimbursement.
204.000
Physician's Role in Ambulance
Services
Ambulance service for eligible Medicaid beneficiaries is
covered by Medicaid when a physician certifies that the ambulance
transportation is medically necessary. It is the responsibility of the
transportation provider to maintain physician documentation verifying the
medical necessity of ambulance transportation.
205.000
Records Ambulance Providers
Are Required to Keep
A. Ambulance
providers are required to keep the following records and, upon request, to
immediately furnish the records to authorized representatives of the Arkansas
Division of Medical Services and the State Medicaid Fraud Control Unit and to
representatives of the Department of Health and Human Services:
1. Verification of the diagnosis
2. Copy of the certification of necessity by
a physician
3. Medicare
documentation
4. Record of place of
origin, destination, date, who was transported
5. Number of miles traveled one-way (Medicaid
only reimburses one-way mileage to ambulance providers)
B. All required records must be kept for a
period of five (5) years from the ending date of service; or until all audit
questions, appeal hearings, investigations or court cases are resolved,
whichever period is longer.
C.
Furnishing medical records on request to authorized individuals and agencies
listed above in subpart A is a contractual obligation of providers enrolled in
the Medicaid Program. Failure to furnish medical records upon request may
result in the imposition of sanctions.
D. The provider must contemporaneously
establish and maintain records that completely and accurately explain all
evaluations, care, diagnoses and any other activities in connection with any
Medicaid beneficiary.
E. At the
time of an audit by the Division of Medical Services, Medicaid Field Audit
Unit, all documentation must be available at the provider's place of business
during normal business hours. All documentation must be immediately made
available to representatives of the Division of Medical Services at the time of
an audit by the Medicaid Field Audit Unit. There will be no more than thirty
days allowed after the date of the recoupment notice in which additional
documentation will be accepted.
211.000
Introduction
The Medical Assistance (Medicaid) Program is designed to assist
Medicaid beneficiaries in obtaining medical care within the guidelines
specified in Section I of this manual. Reimbursement may be made for ambulance
services within the Medicaid Program's limitations. Ambulance services must be
certified as medically necessary by a physician.
212.000
Scope
Emergency ambulance services may be covered only when provided
by an ambulance company that is licensed by the Arkansas State Ambulance Board
and is an enrolled provider in the Arkansas Medicaid Program. Emergency
ambulance services may be covered only when an emergency exists for the
transported individual. (See the Glossary-Section
IV of this manual- for a
definition of "emergency services.")
Ground ambulance services must be provided by a licensed
ambulance service, even if the trip is a routine or non-emergency
transfer.
Air ambulance services are covered for eligible Medicaid
beneficiaries on an emergency basis or as deemed medically necessary by a
physician.
When emergency ambulance services are provided as described
above, and the beneficiary is transported to the hospital, the Arkansas
Medicaid Program will cover the ambulance transportation only when the
beneficiary is admitted to the hospital or when the patient's condition is an
emergency. (See the Glossary-Section
IV of this manual-for a
definition of "emergency services.")
212.100
Subscription Plans for
Ambulance Services
When ambulance subscription plans operate as insurance
policies, Medicaid considers them third party resources. Federal regulations
define private insurer, in part, to be "any...prepaid plan offering either
medical services or full or partial payment..." As long as the membership fee
paid by a Medicaid beneficiary is treated by the ambulance subscription plan as
an insurance premium and the ambulance company does not then bill Medicaid for
ambulance services provided to the Medicaid beneficiary, the ambulance company
will not be in violation of Medicaid regulations. If, on the other hand, the
ambulance provider collects a membership fee from Medicaid beneficiaries and
then bills Medicaid for ambulance services provided to those Medicaid
beneficiaries, the provider will be in violation of the Medicaid regulations by
soliciting and/or accepting the membership fee.
Any ambulance company that markets a subscription plan must
make it very clear in its marketing materials that Medicaid beneficiaries are
not required to pay an enrollment fee to the subscription plan or make
voluntary contribution to the subscription plan provider in order to avoid
charges for medically necessary ambulance transportation.
213.000
Pick-Up and Delivery Locations
Medicaid will cover ambulance services for Medicaid
beneficiaries to and/or from the following locations when certified by the
physician that transportation by ambulance is medically necessary:
A. From the location a beneficiary has an
accident or becomes ill to a hospital.
B. From the patient's home or place of
residence to a hospital.
C. From a
nursing home to a hospital.
D. From
a hospital (after receiving emergency outpatient treatment) to a nursing home
if the patient is bedridden.
E.
From a hospital (after being discharged from an inpatient stay) to a nursing
home when the beneficiary is being admitted to the nursing home.
F. From a hospital to a hospital for
inpatient services. However, if a patient is transported from a hospital to
receive services on an outpatient basis, the cost of the ambulance is included
in the hospital reimbursement amount. The ambulance company may not bill
Medicaid or the beneficiary for the service.
G. From the patient's home or place of
residence to a nursing home when the beneficiary is being admitted to the
nursing home.
H. From a nursing
home (after being discharged) to a patient's home or place of
residence.
I. From a hospital to
the patient's home or place of residence following an inpatient hospital
stay.
J. From a nursing home to a
nursing home when the original nursing home has been decertified by Medicaid
and the transportation is determined necessary by the Office of Long Term Care,
Arkansas Division of Medical Services. In these instances, the Arkansas
Medicaid Program will contact the Ambulance Transportation provider who is
rendering the service to provide special billing instructions.
216.000
Ambulance Trips
with Multiple Medicaid Beneficiaries
There will be occasions when more than one eligible Medicaid
beneficiary is picked up and transported in an ambulance at the same time. When
this situation exists, the procedures listed below must be followed:
A. A separate claim must be filed for each
eligible Medicaid beneficiary. Each claim must have a physician
certification.
B. If there is a
mileage charge, it must be charged on only one of the eligible beneficiary's
claims.
C. The basic pickup charge
and other procedures that are used may be charged on each eligible
beneficiary's claim.
NOTE: If an eligible beneficiary and her newborn child
are transported at the same time, the above procedures will apply. However, if
the newborn has not been certified Medicaid eligible, it will be the
responsibility of the parent(s) to apply and meet
the eligibility requirements for the newborn to be
certified as Medicaid eligible. If the newborn is not certified as Medicaid
eligible, the parent(s) will be responsible for the charges incurred by the
newborn.
242.000
Rate Appeal Process
A provider may request reconsideration of a Program decision by
writing to the Assistant Director, Division of Medical Services. This request
must be received within 20 calendar days following the application of policy
and/or procedure or the notification of the provider of its rate. Upon receipt
of the request for review, the Assistant Director will determine the need for a
program/provider conference and will contact the provider to arrange a
conference if needed. Regardless of the program decision, the provider will be
afforded the opportunity for a conference, if he or she so wishes, for a full
explanation of the factors involved and the program decision. Following review
of the matter, the Assistant Director will notify the provider of the action to
be taken by the Division within 20 calendar days of receipt of the request for
review or the date of the program/provider conference.
If the decision of the Assistant Director, Division of Medical
Services is unsatisfactory, the provider may then appeal the question to a
standing Rate Review Panel established by the Director of the Division of
Medical Services which will include one member of the Division of Medical
Services, a representative of the provider association and a member of the
Department of Health and Human Services (DHHS) Management Staff, who will serve
as chairman.
The request for review by the Rate Review Panel must be
postmarked within 15 calendar days following the notification of the initial
decision by the Assistant Director, Division of Medical Services. The Rate
Review Panel will meet to consider the question(s) within 15 calendar days
after receipt of a request for such appeal. The question(s) will be heard by
the panel and a recommendation will be submitted to the Director of the
Division of Medical Services.
251.000
Introduction to Billing
Ambulance transportation providers use the CMS-1500 claim
format to bill the Arkansas Medicaid Program for services provided to eligible
Medicaid beneficiaries. Each claim must contain charges for only one
beneficiary.
Section
III of this manual contains information about Provider Electronic
Solutions (PES) and other available options.
