Arkansas Administrative Code
Agency 016 - DEPARTMENT OF HUMAN SERVICES
Division 06 - Medical Services
Rule 016.06.07-054 - Section I Provider Manual Update Transmittal
Universal Citation: AR Admin Rules 016.06.07-054
Current through Register Vol. 49, No. 9, September, 2024
171.210 Caseload Maximum and PCP Caseload Limits
A. Each PCP may
establish an upper limit to his or her Medicaid caseload, up to the default
maximum of 1000.
1. The state may permit
higher maximum caseloads in areas the federal government has designated as
medically underserved.
2. The state
may permit higher maximum caseloads for PCPs who state in writing that a
caseload limit of 1000 will create a hardship for them, their patients and/or
the community they serve.
B. The state will not require any PCP to
accept a caseload greater than the PCP's requested caseload maximum.
C. A PCP may increase or decrease his or her
maximum desired caseload by any amount, at any time, by submitting a signed
request to their Arkansas Foundation for Medical Care (AFMC) Medicaid Managed
Care Services (MMCS) Provider Relations Representative. Prior to making the
request for an increase of a caseload that is already at it's maximum, the PCP
is encouraged to review their caseload using the AFMC AMII (Arkansas Medicaid
Information Interchange) web portal for inactive patients to determine if those
patients should be removed from their caseload. If it is determined that the
inactive patients should be removed from their caseload, the PCP must:
1. Contact the patient in writing at least 30
days in advance of the effective date of the termination to give the patient
the option of making a visit to the PCP to remain an active patient. If the
patient does not choose to make a visit to the PCP, the termination can be
effective at the end of 30 calendar days.
2. The PCP may see new patients with approval
from AFMC Medicaid Managed Care Services during the 30 calendar day
notification process.
3. The notice
must state that the enrollee has 30 calendar days in which to enroll with a
different PCP.
4. The PCP must
forward a copy to the enrollee to the local DHS office in the enrollee's county
of residence.
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.
This site is protected by reCAPTCHA and the Google
Privacy Policy and
Terms of Service apply.
