016.06.18 Ark. Code R. 001

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

Rule 016.06.18-001 - Section 1-6-17, Four Visit-No Referrals

170.100 Introduction

Arkansas Medicaid's Primary Care Case Management (PCCM) Program operates statewide under the authority of the Medicaid State Plan.

A. Most Medicaid beneficiaries and all ARKids First-B participants must enroll with a primary care physician (PCP), also known as a primary care case manager (PCCM).

1. PCPs provide primary care services and health education.

2. PCPs make referrals for medically necessary specialty physician's services, hospital care and other services.

3. PCPs assist their enrollees with locating medical services.

4. PCPs coordinate and monitor their enrollees' prescribed medical and rehabilitation services.

B. Medicaid enrollees may receive services only from their PCP unless their PCP refers them to another provider, or unless they access a service that does not require a PCP referral,

C. If a beneficiary does not have a primary care provider, Arkansas Medicaid will allow up to four (4) visits per state fiscal year without a Primary Care Physician (PCP) referral to a hospital affiliated Walk-in Clinic or Emergent Clinic.

D. These visits apply to all related benefit limits.

016.06.18 Ark. Code R. 001

7/19/2018