016-06-07 Ark. Code R. § 55

Current through Register Vol. 49, No. 6, June, 2024

Rule 016.06.07-055 - Living Choices Assisted Living Provider Manual Update Transmittal #41

212.000Living Choices Assisted Living Services

Medicaid covers Living Choices services on a daily, all-inclusive basis, rather than on an itemized per-service basis. A day is a covered date of service when a participant receives any of the services described in Sections 212.100 through 212.500 between midnight on a given day and midnight of the following day. A day is not a covered date of service when a participant does not receive any Living Choices services between midnight of that day and midnight of the following day.

A. Basic Living Choices Assisted Living direct care services are:

1. Attendant care services,

2. Therapeutic social and recreational activities,

3. Periodic nursing evaluations,

4. Limited nursing services,

5. Assistance with medication to the extent that such assistance is in accordance with the Arkansas Nurse Practice Act and interpretations thereto by the Arkansas Board of Nursing,

6. Medication oversight to the extent permitted under Arkansas law and

7. Assistance obtaining non-medical transportation specified in the plan of care.

B. Living Choices participants are eligible for pharmacist consultant services. Level II ALFs are required by their licensing regulations to engage a Consultant Pharmacist in Charge. Consultant Pharmacists in Charge may enroll in the Living Choices Program to provide individualized pharmacy consultant services in accordance with Living Choices participants' plans of care.

C. Living Choices waiver participants are eligible for the regular benefit of three prescription drugs per month, plus three additional prescription drugs by prior authorization, and up to three more prescriptions per month, for a total of nine prescriptions per month. Living Choices waiver participants who are dual eligibles (receiving both Medicare and Medicaid) must obtain prescribed medications through the Medicare Part D Prescription Drug Plan, or for certain prescribed medications excluded from the Medicare Part D Prescription Drug Plan, through the Arkansas Medicaid State Plan Pharmacy Program.

214.000Benefit Limits

A. There are no benefit limits applicable to the Living Choices Assisted Living bundled services and pharmacist consultant benefits.

B. Living Choices Assisted Living Program participants are eligible for three prescription drugs per month in addition to the regular Medicaid pharmacy benefit. The regular Medicaid pharmacy benefit is three prescription drugs per month, plus three additional prescription drugs available by prior authorization, for a total of six. Living Choices participants may have as many as nine prescription drugs per month covered by Medicaid. Dual eligibles, receiving both Medicare and Medicaid, receive prescription drug coverage through Part D Medicare and have no restrictions on the number of prescription drugs that can be received during a month.

016.06.07 Ark. Code R. § 055

10/4/2007