Medicaid Benefits: Online Database

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Acute Care Services

Institutional and Clinic Services

Practitioner Services

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Physical Therapy and Other Services

Products and Devices

Transportation Services

Other Services

Long-Term Care Services

Community Based Care

Institutional Care

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Benefits by State: Arkansas (October 2008) Notes

Acute Care Services

Is the Benefit Covered?	Copayment Requirement	Prior Approval Requirement	Coverage Limitations	Reimbursement Methodology	Populations Covered

Institutional and Clinic Services
Clinic Services, by an organized facility or clinic not part of a hospital: Freestanding Ambulatory Surgery Center
Yes		Specified surgical procedures		Fee for service, all-inclusive rate for surgical procedures	CN & MN
Clinic Services, by an organized facility or clinic not part of a hospital: Public Health and Mental Health Clinics
Yes			Developmental day treatment clinic services up to 4 time units/year for physical, occupational and speech evaluations, 4 time units/day (15 minutes each) for individual and group therapy	Fee for service	CN & MN
Federally Qualified Health Center Services
Yes			12 ambulatory encounters/year irrespective of setting	Greater of prospective rate/encounter or allowable cost	CN & MN
Inpatient Hospital Services, other than in an Institution for Mental Diseases
Yes	10% of first day's per diem rate up to specified limit	Admissions for specified procedures, elective surgery admissions	24 days/year	Cost based payment for pediatric, teaching and critical access hospitals; cost based payment with daily cap for other acute hospitals; prospective per diem for rehab hospitals	CN & MN
Outpatient Hospital Services
Yes		Specified surgical procedures	12 non-emergency visits/year	Cost based payment for pediatric, teaching and critical access hospitals; fee for service for other hospitals	CN & MN
Rehabilitation Services: Mental Health and Substance Abuse
Yes		Specified services	Substance abuse services require mental health primary diagnosis	Fee for service	CN & MN
Rural Health Clinic Services
Yes			12 visits/year irrespective of setting included in limits for other specified practitioners	Prospective cost based rate/encounter	CN & MN
Practitioner Services
Certified Registered Nurse Anesthetist Services
Yes				Fee for service at 80% of physician fee	CN & MN
Chiropractor Services
Yes			12 visits/year	Fee for service	CN & MN
Dental Services
No
Medical and Remedial Care - Other Practitioners

Medical/Surgical Services of a Dentist
Yes			12 visits/year irrespective of setting included in limits for other specified practitioners	Fee for service	CN & MN
Nurse Midwife Services
Yes			12 visits/year irrespective of setting included in limits for other specified practitioners	Fee for service at 80% of physician fee	CN & MN
Nurse Practitioner Services
Yes			12 visits/year irrespective of setting included in limits for other specified practitioners	Fee for service at 80% of physician fee	CN & MN
Optometrist Services
Yes			1 refractive exam/2 years, 12 visits/year irrespective of setting included in limits for other specified practitioners	Fee for service	CN & MN
Physician Services
Yes		Specified surgical procedures	12 visits/year irrespective of setting included in limits for other specified practitioners, 2 in-person and 2 telemedicine consultations/year	Fee for service	CN & MN
Podiatrist Services
Yes			2 visits/year	Fee for service, lab services reimbursed up to Medicare payment ceilings	CN & MN
Psychologist Services
No
Prescription Drugs
Prescription Drugs
Yes	$.50-$3/Rx depending on drug cost	More than 3 prescriptions per month for non-institutionalized beneficiaries	6 Rxs/month except for persons in nursing facilities or participating in HCBS waivers	AWP-14% for brand Rx, AWP-20% for generic Rx, plus $5.51 dispensing fee for each, additional $2.00 dispensing fee for generic Rx with no FUL or state MAC	CN & MN
Physical Therapy and Other Services
Occupational Therapy Services
No
Physical Therapy Services
No
Services for Speech, Hearing and Language Disorders
No
Products and Devices
Dentures
No
Eyeglasses
Yes	$2/dispensing service	2 pair eyeglasses rather than bifocals	1 pair eyeglasses/year, contact lenses limited to post-cataract surgery	Products provided by state's volume purchase contractor, dispensing provider paid fee for service	CN & MN
Hearing Aids
No
Medical Equipment and Supplies
Yes		Specified med equipment and med supply items	Med supplies limited to $250/month	Fee for service for med equipment, med supplies paid up to Medicare payment ceilings	CN & MN
Prosthetic and Orthotic Devices
Yes		Augmentative communication devices	Orthotic appliances limited to $3,000/year, prosthetic devices limited to $20,000/year	Fee for service, some items paid percentage of item invoice cost	CN & MN
Transportation Services
Ambulance Services
Yes				Fee for service	CN & MN
Non-Emergency Medical Transportation Services
Yes				See service-specific FN	CN & MN
Other Services
Diagnostic, Screening and Preventive Services
No
Early and Periodic Screening, Diagnosis and Treatment
See service-specific FN.
Extended Services for Pregnant Women

Family Planning Services
See service-specific FN.
Laboratory and X-Ray Services, outside Hospital or Clinic
Yes			$500/year limit on all lab and most x-ray services	Fee for service, and using Medicare payment ceilings for lab services	CN & MN
Targeted Case Management
Yes				Fee for service, negotiated rate or cost based payment	CN & MN

Long-Term Care Services


Community Based Care
Home and Community Based Services Waiver
Yes		Services for the following populations: 2, 4 & 8 - See service-specific FN	Dependent upon the services provided	CN & MN
Home Health Services, includes nursing services, home health aides, and medical supplies/equipment
Yes	Specified med equipment	50 visits/year, only specified med equipment covered, med supplies covered up to $250/month and included in limitations with other providers	Fee for service, med supplies paid up to Medicare payment ceilings	CN & MN
Hospice Care
Yes		Two 90-day periods with additional 60-day periods as necessary	Prospective rate using Medicare wage index	CN & MN
Personal Care Services
Yes		64 hours/month	Fee for service using hourly rates	CN
Private Duty Nursing Services
Yes	Yes	Limited to ventilator dependent beneficiaries and those with functioning tracheostomy requiring suctioning and oxygen supplementation, $80 maximum payment for medical supplies/month	Fee for service	CN & MN
Program of All-Inclusive Care for the Elderly
Yes	Yes		Capitated payment	CN
Institutional Care
Inpatient Hospital, Nursing Facility and Intermediate Care Facility Services In Institutions for Mental Diseases, age 65 and older
No
Inpatient Psychiatric Services, under age 21
Yes	Yes	7 consecutive therapeutic leave days	Prospective cost based per diem	CN & MN
Intermediate Care Facility Services for the Mentally Retarded
Yes		5 hosp leave days/hospitalization, facility must have 85% occupancy rate to be paid, unlimited therapeutic leave days up to 14 consecutive days	Prospective cost based class rate for facilities with fewer than 16 beds, prospective cost based per diem for larger private facilities, cost based payment for public facilities	CN
Nursing Facility Services, other than in an Institution for Mental Diseases
Yes		5 hosp leave days/hospitalization, facility must have 85% occupancy rate to be paid, unlimited therapeutic leave days up to 14 days consecutively	Prospective cost based per diem	CN
Religious Non-Medical Health Care Institution and Practitioner Services
No

Notes: This State has added the optional Medicaid buy-in group of disabled adults permissible through the Ticket to Work and Work Incentives Improvement Act (TWWIIA). These beneficiaries are allowed to continue Medicaid coverage, and receive full benefits, if their income is at or below 250 percent of the federal poverty level. Beneficiaries in this group are not required to pay monthly premiums but are required to make a copayment for most services received. These copayment amounts are not reflected on the tables but are generally $10 per service or a percentage of the program’s payment for a particular service.