016.06.05 Ark. Code R. 068
Refer to Attachment 4.19-B, Item 4.b.(5) for reimbursement information for private duty nursing services for high technology non-ventilator recipients in the Child Health Services (EPSDT) Program.
Reimbursement is based on the lesser of the amount billed or the maximum Title XIX (Medicaid) charge allowed. The Title XIX maximum was established based on a 1980 survey conducted by Developmental Disabilities Services (DDS) of 85 Arkansas DDTCS providers of their operational costs excluding their therapy services. An average operational cost was derived for each service. Then an average number of units was derived for each service. The average operational cost for each service was divided by the average units for that particular service to arrive at a maximum rate.
For dates of service occurring on or after September 27, 2005, the maximum per unit rate for Pre-School Services is increased to $15.57and the maximum per unit rate for Adult Development Services is increased to $9.99. These new rates were calculated based on analysis of the current 2005 cost to provide quality services in compliance with governing regulations. The rates have been demonstrated to be consistent with the Clinic Upper Payment Limit at 42 CFR 447.321.
For Pre-School Services, 1 unit of service equals 1 hour of service with a maximum of 5 units per day. For Adult Development Services, 1 unit of service equals 1 hour of service with a maximum of 5 units per day.
Services for beneficiaries under age 21 can be extended with prior authorization due to medical necessity. State developed fee schedule rates are the same for both public and private providers of DDTCS services.
Occupational, physical and speech therapy services under the DDTCS Program are reimbursed as is described in Item 4.b.(19).
016.06.05 Ark. Code R. 068