Arkansas Administrative Code
Agency 016 - DEPARTMENT OF HUMAN SERVICES
Division 29 - Division of Medical Services
Rule 016.29.24-001 - Provider Refunds and Primary Care Provider Qualification Updates
Universal Citation: AR Admin Rules 016.29.24-001
Current through Register Vol. 49, No. 9, September, 2024
Section I
142.600
Conditions Related to Provider
Refunds to DMS
Within thirty (30) days, a provider must refund any money the state is obligated to repay the federal government as a result of disallowance, recoupment or other adverse action in connection with Medicaid payments to the provider.
Any outstanding balances over thirty (30) days will be recouped against future payments. Providers unable to refund their outstanding balance within thirty (30) days must contact Gainwell Technologies Provider Assistance Center (PAC) to discuss repayment options. Note: All outstanding balances must be paid back within one (1) year. View or print the Provider Assistance Center contact information.
171.100
PCP-Qualified Physicians and
Advanced Practice Nurse Practitioners
A. Primary Care Provider (PCP)-qualified
physicians are those whose sole or primary specialty is
1. Family practice
2. General practice
3. Internal medicine
4. Pediatrics and adolescent
medicine
5. Obstetrics and
gynecology
B.
Obstetricians and gynecologists may choose whether to be PCPs.
C. Physicians with multiple specialties may
elect to enroll as PCPs if a secondary or tertiary specialty in their Medicaid
provider file is listed in part A above.
D. All other PCP-qualified physicians must
enroll as PCPs.
E. Advanced
practice registered nurses (APRN) licensed by the Arkansas State Board of
Nursing may choose to enroll as PCPs.
171.110
Exclusions
A. Physicians whose only specialty is
emergency care or who practice exclusively in hospital emergency departments
may not enroll as PCPs.
B.
Physician group practices may not be PCPs.
C. Rural Health Clinics (RHCs) may not be
PCPs, but PCP-qualified physicians affiliated with RHCs must be PCPs.
D. Physicians who certify in writing that
they are employed.
171.130
EPSDT Agreement
Requirement
A. A PCP applicant must
sign an agreement to participate as a screening provider in the Child Health
Services (EPSDT) program.
B.
Internists, obstetricians, gynecologists, and physicians who customarily carry
a caseload of patients who are 21 years of age or older are not required to
furnish EPSDT screens.
1. Their participation
in the Child Health Services (EPSDT) program is optional.
2. They must, however, sign Child Health
Services (EPSDT) agreements if they elect to be screening providers.
171.140
Primary
Care Case Manager Agreement
A. Every
PCP applicant must sign a Primary Care Case Manager (PCCM) contract.
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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