Current through Register Vol. 49, No. 9, September, 2024
Section II Hearing
Services
SECTION II HEARING
SERVICES
201.000
Arkansas
Medicaid Participation Requirements
for Hearing
Aid
Dealers
Hearing aid dealers must meet the following criteria to
participate in the Arkansas Medicaid Program.
A. Hearing aid dealers, physicians and
audiologists in Arkansas must be licensed as Hearing Aid dealers. Audiologists
licensed in Arkansas may provide both audiology service and the dispensing of
hearing aids with their audiologist license. Hearing aid dealers, physicians
and audiologists outside of Arkansas must be licensed by their states as
hearing aid dealers. A current copy of the applicable license must accompany
the provider application and Medicaid contract.
1. A copy of subsequent state licensure
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.
2. Failure to timely submit
verification of license renewal will result in termination of enrollment in the
Arkansas Medicaid Program.
B. 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).
C. 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.
D. The provider must adhere to all applicable
professional standards of care and conduct.
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).
202.000
Participation Requirements for
Individual Audiologists
Audiologists must meet the following criteria to participate in
the Arkansas Medicaid Program:
A. 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) 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. Audiologists
must be licensed in their states as audiologists. Audiologists with an Arkansas
license may also dispense hearing aids as per Arkansas Act 1171 of 1991.
1. A copy of the current state license must
accompany the provider application and Medicaid contract.
2. A copy of subsequent state licensure
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.
3. Failure to timely submit verification of
license renewal will result in termination of enrollment in the Arkansas
Medicaid Program.
D. The
provider must adhere to all applicable professional standards of care and
conduct.
NOTE: An audiologist licensed outside the state of
Arkansas who has a Hearing Aid Dealer license and an Audiology license must
enroll under both programs. A provider application and Medicaid contract must
be completed for each program, and two (2) separate Medicaid provider numbers
will be assigned.
202.100
Group Providers of Audiology Services in Arkansas and Bordering
States
Group providers of Audiology Services must meet the following
criteria to be eligible for participation in the Arkansas Medicaid
Program.
A. In order for a group of
audiologists to receive Arkansas Medicaid reimbursement, the group and each
individual audiologist must enroll in Arkansas Medicaid.
1. Each audiologist member of the group who
intends to treat Medicaid beneficiaries must enroll in accordance with the
requirements in section
202.000.
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).
3.
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.
B.
All group providers are "pay to" providers only. The service must be performed
and billed by the performing licensed and enrolled audiologist with the
group.
NOTE: An audiologist licensed outside the state of
Arkansas who has a Hearing Aid Dealer License and an Audiology License must
enroll under both programs. A provider application and Medicaid contract must
be completed for each program, and two (2) separate Medicaid provider numbers
will be assigned.
203.000
Providers in Arkansas and Bordering States
Hearing Services providers in Arkansas and the six bordering
states (Louisiana, Mississippi, Missouri, Oklahoma, Tennessee and Texas) will
be enrolled as routine services providers.
Routine Services Provider
A. Provider is enrolled in the program as a
regular provider of routine services.
B. Reimbursement will be available for all
hearing services covered in the Arkansas Medicaid Program.
C. Paper claims must be filed according to
Section 240.000 of this manual.
Information regarding electronic claim filing is available in Section
III of this manual.
203.100
Providers in States Not
Bordering Arkansas A. 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.
View or print Provider
Enrollment Unit contact information.
A non-bordering state provider may download the provider manual
and provider application materials from the Arkansas Medicaid website,
www.medicaid.state.ar.us/lnternetSolution/Provider/Provider.aspx,
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 the Arkansas Medicaid fiscal
agent.
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.
205.000
Record Keeping Requirements
DHHS requires retention of all records for five (5) years. All
medical records shall be completed promptly, filed and retained for a minimum
of five (5) years from the date of service or until all audit questions, appeal
hearings, investigations or court cases are resolved, whichever is longer.
Failure to furnish records upon request may result in sanctions being
imposed.
A. The provider must
contemporaneously create and maintain records that completely and accurately
explain all evaluations, care, diagnoses and any other activities of the
provider in connection with its delivery of medical assistance to any Medicaid
beneficiary.
B. Providers
furnishing any Medicaid-covered good or service for which a prescription,
admission order, physician's order, care plan or other order for service
initiation, authorization or continuation is required by law, by Medicaid rule,
or both, must obtain a copy of the aforementioned prescription, care plan or
order within five (5) business days of the date it is written. Providers also
must maintain a copy of each prescription, care plan or order in the
beneficiary's medical record and follow all prescriptions, care plans, and
orders as required by law, by Medicaid rule, or both.
C. The provider must make available to the
Division of Medical Services, its contractors and designees and the Medicaid
Fraud Control Unit all records related to any Medicaid beneficiary.
1. All documentation must be available at the
provider's place of business.
2.
When records are stored off-premise or are in active use, the provider may
certify, in writing, that the records in question are in active use or in
off-premise storage and set a date and hour within three (3) working days, at
which time the records will be made available. However, the provider will not
be allowed to delay for matters of convenience, including availability of
personnel.
3. If an audit
determines that recoupment is necessary, there will be no more than thirty (30)
days after the date of recoupment notice in which additional documentation will
be accepted.
