016.29.24 Ark. Code R. 001

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

Rule 016.29.24-001 - Provider Refunds and Primary Care Provider Qualification Updates

Section I

142.600Conditions Related to Provider Refunds to DMS

Within thirty (30) days, a provider must refund any money the state is obligated to repay the federal government as a result of disallowance, recoupment or other adverse action in connection with Medicaid payments to the provider.

Any outstanding balances over thirty (30) days will be recouped against future payments. Providers unable to refund their outstanding balance within thirty (30) days must contact Gainwell Technologies Provider Assistance Center (PAC) to discuss repayment options. Note: All outstanding balances must be paid back within one (1) year. View or print the Provider Assistance Center contact information.

171.100PCP-Qualified Physicians and Advanced Practice Nurse Practitioners

A. Primary Care Provider (PCP)-qualified physicians are those whose sole or primary specialty is

1. Family practice

2. General practice

3. Internal medicine

4. Pediatrics and adolescent medicine

5. Obstetrics and gynecology

B. Obstetricians and gynecologists may choose whether to be PCPs.

C. Physicians with multiple specialties may elect to enroll as PCPs if a secondary or tertiary specialty in their Medicaid provider file is listed in part A above.

D. All other PCP-qualified physicians must enroll as PCPs.

E. Advanced practice registered nurses (APRN) licensed by the Arkansas State Board of Nursing may choose to enroll as PCPs.

171.110Exclusions

A. Physicians whose only specialty is emergency care or who practice exclusively in hospital emergency departments may not enroll as PCPs.

B. Physician group practices may not be PCPs.

C. Rural Health Clinics (RHCs) may not be PCPs, but PCP-qualified physicians affiliated with RHCs must be PCPs.

D. Physicians who certify in writing that they are employed.

171.130EPSDT Agreement Requirement

A. A PCP applicant must sign an agreement to participate as a screening provider in the Child Health Services (EPSDT) program.

B. Internists, obstetricians, gynecologists, and physicians who customarily carry a caseload of patients who are 21 years of age or older are not required to furnish EPSDT screens.

1. Their participation in the Child Health Services (EPSDT) program is optional.

2. They must, however, sign Child Health Services (EPSDT) agreements if they elect to be screening providers.

171.140Primary Care Case Manager Agreement

A. Every PCP applicant must sign a Primary Care Case Manager (PCCM) contract.

016.29.24 Ark. Code R. 001

Adopted by Arkansas Register Volume 49, Number 04, Effective 3/25/2024