Arkansas Administrative Code
Agency 060 - STATE MEDICAL BOARD
Rule 060.00.19-004 - Rule 43- Genetic Counselor Licensure

Eligibility Group

Citation (Regulation [42 CFR] or SSA)

M

V

E

Geographic Area (include specifics if M/V/E varies by area)

Notes

1. Parents and Other Caretaker Relatives

§ 435.110

X

Statewide

2. Pregnant Women

§ 435.116

X

Statewide

Required to enroll with a PCCM only if they need non-obstetrical services which require a PCP referral.

3. Children Under Age 19 (Inclusive of Deemed Newborns under § 435.117)

§ 435.118

X

Statewide

4. Former Foster Care Youth (up to age 26)

§ 435.150

X

Statewide

5. Adult Group (Non-pregnant individuals age 19-64 not eligible for Medicare with income no more than 133% FPL )

§ 435.119

X

Required only if deemed frail and receiving

Traditional Medicaid.

6. Transitional Medical Assistance

(Includes adults and children, if not eligible under § 435.116, § 435.118, or § 435.119)

1902(a)(52), 1902(e)(1), 1925, and 1931(c)(2) of SSA

X

Statewide

7. Extended Medicaid Due to Spousal Support Collections

& 435.115

X

Statewide

Eligibility Group

Citation (Regulation [42 CFR] or SSA)

M

V

E

Geographic Area (include specifics if M/V/E varies by area)

Notes

8. Individuals Receiving SSI age 19 and over only (See E.2. below regarding age <19)

§ 435.120

X

Statewide

Exclude

Medicare

Beneficiaries.

9. Aged and Disabled Individuals in 209(b) States

§ 435.121

N/A-AR is a 1634 State.

10. Individuals Who Would be Eligible for

SSI/SSP but for OASDI COLA Increase since April, 1977

§ 435.135

X

Statewide

Exclude

Medicare

Beneficiaries.

11. Disabled Widows and Widowers

Ineligible for SSI due to an increase of OASDI

§ 435.137

X

Statewide

Exclude

Medicare

Beneficiaries.

12. Disabled Widows and Widowers

Ineligible for SSI due to Early Receipt of Social Security

§ 435.138

X

Statewide

Exclude

Medicare

Beneficiaries.

13. Working Disabled under 1619(b)

1619(b),

1902(a)(10)(A)(i)( II), and 1905(q) of SSA

X

Statewide

Exclude

Medicare

Beneficiaries.

14. Disabled Adult Children

1634(c) of SSA

X

Statewide

Eligibility Group

Citation (Regulation [42 CFR] or SSA)

M

V

E

Geographic Area (include specifics if M/V/E varies by area)

Notes

1. Optional Parents and Other Caretaker Relatives

§ 435.220

N/A

2. Optional Targeted Low-Income Children

§ 435.229

N/A

3. Independent Foster Care Adolescents Under Age 21

§ 435.226

N/A

4. Individuals Under Age 65 with Income Over 133%

§ 435.218

N/A

5. Optional Reasonable Classifications of Children Under Age 21

§ 435.222

N/A

6. Individuals Electing COBRA Continuation Coverage

1902(a)(10)(F) of SSA

N/A

Eligibility Group

Citation (Regulation [42 CFR] or SSA)

M

V

E

Geographic Area (include specifics if M/V/E varies by area)

Notes

7. Aged, Blind or Disabled Individuals Eligible for but Not Receiving Cash

§ 435.210 and § 435.230

N/A

8. Individuals eligible for Cash except for Institutionalized Status

§ 435.211

X

9. Individuals Receiving Home and

Community-Based Waiver Services Under Institutional Rules

§ 435.217

X

10. Optional State Supplement Recipients -

1634 and SSI Criteria States - with 1616 Agreements

§ 435.232

N/A

11. Optional State Supplemental Recipients-209(b) States and SSI criteria States without 1616 Agreements

§ 435.234

N/A

12. Institutionalized Individuals Eligible under a Special Income Level

§ 435.236

X

13. Individuals Participating in a PACE Program under Institutional Rules

1934 of the SSA

X

14. Individuals Receiving Hospice Care

1902(a)(10)(A)(ii) (VII) and 1905(o) of the SSA

X

Institutionalized

15. Poverty Level Aged or Disabled

1902(a)(10)(A)(ii) (X) and

1902(m)(1) of the SSA

X

Statewide

Exclude Medicare Beneficiaries. (AR entitles ARSeniors)

16. Work Incentive Group

1902(a)(10)(A)(ii) (XIII) of the SSA

N/A

17. Ticket to Work Basic Group

1902(a)(10)(A)(ii) (XV) of the SSA

X

Statewide

Exclude Medicare Beneficiaries. (AR entitles Workers with Disabilities)

18. Ticket to Work Medically Improved Group

1902(a)(10)(A)(ii) (XVI) of the SSA

N/A

19. Family Opportunity Act Children with Disabilities

1902(a)(10)(A)(ii) (XIX) of the SSA

N/A

20. Individuals Eligible for State Plan Home and Community-Based Services

§ 435.219

X

Eligibility Group

Citation (Regulation [42 CFR] or SSA)

M

V

E

Geographic Area (include specifics if M/V/E varies by area)

Notes

21. Family Planning Services

§ 435.214

N/A

22. Individuals with Tuberculosis

§ 435.215

N/A

23. Individuals Needing Treatment for Breast or Cervical Cancer (under age 65)

§ 435.213

N/A

Population

Citation (Regulation [42 CFR] or SSA)

V

E

Geographic Area

Notes

Medicare Savings Program - Qualified Medicare Beneficiaries, Qualified Disabled Working Individuals, Specified Low Income Medicare Beneficiaries, and/or Qualifying Individuals

1902(a)(10)(E), 1905(p), 1905(s) of the SSA

X

"Dual Eligibles" not described under Medicare Savings Program - Medicaid beneficiaries enrolled in an eligibility group other than one of the Medicare Savings Program groups who are also eligible for Medicare

X

American Indian/Alaskan Native-

Medicaid beneficiaries who are American Indians or Alaskan Natives and members of federally recognized tribes

§ 438.14

X

Statewide

Children Receiving SSI who are Under Age 19 - Children under 19 years of age who are eligible for SSI under title XVI

§ 435.120

X

Statewide

Qualified Disabled Children Under Age 19 - Certain children under 19 living at home, who are disabled and would be eligible if they were living in a medical institution.

§ 435.225

1902(e)(3) of the SSA

X

Statewide

This population is covered under 1115 TEFRA Waiver

Title IV-E Children - Children receiving foster care, adoption assistance, or kinship guardianship assistance under title IV-E *

§ 435.145

X

Statewide

Non-Title IV-E Adoption Assistance Under Age 21*

§ 435.227

X

Statewide

Children with Special Health Care Needs - Receiving services through a family-centered, community-based, coordinated care system that receives grant funds under section 501(a)(1)(D) of Title V, and is defined by the State in terms of either program participation or special health care needs.

X

Statewide Statewide

Population

V

E

Notes

Other Insurance--Medicaid beneficiaries who have other health insurance

X

Reside in Nursing Facility or ICF/IID--

Medicaid beneficiaries who reside in Nursing Facilities (NF) or Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID).

X

Enrolled in Another Managed Care Program-Medicaid beneficiaries who are enrolled in another Medicaid managed care program

X

Eligibility Less Than 3 Months--Medicaid beneficiaries who would have less than three months of Medicaid eligibility remaining upon enrollment into the program

X

Participate in HCBS Waiver--Medicaid beneficiaries who participate in a Home and Community Based Waiver (HCBS, also referred to as a 1915(c) waiver).

X

Retroactive Eligibility-Medicaid beneficiaries for the period of retroactive eligibility.

X

Other (Please define):

State Plan-Approved Service Delivered by the MCO

Medicaid State Plan Citation

Attachment #

Page #

Item #

Ex. Physical Therapy

3.1-A

4

11.a

Compliance Dates

Sections

For rating periods for Medicaid managed care contracts beginning before July 1, 2017, States will not be held out of compliance with the changes adopted in the following sections so long as they comply with the corresponding standard(s) codified in 42 CFR part 438 contained in 42 CFR parts 430 to 481, edition revised as of October 1, 2015.States must comply with these requirements no later than the rating period for Medicaid managed care contracts starting on or after July 1, 2017.

§ § 438.3(h), 438.3(m), 438.3(q) through (u), 438.4(b)(7), 438.4(b)(8), 438.5(b) through (f), 438.6(b)(3), 438.6(c) and (d), 438.7(b), 438.7(c)(1) and (2), 438.8, 438.9, 438.10, 438.14, 438.56(d)(2)(iv), 438.66(a) through (d), 438.70, 438.74, 438.110, 438.208, 438.210, 438.230, 438.242, 438.330, 438.332, 438.400, 438.402, 438.404, 438.406, 438.408, 438.410, 438.414, 438.416, 438.420, 438.424, 438.602(a), 438.602(c) through (h), 438.604, 438.606, 438.608(a), and 438.608(c) and (d)

For rating periods for Medicaid managed care contracts beginning before July 1, 2018, states will not be held out of compliance with the changes adopted in the following sections so long as they comply with the corresponding standard(s) codified in 42 CFR part 438 contained in the 42 CFR parts 430 to 481, edition revised as of October 1, 2015. States must comply with these requirements no later than the rating period for Medicaid managed care contracts starting on or after July 1, 2018.

§ § 438.4(b)(3), 438.4(b)(4), 438.7(c)(3), 438.62, 438.68, 438.71, 438.206, 438.207, 438.602(b), 438.608(b), and 438.818

States must be in compliance with the requirements at & 438.4(b)(9) no later than the rating period for Medicaid managed care contracts starting on or after July 1, 2019.

§ 438.4(b)(9)

States must be in compliance with the requirements at & 438.66(e) no later than the rating period for Medicaid managed care contracts starting on or after the date of the publication of CMS guidance.

§ 438.66(e)

States must be in compliance with & 438.334 no later than 3 years from the date of a final notice published in the Federal Register.

& 438.334

Until July 1, 2018, states will not be held out of compliance with the changes adopted in the following sections so long as they comply with the corresponding standard(s) codified in 42 CFR part 438 contained in the 42 CFR parts 430 to 481, edition revised as of October 1, 2015.

§ § 438.340, 438.350, 438.354, 438.356, 438.358, 438.360, 438.362, and 438.364

States must begin conducting the EQR-related activity described in & 438.358(b)(1)(iv) (relating to the mandatory EQR-related activity of validation of network adequacy) no later than one year from the issuance of the associated EQR protocol.

§ 438.358(b)(1)(iv)

States may begin conducting the EQR-related activity described in & 438.358(c)(6) (relating to the optional EQR-related activity of plan rating) no earlier than the issuance of the associated EQR protocol.

§ 438.358(c)(6)