016.06.04 Ark. Code R. § 030 Arkids First-B Provider Manual Update Transmittal #15

• Library: Arkansas Administrative Code
• Edition: 2023
• Currency: Current through Register Vol. 48, No. 12, December, 2023
• Citation: 016.06.04 Ark. Code R. § 030
• Year: 2023

Section II ARKids First-B

200.300 ARKids First-B Identification Card When determined eligible, an ARKids First-B participant receives a magnetic encoded identification (ID) card for eligibility verification. New participants in the ARKids First-A and the ARKids First-B Programs will be issued a generic ARKids First ID card. The card will not identify the participant's program as an ARKids First-A or and ARKids First-B The ID card will be for an ARKids First participant and will not specify the program. Currently eligible children will retain their existing ARKids First-A or ARKids First-B cards.

200.310 When a Participant's ARKids First Eligibility Changes The participant's Medicaid ID number will not change when he or she moves from A to B or from B to A within the ARKids First umbrella program The participant will not be issued a new card when the change occurs. Existing ID cards will not be replaced, so it will not be possible for a provider to determine by viewing the ID card whether payment is eligible in the ARKids First-B program that requires additional co-payments or the ARKids First-A program.

200.320 Provider Verification of Eligibility The ARKids First-B identification card does not guarantee an individual's eligibility. Payment is subject to verification that the participant is eligible at the time services are provided. It is crucial to the provider that eligibility is determined at each visit. Eligibility verification transactions require PES software installed on the personal computer (PC) or modification of the office management system according to specifications. The fiscal agent for the Division of Medical Services provides PES software and software updates or vendor specifications, all free of charge. Refer to Section 016undefinedI of the Arkansas Medicaid provider manual for automated eligibility verification procedures.

200.330 ARKids First ID Card Example View or print the ARKids First ID card example.

200.340 Non-Receipt or Loss of ID Card When ARKids First-B participants report non-receipt or loss of an ID card, refer the participant to the DHS County Office or the Division of County Operations, Customer Assistance. View or print the Division of County Operations - Customer Assistance Section Contact Information.

221.100 ARKids First-B Medical Care Benefits

Program Services	Coverage Limits on Benefit	Prior Authorization/ PCP Referral	Co-payment/ Coinsurance
Ambulance (Emergency Only)	Medical Necessity	None	$10 per trip
Ambulatory Surgical Center	Medical Necessity	PCP Referral	$10 per visit
Certified Nurse-Midwife	Medical Necessity	PCP Referral	$10 per visit
Chiropractor	Medical Necessity	PCP Referral	$10 per visit
Dental Care (No Orthodontia)	Routine dental care	None	$10 per visit
Durable Medical Equipment	Medical Necessity $500 per state fiscal year (July 1 through June 30) minus the coinsurance	PCP Referral and Prescription	20% of Medicaid allowed amount per DME item
Emergency Dept. Ser	vices
Emergency Non-Emergency Assessment	Medical Necessity Medical Necessity Medical Necessity	None PCP Referral None	$10 per visit $10 per visit $10 per visit
Family Planning	Medical Necessity	None	None
Federally Qualified Health Center (FQHC)	Medical Necessity	PCP Referral	$10 per visit
Home Health	Medical Necessity (10 visits per state fiscal year (July 1 through June 30)	PCP Referral	$10 per visit
Hospital, Inpatient	Medical Necessity	PA on stays over 4 days if age 1 or over	20% of first inpatient day
Hospital, Outpatient	Medical Necessity	PCP referral	$10 per visit
Immunizations	All per protocol	PCP or Administered by ADH	None
Laboratory & X-Ray	Medical Necessity	PCP Referral	$10 per visit
Medical Supplies	Medical Necessity Limited to $125/mo unless benefit extension is approved	PCP Prescriptions	None
Mental and Behavioral Health, Outpatient	Medical Necessity	PCP Referral PA on treatment services	$10 per visit
Nurse Practitioner	Medical Necessity	PCP Referral	$10 per visit

Physician	Medical Necessity	PCP referral to specialist and inpatient professional services	$10 per visit
Podiatry	Medical Necessity	PCP Referral	$10 per visit
Prenatal Care	Medical Necessity	None	None
Prescription Drugs	Medical Necessity	Prescription	$5 per prescription (Must use generic and rebate manufacturer, if available)
Preventive Health Screenings	All per protocol	PCP Administration or PCP Referral	None
Rural Health Clinic	Medical Necessity	PCP Referral	$10 per visit
Speech Therapy	Medical Necessity	PCP Referral	$10 per visit
Vision Care
Eye Exam	One (1) routine eye exam (refraction) every 12 months	None	$10 per visit
Eyeglasses	One (1) pair every 12 months	None	None

Refer to your Arkansas Medicaid provider manual for prior authorization and PCP referral procedures.

222.300 Dental Services Benefit Limit Dental services for ARKids First-B participants are limited to one (1) initial oral exam, bite-wings, scalings and prophylaxis/fluoride treatments per state fiscal year (July 1-June 30). The procedure codes listed in the table below may be billed for the prophylaxis/fluoride.

National Code	Local Code	Local Code Description
D1110	01110	Prophylaxis - adult (ages 10-20)
D1120	01120	Prophylaxis - child (ages 0-9)
D1201	01201	Topical application of fluoride (including prophylaxis) - child (ages 0-9)
D1205	01205	Topical

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