016.06.09 Ark. Code R. 047

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

Rule 016.06.09-047 - Provider Manual Update Transmittal - Section I & Section V

SECTION I- GENERAL POLICY

171.210ConnectCare Caseload Maximum and PCP Caseload Limits

A. Each PCP may establish an upper limit to his or her Medicaid caseload, up to the default maximum of 2500.

1. The state may permit higher maximum caseloads in areas the federal government has designated as medically underserved.

2. The state may permit higher maximum caseloads for PCPs who state in writing that the default maximum will create a hardship for them, their patients and/or the community they serve.

B. The state will not require any PCP to accept a caseload greater than the PCP's requested caseload maximum.

C. At any time, a PCP may increase or decrease his or her maximum desired caseload by any amount, up to the default maximum by submitting a signed request to his or her Provider Relations Representative, or on-line through the Medicaid Website (www.medicaid.state.ar.us), Provider Enrollment Information, and Access to the Provider Information Portal.

D. To request an increase in a PCP caseload above the default maximum, the PCP must submit a written request with his or her original signature to the Provider Relations Representative. View or print Provider Relations Representative contact information.

E. Prior to making the request for an increase of a caseload that is already at the default maximum, PCPs are encouraged to review their caseload for inactive patients to determine if those patients should be removed from their caseload. To do so, PCPs may use the Arkansas Medicaid Information Interchange (AMII) web portal. If it is determined that the inactive patients should be removed from his or her caseload, the PCP must:

1. Contact the patient in writing at least 30 days in advance of the effective date of the termination to give the patient the option of making a visit to the PCP to remain an active patient. If the patient does not choose to make a visit to the PCP, the termination can be effective at the end of 30 calendar days.

2. With approval from his or her Provider Relations Representative, the PCP may add and see new patients during the 30 calendar day notification process of inactive patients.

3. The notice must state that the enrollee has 30 calendar days in which to enroll with a different PCP.

4. The PCP must forward a copy of the notice to the enrollee and to the local DHS office in the enrollee's county of residence.

MANAGED CARE PROGRAM PRIMARY CARE PHYSICIAN

Family Practitioner

General Practitioner (including osteopath)

* Internal Medicine

* Obstetrician

* Gynecologist Pediatrician

If your specialty of practice is listed above, you MUST complete the Primary Care Physician Participation Agreement and the EPSDT Agreement to participate in the Arkansas Medicaid Program. Please refer to Section I of your Arkansas Medicaid Provider manual for information concerning the Primary Care Physician Program.

* NOTE *Providers whose specialty is either I nternal Medicine or Obstetrician/Gynecology have the option of enrolling in the Child Health Services (EPSDT) program, please review the Primary Care Physicians policy in Section I of your Arkansas Medicaid Provider manual.

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County Codes

County	County	County
County	Code	County	Code	County	Code
Arkansas	01	Garland	26	Newton	51
Ashley	02	Grant	27	Ouachita	52
Baxter	03	Greene	28	Perry	53
Benton	04	Hempstead	29	Phillips	54
Boone	05	Hot Spring	30	Pike	55
Bradley	06	Howard	31	Poinsett	56
Calhoun	07	Independence 32		Polk	57
Carroll	08	Izard	33	Pope	58
Chicot	09	Jackson	34	Prairie	59
Clark	10	Jefferson	35	Pulaski	60
Clay	11	Johnson	36	Randolph	61
Cleburne	12	Lafayette	37	Saline	62
Cleveland	13	Lawrence	38	Scott	63
Columbia	14	Lee	39	Searcy	64
Conway	15	Lincoln	40	Sebastian	65
Craighead	16	Little River	41	Sevier	66
Crawford	17	Logan	42	Sharp	67
Crittenden	18	Lonoke	43	St. Francis	68
Cross	19	Madison	44	Stone	69
Dallas	20	Marion	45	Union	70
Desha	21	Miller	46	Van Buren	71
Drew	22	Mississippi	47	Washington	72
Faulkner	23	Monroe	48	White	73
Franklin	24	Montgomery	49	Woodruff	74
Fulton	25	Nevada	50	Yell	75

State	County Code	State	County Code	State	County Code
Louisiana	91	Mississippi	93	Tennessee	95
Missouri	92	Oklahoma	94	Texas	96

Please note: Per Section I, page 84, subsection 185.12, item 2 of the Arkansas Medicaid Physicians provider manual, a PCP must be physically located in the State of Arkansas or in a bordering state trade-area city. The trade-area cities are:

* Monroe and Shreveport, Louisiana

* Clarksdale and Greenville, Mississippi

* Poplar Bluff, Missouri

* Poteau and Salisaw, Oklahoma

* Memphis, Tennessee

* Texarkana, Texas

016.06.09 Ark. Code R. 047

12/18/2009