Provider relations – policy and education

This quarter’s topics include but aren’t limited to:

• Call Center Outreach to Arkansas Medicaid Clients
• Medicaid Primary Care Provider Referrals
• Official Notice – Colorectal Screening
• Procedure Code Linking Tables

This quarter’s topics include but aren’t limited to:

• ConnectCare Provider Escalated Team Correspondence
• PCMH Performance
• Pharmacy Benefits Expanded for Adult Medicaid Clients
• Vaccines for Children (VFC)

This quarter’s topics include but aren’t limited to:

• COVID-19 Rates
• PCMH Information
• PASSE Ombudsman
• Provider Status Changes
• Educational Opportunities

This quarter’s topics include but aren’t limited to:

• Medicaid Providers Play a Critical Role in COVID-19 Vaccinations
• Arkansas Health and Opportunity for Me (ARHOME)
• Arkansas Medicaid Reimburses Three Types of Emergency Department Visits
• PCP Online Assignment Portal vs. SeeYourDoc.org

This quarter’s topics include but aren’t limited to:

• Ambulatory Surgical Centers Allowed to Temporarily Enroll as Hospitals
• Arkansas Medicaid PCP Caseload Management Responsibilities
• Medication-Assisted Treatment in Arkansas
• What’s New for Arkansas Medicaid Providers

COVID-19 Response

For clients:
DHS’s Response to COVID-19 for Clients 

For providers:
DHS’s Response to COVID-19 for Providers 

AFMC’s response:
AFMC COVID-19 Updates and Resources for Providers

• Telehealth Payers Crosswalk
• Reduce the Impact of COVID-19 On Your Practice With Telehealth (Webinar)
• CMS Telehealth and Telemedicine Toolkit
• Telehealth and in-office scripts to encourage patient visits

AMS’ Response:
Personal protective equipment request form

Behavioral Health

Find Substance Abuse or Mental Health Treatment: 844-763-0198

• National Suicide Prevention Lifeline – 800-273-TALK

Medication-Assisted Treatment (MAT) for Opioid Use Disorder

Medicaid Manual updates

Immunizations

Flu and Medicaid vaccine administration payment increase

CDC vaccine website

Medicaid Educational Regional Conference (Virtual)

December 9, 2020 – Behavioral health and waiver providers

December 10, 2020 – Physicians, nurses, office managers, billers, and hospitals

MMIS Medicaid 101 Webinars

Medicaid provider trainings

Recorded trainings

MMIS Portal

• MMIS Job Aid – Uploading Documents (Updated)

Patient-centered Medical Home (PCMH)

Activities due by Dec. 31, 2020
2020 PCMH Program policy addendum

PCMH Update/change form

PCMH Pooling form

PCMH Withdrawal form

Questions: pcmh@afmc.org

PCP

PCP selection and change form

• Do’s and Don’ts DMS-2609
• DMS-2609 (English version)
• DMS-2609 (Spanish version)

Services not requiring a referral, see section 172.100 of all manuals

PCP Referral Form DMS-2610 (Updated)

PCP requirements for Category 06 beneficiaries

Pharmacy

Magellan is the Medicaid pharmacy vendor and operates the Magellan Pharmacy Call center. On Magellan’s website are many tools including the preferred drug list, drug prior authorization criteria, tobacco cessation tools and the smoking cessation counseling checklist.

Prescription drug information

• Tobacco cessation programs
• Covered tobacco cessation products
• Public Health Service (PHS) guideline-based checklist for smoking cessation counseling

Provider Enrollment

Updating provider enrollment on status changes, section 141.000 of all Medicaid manuals

Top 4 provider enrollment issues when applying on the portal

What’s New

What’s new for Arkansas Medicaid providers

• Affiliated provider listing available in the provider portal
• Antigen testing
• Electronic Visit Verification (EVV) requirements for participation

COVID-19 Response

DHS’s Response to COVID-19 for Beneficiaries 

• How to apply for Medicaid services
• Frequently asked questions
• DHS contact information
• Additional topics added as needed

DHS’s Response to COVID-19 for Providers 

• Care Continuity Emergency Response Reimbursement Payments
• Hospital direct and non-direct care payments
• Laboratory/testing
• Medicaid provider/services requirements
• Pharmacy and medical devices
• Rural health centers and federally qualified health centers

Arkansas Medical Society

• Personal protective equipment request form

AFMC COVID-19 Updates and Resources for Providers

• Telehealth Payers Crosswalk
• Reduce the Impact of COVID-19 On Your Practice With Telehealth (Webinar)
• CMS Telehealth and Telemedicine Toolkit
• Additional topics available and being added as needed

Telehealth

• Telehealth and in-office scripts to encourage patient visits

Episodes of Care

• Reports

MMIS Medicaid 101 Webinars

• https://medicaid.mmis.arkansas.gov/Provider/Training/Training.aspx

Opioid Addiction Treatment Resources

• Opioid Addiction Treatment Resources
• Questions: Jennifer Shuler, MNSc, RN, APRN, ACNP-BC
  Nurse Practitioner/Co-State Opioid Treatment Authority
  501-396-6347
  jennifer.shuler@dhs.arkansas.gov

Patient-centered Medical Home (PCMH)

• 2019–2020 PCMH Manual
• 2020 PCMH Program Policy Addendum
• Activities due by Dec. 31, 2020
• PCMH Update/Change form
• PCMH Withdrawal form
• PHMR Reconsideration Report
• PCMH Webinar 6/19/2020
• Questions: pcmh@afmc.org

PCP

Services not requiring a referral

• Section 172.100 of all manuals

PCP selection and change form

• DMS-2609 (English version)
• DMS-2609 (Spanish version)

Pharmacy

Magellan

• Contact Information: https://arkansas.magellanrx.com/provider/
  Go to the link above, and click “Contact Us” at the top of the page
• Drug look up: https://arkansas.magellanrx.com/provider/
  Go to the link above, and click “Tools” and then “Drug Lookup” at the top of the page
• Evidence-based Prescription Drug Program (PDL)
  Go to the link above, and clinic “Resources” and then “Documents” at the top of the page
• Evidence-based Prescription Drug Program Overview
• Preferred Drug List
• Prior Authorization Criteria

Provider Electronics Solutions (PES)

Sept. 1, 2020, Arkansas Medicaid will no longer accept claims through PES.

Smoking Cessation

• ARKids First-B Manual Section 222.750
• EPSDT Manual Sections 215.290, 242.100
• Nurse Practitioner Manual Sections 252.454
• Physician Manual Sections 257.000, 292.900
• Tobacco Cessation Programs:
  https://arkansas.magellanrx.com/provider/
  Go to the link above, and clinic “Resources” and then “Documents” at the top of the page
• Coverage of tobacco cessation products as of Jan. 1, 2020
• Public Health Service (PHS) Guideline-Based Check List (Smoking Cessation Counseling Checklist)

What’s New

What’s new for Arkansas Medicaid providers

COVID-19 Response

DHS’s Response to COVID-19 for Beneficiaries 

• How to apply for Medicaid services
• Frequently asked questions
• DHS contact information
• Additional topics being added as needed

DHS’s Response to COVID-19 for Providers 

• Telemedicine Requirements for Physicians during the COVID-19 Public Health Emergency
• DMS Medicaid Provider Guidance on COVID-19 Laboratory Testing
• Prior Authorization Extensions during COVID-19 Outbreak
• Use of Telemedicine to Provide Occupational, Physical and Speech Therapy during COVID0-19 Outbreak
• Use of Telemedicine to Provide Occupational, Physical and Speech Therapy by licensed Assistants during COVID-19 Outbreak
• Telemedicine Requirements for Nurse Practitioners during the COVID-19 Public Health Emergency
• Suspension of 12 Visit Limit during the COVID-19 Public Health Emergency
• Additional topics available and being added as needed

AFMC COVID-19 Updates and Resources for Providers

• Telehealth Payers Crosswalk
• Reduce the Impact of COVID-19 On Your Practice With Telehealth (Webinar)
• CMS Telehealth and Telemedicine Toolkit
• Additional topics available and being added as needed

ARKids First-B

• Wellness screening periodicity schedule updates effective 1/1/2020
  ARKids First-B Manual Sections 222.800 – 222.850
• Official Notice

Beneficiary Education Sessions

• April – June
  https://afmc.org/individuals/arkansans-on-medicaid/beneficiary-education/beneficiary-education-training-sessions/

Episodes of Care

• Reports
• April episode of care reports can be viewed on AHIN on or after April 30, 2020

EPSDT

• EPSDT screening periodicity schedule updates effective 1/1/2020
  EPSDT Manual Section 215.100 – 215.340
• Official Notice

Opioid Addiction Treatment Resources

• Opioid Addiction Treatment Resources
• Questions: Jennifer Shuler, MNSc, RN, APRN, ACNP-BC
  Nurse Practitioner/Co-State Opioid Treatment Authority
  501-396-6347
  jennifer.shuler@dhs.arkansas.gov

Patient-centered Medical Home (PCMH)

• 2019 – 2020 PCMH Manual Addendum
  https://www.paymentinitiative.org/pcmh-manual-and-additional-resources
• 2020 PCMH Program Policy Addendum
  https://www.paymentinitiative.org/pcmh-manual-and-additional-resources
• Activities due by June 30, 2020
• Questions: pcmh@afmc.org

Pharmacy

Magellan

• Contact Information: https://arkansas.magellanrx.com/provider/
  Go to the link above, and click “Contact Us” at the top of the page
• Drug look up: https://arkansas.magellanrx.com/provider/
  Go to the link above, and click “Tools” and then “Drug Lookup” at the top of the page

Smoking Cessation

• ARKids First-B Manual Section 222.750
• EPSDT Manual Sections 215.290, 242.100
• Nurse Practitioner Manual Sections 252.454
• Physician Manual Sections 257.000, 292.900

Third-party Liability

• When a Medicaid Beneficiary also has TPL
• TPL Unit: 501-537-1070

What’s New

What’s new for Arkansas Medicaid providers

ARKids First-B

• Wellness screening periodicity schedule updates effective 1/1/2020
  ARKids First-B Manual Sections 222.800 – 222.850
• Official Notice

Beneficiary Education Sessions

• January – March
  https://afmc.org/individuals/arkansans-on-medicaid/beneficiary-education/beneficiary-education-training-sessions/

Episodes of Care

• Reports
  • January episode of care reports can be viewed on AHIN on or after Jan. 31, 2020

EPSDT

• EPSDT reason codes
• EPSDT screening periodicity schedule updates effective 1/1/2020
  EPSDT Manual Section 215.100 – 215.340
• Official Notice

PASSE

• PASSE Reimbursement for an EPSDT and sick visit performed on the same date of service

Patient-centered Medical Home (PCMH)

• 2019 – 2020 PCMH Manual Addendum
  https://www.paymentinitiative.org/pcmh-manual-and-additional-resources
• 2020 PCMH Program Policy Addendum
  https://www.paymentinitiative.org/pcmh-manual-and-additional-resources
• Metrics due by Feb. 28, 2020
• Activities due by March 31, 2020
• Questions: pcmh@afmc.org

PCP Caseloads

• ConnectCare online PCP assignment process
• ConnectCare caseload maximum and PCP caseload limits: all Medicaid manuals, Section 171.210
• PCP patient termination
  • PCP patient transfers by PCP request – all Medicaid manuals, Section 173.620
  • Deceased patient removal process

Opioid Addiction Treatment Resources

• Medication Assisted Treatment (MAT) Arkansas Medicaid is removing the PA requirements for specific drugs used to treat opioid use disorder
• Steps to obtain Your MAT waiver
  • Physician – https://pcssnow.org/medication-assisted-treatment/waiver-training-for-physicians/steps-to-obtain-your-mat-waiver-physicians/
  • APN – https://pcssnow.org/medication-assisted-treatment/waiver-training-for-nurses/
  • Physician Assistant – https://pcssnow.org/medication-assisted-treatment/waiver-training-for-pas/
• Mental health and addiction services in Arkansas
• Arkansas Community Mental Health Directory
  https://humanservices.arkansas.gov/images/uploads/dbhs/CMHC_Directory_07022019.pdf
• Narcansas – https://www.artakeback.org/narcansas/
• State-Targeted Response grant funded treatment facilities in Arkansas  https://www.artakeback.org/substance-abuse-treatment/
• AR-IMPACT (Improving Multi-disciplinary Pain Care and Treatment) is a free program designed to help health care providers better manage their chronic pain patients and those who need their opioid dosage reduced. https://arimpact.uams.edu/
• MATRIARC (Medication Assisted Treatment Recovery Initiative for Arkansas Rural Communities) is a partnership with the Psychiatric Research Institute and the Arkansas Department of Human Services designed to expand evidence-based treatment for opioid use disorders. https://psychiatry.uams.edu/clinical-care/cast-2/matriarc/
• Project ECHO is part of MATRIARC, weekly video conferences available to community health centers needing assistance in opioid addiction treatment. Video conferences are held each Friday from noon to 1 p.m., with experts in addiction, therapy and case management discussing a variety of subjects related to opioid abuse. https://psychiatry.uams.edu/clinical-care/cast-2/project-echo/
• Questions:
  Jennifer Shuler, MNSc, APRN, ACNP-BC, RN
  Arkansas DHS Co-State Opiod Treatment Authority
  501-396-6347
  jennifer.shuler@dhs.arkansas.gov

What’s New

• What’s new for Arkansas Medicaid providers
  https://medicaid.mmis.arkansas.gov/Provider/Provider.aspx

AHIN Updates

• AHIN Updates
• Enhanced AHIN Portal

Episodes of Care

• SFY 2020 second quarter reports
  • SFY 2020 second quarter episode of care reports can be viewed on AHIN on or after Oct. 31, 2019

EPSDT Reason Codes

• Primary care physicians (PCPs) are required to enter the applicable EPSDT reason code when submitting a claim for an EPSDT screening
• Specialists and providers delivering service as a result of a referral from an EPSDT screening should check the EPSDT box in the Medicaid portal, or choose “yes” under the EPSDT tab if billing through PES or an individual vendor

Exhausted Benefits

• Responsible provider for requesting extension of benefits: Medicaid Physician Manual, Section 220.000

Flu Vaccines

• Injections, therapeutic and/or diagnostic agents: Medicaid Physician Manual, Section 292.950

Hospital Emergency Department

• Non-emergent emergency department visits: PCP referral requirements

MMIS

• Creating a Prior Authorization Request

PASSE

• Beneficiary open enrollment dates: Oct. 1–31
  • PASSE Beneficiary Support Line: 1-833-402-0672
• DMS-640 PCP Referral requirement for PASSE beneficiaries receiving school-based therapy services
• DHS Provider Call Center
  • Contact Information: 1-888-889-6451 or passe.provider.questions@dhs.arkansas.gov

Patient-Centered Medical Home (PCMH)

• 2020 PCMH Enrollment dates: Oct. 1–Nov. 12
• Quarterly Reports
  • Addendum
  • Manual
• Activities due by Dec. 31 – Pages 6, 11–16
  • Care plans for high priority patients
  • Patient literacy assessment tool
  • Ability to receive patient feedback
  • Care instructions for high priority patients
  • 10-day follow up after an acute inpatient
  • Developmental/behavior health assessment for children and adolescents
• Questions: pcmh@afmc.org

PCP Caseloads

• ConnectCare Caseload Maximum and PCP Caseload Limits: All Medicaid Manuals, Section 171.210
• PCP Patient Termination
  • PCP patient transfers by PCP request – All Medicaid Manuals, Section 173.620
  • Deceased patient removal process

Upcoming Conferences

• Arkansas Medicaid Educational Conference: Dec. 17, Embassy Suites Little Rock
• Division of Provider Services and Quality Assurance (DPSQA) Educational Conference: Dec. 18, Embassy Suites Little Rock

Dual Eligibles

Dual eligible benefit plans having no Medicaid benefits

• QMB
• QI-1
• SMB

Episodes of Care

SFY 2020 first quarter reports

• SFY 2020 1st quarter episode of care reports can be viewed on AHIN on or after July 31, 2019.

Exhausted Benefits

• Responsible provider for requesting extension of benefits: Medicaid Physician Manual, Section 220.000
• Charges that are and aren’t the responsibility of the beneficiary: All Medicaid Manuals, Section 131.000 –132.000

MMIS

• Uploading Documents to the Portal Job Aid
• MMIS Provider 101 and upcoming events
• Upcoming MMIS workshops

PASSE

• DHS PASSE webpage
• PASSE Resource webpage
• PASSE contacts (including Care Coordination Supervisor contacts)

Patient-Centered Medical Home (PCMH)

• Webinar 6/21/19
• Quarterly Reports
  • Addendum
  • Manual
• Questions: pcmh@afmc.org

Pharmacy

Magellan

• Contact Information: https://arkansas.magellanrx.com/provider/
  • Go to the link above, and click “Contact Us” at the top of the page
• Drug look up: https://arkansas.magellanrx.com/provider/
  • Go to the link above, and click “Tools” and then “Drug Lookup” at the top of the page

Provider Enrollment

• Needed documents for application
• Revalidation Webinar (November 2018)
• Checking application status via the portal (Go to Page 19 in the pdf.)

Therapy

• PCP Electronic Signature on DMS-640
• Medicaid Physician Manual: Section 203.210
• Medicaid OT, PT and ST Manual: Section 214.000

Voice Response System (VRS)

• VRS Update
• All Medicaid manuals: Sections 173.100–173.200, 173.400

Arkansas Works

• Non-Emergency Transportation
  • NET broker map

DMS-2609 PCP Selection/Change Form

• PCP assignment not needed for IAPB or Medicare primary

Extension of Benefits

• Benefit Limits
  • RA message – vendor change
• Prior Authorization Process
  • E-blast for scheduled webinars

Immunization Schedule

• Add schedule to your website

Medicaid Management Information System (MMIS)

• Outreach Specialists map

Medicaid Non-Emergency Transportation (NET)

• NET broker map
• NET tools

PASSE

• NET for PASSE members
  • NET broker map
• PASSE choice counseling for members: 1-833-402-0674
• Tools for PASSE members and providers

PASSE Contacts

• DHS PASSE Provider Line………………………………1-888-889-6451
• Arkansas Total Care……………………………………….1-866-282-6280
• Empower Healthcare Solutions………………………..1-855-429-1028
• Summit Community Care………………………………..1-844-462-0022

Patient-Centered Medical Home (PCMH)

• HPB selection — Due April 12
• Population Health Management Report
• Quarterly Reports
• Addendum
• Manual
• Questions: pcmh@afmc.org

Physician Assistant — Direct Supervision

• Arkansas State Board — Rules and Regulations Excerpt
• Medicaid Physician Manual — Section 213.110

Provider Enrollment

• Needed documents for application
• Webinar (November 2018)

Referrals

• Emergency department

Telemedicine

• Medicaid Manual — Section 105.190
• RA Message (2018)

Title V Children with Special Health Care

Needs Webinar (2/7/19)

Arkansas Health Care Payment Improvement Initiative (AHCPII)

Episodes of Care

• Tonsil update

PCMH

• Addendum
• Manual

Arkansas Works

New age range

County resources

Educational tools

Connect Care

Benefit plan 06

• IABP: PCP assignment NOT required

Crosswalk

DMS-2609 PCP selection/change form

Dismissal of a beneficiary

Dual eligible beneficiary

• Dual Eligibles At a Glance
• PCP assignment NOT required

Foster care

Voice response system

Extension of Benefits: Benefit Limit

Review Point

No paper, no phone calls, no fax machines, secure submission

RA message – vendor change

PASSE

Delay

Provider Handbook

Provider Resources

Provider Enrollment

Needed documents for application

Webinar (November 2018)

Referrals

Emergency department

What’s New

Arkansas Take Back

• Permanent site

Arkansas Works

• Recipients can lose eligibility
• Educational tools
• Work requirements: Activities/exemptions

Behavioral Health

• Informational report
• OBHS manual
• Referral change for primary care physicians
• Webinars – Stakeholder and transformation

County Codes (DMS-2608)

Episodes of Care (EOC)

• URI – AFMC Resources

PASSE

• Independent assessment
• PASSE Contacts
• Recorded webinars

PCMH News

• 12-month activities – Due by Dec. 31
• Open enrollment for 2019 performance period (Oct. 10–Nov. 21, 2018)
• Metric breakdown
  • ADHD
  • Asthma
  • ODA
• PCMH updates webinar – Aug. 24, 2018
• Recorded webinars
• PBPM payment report
• Behavioral health pharmacy exclusion

Arkansas Health Care Payment Improvement Initiative (AHCPII)

• AHCPII website

Patient Centered Medical Home (PCMH)

• PCMH 24/7 Best Practices
• PCMH Contacts
• PCMH manual and program policy addendum
  • Health literacy tools
  • PCMH Recovery of Practice Support
  • PCMH Research, Reconsideration and Appeals
  • History Button and Medical Neighborhood Report

Practice transformation

• Arkansas Foundation for Medical Care (AFMC)

Episodes of Care

• Episodes of Care (Algorithms) and Update – Performance Period and Final Report Dates

Links

• AFMC Service Center
• Beneficiary education
• Drug Lists
  • Cough and cold drug list
  • Generic drug upper limit list
  • Over the counter (OTC) drug list
  • Magellan Pharmacy Call Center
  • Preferred drug list (PDL)
• Emergency Room
  • ER Flow Sheets
  • ER Billing Sheet
• EPSDT
  • Billing sheet
  • EPSDT Booklet
  • Fee schedule
  • Screenings and sick visits
    • Messages for remittance advices
• Learn on Demand
  • Program flier
• Medicaid Management Information System (MMIS)
  • Aid Category to Benefit Plan Crosswalk
  • AFMC MMIS Specialists Map
  • Managed Care Capitation and Administrative Fees
  • Submitting and Reviewing a Claim Job+Aid
• Medicaid Policy
  • Retro assignment/newborns VRS
  • Voice Response System
• Quality improvement project updates
  • Alcohol Use Disorder
  • Antibiotic resistance
  • Congestive heart failure
  • Diabetes
  • Flu prevention
  • LARC
  • Maternal mortality
  • Opioids
• Review
  • ReviewPoint
  • Prior Authorizations
• “What’s new” for providers
• Who may not enroll with a PCP