STATE PLAN SERVICES/DDS ACS WAIVER/EPSDT

1. STATE PLAN SERVICES/DDS ACS WAIVER/EPSDT WORKING TOGETHER February 27, 2012

2. Introductions

3. Purpose of Training • Explain policies • Define Medicaid State Plan covered services • Explain the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) process • Define when services are covered under the DDS ACS Waiver • Explain the consequences of failure to apply each service appropriately • Clarify how Medicaid/EPSDT/DDS ACS Waiver work together • Explain requirements to become a State Plan covered services provider (specifically DME) • Provide access to resources available • Provide contact information for questions

4. Policy • Application for a §1915(c) Home and Community-Based Waiver – Instructions, Technical Guide and Review Criteria (Technical Guide) 3. Extended State Plan Services Page 112 – • The services included in a waiver must not duplicate services that are provided under the State plan. However, through a waiver, a state may augment the services that it provides under the State plan. • Since Federal requirements concerning EPSDT services mandate that Medicaid eligible children receive all medically necessary services listed in §1905(a) of the Act that they require regardless of whether such services are specifically included in the State plan, the waiver may not provide for the coverage of services that could be furnished to children under EPSDT • DDS ACS Waiver Provider Manual Section 218.000 Specialized Medical Supplies – • Durable and non-durable medical equipment not available under the Arkansas Medicaid State Plan that is necessary to address beneficiary functional limitations. • Necessary medical supplies not available under the Arkansas Medicaid State Plan. Items reimbursed with waiver funds are in addition to any medical equipment and supplies furnished under the state plan and exclude those items that are not of direct medical or remedial benefit to the beneficiary. All items shall meet applicable standards of manufacture, design and installation. • When the items are included in Arkansas Medicaid State Plan services, a denial of extension of benefits by DMS Utilization Review will be required prior to approval for waiver funding by DDS. • DDS ACS Waiver Provider Manual Section 220.000 Case Management Services - • Case management services assist beneficiaries in gaining access to needed waiver services and other Arkansas Medicaid State Plan services, as well as medical, social, educational and other generic services, regardless of the funding source to which access is available.

5. State Plan Services • What is covered under Medicaid State Plan? • Specialized medical equipment and supplies • Adaptive equipment • Environmental modifications

6. EPSDT • What is covered under EPSDT? • Services not otherwise covered under the Medicaid Program will be considered for coverage if the services are prescribed by a physician as a result of an EPSDT screen. The services must be medically necessary and permitted under federal Medicaid regulations. • EPSDT covers any medically necessary service that will lead to the maximum reduction of medical and physical disabilities and restore the child to his or her best possible functional level. Services that are necessary to treat or ameliorate a defect, physical and mental illness, or a condition identified by a screen, must be considered for EPSDT beneficiaries under age 21 regardless of whether the service is otherwise included in the Arkansas Medicaid State Plan. • For those services that are not included in the Arkansas Medicaid State Plan, the PCP must complete - form DMS-693, titled Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Prescription/Referral for Medically Necessary Services/Items Not Specifically Included in the Medicaid State Plan. • All information requested on form DMS-693 must be provided. The PCP must attach a copy of the Child Health Services (EPSDT) screen results found in the patient chart records. The DMS-693 form must be submitted to the Division of Medical Services, Utilization Review Section, which will review the information for medical necessity.

7. DDS ACS Waiver Services • What is covered as an Extended State Plan service under the waiver • Specialized medical equipment and supplies • Adaptive equipment • Environmental modifications

8. Submit to Medicaid via a Medicaid DME provider Medicaid State Plan Covered Service YES NO Available under EPSDT Reference CHS (EPSDT) Provider Manual YES NO DDS ACS Waiver Covered Service Submit to DDS YES NO Deny

9. Billing • Medicaid Utilization Review will deny the service if the request is not submitted by the appropriate provider type • Any service billed through an Organized Health Care Delivery System (OHCDS) that is a valid covered State Plan service will be referred to Program Integrity for possible recoupment

10. DME, Prosthetics, Orthotics and Medical Suppliers Provider Enrollment Requirements • Enrolled in the Title XVII (Medicare) Program as a durable medical equipment/oxygen, orthotic appliances or prosthetic device provider. • Orthotics/prosthetics providers should maintain accreditation by the American Board for Certification in Orthotics and Prosthetics. • Providers must provide Arkansas Medicaid proof of DME Medicare accreditation and surety bond dated on or after October 1, 2009. New Providers will be required to submit Medicare accreditation and surety bond upon enrollment. • Meet all national licensing and certification requirements and all licensing and certifications required by the State of Arkansas • Enrolled in the AR Medicaid program • Link to enrollment criteria and information is listed on the resource page

11. Resources • Provider manuals - https://www.medicaid.state.ar.us/InternetSolution/Provider/docs/docs.aspx Prosthetics (includes DME and Orthotics) - https://www.medicaid.state.ar.us/InternetSolution/Provider/docs/prosthet.aspx Child Health Services (EPSDT) - https://www.medicaid.state.ar.us/InternetSolution/Provider/docs/epsdt.aspx DDS Alternative Community Services (ACS) Waiver - https://www.medicaid.state.ar.us/InternetSolution/Provider/docs/ddswvr.aspx • DDS ACS waiver application – http://humanservices.arkansas.gov/ddds/Pages/waiverServices.aspx • Medicaid Handbook - https://www.medicaid.state.ar.us/general/reports.aspx#mob • Medicare Provider Enrollment - http://www.arkmedicare.com/provider/enrollment/default.htm • Find a Medicaid Provider - https://www.medicaid.state.ar.us/InternetSolution/Provider/Search/Provider/ProviderSearch.aspx

12. Contact Information • Arkansas Division of Medical Services, HP Enterprise Services Provider Enrollment Unit Toll free 1-800-457-4454 Local and out of state (501) 376-2211 Fax (501) 374-0746 Mailing address Medicaid Provider Enrollment Unit HP Enterprise Services P.O. Box 8105 Little Rock, AR 72203-8105 • Arkansas DHS, Division of Medical Services, Utilization Review Section Toll free 1-800-482-5850, extension 2-8340 Telephone (501) 682-8340 Fax (501) 682-8013 Mailing address Arkansas DHS Division of Medical Services Utilization Review Section P.O. Box 1437, Slot S413 Little Rock, AR 72203-1437 • DDS contact: Ruby Jeffers, Program Administrator Field Staff/Waiver Services 501-683-0575 Ruby.Jeffers@arkansas.gov

13. Questions