Child Health Management Services

Child Health Management Services and Durable Medical Equipment review team photo

Child Health Management Services (CHMS) clinics provide both developmental and medically focused treatment for children who are Arkansas Medicaid beneficiaries and who meet the qualifying criteria. These services are available in a day school setting and include physician and nursing services, physical therapy, occupational therapy, speech therapy, nutrition, early childhood developmental teaching and psychological services. CHMS services are intended for children with the most significant medical and/or developmental diagnoses who require multidisciplinary treatment.

Prior authorization is required for all treatment services provided in a CHMS clinic. To request prior authorization, please send the following documentation to AFMC along with the completed DMS-102. Request for Authorization of Child Health Management Services form:

  • A treatment plan signed by the CHMS medical director and the child’s PCP that includes all services to be provided in the clinic
  • The most recent evaluations along with documentation to support the child’s current medical and/or developmental status
  • CHMS enrollment orders signed and dated by the CHMS medical director and the PCP
  • DMS-640 prescription for occupational, physical, speech therapy

Please refer to Section II of the Medicaid Child Health Management Services Manual found on Arkansas Medicaid’s Web site for complete program information.

Prior authorization requests may be submitted via hardcopy via U.S. Mail, FedEx, UPS, etc., or electronically through AFMC ReviewPoint®.

For U.S. Mail:
AFMC
P.O. Box 180001
Fort Smith, AR 72918-0001

For FedEx, UPS or other such carriers:
AFMC
5111 Rogers Avenue, Suite 476
Fort Smith, AR 72903

AFMC ReviewPoint® is an alternate method of submitting requests and/or medical records.

AFMC review process

A registered nurse reviewer initially screens the prior authorization requests. If the documentation submitted supports medical necessity, the nurse reviewer may approve the prior authorization.

If the nurse reviewer is unable to approve medical necessity of the requested service, the review is referred to a physician advisor for determination. AFMC utilizes actively practicing physicians who are licensed in the state of Arkansas to review the prior authorization requests. The physician advisor uses his/her medical judgment in accordance with established Medicaid policies to review medical necessity of the requested services.

Review notifications

Upon completion of each prior authorization request, AFMC provides written notification of the review determination to the requesting provider and the Medicaid beneficiary.

Approval notifications – include each procedure code/modifiers and units approved along with the authorization number for billing

Denial notifications – include case-specific clinical rationale and detailed information about how to appeal the determination, including the time frame allowed for submission and the requirement to provide additional information to support the medical necessity of the service denied.

Due process rights

If AFMC is unable to fully approve any requested service, all applicable parties are notified in writing of the review determination along with detailed information regarding their due process rights.

Reconsideration requests

The provider may request reconsideration of the AFMC decision within 35 calendar days of the date on the review notification letter. Requests must include a copy of the denial letter and additional documentation to substantiate the medical necessity of the requested services. Requests received after 35 calendar days of the denial date will not be accepted for reconsideration.

If the denial decision is reversed during the reconsideration review, an approval is forwarded to the provider and Medicaid beneficiary specifying the approved units and services. If the denial decision is upheld, the provider and the Medicaid beneficiary will be notified in writing of the review determination. Reconsideration is available only once per prior authorization request.

Appeal hearing requests

Medicaid beneficiaries may request an appeal of the AFMC decision through the Office of Appeals and Hearings. The appeal request sent to the Appeals and Hearings Section of DHS within 35 calendar days of the date on the denial letter.

Providers may request an appeal of the AFMC decision through the Arkansas Department of Health, Medicaid Provider Appeals Office, 4815 West Markham Street – Slot 31, Little Rock, AR 72205.  Please refer to Section 190.000 of the Arkansas Medicaid Provider Manual for more information.

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Health Information and Privacy Protection

How AFMC protects you

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