Child Health Management Services

Child Health Management Services and Durable Medical Equipment review team photo

Child Health Management Services (CHMS) cinics 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 Child Health Management Services 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

Notice of adverse actions, reconsideration, appeals and hearings

If AFMC is unable to fully approve any requested service, all applicable parties are notified in writing of the review determination along with detailed instructions on how to request an appeal.

Reconsideration requests

The provider may request reconsideration of the denial within 35 calendar days of the date on the denial letter. Requests must be made in writing and 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 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.

Fair hearing requests

The Medicaid beneficiary may request a fair hearing of a denied review determination made by either the Utilization Review Department of Human Services (DHS) or AFMC. The fair hearing request must be in writing and sent to the Appeals and Hearings Section of DHS within 35 calendar days of the date on the denial letter.

Providers may refer to section 190.000 of the Arkansas Medicaid Provider Manual for more information. Medicaid Provider Fair Hearing requests must be sent to Arkansas Department of Health, Medicaid Provider Appeals Office, 4815 West Markham Street – Slot 31, Little Rock, AR 72205.

Requests should be submitted to:
Attention: CHMS
AFMC
P.O. Box 180001
Fort Smith, AR 72918-0001
Fax: 479-649-0776

For complete qualifying criteria, you may view the Arkansas Medicaid manual for Child Health Management Services here.

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

Questions?

  • This field is for validation purposes and should be left unchanged.

 

Learn more about the Medicaid Fairness Act

Go here

Learn more about AFMC ReviewPoint®

Go here
Health Information and Privacy Protection

How AFMC protects you

AFMC respects your concerns about personal data protection and value our relationship with you. AFMC complies with federal and state laws, also an internal compliance program to protect the privacy of medical records, personal health information (PHI), and personal identifiable information (PII). AFMC implements a set of processes and system controls designed to ensure security of your privacy regulated by the Federal Information Security Management Act (FISMA). We put continuous efforts into monitoring potential risk by conducting audits, risk management, security planning and other FISMA related best practices. The Standards of Conduct articulates AFMC’s commitment to follow applicable federal and state laws and regulations, including the following: Title XVIII of the Social Security Act; Medicare regulations found in 42 C.F.R., sections 422 and 423; Patient Protection and Affordable Care Act (PPACA); Health Insurance Portability and Accountability Act (HIPAA) and as modified by HITECH Act; False Claims Act (FCA) and the Federal Criminal False Claims statutes; NIST Special Publication 800-26, Department of Defense (DoD) Policy 8500; Director of Central Intelligence Directive (DCID) 6/3; ISO/IEC Standard 17799; General Accounting Office (GAO) Federal Information System Controls Audit Manual (FISCAM); and Health and Human Services (HHS) Centers for Medicare and Medicaid Services (CMS) Core Security Requirements.

How to protect yourself

AFMC will protect your privacy as described in this Privacy Statement, however, you should keep in mind that if you voluntarily disclose personal information, especially confidential health information, it is possible that despite our efforts, information may be accessible by others. You can help guard against this by:
  • Enabling security features on personal mobile devices
  • Use strong passwords with your laptop and mobile accounts
  • Safely dispose of personal information (mail, old hard drives and computers)
  • Ensure that personal computers have the latest security updates to decrease risk
  • Keeping hard copy of sensitive information stowed away in secure cabinet or briefcase
  • Don’t overshare information through social networking
  • Be conscious of web security (internet browser settings)
  • Be conscious of your surrounding when carrying sensitive information