016.29.23 Ark. Code R. 011
STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT MEDICAL ASSISTANCE PROGRAM
STATE ARKANSAS
Page 9a
AMOUNT, DURATION AND SCOPE OF SERVICES PROVIDED
Revised: January 1, 2024
CATEGORICALLY NEEDY
Payment will be made for ambulance services, provided the conditions below are met and the services are provided in accordance with laws, regulations and guidelines governing ambulance services under Part B of Medicare. These services are equally available to all beneficiaries. The use of medical transportation must be for health-related purposes and reimbursement will not be made directly to Title XIX beneficiaries.
Alternative location is the location to which an ambulance is dispatched, and the ambulance service treatment is initiated from a 911 call that is documented in the records of the ambulance service. Alternative destination means a lower-acuity facility that provides medical services, including:
* A federally qualified health center;
* An urgent care center;
* A physician's office or medical clinic, as chosen by the beneficiary;
* A behavioral or mental healthcare facility
Excluded alternative destinations are facilities that provide a higher-acuity medical service or medical services for a routine chronic condition, such that they would be considered as destinations for which transportation under (1) above would occur:
* Emergency Room;
* Critical Access Hospital;
* Rural Emergency Hospital;
* Dialysis center;
* Hospital;
* Private residence;
* Skilled nursing facility
Air ambulance services are provided to Arkansas Medicaid beneficiaries only in emergencies.
Air ambulance providers must be licensed by the Arkansas Ambulance Boards and enrolled as a Title XVIII, Medicare Provider.
EIDT and ADDT providers may provide transportation to and from their facility. The Medicaid transportation broker must provide transportation to and from the nearest qualified medical provider for the purpose of obtaining medical treatment.
STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT MEDICAL ASSISTANCE PROGRAM
STATE ARKANSAS
Page 8b
AMOUNT, DURATION AND SCOPE OF SERVICES PROVIDED
Revised: January 1, 2024
MEDICALLY NEEDY
Payment will be made for ambulance services, provided the conditions below are met and the services are provided in accordance with laws, regulations and guidelines governing ambulance services under Part B of Medicare. These services are equally available to all beneficiaries. The use of medical transportation must be for health-related purposes and reimbursement will not be made directly to Title XIX beneficiaries.
Alternative location is the location to which an ambulance is dispatched, and the ambulance service treatment is initiated from a 911 call that is documented in the records of the ambulance service. Alternative destination means a lower-acuity facility that provides medical services, including:
* A federally qualified health center;
* An urgent care center;
* A physician's office or medical clinic, as chosen by the beneficiary;
* A behavioral or mental healthcare facility
Excluded alternative destinations are facilities that provide a higher-acuity medical service or medical services for a routine chronic condition, such that they would be considered as destinations for which transportation under (1) above would occur:
* Emergency Room;
* Critical Access Hospital;
* Rural Emergency Hospital;
* Dialysis center;
* Hospital;
* Private residence;
* Skilled nursing facility
Air ambulance services are provided to Arkansas Medicaid beneficiaries only in emergencies.
Air ambulance providers must be licensed by the Arkansas Ambulance Boards and enrolled as a Title XVIII, Medicare Provider.
Ambulance service to a doctor's office or clinic is not covered, except as described in Sections 204.000 and 214.100.
Ground ambulance triage, treat, and transport to alternative location/destination services (T3AL) may be covered only when provided by an ambulance company that is licensed and is an enrolled provider in the Arkansas Medicaid Program. An ambulance service may triage and transport a beneficiary to an alternative destination or treat in place if the ambulance service is coordinating the care of the beneficiary through telemedicine with a physician for a medical-based complaint or with a behavioral health specialist for a behavioral-based complaint. Telemedicine rules are described in Section 105.190 and must be followed unless instructions are given within Section II of the prevailing Medicaid manual. The use of audio-only electronic technology is not allowed for T3AL services.
For the purposes of T3AL, a behavioral health specialist is a board-certified psychiatrist or an Independently Licensed Practitioner who can provide counseling services to Medicaid beneficiaries in the Outpatient Behavioral Health program.
An ambulance service may:
An encounter between an ambulance service and a beneficiary that results in no transport of the enrollee is allowable if the beneficiary declines to be transported against medical advice and the ambulance service is coordinating the care of the beneficiary through telemedicine with a physician for a medical-based complaint.
An encounter between an ambulance service and a beneficiary is billable as follows:
Alternative location is the location to which an ambulance is dispatched, and ambulance service treatment is initiated as a result of a 911 call that is documented in the records of the ambulance service.
Alternative destination means a lower-acuity facility that provides medical services, including:
Excluded alternative destinations are facilities that provide a higher-acuity medical service or medical services for routine chronic conditions including:
RULES SUBMITTED FOR REPEAL
Rule #1: DDS Policy 3010 - Human Rights Committee
Rule #2:DDS Policy 3011 - Behavior Management
016.29.23 Ark. Code R. 011