Current through Register Vol. 49, No. 9, September, 2024
201.000
Arkansas Medicaid
Participation Requirements for Pharmacy Providers
Providers of pharmacy services must meet the following criteria
in order to be eligible for participation in the Arkansas Medicaid
Program:
A. The pharmacy must complete
a provider application, a Medicaid contract and a Request for Taxpayer
Identification Number and Certification 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 (W-9).
B. The pharmacy must have a current retail
pharmacy permit issued by the applicable State Board of Pharmacy. A current
copy of the pharmacy permit must accompany the provider application and
Medicaid contract. Subsequent permits must be provided when renewed.
1. Subsequent retail pharmacy permit renewal
must be forwarded to the Medicaid Provider Enrollment Unit within 30 days of
issuance.
2. Failure to ensure that
current permit and/or certification is on file with the Medicaid Provider
Enrollment Unit will result in termination from the Arkansas Medicaid
Program.
C. The pharmacy
must have a DEA number issued by Drug Enforcement Agency. A current copy of the
DEA certificate must accompany the provider application, Request for Taxpayer
Identification Number and Certification, and Medicaid contract. Subsequent
certificates must be provided when renewed.
1.
Subsequent DEA certifications must be forwarded to Provider Enrollment within
30 days of issuance.
2. Failure to
ensure that current DEA certification is on file with the Medicaid Provider
Enrollment Unit will result in termination from the Arkansas Medicaid
Program.
D. Indian
Health Services (HIS) pharmacy providers enrolled in other states' pharmacy
programs will meet Arkansas enrollment criteria if they provide proof of other
state enrollment.
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. The Pharmacy
provider must adhere to all applicable professional standards of care and
conduct.
211.000
Scope
The Arkansas Medicaid Pharmacy Program conforms to the Medicaid
Prudent Pharmaceutical Purchasing Program (MPPPP) that was enacted as part of
the Omnibus Budget Reconciliation Act (OBRA) of 1990. This law requires
Medicaid to limit coverage to drugs manufactured by pharmaceutical companies
that have signed rebate agreements. A numeric listing of approved
pharmaceutical companies and their respective labeler codes is located on the
Arkansas Division of Medical Services (DMS) Web site at
www.medicaid.state.ar.us. View or print numeric listing of
approved pharmaceutical companies and their respective labeler
codes. Except for drugs in the categories excluded from
coverage, Arkansas Medicaid covers all drug products manufactured by companies
with listed labeler codes. As additions or deletions by labelers are submitted
to the State by the Centers for Medicare and Medicaid Services (CMS), the Web
site will be updated.
The Arkansas Medicaid Program will cover the following drug
categories:
A. Prescription drugs are
covered by the Arkansas Medicaid Program pursuant to an order from an
authorized prescriber. The Multisource Drugs Listing located on the DMS Web
site at www.medicaid.state.ar.us lists those products covered by the Arkansas
Medicaid Program that have a generic upper limit (See Section 251.300 for an
explanation of generic upper limit.)
As changes are made to the drug coverage, providers will be
notified of the revisions.
B. Over-the-counter items are listed on the
Web site at www.medicaid.state.ar.us. These items are covered only if they
contain an appropriate National Drug Code on their label and are manufactured
by a company that has signed a rebate agreement. Over-the-counter items are not
covered for long-term care facility residents. View or print a list
of over-the-counter items.
C. For individuals age 21 years and older,
the Arkansas Medicaid Program will reimburse pharmacies the cost of
administering, by injection, two types of vaccines:
1. Influenza virus vaccine, whole virus, for
intramuscular or jet injection use and
2. Pneumococcal polysaccharide vaccine,
23-valent, adult or immunosuppressed patient dosage, for subcutaneous or
intramuscular use.
NOTE: The Arkansas Medicaid Program will cover the
above-listed vaccines only for Medicaid beneficiaries age 21 years and
older.
A prescription order from an authorized prescriber must be on
file; however, no primary care physician (PCP) referral is required to
administer the vaccines.
These vaccines are payable for Medicaid-eligible beneficiary
age 21 years and older. The influenza virus vaccine is limited to one per state
fiscal year (July through June). The pneumococcal polysaccharide vaccine is
limited to one every ten years.
Medicaid will reimburse the Medicare deductible and/or
coinsurance for all beneficiaries receiving both Medicare and Medicaid
benefits.
Pharmacies must use the CMS-1500 claim form when billing
Medicaid for these vaccines.
NOTE: Please refer to section 262.100 for the procedure
codes for influenza virus and pneumococcal polysaccharide vaccines.
212.000
Exclusions
A. Products manufactured by non-rebating
pharmaceutical companies.
B.
Effective January 1, 2006, the Medicaid agency will not cover any drug covered
by Medicare Part D for full-benefit dual eligible individuals who are entitled
to receive Medicare benefits under Part A or Part B.
C. The Medicaid agency provides coverage, to
the same extent that it provides coverage for all Medicaid beneficiaries under
§ 1927 (d) of the Social Security Act, for the following excluded or
otherwise restricted drugs or classes of drugs, or their medical uses; with the
exception of those covered by Part D plans as supplemental benefits through
enhanced alternative coverage as provided in
42
CFR §
423.104(f) (1) (ii)
(A) to full benefit dual eligible
beneficiaries under the Medicare Prescription Drug Benefit- Part D.
The following excluded drugs set forth on the Arkansas Medicaid
website (www.medicaid.state.ar.us), are covered:
1. select agents when used for weight
gain
2. select agents when used for
the symptomatic relief of cough and colds
3. select prescription vitamins and mineral
products, except prenatal vitamins and fluoride
4. select nonprescription drugs
5. select agents when used to promote smoking
cessation
6. barbiturates
7. benzodiazepines
D. Medical accessories are not covered under
the Arkansas Medicaid Pharmacy Program. Typical examples of medical accessories
are atomizers, nebulizers, hot water bottles, fountain syringes, ice bags and
caps, urinals, bedpans, glucose monitoring devices and supplies, cotton, gauze
and bandages, wheelchairs, crutches, braces, supports, diapers and nutritional
products.
214.000
Appealing An Adverse Action
Please see section
190.000 et al for information
regarding administrative appeals.
221.000
Record-Keeping
Requirements
A. Medicaid requires that
drug records (e.g., purchase invoices, official dispensing records,
prescriptions and inventory records) must be kept in a manner that is readily
retrievable and retained for at least five (5) years or until all issues are
resolved regarding audits, litigations, appeals, etc. Although the Arkansas
State Board of Pharmacy requires record retention for at least two (2) years,
the record-retention requirement is expanded to five (5) years for Medicaid
providers.
B. The Pharmacy 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.
C. Pharmacy providers furnishing any
Medicaid-covered service, for which a prescription is required by law, by
Medicaid rule, or both, must have a copy of the prescription for such good or
service. Unless required earlier by other rule or law, the provider must obtain
a copy of the prescription within five (5) business days of the date the
prescription is written.
D. The
Pharmacy provider must maintain a copy of each relevant prescription in the
Medicaid beneficiary's records and follow all prescriptions and care
plans.
E. Upon request, providers
must immediately furnish records to authorized representatives of the Arkansas
Division of Medical Services, the State Medicaid Fraud Unit, representatives of
the Department of Health and Human Services (DHHS), the Medicaid Fraud Division
of the Attorney General's Office and the Centers for Medicare and Medicaid
Services (CMS). Failure to furnish records upon request may result in sanctions
being imposed.
