060.00.19 Ark. Code R. 004

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

Rule 060.00.19-004 - Rule 43- Genetic Counselor Licensure

A.Mandatory Eligibility Groups (Eligibility Groups to which a state must provide Medicaid coverage)

1.Family/Adult

Eligibility Group	Citation (Regulation [42 CFR] or SSA)	M	V	E	Geographic Area (include specifics if M/V/E varies by area)	Notes
1. Parents and Other Caretaker Relatives	§ 435.110	X	Statewide
2. Pregnant Women	§ 435.116	X	Statewide	Required to enroll with a PCCM only if they need non-obstetrical services which require a PCP referral.
3. Children Under Age 19 (Inclusive of Deemed Newborns under § 435.117)	§ 435.118	X	Statewide
4. Former Foster Care Youth (up to age 26)	§ 435.150	X	Statewide
5. Adult Group (Non-pregnant individuals age 19-64 not eligible for Medicare with income no more than 133% FPL)	§ 435.119	X	Required only if deemed frail and receiving
Traditional Medicaid.
6. Transitional Medical Assistance (Includes adults and children, if not eligible under § 435.116, § 435.118, or § 435.119)	1902(a)(52), 1902(e)(1), 1925, and 1931(c)(2) of SSA	X	Statewide
7. Extended Medicaid Due to Spousal Support Collections	& 435.115	X	Statewide

2.Aged/Blind/Disabled Individuals

Eligibility Group	Citation (Regulation [42 CFR] or SSA)	M	V	E	Geographic Area (include specifics if M/V/E varies by area)	Notes
8. Individuals Receiving SSI age 19 and over only (See E.2. below regarding age <19)	§ 435.120	X	Statewide	Exclude Medicare Beneficiaries.
9. Aged and Disabled Individuals in 209(b) States	§ 435.121	N/A-AR is a 1634 State.
10. Individuals Who Would be Eligible for SSI/SSP but for OASDI COLA Increase since April, 1977	§ 435.135	X	Statewide	Exclude Medicare Beneficiaries.
11. Disabled Widows and Widowers Ineligible for SSI due to an increase of OASDI	§ 435.137	X	Statewide	Exclude Medicare Beneficiaries.
12. Disabled Widows and Widowers Ineligible for SSI due to Early Receipt of Social Security	§ 435.138	X	Statewide	Exclude Medicare Beneficiaries.
13. Working Disabled under 1619(b)	1619(b), 1902(a)(10)(A)(i)( II), and 1905(q) of SSA	X	Statewide	Exclude Medicare Beneficiaries.
14. Disabled Adult Children	1634(c) of SSA	X	Statewide

B.Optional Eligibility Groups

1..Family/Adult

Eligibility Group	Citation (Regulation [42 CFR] or SSA)	M	V	E	Geographic Area (include specifics if M/V/E varies by area)	Notes
1. Optional Parents and Other Caretaker Relatives	§ 435.220	N/A
2. Optional Targeted Low-Income Children	§ 435.229	N/A
3. Independent Foster Care Adolescents Under Age 21	§ 435.226	N/A
4. Individuals Under Age 65 with Income Over 133%	§ 435.218	N/A
5. Optional Reasonable Classifications of Children Under Age 21	§ 435.222	N/A
6. Individuals Electing COBRA Continuation Coverage	1902(a)(10)(F) of SSA	N/A

2.Aged/Blind/Disabled Individuals

Eligibility Group	Citation (Regulation [42 CFR] or SSA)	M	V	E	Geographic Area (include specifics if M/V/E varies by area)	Notes
7. Aged, Blind or Disabled Individuals Eligible for but Not Receiving Cash	§ 435.210 and § 435.230	N/A
8. Individuals eligible for Cash except for Institutionalized Status	§ 435.211	X
9. Individuals Receiving Home and Community-Based Waiver Services Under Institutional Rules	§ 435.217	X
10. Optional State Supplement Recipients - 1634 and SSI Criteria States - with 1616 Agreements	§ 435.232	N/A
11. Optional State Supplemental Recipients-209(b) States and SSI criteria States without 1616 Agreements	§ 435.234	N/A
12. Institutionalized Individuals Eligible under a Special Income Level	§ 435.236	X
13. Individuals Participating in a PACE Program under Institutional Rules	1934 of the SSA	X
14. Individuals Receiving Hospice Care	1902(a)(10)(A)(ii) (VII) and 1905(o) of the SSA	X	Institutionalized
15. Poverty Level Aged or Disabled	1902(a)(10)(A)(ii) (X) and 1902(m)(1) of the SSA	X	Statewide	Exclude Medicare Beneficiaries. (AR entitles ARSeniors)
16. Work Incentive Group	1902(a)(10)(A)(ii) (XIII) of the SSA	N/A
17. Ticket to Work Basic Group	1902(a)(10)(A)(ii) (XV) of the SSA	X	Statewide	Exclude Medicare Beneficiaries. (AR entitles Workers with Disabilities)
18. Ticket to Work Medically Improved Group	1902(a)(10)(A)(ii) (XVI) of the SSA	N/A
19. Family Opportunity Act Children with Disabilities	1902(a)(10)(A)(ii) (XIX) of the SSA	N/A
20. Individuals Eligible for State Plan Home and Community-Based Services	§ 435.219	X

3.Partial Benefits

Eligibility Group	Citation (Regulation [42 CFR] or SSA)	M	V	E	Geographic Area (include specifics if M/V/E varies by area)	Notes
21. Family Planning Services	§ 435.214	N/A
22. Individuals with Tuberculosis	§ 435.215	N/A
23. Individuals Needing Treatment for Breast or Cervical Cancer (under age 65)	§ 435.213	N/A

C.Medically Needy

Eligibility Group	Citation (Regulation [42 CFR] or SSA)	M	V	E	Geographic Area (include specifics if M/V/E varies by area)	Notes
1. Medically Needy Pregnant Women	§ 435.301(b)(1)(i) and (iv)	X
2. Medically Needy Children under Age 18	§ 435.301(b)(1)(ii)	X
3. Medically Needy Children Age 18 through 20	& 435.308	N/A
4. Medically Needy Parents and Other Caretaker Relatives	§ 435.310	X
5. Medically Needy Aged	§ 435.320	X
6. Medically Needy Blind	& 435.322	X
7. Medically Needy Disabled	§ 435.324	X
8. Medically Needy Aged, Blind and Disabled in 209(b) States	§ 435.330	N/A

2.Voluntary Only or Excluded Populations. Under this managed care authority, some populations cannot be subject to mandatory enrollment in an MCO, PCCM, or PCCM entity (per 42 CFR 438.50(d)). Some such populations are Eligibility Groups separate from those listed above in E.1., while others (such as American Indians/Alaskan Natives) can be part of multiple Eligibility Groups identified in E.1. above.

Please indicate if any of the following populations are excluded from the program, or have only voluntary enrollment (even if they are part of an eligibility group listed above in E.1. as having mandatory enrollment):

Population	Citation (Regulation [42 CFR] or SSA)	V	E	Geographic Area	Notes
Medicare Savings Program - Qualified Medicare Beneficiaries, Qualified Disabled Working Individuals, Specified Low Income Medicare Beneficiaries, and/or Qualifying Individuals	1902(a)(10)(E), 1905(p), 1905(s) of the SSA	X
"Dual Eligibles" not described under Medicare Savings Program - Medicaid beneficiaries enrolled in an eligibility group other than one of the Medicare Savings Program groups who are also eligible for Medicare	X
American Indian/Alaskan Native- Medicaid beneficiaries who are American Indians or Alaskan Natives and members of federally recognized tribes	§ 438.14	X	Statewide
Children Receiving SSI who are Under Age 19 - Children under 19 years of age who are eligible for SSI under title XVI	§ 435.120	X	Statewide
Qualified Disabled Children Under Age 19 - Certain children under 19 living at home, who are disabled and would be eligible if they were living in a medical institution.	§ 435.225 1902(e)(3) of the SSA	X	Statewide	This population is covered under 1115 TEFRA Waiver
Title IV-E Children - Children receiving foster care, adoption assistance, or kinship guardianship assistance under title IV-E *	§ 435.145	X	Statewide
Non-Title IV-E Adoption Assistance Under Age 21*	§ 435.227	X	Statewide
Children with Special Health Care Needs - Receiving services through a family-centered, community-based, coordinated care system that receives grant funds under section 501(a)(1)(D) of Title V, and is defined by the State in terms of either program participation or special health care needs.	X	Statewide Statewide

* = Note - Individuals in these two Eligibility Groups who are age 19 and 20 can have mandatory enrollment in managed care, while those under age 19 cannot have mandatory enrollment. Use the Notes column to indicate if you plan to mandatorily enroll 19 and 20 year olds in these Eligibility Groups.

3.(Optional) Other Exceptions. The following populations (which can be part of various Eligibility Groups) can be subject to mandatory enrollment in managed care, but states may elect to make exceptions for these or other individuals. Please indicate if any of the following populations are excluded from the program, or have only voluntary enrollment (even if they are part of an eligibility group listed above in E.1. as having mandatory enrollment):

Population	V	E	Notes
Other Insurance--Medicaid beneficiaries who have other health insurance	X
Reside in Nursing Facility or ICF/IID-- Medicaid beneficiaries who reside in Nursing Facilities (NF) or Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID).	X
Enrolled in Another Managed Care Program-Medicaid beneficiaries who are enrolled in another Medicaid managed care program	X
Eligibility Less Than 3 Months--Medicaid beneficiaries who would have less than three months of Medicaid eligibility remaining upon enrollment into the program	X
Participate in HCBS Waiver--Medicaid beneficiaries who participate in a Home and Community Based Waiver (HCBS, also referred to as a 1915(c) waiver).	X
Retroactive Eligibility-Medicaid beneficiaries for the period of retroactive eligibility.	X
Other (Please define):

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State Plan-Approved Service Delivered by the MCO	Medicaid State Plan Citation
State Plan-Approved Service Delivered by the MCO	Attachment #	Page #	Item #
Ex. Physical Therapy	3.1-A	4	11.a

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Appendix A: Compliance Dates (from Supplementary Information in 81 FR 27497, published 5/6/2016)

States must comply with all provisions in effect as of the issuance of this preprint. Additionally, the following compliance dates apply:

Compliance Dates	Sections
For rating periods for Medicaid managed care contracts beginning before July 1, 2017, States will not be held out of compliance with the changes adopted in the following sections so long as they comply with the corresponding standard(s) codified in 42 CFR part 438 contained in 42 CFR parts 430 to 481, edition revised as of October 1, 2015.States must comply with these requirements no later than the rating period for Medicaid managed care contracts starting on or after July 1, 2017.	§ § 438.3(h), 438.3(m), 438.3(q) through (u), 438.4(b)(7), 438.4(b)(8), 438.5(b) through (f), 438.6(b)(3), 438.6(c) and (d), 438.7(b), 438.7(c)(1) and (2), 438.8, 438.9, 438.10, 438.14, 438.56(d)(2)(iv), 438.66(a) through (d), 438.70, 438.74, 438.110, 438.208, 438.210, 438.230, 438.242, 438.330, 438.332, 438.400, 438.402, 438.404, 438.406, 438.408, 438.410, 438.414, 438.416, 438.420, 438.424, 438.602(a), 438.602(c) through (h), 438.604, 438.606, 438.608(a), and 438.608(c) and (d)
For rating periods for Medicaid managed care contracts beginning before July 1, 2018, states will not be held out of compliance with the changes adopted in the following sections so long as they comply with the corresponding standard(s) codified in 42 CFR part 438 contained in the 42 CFR parts 430 to 481, edition revised as of October 1, 2015. States must comply with these requirements no later than the rating period for Medicaid managed care contracts starting on or after July 1, 2018.	§ § 438.4(b)(3), 438.4(b)(4), 438.7(c)(3), 438.62, 438.68, 438.71, 438.206, 438.207, 438.602(b), 438.608(b), and 438.818
States must be in compliance with the requirements at & 438.4(b)(9) no later than the rating period for Medicaid managed care contracts starting on or after July 1, 2019.	§ 438.4(b)(9)
States must be in compliance with the requirements at & 438.66(e) no later than the rating period for Medicaid managed care contracts starting on or after the date of the publication of CMS guidance.	§ 438.66(e)
States must be in compliance with & 438.334 no later than 3 years from the date of a final notice published in the Federal Register.	& 438.334
Until July 1, 2018, states will not be held out of compliance with the changes adopted in the following sections so long as they comply with the corresponding standard(s) codified in 42 CFR part 438 contained in the 42 CFR parts 430 to 481, edition revised as of October 1, 2015.	§ § 438.340, 438.350, 438.354, 438.356, 438.358, 438.360, 438.362, and 438.364
States must begin conducting the EQR-related activity described in & 438.358(b)(1)(iv) (relating to the mandatory EQR-related activity of validation of network adequacy) no later than one year from the issuance of the associated EQR protocol.	§ 438.358(b)(1)(iv)
States may begin conducting the EQR-related activity described in & 438.358(c)(6) (relating to the optional EQR-related activity of plan rating) no earlier than the issuance of the associated EQR protocol.	§ 438.358(c)(6)

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-0933. The time required to complete this information collection is estimated to average 10 hours per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C 4-26-05, Baltimore, Maryland 21244-1850 CMS-10120 (exp. TBD - currently 4/30/17)

060.00.19 Ark. Code R. 004

Adopted by Arkansas Register Volume XLIII Number 06, Effective 11/28/2019