Arkansas Administrative Code
Agency 016 - DEPARTMENT OF HUMAN SERVICES
Division 27 - Department of Medical Services
Rule 016.27.20-008 - SPA #2020-0003 EIDT/ADDT Rate Increase
Current through Register Vol. 49, No. 9, September, 2024
ATTACHMENT 3.1-A
STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT MEDICAL ASSISTANCE PROGRAM
AMOUNT, DURATION AND SCOPE OF SERVICES PROVIDED
Revised: January 1, 2020
CATEGORICALLY NEEDY
9. Clinic Services
Limited to comprehensive day treatment centers offering the following core services to beneficiaries age 18 and above:
Optional Services available through ADDT in conjunction with core services are as follows:
Occupational, Physical, and Speech Therapy Services are provided in accordance with Items 3.1-A.4b(15), 3.1-A.11, 3.1-B.4b(15), and 3.1-B(11).
Extensions of the benefit limit for all ADDT services will be provided if medically necessary.
9. Clinic Services
Limited to adult day treatment centers offering the following core services to beneficiaries age eighteen ( 18) and above:
Occupational, Physical, and Speech Therapy Services are provided in accordance with Items 3.1-A.4b(15), 3.1-A.11, 3.1-B.4b(15), and 3.1-B(11).
Extensions of the benefit limit for all ADDT services will be provided if medically necessary.
8. Private Duty Nursing Services (Continued)
Refer to Attachment 4.19-B, Item 4.b.(5) for reimbursement information for private duty nursing services for high technology non-ventilator recipients in the Early and Periodic Screening Diagnosis and Treatment ( EPSDT) Program.
9. Clinic Services
Reimbursement for comprehensive evaluation services is based on the lesser of the amount billed or the maximum Title XIX (Medicaid) charge allowed. The Title XIX maximum was established based on a 1980 survey conducted by Developmental Disabilities Services (DDS) of 85 Arkansas Developmental Day Treatment providers of their operational costs excluding their therapy services. An average operational cost and average number of units were derived for each service. The average operational cost for each service was divided by the average units for that particular service to arrive at a maximum rate.
For dates of service occurring on or after January 1, 2020, the maximum per unit rate for Adult day habilitation services increased to$11.77. These new rates were calculated based on analysis of the current 2019-2020 costs to provide quality services in compliance with governing regulations. The rates have been demonstrated to be consistent with the Clinic Upper Payment Limit at 42 CFR 447.321. For ADDT day habilitation services, there is a maximum of 5 hours of services per day.
For EIDT, auditory, developmental and neuropsychological testing services listed in the 1990 Blue Cross/Blue Shield Fee Schedule that are not subject to the other specifically identified reimbursement criteria are reimbursed based on 80% of the October 1990 Blue Cross/Blue Shield Fee Schedule amounts. For those services that were not included on the October 1990 Blue Cross/Blue Shield Fee Schedule, rates are established per the most current Blue Cross/Blue Shield Fee Schedule amount less 2.5% and then multiplied by 66%.
For EIDT, Psychological diagnosis/evaluation services provided by EIDTs certified as Academic Medical Centers (AMCs) are reimbursed from the Outpatient Behavioral Health Services (OBHS) Fee Schedule as described in Attachment 4.19-B, Item 13.d.1.
For EIDT, Medical professional services reimbursement is based on the physician's fee schedule. Refer to the physician's reimbursement methodology as described in Attachment 4.19-B, Item 5.
The maximum rate for five minutes of registered nursing services is $4.77. The maximum rate for five minutes of licensed practical nursing services is $3.17. Reimbursement for registered nurses and licensed practical nurses is based on the Private Duty Nursing Fee Schedule as described in Attachment 4.19B, Item 8.
State developed fee schedule rates are the same for both public and private providers of EIDT and ADDT services. Occupational, physical and speech therapy services under the EIDT and ADDT Program are reimbursed as is described in Item 4.b.(19).
Extensions of benefits will be provided for all EIDT and ADDT services, if medically necessary.
Refer to Attachment 4.19-B, Item 4.b.(5) for reimbursement information for private duty nursing services for high technology non-ventilator recipients in the Early and Periodic Screening Diagnosis and Treatment ( EPSDT) Program.
9. Clinic Services
Reimbursement for comprehensive evaluation services is based on the lesser of the amount billed or the maximum Title XIX (Medicaid) charge allowed. The Title XIX maximum was established based on a 1980 survey conducted by Developmental Disabilities Services (DDS) of 85 Arkansas Developmental Day Treatment providers of their operational costs excluding their therapy services. An average operational cost and average number of units were derived for each service. The average operational cost for each service was divided by the average units for that particular service to arrive at a maximum rate.
For dates of service occurring on or after January 1, 2020, the maximum per unit rate for Adult day habilitation services increased to$11.77. These new rates were calculated based on analysis of the current 2019-2020 costs to provide quality services in compliance with governing regulations. The rates have been demonstrated to be consistent with the Clinic Upper Payment Limit at 42 CFR 447.321. For ADDT day habilitation services, there is a maximum of 5 hours of services per day.
For EIDT, auditory, developmental and neuropsychological testing services listed in the 1990 Blue Cross/Blue Shield Fee Schedule that are not subject to the other specifically identified reimbursement criteria are reimbursed based on 80% of the October 1990 Blue Cross/Blue Shield Fee Schedule amounts. For those services that were not included on the October 1990 Blue Cross/Blue Shield Fee Schedule, rates are established per the most current Blue Cross/Blue Shield Fee Schedule amount less 2.5% and then multiplied by 66%.
For EIDT, Psychological diagnosis/evaluation services provided by EIDTs certified as Academic Medical Centers (AMCs) are reimbursed from the Outpatient Behavioral Health Services (OBHS) Fee Schedule as described in Attachment 4.19-B, Item 13.d.1.
For EIDT, Medical professional services reimbursement is based on the physician's fee schedule. Refer to the physician's reimbursement methodology as described in Attachment 4.19-B, Item 5.
The maximum rate for five minutes of registered nursing services is $4.77. The maximum rate for five minutes of licensed practical nursing services is $3.17. Reimbursement for registered nurses and licensed practical nurses is based on the Private Duty Nursing Fee Schedule as described in Attachment 4.19B, Item 8.
State developed fee schedule rates are the same for both public and private providers of EIDT and ADDT services. Occupational, physical and speech therapy services under the EIDT and ADDT Program are reimbursed as is described in Item 4.b.(19).
Extensions of benefits will be provided for all EIDT and ADDT services, if medically necessary.
