Agencies | Online Services | Policies

Medical Services Table of Contents

Medical Services Record of Manual Transmittals

Medical Services Policy

MS 00-02      New and Revised Policy

MS 00-03      TEA Medicaid

MS 00-04      Revised Policy

MS 00-06      Acceptance of SSA-2853 for Verification of SSN Enumeration

MS 00-07      Look back period for Health Insurance Coverage / ARKids

MS 00-09      Revised Policy - SMB, QI-1 & QI-2

MS 01-02  New Policy - Medicaid Eligibility for the Working Disabled

MS 01-03  Medicare Savings Programs

MS 01-06  Revised Policy - Working Disabled

MS 01-08  MS Table of Contents

MS 01-09  SSI COLA Correction

MS 01-10  New and Revised Policy

MS 01-12  New Policy - Breast and Cervical Cancer Medicaid

MS 02-02  New Policy - Income - Family Medicaid Basic Eligibility Requirements

MS 02-05  Revised Policy:  ARKids First

MS 02-06  New Policy - Definition of a Resource

MS 02-09  Tuberculosis (TB) Medicaid

MS 02-10  TEFRA Waiver

MS 02-11  Assisted Living Facilities Waiver

MS 02-12  2003 Appendix S, SSI Chart

MS 03-02 ElderChoices & AAPD Waiver Policy

MS 03-03  2003 Federal Poverty Levels

MS 03-04  ElderChoices & AAPD Waiver Policy Correction  

MS 03-06  Citizenship and Alien Status

MS 03-07  Citizenship and Alien Status-Instructions for Deeming from Alien Spouse

MS 04-01  2004 Appendix S, SSI Chart

MS 04-02  2004 Federal Poverty Level

MS 04-03  ARKids First

MS 04-04 Revised Policy:  Transfer of Resources

MS 04-07 Medicaid Coverage of Pregnant Women

MS 04-08 Adding Spousal Resources Provisions to ElderChoices

MS 05-02 Appendix R, Transfer of Assets Divisor

MS 05-03 2005 Federal Poverty Levels

MS 05-04 Continuing Eligibility for Medicaid Certified Women Who are Pregnant

MS 05-06 Revised Policy: MS 3336.9 Removing Income Trust Cap

MS 06-01 2006 Appendix S – SSI Chart

MS 06-03 Appendix R – Transfer of Assets Divisor

MS 06-04 2006 Federal Poverty Levels

MS 06-05 Verification of Citizenship

MS 06-06 ARKids B 5% Co-pay Cap

MS 07-01 2007 Appendix S (SSI and Quarters of Coverage Charts)

MS 07-02 Allowable Trustee Fees

MS 07-04 2007 Federal Poverty Levels

MS 07-05 Appendix R, Transfer of Assets Divisor

MS 07-06 SSA/SSI Retroactive Payment Exclusion

MS 07-07 Pregnant Women Income Verification

MS 07-08 Creditable Coverage for the Family Planning Waiver

MS 07-09 Changes to the Alternatives for Adult with Physical Disabilities Waiver (AAPD)

MS 07-10 Family Planning Policy - Correction

MS 07-12 Earning Disregard – Nursing Facility Residents

MS 07-13 Alternatives for Adult with Physical Disabilities Waiver (AAPD)-Correction

MS 08-01 2008 Appendix S (SSI and Quarters of Coverage Charts)

MS 08-02 Life Expectancy Tables

MS 08-03 Creditable Coverage for the Family Planning Waiver

MS 08-04 Life Estate

MS 08-05 2008 Federal Poverty Levels

MS 08-06 Appendix R, Transfer of Assets Divisor

MS 08-07 SSI Lump Sum Payment Exclusion

MS 08-08 Social Security Enumeration Requirement

MS 08-10 Long Term Care Insurance Partnership Program

MS 08-12 Student Earned Income Exclusion

MS 08-13 PACE – Program of All Inclusive Care for the Elderly

MS 08-14 Pregnant Women Eligibility – Residence Requirement

MS 08-15 Money Follows the Person Waiver Services

MS 08 16 Non-Qualified Alien Children in ARKids Budget

MS 09-01 2009 Appendix S (SSI and Quarters of Coverage Charts)

MS 09-02 Family Planning Waiver

MS 09-03 Disability Decision – (SSA vs. MRT)

MS 09-05 ElderChoices – Adult Family Home Service

MS 09-06 Twelve Month Filling Deadline on Medicaid Claims

MS 09-09 Working Disabled Eligible to Receive AAPD Services

MS 09-10 Citizenship Requirement-Correction

MS 09-11 Appendix R, Transfer of Assets Divisor

MS 09-12 Revised Policy – Medicare Saving Reevaluations

MS 09-13 2009 Federal Poverty Levels

MS 09-14 Arkids – Removal of the Option Various Revisions

MS 09-15 AAPD Waiver – Choice of Coverage No Longer an Option Recipients 65 and Older

MS10-02 Medicare Savings – Resource Limits

Medical Services Policy Directives

MS 82-3      Beneficiary and Earnings Data Exchange (BENDEX)

MS 89-10   SSN Enumeration Procedures When A Request For An SSN For A Child Was Made At A Hospital

MS 91-28    MRT Guidelines

MS 92-6      Supplementary Insurance for Medicare Recipients

MS 92-7      Program Initiatives – Food Stamp Lawsuit

MS 92-11    The Computer Matching Act of 1988 – 30 Day Notice Requirement

MS 98-1      1988 Cost of Living Increase

MS 98-11    Medicaid Explanations

MS 98-12    TEA Medicaid and Extended (Transitional) Medicaid

MS 98-13    MRT Guidelines

MS 99-1      1999 Cost of Living Increase

MS 99-4      Ensuring Medicaid for TEA Households

MS 99-7      New Federal Poverty Levels

MS 99-11    Certificate of Creditable Coverage

MS 99-13    Transitional Medicaid - Declaration of Earnings

MS 00-1      2000 Cost of Living Increase

MS 00-5     New Federal Poverty Level Chart

MS 00-8    ARKids First and SOBRA Procedural Changes

MS 01-01  2001 Cost of Living Increase

MS 01-04  2001 Federal Poverty Levels

MS 01-05  No Resource Test for ARKids A

MS 01-07  Change in Application Procedure for AAPD Waiver

MS 01-11  Coverage for Pregnant Women with Income up to 200% FPL

MS 01-13  2002 Cost of Living Increase

MS 01-14  Medicaid Renewals at Food Stamp QR and Midpoint Review

MS 02-01  Child Support Referrals for Voluntary Cooperation

MS 02-03  2002 Federal Poverty Level

MS 03-01  Implementation of SCHIP Provisions to ARKids B

MS 03-05  Family Planning Waiver Extension

MS 04-06 Reducing Interview Requirements for Initial Medicaid Applications

MS 04-09 The Impact of Medicare Approved Prescription Drug Coverage on the Food Stamp Program and the Medicaid Program

MS 04-11 Accepting Faxed Applications

MS 05-01 2005 Appendix S, SSI Chart

MS 05-05 ARKids First Telephone Renewals

MS 06-02 Referrals for IndependentChoices

MS 06-07 Citizenship Requirement – Secondary or Lower Verification - Verification of Identity for Adult Medicaid Applicants/Recipients

MS 06-08 Procedures Developed with the Division of Health related to Citizenship Verification for Medicaid Applications Taken at Local Health Units

MS 06-09 Deficit Reduction Act of 2005 – Long Term Care Changes

MS 07-03 Citizenship Verification Requirement Exemption-SSA Disability Recipients

MS 07-11 Medical Review Team (MRT) Denials and Closures Explanation of Adverse Action

MS 07-14 Termination of ARKids First Telephone Renewal Requirement

MS 08-09 Closing ARKids A and B Cases

MS 09-04 Adult Family Home – Service within ElderChoices

MS 09-08 Working Disabled Eligible to Receive AAPD Services

MS 09-16 AAPD Waiver Waiting List

 

 

1000     Medical Services

1010     Legal Basis

1020     Administration

1030     Purpose of Medical Services

1040          Benefits Available Under Medicaid

 

1100     County Office Responsibilities For Services

1110     Client Representation Services Program

1120     Child Health Services Program (EPSDT)

                          1120.1    Purpose of Child Health Services Program

                          1120.2    Administration

                             1120.3    Individuals Eligible for Child Health Services

     1120.4    Eligible Providers of Child Health Services

                                           1120.4.1    Provider Participation Requirements

                                           1120.4.2    Choice of Providers

           1121    Formal Screening Services

                         1121.1    Medical Screening Services

                         1121.2    Dental Screening Services

   1121.3    Visual Screening Services

   1121.4    Hearing Screening Services

   1121.5    Initial CHS Examinations

   1121.6    Requirements for Interperiodic Screenings

   1121.7    Covered Services

1122    Informing Procedure

1123    ACES Certification Requirements for Child Health Services

   1123.1    ACES EPSDT Indicator Update Screen (WEPS)

1124    Services

   1124.1    Support Services

   1124.2    Scheduling Assistance

   1124.3    Transportation

   1124.4    Follow-up

                                         1124.4.1    Refused Services

                                         1124.4.2    Canceled Appointments

                                         1124.4.3    "No Shows"

1125    Diagnosis and Treatment

1126    Provider - Initiated Child Health Services

1127    Forms and Reports

   1127.1    DCO-694

   1127.2    Child Health Services Monthly Reports

   1127.3    Ordering Forms

1150    Children's Medical Services Program

1151    Cost Sharing Coinsurance/Copayment

1155    Expedited Services for Child Abuse Cases

1160    Head Start

1170    Hospital/Physician Referral Program

   1170.1    Hospital/Physician Responsibility

   1170.2    County Office Responsibility

1180     Hospital/Physician Referral for Newborns

1190     Primary Care Physician Managed Care Program

1191     Recipient Responsibilities

1192     County Office Responsibilities

    1192.1    System Requirements for PCP Selection

1193     Changes in Primary Care Physicians

    1193.1    PCP Changes for SSI Recipients

    1193.2  Changes in Recipient Status

1193.3    System Requirements for PCP Changes

1194     Procedures for CMS Recipients

    1194.1    CMS Responsibilities

    1194.2    County Office Responsibilities

1200     Transportation Services

1200.1    Services for Which Transportation is Paid

1200.2    Primary Care Physicians

1200.3    Freedom of Choice (Non-PCP Recipients)

1200.4    Methods of Transportation and Payment

1200.5    Loaded Miles

1200.6    Meals, Lodging and Incidental Expenses

1200.7    Domiciliary Care

1200.8    Therapeutic Visits

1200.9    Emergency Transportation

1200.10  Visits for Prolonged Treatment

1200.11  Out-of-State Transportation

1200.12  Transportation of Former Recipients for Utilization Review

1205     County Office Administration

1205.1    Case Records

1205.2    Volunteers

1205.3    Verification and Prior Authorization

1205.4    TR-1s

1205.5    Misuse of Transportation

1205.6    Lost or Stolen Checks

1205.7    Canceled Visits

1205.8    Authorizing County

1205.9    Replenishing Funds

1205.10  Preferential Treatment

1300     General Information

1310     Child Support Enforcement Services

1320     Coordination with Other Programs

1330     Disclosure of Information/Confidentiality

1331     Authorized Representatives

1332     Medical Records and DCO-109s

1333     Medical Providers/Service Organizations

1334     Collateral Information

1340     Disposition of Medicaid Case Records

1348     Inmates of Public Institutions

1350     Mandatory Assignment of Rights to Medical Support/Third Party Liabilities

1350.1    County Office Responsibility

1350.2    Recipient Responsibility

1350.3    Provider Responsibility

1350.4    Procedure for Failure to Cooperate

1360     Medicaid for the Homeless

1370     Medicaid Identification Card

1371     Reissuing of Medicaid ID Cards

1380     Medicare/Medicaid

1385     Quality Assurance

1390     Social Security Enumeration

1400     Twelve Month Filing Deadline on Medicaid Claims

2000     Individuals Eligible for Medicaid

2005     Date Specific Eligibility

2010     Supplemental Security Income (SSI) Eligibles

2010.1    National Correction Procedure

2011     Definition of Eligible Spouse

2012     Definition of Eligible Child

2013     Definition of Marital Status

2014     Definition of Living Arrangements

2020     Converted Cases Not Blind or Disabled Under SSI Criteria

2025     Essential Person (Ineligible Spouse) in December 1973

2030     Eligible Due to Disregard of Social Security COLA Increases

2031     Central Office Procedure

2032     County Office Responsibilities

2033     Eligibility Criteria for Closed SSI Cases

2033.1     Examples of Potential Eligibles

2034     Determining Eligibility

2034.1     Certification and Other System Procedures

2035     Identification of Stragglers

2036     Medicaid for Children Who Lost SSI Due to Childhood Disability Redeterminations

2036.1     Extent of Services

2036.2     Identification of Eligibles

2036.3     Continuation Procedures

2036.4     Reevaluation of Eligibility

2036.5     Changes and Closures

2040     Medicaid Eligible Due to 20% Social Security Increase in September 1972

2041    Determination of Current Eligibility

2042    Reevaluation of Eligibility

2043    Closure

2044     August, 1972 Eligibility Criteria

2044.1    August, 1972 AFDC Criteria

2044.2    August, 1972 AABD Criteria

2044.3    Public Institution Eligibles in December 1973

2045     Medicaid For Disabled Widows and Widowers

2045.1    Eligibility Criteria

2045.2    Processing Reapplications and Reevaluations

2046     Disabled Widows and Widowers

2046.1    Eligibility Criteria

2046.2    Application Procedures and Eligibility Determination

2046.3    Reevaluation

2049  Medicaid for Disabled Widows, Widowers, and Disabled Surviving Divorced Spouses (OBRA 90)

2049.1    Scope of Services

2049.2    Eligibility Criteria

2049.3    Referrals from SSA

2049.4    Application Procedures

2049.5    Eligibility Determinations

2049.6    Individuals Who Have Remarried

2049.7    Certification Procedures

2049.8    Reevaluations

2049.9    Individuals Who Become Eligible for or Entitled to Part A Medicare

2049.10 Changes and Closures

2050     Medicaid for Disabled Adult Children

2050.1    Resource and Income Guidelines

2050.2    Certification

2050.3    Reevaluations and COLA Adjustments

2055     Medicaid for Drug Addicts and Alcoholics (DA&A)

2061     Transitional Medicaid (TM) Category 25

2061.1    Extent of Services

2061.2    Eligibility Requirements

2061.3    TEA Medicaid Case Closure - Due to Earnings

2061.4    Received TEA Medicaid in 3 of the last 6 Months

2061.5    Residence

2061.6    Dependent Child

2061.7    Reporting Requirements in the Initial 6 Months Transitional Medicaid Extension Period (First Six Months)

2061.8    Determining Initial Eligibility When There Was An Untimely Report of Earnings

2061.9    Additional 6 Months TM Extension Period (Second Six Months)

2062     Received Transitional Medicaid In Each of the Initial 6 Months

2062.1    Reporting Requirements in the Additional 6 months Extension Period (Second Six Months)

2062.2    Employment Requirement

2062.3    The 185% Earned Income Test and Computation of Average Monthly Gross Earnings

2062.4    Changes in the Transitional Medicaid Period

2062.5    System Closures, System Reports, and County Responsibilities

2062.6    Summary of Sequence of Notices/Reports in Transitional Medicaid

2063     Extended Medicaid Eligibility When TEA Medicaid Case Closed Due to Child Support Income

2070     Inpatient Psychiatric Care Eligibles at Arkansas State Hospital and George W. Jackson Center

2071    Eligibility Criteria Applicable to Referred Patients

2072    County Office Responsibilities - Inpatient Psychiatric Care Referrals

2075     DDS Alternative Community Services

2075.1    Eligibility Requirements

2075.2    Disability Determinations

2075.3    Eligibility Determinations

2075.4    No Contribution to the Cost of Care

2075.5    Approving the Application

2075.6    DDS Waiver Applicants Currently Residing in ICF/MR Facilities

2075.7    Continuing Eligibility

2077     DDS Alternative Disposition Plan (ADP) Nursing Home Reform Waiver

2077.1    Eligibility Assessment

2077.2    Eligibility Requirements

2077.3    Application Procedures

2077.4    Continuing Eligibility

2085 Transitional Employment Assistance (TEA) Related Medicaid

2085.1 Extent of Services

2086 Eligibility Requirements

2086.1 TEA Requirements Not Applicable to TEA Related Medicaid

2086.2 Application Process

2086.3 Time Limit on Disposition of Applications

2087 Authorization of Eligibility

2087.1 Denial and Withdrawal

2088 Reevaluation and Changes

2088.1 Loss of Eligiblity Due to Income

2100 Medicaid Eligibility Prior to Month of Application - Retroactive Eligibility

2105 Retroactive Eligibility - AFDC

2106 Retroactive Eligibility - Pregnant Women

2107 Retroactive Eligibility - U-18

2108 Retroactive Eligibility - LTC

2110 Retroactive Eligibility - SSI Eligibles

2111 Deeming of Income: SSI Retroactive Medicaid Determinations

2111.1 Deeming of Income from Ineligible Spouse

2111.2 Deeming of Income from Ineligible Parent(s) to Child

2111.3 Deeming of Income From a Parent Who Would Be Eligible Except for Excess Deemed Income to an Eligible Child

2111.4 Deeming of Income to an Eligible Child from Parent/Parents Who Would Be Eligible Except for Excess Income

2111.5 Items (Income) Not Included in Deeming

2112 Deeming of Resources - SSI Retroactive Medicaid Determinations

2112.1 Resources of Ineligible Spouse

2112.2 Resources of Ineligible Parent(s)

2120 Retroactive Eligibility of Recipients Not Currently Eligible for SSI

2160 Fixed Eligibility

2200 State Residency

2210 State Residency Determinations

2215 Prohibited State Residency Determinations

2220 Interstate Agreements

3000     Guidelines for the Long Term Care Program and Other AABD Categories

3100     General Information

3110     Facilities Which Provide Services

3120     Services Provided Under Medicaid

3130     Licensing and Classification of Facilities

3135     Nursing Facility

3140     Personal Allowance for Facility Residents

3150     Special Charges to Recipients in Facilities

3160     Nondiscrimination

3170     Freedom of Choice

3180     Placement

3200     Application Process

3210     Initial Application for Facility Payment

3220     Reapplication for Facility Payment

3230     Distinction Between Application and Inquiry

3240    Steps in Application Process

3241     Initial Contact

3242     Referrals from Arkansas State Hospital and George W. Jackson Center

3243     Referrals from Arkansas Human Development Centers

3244     Case Record and Control Card

3245     Entry of Application to WIMA

3247     Denial of Application at Intake

3248     Recording of Applications on Control Sheet

3249     Referral to SSI

3250     Securing Information

3251     Time Limit on Disposition of Application

3252     Delayed Action on Application

3253     County Office

3254     Applicant

3300    Eligibility Determination

3301    Eligibility Requirements

3310    Establishing Categorical Eligibility

3320    Verification of Institutional Status

3321    Verification of Age

3322    Verification of Blindness or Disability

3322.1     SSA vs. MRT Disability Decisions

3322.2     Referrals to SSA

3322.3     Applications Which Will Require An MRT Decision

3322.4     Verification of Social Security Disability or SSI Status

3322.5     Dual Applications

3323    Procedure for Verification by Medical Review Team

3323.1     For Blindness

3323.2     For Disability

3323.3     Medical Review Team (MRT) Decision

3323.4     Reapplication Due to Mental or Physical Incapacity

3323.5     Reexamination of Disability by the Medical Review Team (MRT)

3323.6     Reexamination Required by the Medical Review Team (MRT)

3323.7     Substantial Gainful Activity

3324     Verification of Citizenship or Alien Determinations

3324.1     Declaration of Citizenship or Satisfactory Immigration Status

3330     Resources - AABD

3330.1     Countable Resource Limitations

3330.2     Incapacitation

3331     Real Property

3331.1     Evidence of Ownership

3331.2     Forms Of Ownership

3331.3     Determining Value of Ownership Interest

3331.4     Determining Equity Value

3331.5     Real Property Exclusions

3332     Personal Property

3332.1     Forms of Ownership

3332.2     Determining Value of Personal Property

3332.3     Personal Property Exclusions

3333     Treatment of Resource Changes

3334     Transfer Of Assets - History And References

3334.1     Transfer of Resources - General

3334.2     Documentation of Resource Transfers

3334.3     Determination of Uncompensated Value and Period of Consideration

3334.4     Determining Value of Compensation Received

3334.5     Notifying Individual of Established Uncompensated Value

3334.6     Rebuttal of Presumption That Resources Were Transferred to Establish Eligibility

3334.7     Factors Which Indicate Transfer Exclusively for Some Other Purpose

3334.8     Reacquisition of/or Additional Compensation Received on Resource Transfer at Less Than FMV

3334.9     Transfer Of Resources Effective 9/1/81 Through 6/30/88 (Through  9/30/89 For Interspousal Transfers)

3334.9.1     Determination of Uncompensated Value and Period of Consideration

3334.9.2    Exceptions to the Period of Ineligibility Due to Transfer of a Home for Less than Fair Market Value

3334.9.3     Related Policy

3335     Transfer Of Resources Effective 7/1/88 Through 8/10/93

3335.1     Determination of Uncompensated Value and Period of Ineligibility

3335.2     Exceptions to (the period of) Ineligibility Due to Transfer of a Resource for Less than FMV

3335.3     Other Policy Related to Resource Transfers Made 7/1/88 Through 8/10/93 (For Interspousal Transfers, 10/1/89 Through 8/10/93)

3336     Transfer Of Assets Made 8/11/93 Or Later

3336.1     Assets Defined

3336.2     The Look Back Date

3336.3     Income Transfers and Failure to Apply For Benefits

3336.4     When an Ineligible Spouse Gives Away Income

3336.5     Spousal Transfers

3336.6     Income Received and Transferred in Same Month

3336.7     Ownership Held in Common With Others

3336.8     Transfers to Trusts and Annuities

3336.9     Income Trusts

3336.10    Determination of Uncompensated Value and Period of Ineligibility for Resource Transfers

3336.11   Determination of Uncompensated Value and Period of Ineligibility When Income Has Been Diverted

3336.12  Penalty to Impose When Transfer Occurs 8/11/93 Through 9/30/93

3336.13   Apportionment of Penalty for Spouses

3336.14  Penalty Continues Without Interruption Until Expiration

3336.15  Exceptions to the Period of Ineligibility

3336.16  Related Policy

3336.17  Life Expectancy Tables

3337     Treatment of Income and Resources for Certain Institutionalized Spouses

3337.1     Definitions

3337.2     Resources

3337.3     Initial Assessment

3337.4     Resource Eligibility

3337.5     CSMR and CSRA Computation

3337.6     Determining Resources of the IS After CSRA Computation

3337.7     Spousal Protected Amount (CSMR)

3337.8     Retroactive Eligibility

3337.9     Appeal Rights - Changing the CSRA

3337.10   Rules for Transfer by the IS

3337.11   Time Period for Transfer of CSRA to Community Spouse

3337.12   Rules for Transfer by the CS

3337.13    Consideration of Resources After Eligibility is Determined

3338     Income Eligibility Determination for the IS

3338.1     Consideration of Income

3338.2     Rebutting Consideration of Income

3338.3     Determination of Nursing Home Net Income

3338.4     Option To Estimate Net Income

3338.5     Verification or Refusal of Contributions

3338.6     Quality Control Errors

3338.7     Appeals and Hearings

3338.8     Certification

3338.9     Changes

3338.10    Retroactive Adjustments

3338.11    NonRecurring Lump Sums

3338.12    Reevaluations

3340     Income

3341     Income Evaluation

3342     Consideration of Ineligible Spouse/Parent(s) Income after Initial Eligibility Has Been Established

3343     Determination and Verification of Earnings from Employment

3343.1     Earnings of ICF/MR Facility Residents

3344    Determination and Verification of Earnings from Farm, Business or Self-Employment

3344.1     Determining Amount of Net Earnings from Self-Employment

3344.2     Unstated Income

3344.3     When to Develop Unstated Income

3344.4     Development of Living Expenses

3344.5     Determination of Unstated Income

3345    Sources of Unearned Income

3346    Determination and Verification of Unearned Income

3346.1     Social Security Benefits

3346.1.1 Voluntary Reduction of Benefits

3346.2     Railroad Retirement Benefits

3346.3     Military Allowances or Allotments

3346.4     Veterans Benefits

3346.5     Civil Service Benefits

3347     In-Kind Support and Maintenance and Other In-Kind Income

3347.1     Valuation of In-kind Income and In-kind Support and Maintenance

3347.2     Third Party Payments Excluded as In-Kind Support and Maintenance

3348     Supplemental Security Income Exclusions

3348.1     Assets Disregarded as Income

3349     Preliminary Budget for Determination of Income Eligibility

3350     Medical Necessity

3350.5     County Office Procedures

3351    Prompt Notice of Skilled Care Classifications

3352    Appeal of Utilization Control Committee Action

3400    Determination of Net Income

3401    Treatment of Extended SSI Benefits for Institutionalized Recipients

3410    Authorization of Services

3420    Effective Eligibility Dates for LTC and ICF/MR Services

3500    Disposition of Application

3500.1     Certification of Patients Approved for Medicare

3600    Continuing Eligibility

3610    Reevaluation of Eligibility

3611     Foster Care (Cat. 91 or 92) and U-18 Cases

3613     SSI

3614     AA, AB, and AD

3615    Completion of Reevaluation

3620    Utilization Control

3621    Changes in Classification

3622    Continued Stay in a Facility Not Medically Necessary

3623    Appeal of Utilization Control Action

3625    Continued Stay in a Facility Not Medically Necessary (PASARR)

3630    Change of Status

3631     Advance Notice for Terminations of Assistance

3632     Advance Notice for Reduction of Assistance

3633     When Advance Notice is Not Required

3634    Acquisition of Additional Income and Resources

3634.1     Case Adjustments for Lump Sum Payments in Prior Months

3635    Completion of Changes, DCO-57 Data Entry Form

3636    Absences from Long Term Care Facilities

3637    County Office Responsibilities Following Report of Absence on Form DCO-702

3637.1    Death or Discharge

3637.2    Home Visits

3637.3     Procedure for Reactivating a Suspension Case

3637.4     Hospitalization

3637.5     Hospitalization at the Arkansas State Hospital (Little Rock) or the George W. Jackson Center (Jonesboro)

3637.6     Procedures for Suspension of Cases-State Hospital and George W. Jackson Center

3637.7     Transfer

3637.8     Transfer - Resident of Human Development Center

3640    Operations Plan - Relocation of Recipients

3641     Responsibility

3642     Authority

3643     Procedures

3650    Closure

3650.1    To Close Case:

4000     Children's Medical Services

4001    Eligible Children

4005     Early Identification of Children in Need of Health Care Services

4010    Legal Basis for Children's Medical Services

4015    Responsibility for Children's Medical Services

4020     Funding for Children's Medical Services

4025     Referrals for Children's Medical Services

4030    Application for Children's Medical Services

4035     Information Required to Process the CMS Application

4045     County Office Disposition

4050     Return of EMS-800 to County Office

4100     Eligibility Requirements for CMS

4105     Age

4110     Residence

4115     Marital Status

4120     Financial Need

4125     Medical Eligibility

4150     Denials and Closures

4155     Denials

4160     Closures

4165     Reevaluations

4200    Services Available Through CMS

4205     Transportation for CMS/Medicaid Eligibles

4210     Hospital Services

4215     Emergency Hospital Admissions

4220     Non-Emergency Hospital Admissions

4225     Specialized Care

4230     Appliances, Prostheses and Equipment

4235     X-Ray and Laboratory Services

4240     Therapy Services

4245     Medication

4250     Service Coordination Services

4300     Quality Assurance

4310     Record Reviews

4320     Statistical Analysis

6500     Medicaid Coverage of Foster Children

6510     Extent of Services

6520     Identification of Eligibles

6530     Initial Determination of Eligibility

6530.1     Service Specialist Responsibilities

6530.2     Service Representative Responsibilities

6540     Reevaluations

6540.1     Service Representative Responsibilities

6550     Changes

6560     Transfers To Another County

6561     Transfers Out-of-State

6562     Placement with Parents

6570     Adoptions

6580     Continuing Eligibility of Foster Care Children Placed for Adoption

6590     Non-Title IV-E Adoptive Children With Special Needs

6590.1     Medicaid Category for Non-Title IV-E Special Needs Adoptive Children

6590.2     Eligibility Requirements

6590.3     Referrals

6590.4     Application Process

6590.5     Disposition of Non IV-E Special Need Referrals

6590.6     Coverage for Non IV-E Adoptive Children Whose Adoption Agreement was Signed Prior to Implementation of This Policy

6590.7     Retroactive Coverage

6590.8     Reevaluations

6590.9     Changes

6590.10    Closures

6600     Medicaid for IV-E Children Who Enter Arkansas from other States

6610     Identification of Eligibles

6611     IV-E Adoptive Children

6612     IV-E Foster Children

6620     ICAMA/ICPC Responsibilities

6630     Service/Adoption Specialist Responsibilities

6640     Service Representative Responsibilities

6641     Office Interview

6642     Registration of the Application

6643     Retroactive Coverage

6644    45 Day Time Limit

6645     Eligibility Requirements

6646     Certification

6650     Case Record

6660     Reevaluation

6670     Procedures for IV-E Children Who Leave Arkansas

6671     Service/Adoption Specialist Responsibilities

6672     ICAMA/ICPC Responsibilities

6673     Service Representative Responsibilities

6700 Citizenship

6703 Citizenship of Children Born Outside of the U.S.

6705 Declaration of Citizenship

6710 Medicaid Coverage for Aliens

6711 Alien Categories

6715 Public Charge

6720 Alien Status Verification Requirements

6721 Using SAVE (Systematic Alien Verification for Entitlement)

6722 Secondary Documentation of Alien Status

6730 Non-Financial Eligibility Requirements

6735 Aliens Subject to Five-Year Bar

6736 Aliens Exempt from Five-Year Bar

6740 Establishing Qualifying Quarters

6741 Verifying Qualifying Quarters

6750 Victims of Trafficking

6760 Sponsor Affidavits of Support and Deeming

6763  Exceptions to Deeming

6765  Battered Aliens

6767  Indigent Aliens

6770 Alien Documentation Chart

6780 Emergency Medicaid Services for Aliens

6783 Non-Citizens Not Eligible for Emergency Services

7000     Medically Needy Program

7010    Extent of Medical Services for Medically Needy

7020    Identification of Eligible Recipients

7030    Medically Needy Group Designations

7031     Exceptional Medically Needy

7032     Spend Down Medically Needy

7040    Screening Applicants for Medically Needy Program

7041     Supplemental Security Income (SSI) Related Eligibility

7042     Aid to Families with Dependent Children (AFDC) and AFDC Unemployed Parents (AFDC-UP) Related Eligibility

7043     Under 18 Category Related Eligibility

7050     Special Cases - Medically Needy

7060     Definition of Medically Needy Program Terms

7061     Medically Needy Income Level (MNIL)

7062     Medicare Part B "Buy-In" Premium

7063     Excess Income

7064     Spend Down

7065     Spend Down Period

7066     Spend Down Entitlement Period

7067     Unmet Liability (Date of SD)

7068     Exceptional Medically Needy Duration of Eligibility

7070     Medically Needy Category Designations at Certification

7100     Initial Requests for Medically Needy Services

7101     On-Site Applications

7101.1     On-Site Applications at ACH

7101.2     On-Site Applications at UAMS

7110     Multiple Applications

7120     Reapplication for Medically Needy Services

7130     Distinction between Application and Inquiry

7140     Initial Contact with Applicant in Person

7150     Steps in Application Process

7151     Application Interview

7152     Nondiscrimination

7153     Securing Information to Determine Eligibility

7154     Completion of Application Forms

7155     Entry of Application(s) on WIMA

7157     Home Visits

7158     Securing Information from Collateral Source

7159     Time Limits to Dispose of Application

7200     Disposition of Application

7210     Approval

7220     Denial and Withdrawal

7221     Transfer to Another County

7221.1   Responsibility of Transferring County

7221.2   Responsibility of Receiving County

7230     Delayed Action on Application

7231     County Office Delay

7232     Applicant Delay

7300     Medically Needy Eligibility Determination

7310     Categorical Relatedness - Medically Needy

7320     Medically Needy - AFDC Categorical Relatedness (AFDC-MN and UP-MN)

7321     Factors Specific to Unemployed Parent Medically Needy

7321.1     Deprivation Due to Unemployment of the Principal Wage  Earner

7321.2     Reporting Requirements

7321.3     Retroactive Eligibility

7321.4     UP-MN Spend Downs

7325     Medically Needy Pregnant Women Categories

7330     Medically Needy - SSI (AABD) Categorical Relatedness

7340     Medically Needy - Under 18 Categorical Relatedness

7340.1    Medically Needy - Foster Care

7400     SSI Related Treatment of Income (AABD-MN)

7410     Income Evaluation

7420     SSI Relatedness

7430     Income of Other Persons (Deeming)

7431     Deeming of Income from Ineligible Spouse (AABD-MN)

7432     Deeming of Income from Ineligible Parent(s) to Blind or Disabled Child

7433     Deeming of Income to Individual Who Would Be Eligible Except  for Excess Income to Eligible Blind or Disabled Child

7434     Deeming of Income to Eligible Child from Parent/Parents Who Would Be Eligible Except for Excess Income

7440     Items (Income) Not Included in Deeming

7500     Medically Needy Resource Limitations and Resource Determination

7510     Resources of Other Persons (Deeming)

7600     Income Determination for Medically Needy Program

7610     Medically Needy Income Levels (7-1-88)

7611     Determination of Household Size Used for MN Income Consideration

7620     Income Eligibility Determination for Exceptional Medically Needy

7622      Establish Duration of Eligibility - Exceptional Medically Needy Cases

7630     Income Determination for Spend Down

7631     Eligibility Based on Incurred Medical Expenses (Spend Down)

7632     Incurred Medical Expenses Not Coverable Under Medically Needy Program

7633     Incurred Medical Expenses Included in Chronological Spend Down

7634     Treatment of Third Party Resources

7634.1     Medicare - Medicare consists of two types of coverage:

7634.2     Private Health Insurance

7634.3     Nonspecific Assignable Payments

7700     County Office Certification Responsibility

7710     Central Office Certification Responsibility

7800     Medically Needy Case Controls

7810     Time Schedule for Reevaluation of Eligibility for Exceptional Medically Needy Cases

7830     Medically Needy Case Actions - Exceptional and Spend Down

7840     Change Notification to Medically Needy Recipient by County Office

7850     Medically Needy Case Closures

7900     Medically Needy Case Record

8000     Overpayments

8001     Overpayments Due to Ineligibility

8006     Overpayment Due to Understated Liability (LTC Cases)

8010     Overpayment Evaluation - Excess Income

8015     Overpayment Evaluation - Excess Resources

8017     Other Ineligibility

8020     Overpayment Evaluation - Ineligible Individuals (Non - LTC)

8025     Procedures for Reporting Overpayments

8026     Record Information in Case Narrative

8027     Control Register and File

8028     Referral to Central Office Overpayments Unit

8030     Responsibility of Overpayments Unit

8031     Collections

8032     Responsibility of Central Office Accounting Section

8033    Recovery

8035     Willful Withholding of Information

8040     Keeping Overpayments Unit Informed

8045     Contacts With Clients

8050     State (Income) Tax Refund Interception (STRI)

8060     Accounts Eligible for Interception

8070     Requesting The Hearing

8080     Designation of a Representative

8090     Beginning the STRI Hearing Process

8100     Subpoena of Witnesses by Taxpayer

8110     Notification of the Hearing

8120     Postponement of the Hearing

8130     Place of the Hearing

8140     The Hearing Officer

8150     Conducting the Hearing

8160     The Administrative Hearing Decision

8170    Contents of the Administrative Hearing Decision

8180    Notification of Decision

8190    Judicial Review

9000     Fraud Investigation

9001     Purpose

9002     Organization

9003     Functions

9004     Referral Sources

9005     Reporting Suspected Fraud

9006     Review of Case

9007     Case Accepted for Investigation

9008     Disposition of Investigations

9009     Decision to Prosecute

9300     Administrative Hearings

9301     Appeal Procedure

9302     Administrative Hearing File

9303     Continuation of Assistance or Services During Appeal Process 

9304  Scheduling the Hearing

9305  Place of Hearing

9306  Group Hearing

9307  Assistance in Preparation of Appeal

9308  Abandonment of the Appeal

9309  Withdrawal of Appeal

9310  County Office Hearing Responsibilities

9312  Conduct of the Hearing

9313  Right to Different Medical Assessment

9314  Hearing Decision

9315  Judicial Review

11300 Resources for Family Medicaid Categories

11301 Definition of a Resource

11305 Resource Limit

11310 Resources to be Disregarded

11315 The Homestead

11320 Resources Considered with Special Exemptions or Exclusions

11321 Motor Vehicles

11322 Jointly Owned Vehicles

11323 Determining Net Equity

11324 Funeral Agreements

11325 Resources Considered in Full

11330 Requesting a Legal Opinion on Resource Ownership or Availability

11335 Sale of a Resource

11340 Excess Real Property

11345 Determining Ownership

11350 Determining Market Value and Net Equity

11355 Personal Property

11356 Cash and Money on Deposit

11357 Jointly Held Bank Accounts with Non-SSI Recipients

11358 Jointly Held Bank Accounts with SSI Recipients

11359 Life Insurance Policies

11360 Tax Refunds

11361 Joint Refunds (Client and Spouse)

11362 U. S. Savings Bonds

11363 Stocks and Bonds

11364 Other Types of Personal Property

11400  Income

        11405  Income to be Disregarded

        11410  Income Disregards of a Minor Child

        11415  Earned Income

        11420  Verification of Earned Income

        11425  Computation of Earnings Received as an Employee

        11430  Computation of Earnings from Self-Employment

12100 Medicaid Coverage for Pregnant Women

            12200 Presumptive Eligibility     

12500 Family Planning Waiver

12505 Extent of Services

12510 Identification of Eligibles

12515 Application Process – New Applicants

12520 Application Process – Pregnant Women Categories

12525 Eligibility Requirements

12530 Child Support Enforcement Services

12535 Time Limit on Disposition of Applications

12540 Prior to Authorization of Eligibility

12545 Authorization of Eligibility

12550 Denial and Withdrawal

12555 Certification Period

12560 Quality Assurance Reviews

12565 Dual Coverage

12570 Changes/Reevaluations

12575 Loss of Eligibility

12580 Reinstatement of Eligibility

16000 ARKids First

16010 ARKids A

16015 ARKids B

16020 Extent of Services

16030 Nondiscriminaton

16040 ARKids Eligibility Criteria

16045 Income Eligibility Determination

16047 Effect of Living Arrangement on Eligibility Determination

16048 Court Orders

16050 Continuation of Coverage for Inpatients

16055 Retroactive Eligibility for ARKids

16060 Application Process

16061 Right to Apply

16062 Distinction Between Application and Inquiry

16070 Completion of the Application

16071 Emancipated Minors

16072 Institutionalized Children

16073 Completion of Forms During Eligibility Determination

16075 Self Declaration

16077 Verification

16080 Registering Applications

16085 Time Limit for Disposition of Application

16090 Delayed Action on an Application

16092 Applicant Delay

16100 Disposition of the Application

16110 Approval

16115 Denial

16120 Withdrawal

16125 Continuing Eligibility

16130 Changes

16135 Facility Transfers of Court Ordered Juveniles

16140 Change Notification to Participant (Advance Notice)

16150 Renewals

16200 Newborn Eligibles

16205 Eligibility Requirements

16210 Referral by Hospital/Physician for Newborn Coverage

16215 Eligibility or Assumed Eligibility of the Mother

16220 Certification Procedures

16225 Retroactive Requests for Coverage

16230 Reevaluations and Conversions to ARKids A or B

16235 Closures

           20000 Long Term Care Insurance Partnership Program

                        20010 Asset Disregard

                        20020 Policy Identifiers

                        20021 Disclosure  

20030 Exchanges 

                        20040 Exhaustion of Benefits    

                        20050 State Reciprocity

20060 Transfer Protection

20070 Effect of Asset Disregard in Estate Recovery

           21700 Estate Recovery

21705 Definitions

21710 County Office Responsibilities

21715 Recovery Procedures

21720 Application for a Hardship Waiver

21725 Appeal Rights

23000  Medicare Savings Programs

            23000  Medicare Savings Programs

   
         23010  Medicare Savings Programs - Comparison Chart

            23100  History of ARSeniors, QMB, SMB, QI-1

            23105  Scope of Services

            23110  Eligibility Requirements

            23115  Self Declaration   

            23120  Simultaneous Coverage in Other Categories

            23125  Medicare Part A Entitlement

            23130  Application Process

            23135  Time Limit on Processing Applications

            23140  Determining Eligibility

            23145  Disposition

            23150  Medicaid Category Changes

            23155  Temporary Disregard of SSA Cost of Living Adjustment (COLA)

            23160  Reevaluation

            23165  Change/Closure

            23500  Qualified Disabled and Working Individuals

            23505  Extent of Services

            23510  Application Process

            23515  Eligibility Requirements

            23520  Income Determinations

            23525  Initial Enrollment Period (IEP) and General Enrollment Period for Medicare
           Part A

            23530  Disposition of Application

            23535  Reevaluations/Changes/Closures 

26100  Aging and Adult Services Waivers

            26105  History of ElderChoices and AAPD Waiver

            26110  Scope of Services

            26115  Eligibility Requirements

            26120  Application Process

            26125  Assessment Process

            26130  Applications from Nursing Facility Residents

            26135  Assessment Process for Nursing Facility Residents

            26140  Residents of Residential Care Facilities

            26145  Eligibility Determination

            26150  No Contribution to the Cost of Care

            26155  Approvals for New Applicants

            26156  Approvals for New Applicants (AAPD Only)

            26157  Provisional Plan of Care (ElderChoices Only)

            26158 Comprehensive Plan of Care (Elderchoices Only)

            26159 Optional Participation (Elderchoices Only)

            26160  Approvals for Medicaid Recipients Who Leave LTC

            26165  Denied Applications

            26170  Procedures for AAPD Waiver Individuals Turning 65

            26175  Reevaluations

            26180 Changes/Closures

            26185 Temporary Absences from the Home

26200  Assisted Living Facilities Waiver

            26205  Eligibility Requirements

            26210  Application Process

            26212  Registering the ALF Application

            26215  Applications from Nursing Facilities or ElderChoices or AAPD Waiver Recipients

            26220  Assessment Process

            26225  Eligibility Determination

            26230  Contribution to the Cost of Care

            26235  Approvals for New Applicants (Non-LTC)

            26240  Approvals for Medicaid Recipients Who Leave LTC, ElderChoices or AAPD Waiver

            26245  Reevaluations

            26250  Changes/Closure

            26255  Temporary Absences from the Assisted Living Facility

26300 Money Follows the Person

            26305 Procedures for Medicaid Recipients Who Leave Facility Care

26500   PACE – Program of All Inclusive Care for the Elderly

                  26510   Individuals Eligible for PACE

                  26520   Basic Eligibility Requirements

                  26530   Medical Criteria

                  26540   Income

                  26550   Contribution to the Cost of Care

                   26560   Resources

                   26561 Transfer of Resources

                   26570   Initial Application Process

26571   Assessment Process for Nursing Facility Residents or ElderChoices, AAPD or Assisted Living Waiver Participants

26580   Approval of Application

26590   Enrollment

26591   Disenrollment

26600   Provider Post-Enrollment Assessments

26700   Reevaluations

26800   Approvals for Waiver Recipients to PACE and PACE Participants to Waiver

27000  TEFRA Waiver

            27000  TEFRA Waiver/Home Care for Children

            27005  Eligibility Requirements

            27010  Determining Monthly Premiums

            27015  Adjustment of Premiums

            27020  Payment of Premiums

            27025  Application Process

            27028  Re-application When Case Closed Due to Non-Payment of Premiums

            27030  Eligibility Determinations

            27035  Alternating TEFRA and SSI Eligibility

            27040  SSA Disability Determinations

            27045  MRT Disability Determination

            27050  Reexamination by MRT

            27055 Determining Appropriateness of Care and Cost Effectiveness

            27060  Disposition of Application

            27065  Monitoring Cost Effectiveness

            27070  Reevaluations

            27075  Changes/Closure   

28000  Working Disabled

28000  Medicaid Coverage for the Working Disabled

28010  Extent of Services

28015  Working Disabled Eligibility Criteria

28020  Definition of Working

28025  Disability Determination

28030  Income Determination

28035  Resources

28040  Approved Account

28045  Cost Sharing

28050  Approval of Applications

28055 Denials and Withdrawals

28060  Effective Date of Eligibility

28065  Re-evaluations

28070  Changes and Closures

31000 Breast and Cervical Cancer Medicaid

31005 Eligibility Requirements

31010 Screening

31015 Creditable Coverage

31020 Age Limits

31025 Citizenship or Alien Status

31030 Income

31035 Resources

31040 Scope of Coverage

31045 Application Process

31050 Continuing Eligibility

31100  Tuberculosis Medicaid

31105  Scope of Services

31110  Eligibility Requirements

31115  Citizenship or Alien Status

31120  Resources

31125  Application Process

31130  Continuing Eligibility

31135  Case Closures

 

MS Appendixes

IRS Safeguards

Appendix A

Appendix F

Appendix P

Appendix R

Appendix S

Appendix T

Appendix V