Arkansas Administrative Code

20 CAR § 575-102. Definitions. As used in this part: (1)(A) “Cost effectiveness” means insurance premium payments are cost effective if the premiums, coinsurance, deductibles, and other cost-sharing obligations under a health plan, plus an amount for administrative costs, are lik…

20 CAR § 575-103. HIPP program. (a) The Division of Medical Services may cover payment of premiums for Medicaid beneficiaries enrolled in a cost-effective health plan. (b) The division may also cover payment of deductibles, coinsurance, and other cost-sharing obligations under th…

20 CAR § 575-104. Medicaid eligibility unaffected. (a)(1) Enrollment in a health plan does not change the client's eligibility for Medicaid benefits. (2) If services covered under Medicaid are not covered by the health plan, payment for those services is made according to the app…

20 CAR § 575-105. Third-party liability. The health plan is considered to be a third party that is legally liable for the payment of care and services provided under the state Medicaid plan.

20 CAR § 575-106. Enrollment. (a)(1) Health plans usually limit an individual's enrollment period. (2) If an individual who is already enrolled in a health plan becomes Medicaid eligible, the Division of Medical Services may cover premium payments as of the effective date of Medi…

20 CAR § 575-107. Cost effectiveness determination. The Division of Medical Services determines the cost effectiveness of health plans using the following methodology: (1)(A) The Medicaid client furnishes information on the health plan to the division. (B) This information must i…

20 CAR § 575-108. Exceptional medical costs (special conditions). If the client provides documentation of ongoing medical costs or future medical costs that exceed the estimated average Medicaid costs, the Division of Medical Services may determine that the health plan is cost ef…

20 CAR § 575-109. Balance billing. (a) The Division of Medical Services pays only up to the Medicaid allowable amount. (b)(1) For example, if a provider bills fifty dollars ($50.00) for a service and the insurer pays forty dollars ($40.00), but the Medicaid allowable is thirty-se…

20 CAR § 575-110. Payment for services. (a) The Division of Medical Services will pay the health insurance premium directly to the policyholder or designated party through premium payment from payroll deduction or individual plans. (b) The division will reimburse the policyholder…

20 CAR § 577-101. Definitions. As used in this part: (1) “Accounts receivable” means the accounts receivable unit of the Division of Finance of the Department of Human Services; (2) “Director” means the Director of the Division of Medical Services; (3) “Division” means the Divisi…

20 CAR § 577-102. Patient revenues. All nursing facilities shall report their patient revenues on a monthly basis on a form prescribed by the Division of Medical Services for the specific purpose of reporting patient revenue.

20 CAR § 577-103. Fee assessment, billing, collection. (a) Each nursing facility shall file a report with the Department of Human Services by the tenth of each month for the preceding month, listing the patient midnight census as required by rules promulgated by the Division of M…

20 CAR § 577-104. Change of ownership or management. The liability for any amount owed the Division of Medical Services in connection with the quality assurance fee is joint and several as between or among the original obligor and any successor licensees.

20 CAR § 577-105. Administration of fees. (a) Fees assessed and collected will be deposited into a designated account within the Arkansas Medicaid Program Trust Fund as established under Arkansas Code § 19-5-985. (b) No nursing facility shall be guaranteed, expressly or otherwise…

20 CAR § 577-106. Sanctions. (a) Sanctions will be assessed by the Division of Medical Services on all nursing facilities that fail to comply with the provisions of Acts 2001, No. 635, as implemented by this part. (b) Any fee or fine imposed under this part, as authorized by Acts…

20 CAR § 577-107. Appeal procedures. (a) Appeal procedures for nursing facilities are outlined in 20 CAR § 579-110 of the Department of Human Services Medical Assistance Program Manual of Cost Reimbursement Rules for Long Term Care Facilities. (b) Providers can obtain a copy of t…

20 CAR § 578-101. Purpose. The purpose of the Life Choices Lifeline and Continuum of Care Program is to provide a statewide telemedicine network and care program to provide community outreach, direct services, support, social services case management, care coordination, consultat…

20 CAR § 578-102. Definitions. As used in this part: (1)(A) “Abortion” means the act of using or prescribing any instrument, medicine, drug, or any other substance, device, or means with the intent to terminate the clinically diagnosable pregnancy of a woman, with knowledge that …

20 CAR § 578-201. Components. The Life Choices Lifeline and Continuum of Care Program shall consist of at least the following components: (1) Direct-to-participant marketing within Arkansas; (2) Participant outreach; (3) Direct services, supports, social services case management,…

20 CAR § 578-202. Eligibility. (a) The Life Choices Lifeline and Continuum of Care Program is available to residents of all counties of the State of Arkansas who meet the eligibility criteria set out below, including residents in rural areas that may currently lack access to heal…

20 CAR § 578-203. Provider requirements. A provider of Life Choices Lifeline and Continuum of Care Program services cannot: (1) Be an abortion provider; (2) Assist women in obtaining an abortion, refer women to an abortion provider, recommend abortion, promote abortion, refer for…

20 CAR § 578-204. Care agent requirements. Care agents employed by the agency to offer the required services: (1) Must have the qualification specified by that service; (2) Must not have performed an abortion in the last two (2) years or served as a director, board member, office…

20 CAR § 578-205. Required services. (a)(1) Program services may be provided, as appropriate, in person through existing facilities or remotely through a telephonic system or other comparable technological system. (2) Any technological or telephonic system used must maintain the …

20 CAR § 578-206. Excluded services. An agency may not provide or prescribe abortion services or abortion aid, nor take any action that directly or indirectly advises a woman to obtain or assists a woman in obtaining an abortion.

20 CAR § 578-301. Monthly report. An agency shall provide to the Division of Medical Services a monthly report that contains: (1) The number of unique individuals who contacted the agency; (2) The number of individuals who were eligible to receive services and the number who enro…

20 CAR § 578-302. Annual report. By September 1 of each year, the agency must submit an annual report for the previous fiscal year, to be compiled for the General Assembly that includes: (1) The number of participants served by the agency; and (2) The types of referrals and servi…

20 CAR § 578-303. Confidentiality of the reports. (a) All personally identifiable information used in or to create the reports detailed in this subpart is confidential and is not subject to the Freedom of Information Act of 1967, Arkansas Code § 25-19-101 et seq. (b) Disclosures …

20 CAR § 579-101. General principles. (a)(1) All long-term care facilities will be reimbursed according to the principles and procedures specified in this part. (2) Allowable costs are those costs necessary and reasonable for performance of covered services required by Medicaid r…

20 CAR § 579-102. Recordkeeping. (a)(1) Providers are required to maintain adequate financial records and statistical data for proper determination of costs payable under the program. (2) The cost report is to be based on financial and statistical records maintained by the facili…

20 CAR § 579-103. Activities not related to resident care. If the provider conducts activities not related to resident care, additional accounts must be added to accommodate those activities.

20 CAR § 579-104. Accrual and cash basis of accounting. (a)(1) For nongovernmental providers, the financial and statistical report must be filed using information stated on the accrual method of accounting. (2) The chart of accounts is designed to be used in a complete accrual ac…

20 CAR § 579-105. Chart of accounts. (a) The applicable chart of accounts shall be used by all long-term care facilities participating in the Title XIX program. (b) Each chart of accounts provides for the basic classifications of all assets, liabilities, income, and expense neces…

20 CAR § 579-106. Cost reporting requirements. (a)(1)(A) All providers in operation under a valid Medicaid agreement for long-term care services must file a financial and statistical report, commonly referred to as a “cost report” or “FSR”. (B) In addition to the annual reporting…

20 CAR § 579-107. Desk reviews. (a)(1) The Department of Human Services will review all cost reports to verify that all facilities have submitted reports properly and in compliance with this manual. (2) Providers will be notified in writing of the results of the desk review. (b) …

20 CAR § 579-108. Audits of financial records. (a)(1) The Department of Human Services will provide for periodic audits of some or all cost reports and supporting records. (2) The department may also conduct limited reviews of cost data and/or client statistics reported in the co…

20 CAR § 579-109. Unauditable situations. (a)(1) If a facility is unable or unwilling to provide necessary documentation to support the financial or statistical records contained in their cost report, the auditors will issue a “disclaimer” report signifying that the audit could n…

20 CAR § 579-110. Appeal procedures. (a) Time limit for appeals. (1)(A) Any long-term care facility may appeal the facility’s reimbursement rate, a recoupment, a cost disallowance, a fine, a sanction, the imposition of a civil money penalty, or suspension or termination from the …

20 CAR § 579-111. Penalties for failure to comply with the Medicaid long-term care program. (a)(1) By agreeing to participate in the long-term care program, providers must abide by this part. (2) Participation in the program may be terminated should the provider: (A) Fail to keep…

20 CAR § 579-112. Overpayments and underpayments. (a)(1) Administrative errors on the part of the Division of Medical Services or the facilities may result in erroneous payments. (2) These errors most commonly result from: (A) Failures to report a death, discharge, or transfer; (…

20 CAR § 579-201. Generally. Federal law requires that states use published payment methodologies and justifications which specify comprehensively the methods and standards for making Medicaid provider payments to long-term care facilities.

20 CAR § 579-202. Assurance of payment. Certified Title XIX long-term care facilities furnishing services in accordance with all state and federal Medicaid laws and rules will be paid in accordance with rates established under the state Medicaid plan.

20 CAR § 579-203. Acceptance of payment. Participation in the Title XIX program is limited to those facilities which agree to accept the Medicaid payment as payment in full for all care services provided to Medicaid recipients.

20 CAR § 579-204. Rate limitations based on Medicaid rates. (a) The purpose of this provision is to ensure that the Medicaid program is not charged unfairly high rates as compared to other payers. (b) To that end, Medicaid reimbursement is limited by the weighted average per diem…

20 CAR § 579-205. Facility class. The Department of Human Services has established the following specific payment methods: (1) Nursing facilities. (A) Reimbursement methodology. (i) Reimbursement rates for nursing facilities will be cost-based, facility-specific rates that will c…

20 CAR § 579-206. Mandatory changes. (a)(1) The Department of Human Services acknowledges that state laws passed by the General Assembly and administrative rules promulgated by the Division of Medical Services occasionally require the state’s long-term care facilities to incur co…

20 CAR § 579-301. General information. (a) This subpart sets forth principles for determining the allowable costs for the facilities which: (1) Meet the definition of a nursing facility (NF) under 42 C.F.R. pt. 483, subpt. B, if licensed and certified as an NF; (2) Meet the defin…

20 CAR § 579-302. List of allowable costs. The following list of allowable costs is not all inclusive but serves as a general guide and clarifies certain key expense areas. The absence of a particular cost does not necessarily mean that it is not an allowable cost. As discussed f…

20 CAR § 579-303. List of unallowable costs. The following list of unallowable costs is not all inclusive, but rather serves as a general guide and clarifies certain key expense areas. The absence of a particular item does not necessarily mean that it is an allowable cost. Except…

20 CAR § 579-304. Items that will reduce allowable costs. (a)(1) Interest income on unrestricted funds will reduce interest expense on all short-term debt not to exceed interest expense. (2) Short-term debt will be defined as debt having a term of forty-eight (48) months or less.…

20 CAR § 579-305. Special items to meet needs of residents of ICF/IID and the Arkansas Health Center Nursing Facility. (a) In addition to those items listed in 20 CAR § 579-302, the following items will be allowable costs for intermediate care facilities for individuals with inte…