Arkansas Administrative Code
Agency 016 - DEPARTMENT OF HUMAN SERVICES
Division 06 - Medical Services
Rule 016.06.09-011 - State Plan Amendment #2008-018; Nurse Practitioner Update #77 and Section V - Provider Application Form (DMS-652)
Current through Register Vol. 49, No. 9, September, 2024
200.000. NURSE PRACTITIONER GENERAL INFORMATION
201.000
The Arkansas Medicaid Program enrolls registered nurse practitioners or advanced practice nurses for participation in the Nurse Practitioner Program. To participate in the Arl[LESS THAN]ansas Medicaid Program, providers must adhere to all applicable professional standards of care and conduct and meet all enrollment requirements listed below.
A. The provider must be licensed by the state authority in the state in which sen/ices are furnished.
B. The provider must complete a provider application (form DMS-652), a Medicaid contract (fonn 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 Gertification (Form W-9).
C. The following documents must be submitted with the provider application and Medicaid contract:
D. Enrollment as a Medicaid provider is conditioned upon approval of a completed provider applicatibh and the execution of a Medicaid Provider Agreement.
E. 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.
When a provider is a membei- of a group and payment is to go to the group, the individual provider and the group must both enroll according to the requirements below.
All group providers are "pay to"providers only. The Medicaid service must be provided by a certifiecl and enrolled registered nurse practitioner or advahced practice nurse within the group.
Providers in Arkansas and the six bordering states (Louisiana, Mississippi, Missouri, Oklahoma, Tennessee and Texas) that satisfy Arkansas Medicaid participation requirements may be enrolled as routine services providers.
Routine services providers may furnish and claim reimbursement for services covered by Arkansas Medicaid, subject to benefit limitations and coverage restrictions set forth in this manual.
* A rion-bprdering state:;|irovider may down the provider itianual and provider application matenalsfrorh the Arkansas Medicaid websites,
www.medicaid.state.ar.us/internetSolution/Prbvideri'Provider.aspx. arid then submit the application and claim to the Medicaid Provider Enrollment Unit.
Nurse
The registered nurses practitibnerrnust be certified as g registerjed nurse practitioner by the state in which services are furnished.
Advanced practice nurses must hold certification from a nationally rgcpgnized certifying body approved tiy the state in which services are furnished. Certification inUst be in the category and the specialty for which the advanced practice nurse is educationally prepared.
MEDICAL ASSISTANCE PROGRAM j
DIV ISION OF MEDICAL SERVICES
PROVIDER APPLICATION
As a condition for entering Into or renewing a provider agreement, all applicants must complete this provider i application. A true, accurate and complete disclosure of all requested information is required by the Federal and State Regulations that govern the Medical Assistance Program. Failure of an applicant to submit the requested information or the submission of inaccurate or incomplete information may result in refusal by the Medical Assistance program to enter into, renew or continue a provider agreement with the applicant. Furthermore, the applicant is required by Federal and State Regulations to update the information submitted on the Provider Application.
Whenever changes in this information occur, please submit the change in writing to:
Medicaid Provider Enrollment Unit
EDS
P.O. Box 8105
Little Rock, AR 72203-8105
All dates, except where otherwise specified, should be written in the month/day/year (MMDDYY) format. Please print all information.
This information is divided into sections. The following describes which sections are to be completed by the applicant:
|
Section 1 |
All providers |
|
Section II |
Facilities Only |
|
Section III Section IV |
Pharmacists/Registered Respiratory Therapist Only Provider Group Affiliations |
|
Electronic Fund Transfer |
All Providers (optional) |
|
Managed Care Agreement - |
Primary Care Physician |
|
W-9 Tax Form |
All Providers |
|
Contract |
All Providers |
|
Ownership and Conviction |
|
|
Disclosure |
All Providers |
|
Disclosure of Significant |
|
|
Business Transactions |
All Providers |
ATTACHMENT 3.1-A
AMOUNT, DURATION AND SCOPE OF SERVICES PROVIDED
[LESS THAN]
The benefit limit will be considered in conjunction with the benefit limit established for rural health clinic services, medical services furnished by a dentist, office medical services furnished by an optometrist, certified nurse midwife services and advanced practice nurse or registered nurse practitioner services or a combination of the six. Beneficiaries under age 21 in the Child Health Services (EPSDT) Program are not benefit limited.
Certain services, specified in the appropriate provider manual, are not counted toward the 12 visit limit.
For physicians' services, medical services provided by a dentist, office medical services furnished by an optometrist, certified nurse midwife services or rural health clinic core services beyond tlie 12 visit limit, extensions will be provided if medically necessary.
Advanced Nurse Practitioners and Registered Nurse Practitioners
Office medical services provided by an advanced nurse practitioner and registered nurse practitioner are limited to twelve (12) visits per State Fiscal Year (July 1 through June 30) for beneficiaries age 21 and over. The benefit limit will be in conjunction with the benefit limit established for physicians' services, medical services furnished by a dentist, rural health clinic services, certified nurse midwife services and advanced practice nurse or registered nurse practitioner or a combination of the six. For services beyond the twelve (12) visit limit, extensions will be provided if medically necessary. Certain services, specified in the appropriate provider manual, are not counted toward the 12 visit limit. Beneficiaries in the Child Health Services (EPSDT) Program are not benefit limited.
Any person possessing the qualifications for a registered nurse in the State of Arkansas who is also certified as a nurse-midwife by the American College of Nurse-Mid wives, upon application and payment of the requisite fees to the Arkansas State Board of Nursing, be qualified for licensure as a certified nurse-midwife. A certified nurse-midwife meeting the requirements of Arkansas Act 409 of 1995 is authorized to practice nurse-midwifery.
Services provided by a certified nurse midwife are limited to twelve (12) visits a year for beneficiaries age 21 and older. This yearly limit is based on the State Fiscal Year (July 1 through June 30). The benefit limit will be considered in conjunction with the benefit limit established for physicians' services, medical services furnished by a dentist, rural health clinic services, office medical services furnished by an optometrist and advanced practice nurse or registered nurse practitioner or a combination of the six. For services beyond the twelve visit limit, extensions will be provided if medically necessary. Certain services, specified in the appropriate provider manual, are not counted toward the 12 visit limit. Beneficiaries under age 21 in the Child Health Services (EPSDT) program are not benefit limited.
ATTACHMENT 3.1-B
AMOUNT, DURATION AND SCOPE OF SERVICES PROVIDED
The benefit limit will be considered in conjunction with the benefit limit established for rural health clinic services, medical services furnished by a dentist, office medical services furnished by an optometrist, certified nurse midwife services and services provided by an advanced practice nurse or registered nurse practitioner or a combination of the siX; Beneficiaries under age 21 in the Child Health Services (EPSDT) Program are not benefit limited.
Certain services, specified in the appropriate provider manual, are not counted toward the 12 visit limit.
For services beyond the 12 visit limit, extensions will be provided if medically necessary.
Each attending physician/dentist is limited to billing one day of care for inpatient hospital covered days regardless of the number of hospital visits rendered.
The benefit limit will be considered in conjunction with the benefit limit established for physicians' services, rural health clinic services, office medical services furnished by an optometrist, certified nurse midwife services and services provided by an advanced practice nurse or registered nurse practitioner or a combination of the six. For services beyond the 12 visit limit, extensions will be provided if medically necessary. Certain services, specified in the appropriate provider manual, are not counted toward the 12 visit limit. Recipients under age 21 in the Child Health Services (EPSDT) Program are not benefit limited.
Surgical services furnished by a dentist are not benefit limited.
Advanced Nurse Practitioners and Registered Nurse Practitioners
Office medical services provided by an advanced nurse practitioner and registered nurse practitioner are limited to twelve (12) visits per State Fiscal Year (July 1 through June 30) for beneficiaries age 21 and over. The benefit limit will be in conjunction with the benefit limit established for physicians' services, medical services furnished by a dentist, rural health clinic services, certified nurse midwife services and advanced practice nurse or registered nurse practitioner or a combination of the six. For services beyond the twelve (12) visit limit, extensions will be provided if medically necessary. Certain services, specified in the appropriate provider manual, are not counted toward the 12 visit limit. Beneficiaries in the Child Health Services (EPSDT) Program are not benefit limited.
Any person possessing the qualifications for a registered nurse in the State of Arkansas who is also certified as a nurse-midwife by the American College of Nurse-Midwives, upon application and payment of the requisite fees to the Arkansas State Board of Nursing, be qualified for licensure as a certified nurse-midwife. A certified nurse-midwife meeting the requirements of Arkansas Act 409 of 1995 is authorized to practice nurse-midwifery.
Services provided by a certified nurse midwife are limited to twelve (12) visits a year for beneficiaries age 21 and older. This yearly limit is based on the State Fiscal Year (July 1 through June 30). The benefit limit will be considered in conjunction with tlie benefit limit established for physicians' services, medical services furnished by a dentist, rural health clinic services, office medical services furnished by an optometrist and services provided by an advanced practice nurse or registered nurse practitioner or a combination of the six. For services beyond the twelve visit limit, extensions will be provided if medically necessary. Certain services, specified in the appropriate provider manual, are not counted toward the 12 visit limit. Beneficiaries under age 21 in the Child Health Services (EPSDT) program are not benefit limited.
ATTACHMENT 4.19-B
METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES OTHER TYPES OF CARE
Refer to Attachment 4.19-B, Item 4.b. (17).
Reimbursement is the lower of the amount billed or the Title XIX maximum allowable.
The Title XIX maximum is based on 80% of the physician fee schedule except EPSDT procedure codes. Medicaid maximum allowables are the same for all EPSDT providers. Immunizations and Rhogam RhoD Immune Globulin are reimbursed at the same rate as the physician rate since the cost and administration of the drug does not vary between the nurse practitioner and physician.
Refer to Attachment 4.19-B, Item 27, for a list of the advanced practice nurse and registered nurse practitioner.
Except as otherwise noted in tlie plan, state developed fee schedule rates are the same for both governmental and private providers of services provided by Advanced Practice Nurse. The agency's fee schedule rate was set as of April 1,2004 and is effective for services provided on or after that date. AH rates are published on the agency's website® vrww.niedicaid.state.ar.us.
]hfoihe Health Services
Intermittent or part-time nursing services furnished by a home health agency or a registered nurse when no home health agency exists in the area;
Home health aide services provided by a home health agency; and
Physical therapy
Reimbursement is based on the lesser of the amount billed or the Title XIX (Medicaid) maximum charge allowed. State developed fee schedule rates are the same for both public and private providers of home health services.
. The initial computation (effective July 1, 1994) or the Medicaid maximum for home health reimbursement was calculated using audited 1990 Medicare cost reports for three high volume
Medicaid providers, Medical Personnel Pool, Arkansas Home Health, W. M. and the Visiting Nurses Association. For each provider, the cost per visit for each home health service listed above in items 7.a., b. and c. was established by dividing total allowable costs by total visits. This figure was then
Reimbursement is based on the lower of the amount billed or the Title XIX maximum allowable.
The Title XIX maximum is 80% of the physician fee schedule except EPSDT procedure codes. Medicaid maximum allowables are the same for all EPSDT providers. Immunizations and Rhogam RhoD Immune Globulin are reimbursed at the same rate as the physician rate since the cost and administration of the drug does not vary between the advanced practice nurse and physician.
Except as othenvise noted in the plan, state developed fee schedule rates are the same for both governmental and private providers of services provided by Advanced Practice Nurse. The agency's fee schedule rate was set as of April 1,2004 and is effective for services provided on or after that date. AH rates are published on the agency's website® www.medicaid.state.ar.us.
