016.06.06 Ark. Code R. 025

Current through Register Vol. 49, No. 9, September, 2024

Rule 016.06.06-025 - Section I - All Arkansas Medicaid Provider Manuals

171.000Primary Care Physician Participation

171.100PCP-Qualified Physicians and Single-Entity Providers

A. Obstetricians and gynecologists may choose whether or not to be PCPs.

B. All other PCP-qualified physicians and clinics must enroll as PCPs, except for physicians who certify in writing that they are employed exclusively by an Area Health Education Center (AHEC), a Federally Qualified Health Center (FQHC), a Medical College Physicians Group, or a hospital (i.e., they are "hospitalists").

C. PCP-qualified physicians are those whose sole or primary specialty is

1. Family Practice

2. General Practice

3. Internal Medicine

4. Obstetrics and gynecology

5. Pediatrics and Adolescent Medicine

D. Physicians with multiple specialties may elect to enroll as PCPs if a secondary or tertiary specialty in their Medicaid provider file is listed in part C above.

E. PCP-qualified clinics and health centers (single-entity PCPs) are

1. AHECs

2. FQHCs

3. The family practice and internal medicine clinics at the University of Arkansas for Medical Sciences

171.130EPSDT Agreement Requirement

A. A PCP applicant must sign an agreement to participate as a screening provider in the Child Health Services (EPSDT) Program.

B. Internists, obstetricians, gynecologists, and physicians who customarily carry a caseload of patients who are 21 years of age or older are not required to furnish EPSDT screens.

1. Their participation in the Child Health Services (EPSDT) Program is optional.

2. They must, however, sign Child Health Services (EPSDT agreements if they elect to be screening providers.

C. PCP-qualified single-entity providers must execute Child Health Services (EPSDT) agreements.

171.320Child Health Services (EPSDT) Requirements

A. A PCP must monitor and maintain the Child Health Services (EPSDT) screening periodicity of each of his or her enrollees under the age of 21, regardless of who screens those enrollees. The periodic EPSDT screening schedule recommended by the American Academy of Pediatrics can be found in section 215.100 of the Child Health Services/Early and Periodic Screening, Diagnosis and Treatment manual.

B. A PCP may refer his or her enrollees to other providers for EPSDT screens and related lab work.

1. Screening providers must report the results to the referring PCP.

2. The PCP must coordinate and monitor subsequent referrals, treatment or testing.

016.06.06 Ark. Code R. 025

5/5/2006