016.06.06 Ark. Code R. 052

Current through Register Vol. 49, No. 10, October, 2024

Rule 016.06.06-052 - Section I - Provider Manual Update Transmittal

Provider Manual	Transmittal Number
Alternatives for Adults with Physical Disabilities Waiver...........................................	............ 42
Ambulatory Surgical Center......................................................................................	............ 74
ARKids First-B..........................................................................................................	............ 41
Certified Nurse-Midwife.............................................................................................	............ 77
Child Health Management Services..........................................................................	............ 74
Child Health Services/Early and Periodic Screening, Diagnosis and Treatment.......	............ 82
Children's Services Targeted Case Management.....................................................	............ 26
Chiropractic...............................................................................................................	............ 70
DDS Alternative Community Services Waiver...........................................................	............ 67
Dental........................................................................................................................	............ 93
Developmental Day Treatment Clinic Services.........................................................	............ 76
Developmental Rehabilitation Services.....................................................................	............ 26
Division of Youth Services and Division of Children and Family Services Targeted Case Management........................................................................	............ 18
Domiciliary Care........................................................................................................	............ 54
ElderChoices Home and Community-Based 2176 Waiver........................................	............ 68
Federally Qualified Health Center.............................................................................	............ 63
Hearing Services.......................................................................................................	............ 67
Home Health.............................................................................................................	............ 84
Hospice.....................................................................................................................	............ 57
Hospital/End-Stage Renal Disease...........................................................................	............ 102
Hyperalimentation.....................................................................................................	............ 82
Inpatient Psychiatric Services for Under Age 21.......................................................	............ 74
Licensed Mental Health Practitioners........................................................................	............ 58
Living Choices Assisted Living..................................................................................	............ 24
Medicare/Medicaid Crossover Only..........................................................................	............ 51
Nurse Practitioner.....................................................................................................	............ 73
Occupational, Physical, Speech Therapy Services...................................................	............ 66
Personal Care...........................................................................................................	............ 79
Pharmacy..................................................................................................................	............ 92
Physician/Independent Lab/CRNA/Radiation Therapy Center..................................	............ 120

Podiatrist............................................................................................................	................... 71
Portable X-Ray Services....................................................................................	................... 61
Private Duty Nursing Services...........................................................................	................... 73
Program of All-inclusive Care for the Elderly (PACE)........................................	................... 4
Prosthetics.........................................................................................................	................... 86
Rehabilitative Hospital........................................................................................	................... 69
Rehabilitative Services for Persons with Mental Illness.....................................	................... 73
Rehabilitative Services for Persons with Physical Disabilities............................	................... 46
Rehabilitative Services for Youth and Children..................................................	................... 28
Rural Health Clinic Services...............................................................................	................... 63
School-Based Mental Health Services...............................................................	................... 32
Targeted Case Management.............................................................................	................... 65
Transportation....................................................................................................	................... 84
Ventilator Equipment..........................................................................................	................... 65
Visual Care........................................................................................................	................... 83

SECTION I - GENERAL POLICY

161.300Administrative Appeals of Adverse Actions that are not Sanctions

In addition to sanction reconsiderations and appeal as provided in sections 160.000 -169.000, providers may appeal any other decision by the Department of Health and Human Services or its reviewers or contractors that adversely affects a Medicaid provider or beneficiary in regard to receipt of and payment of Medicaid claims and services, referred to as "non-sanction adverse action."

Within 30 calendar days of receiving notice of non-sanction adverse action the provider may appeal. A notice of appeal must be in writing and state with particularity all findings, determinations, and adverse decisions/actions that the provider alleges are not supported by applicable laws (including state and federal laws and rules and applicable professional standards) or both. The appeal should be mailed or delivered to the Office of Appeals and Hearings, Arkansas Department of Health and Human Services, P.O. Box 1437, Slot N401, Little Rock, AR 72203-1437.

161.400Sanction Appeals

Within 30 calendar days of receiving notice of adverse decision/action, or 10 calendar days of receiving an administrative reconsideration decision that upholds all or part of any adverse decision/action, whichever is later, the provider may appeal.

A notice of appeal must be in writing and state with particularity all findings, determinations, and adverse decisions/actions that the provider alleges are not supported by applicable laws (including state and federal laws and rules and applicable professional standards) or both. The appeal should be mailed or delivered to the Director, Division of Medical Services, P.O. Box 1437, Slot S401, Little Rock, AR 72203-1437. No appeal is allowed if the adverse decision/action is due to loss of licensure, accreditation or certification.

162.000 Notice of the Appeal Hearing

When an appeal hearing is scheduled, the Office of Hearings and Appeals shall notify the provider or; if the provider is represented by an attorney, the provider's attorney, in writing, of the date, time and place of the hearing. Notice shall be mailed not less than 10 calendar days before the scheduled date of the hearing. Hearings shall be conducted in accordance with DHHS Policy 1098. The decision of the Office of Appeals and Hearings is the final agency determination.

162.400Appearance in Representative Capacity

A person appearing in a representative capacity shall file a written notice of appearance on behalf of a provider identifying himself by name, address and telephone number; identifying the party represented and shall have a written authorization to appear on behalf of the provider. The Division of Medical Services shall notify the provider in writing of the name and telephone number of the Division's representative.

016.06.06 Ark. Code R. 052

9/8/2006