016.06.10 Ark. Code R. 016

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

Rule 016.06.10-016 - State Plan Amendment #2010-005 - Levonorgestrel-Releasing Intrauterine Contraceptive System (Mirena)

METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES OTHER TYPES OF CARE

ATTACHMENT 4.19-B

4.c. Family Planning Services

Reimbursement is based on the lesser of the amount billed or the maximum Title XIX (Medicaid) charge allowed. State developed fee schedule rates are the same for both public and private providers.

1. The Title XIX (Medicaid) maximum for Family Planning services is 100% of the current physician Medicaid maximum.

At the beginning of each calendar year, the State Agency will negotiate with the affected provider group representatives to arrive at a mutually acceptable increase or decrease from the maximum rate. Market forces, such as private insurance rate, medical and general inflation figures, changes in practice costs and changes in program requirements, will be considered during the negotiation process. Any agreed upon increase or decrease will be implemented at the beginning of the following State Fiscal Year, July 1, with any appropriate State Plan changes.

2. Intrauterine Devices (IUDs)

Reimbursement for the intrauterine device (IUD) is based on 100% of the manufacturer's list price as of July 1,2003. Effective for claims with dates of service July 1,2010 and after, the levongestrel releasing IUD is reimbursed based on 100% of the manufacturer's list price as of May 5, 2010.

016.06.10 Ark. Code R. 016

11/1/2010