016.06.13 Ark. Code R. 016

Current through Register Vol. 49, No. 9, September, 2024

Rule 016.06.13-016 - Arkansas Private Option (Health Care Independence Act of 2013)

5.Alternative Benefit Plan (ABP)

Effective for dates of service on or after January 1, 2014, the Arkansas Medicaid program will cover inpatient acute hospital days in excess of twenty-four days (during a state fiscal year) for those beneficiaries covered under the Alternative Benefit Plan (APB). The per diem rate for ABP inpatient acute hospital days twenty-five and above will be 400 dollars per day. The intent of the policy change is to increase access to care in all hospitals in the state of Arkansas. Inpatient Acute hospital days under twenty-five will be reimbursed in accordance with the methodology set forth in Attachment 4.19A page 1. Except as otherwise noted in the Plan, this rate is the same for both governmental and private providers of inpatient acute hospital services.

Effective for dates of service on or after January 1, 2014, the Arkansas Medicaid program will cover inpatient rehabilitation hospital days in excess of twenty-four days (during a state fiscal year) for those beneficiaries covered under the Alternative Benefit Plan (ABP). The per diem rate for ABP inpatient rehabilitation hospital days twenty-five and above will be 400 dollars per day. The intent of the policy change is to increase access to care in all hospitals in the state of Arkansas. Inpatient rehabilitation hospital days under twenty-five will be reimbursed in accordance with the methodology set forth in Attachment 4.19A page 9a. Except as otherwise noted in the State Plan, this rate is the same for both government and private providers of inpatient rehabilitation hospital services.

METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES -INPATIENT HOSPITAL SERVICES

ATTACHMENT 4.19-A

29.Alternative Benefit Plan (ABP)

All required ABP services and immunizations not specifically identified in the following are covered and reimbursed in accordance with the methodologies described elsewhere in the State Plan. The state's reimbursement methodologies otherwise set forth in the State Plan meet the minimum ABP requirements under the Affordable Care Act (ACA). All APB and non-ABP are rates published on the agency's website (www.medicaid.state.ar.us/download/provider/provdocs/manuals/) . Fee schedules are located on the appropriate provider manual page. Except as otherwise noted in the Plan, the rates are the same for both governmental and private providers.

A.Cochlear Implants, Auditory Brain Stem Implants and Osseointegrated Hearing Aid Implants Effective for dates of service on or after January 1, 2014, the Arkansas Medicaid program will cover these implants for all age ABP beneficiaries. Reimbursement will be the same as is currently covered for under age 21 non-ABP beneficiaries.

B.Diabetic Self-Management Training Effective for dates of service on or after January 1, 2014, the Arkansas Medicaid program will cover Diabetic self-management training by a qualified health care professional for all age ABP beneficiaries. These services will only be provided in the outpatient hospital setting. Reimbursement will be based on the January 1, 2014 Medicare rates for these services.

C. Diagnosis and Treatment of Alcoholism and Drug Abuse, Including Detoxification Treatment and Counseling Effective for dates of service on or after January 1, 2014, the Arkansas Medicaid program will cover Diagnosis and treatment of alcoholism and drug abuse, including detoxification treatment and counseling for all age ABP beneficiaries. Reimbursement will be the same as is currently covered for under age 21 non-ABP beneficiaries

D.Shingles Immunization Effective for dates of service on or after January 1, 2014, the Arkansas Medicaid program will cover shingles immunization for ABP beneficiaries. These immunizations will be covered for age groups as recommended by the Centers for Disease Control (CDC). Reimbursement will be based on 80% of the 2014 Arkansas Blue Cross Blue Shield rate for this immunization.

29.Alternative Benefit Plan (ABP)

E.Human Papillomavirus (HPV) immunization Effective for dates of service on or after January 1, 2014, the Arkansas Medicaid program will cover HPV immunization for ABP beneficiaries. These immunizations will be covered for age groups as recommended by the Centers for Disease Control (CDC).

Reimbursement for ages 19 and over will be based on 80% of the 2014 Arkansas Blue Cross Blue Shield rate for this immunization. Reimbursement for ages 18 and under will be based on the Arkansas Medicaid Vaccines for Children (VFC) reimbursement rate for non-ABP beneficiaries as of January 1, 2014.

016.06.13 Ark. Code R. 016

1/12/2015