Arkansas Administrative Code
Agency 016 - DEPARTMENT OF HUMAN SERVICES
Division 06 - Medical Services
Rule 016.06.18-001 - Section 1-6-17, Four Visit-No Referrals
Universal Citation: AR Admin Rules 016.06.18-001
Current through Register Vol. 49, No. 9, September, 2024
170.100 Introduction
Arkansas Medicaid's Primary Care Case Management (PCCM) Program operates statewide under the authority of the Medicaid State Plan.
A. Most Medicaid beneficiaries and all ARKids
First-B participants must enroll with a primary care physician (PCP), also
known as a primary care case manager (PCCM).
1. PCPs provide primary care services and
health education.
2. PCPs make
referrals for medically necessary specialty physician's services, hospital care
and other services.
3. PCPs assist
their enrollees with locating medical services.
4. PCPs coordinate and monitor their
enrollees' prescribed medical and rehabilitation services.
B. Medicaid enrollees may receive services
only from their PCP unless their PCP refers them to another provider, or unless
they access a service that does not require a PCP referral,
C. If a beneficiary does not have a primary
care provider, Arkansas Medicaid will allow up to four (4) visits per state
fiscal year without a Primary Care Physician (PCP) referral to a hospital
affiliated Walk-in Clinic or Emergent Clinic.
D. These visits apply to all related benefit
limits.
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.
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