I. Introduction
The Arkansas Medicaid Program will enroll qualified acute care
hospitals that have been certified by the Secretary of the Department of Health
and Human Services and licensed as Critical Access Hospitals (CAHs), in the
Arkansas Medicaid Critical Access Hospital Program, effective for dates of
service on and after August 1, 2001.
A. Critical Access Hospitals that are
currently licensed by the Arkansas Department of Health (ADH) as CAHs and
currently enrolled in the Arkansas Medicaid Hospital Program must enroll in the
Critical Access Hospital Program.
B. Hospitals not currently licensed by ADH as
Critical Access Hospitals but which later change their ADH licensure to CAH
must apply for Medicaid Critical Access Hospital Program enrollment at the time
of the licensure change.
II.
Conditions of
Participation
A. Only hospitals
licensed as CAHs by the Arkansas Department of Health (ADH) may enroll in the
Arkansas Medicaid Critical Access Hospital Program.
1. A copy of the current license must
accompany the Medicaid application and contract.
2. Enrolled hospitals must submit proof of
subsequent licensure or license renewal when issued.
B. To be eligible for participation in the
Arkansas Medicaid Critical Access Hospital Program a hospital must have Title
XVIII (Medicare) certification as a Critical Access Hospital.
1. A copy of the current Medicare
certification must accompany the Medicaid application and contract.
2. Enrolled hospitals must submit proof of
subsequent certification or certification renewal when issued.
C. To enroll in the Arkansas
Medicaid Critical Access Hospital Program, a hospital must complete an
application and contract with the Arkansas Medicaid Program.
1. The Arkansas Medicaid enrollment
application and the provider contract, with instructions, are located in
Section I of any Arkansas Medicaid provider manual.
2. You may copy the pages from the manual or
you may call Provider Enrollment at 501-682-8323, to have an enrollment packet
mailed to you.
D. Upon
approval of the application and contract, the Arkansas Medicaid Program will
establish the effective date of the enrollment and assign a provider number,
forwarding to the provider a letter of confirmation of these items.
III.
Coverage
A. Scope of
Coverage
Arkansas Medicaid covers medically necessary inpatient and
outpatient hospital services that are permitted under the Critical Access
Hospitals' licensures, to the extent that the same services are covered under
the Arkansas Medicaid Hospital Program.
B. Coverage Restrictions
Coverage restrictions in the Arkansas Medicaid Hospital
Program, e.g. restrictions regarding observation beds, also
apply in the Arkansas Medicaid Critical Access Hospital Program unless Arkansas
Medicaid issues policy guidelines specifically stating otherwise.
1. Arkansas Department of Health regulations
stipulate that Critical Access Hospitals may provide medically necessary acute
inpatient care for a period not to exceed ninety-six (96) hours, unless:
a. A longer period is required because
transfer to a hospital is precluded due to inclement weather or other emergency
conditions or b. A peer review organization or equivalent entity, upon request,
waives the ninety-six (96) hour restriction on a case-by-case basis.
2. The Arkansas Medicaid Program
has contracted with Arkansas Foundation for Medical Care, Inc. (AFMC) to
determine and certify lengths of stay in the Medicaid Utilization Management
Program (MUMP).
a. CAHs shall contact AFMC and
follow MUMP procedures to certify stays longer than 4 days.
b. CAHs receiving inpatients by transfer from
a hospital or another CAH must obtain AFMC certification of inpatient stays of
any length.
c. In addition to MUMP
criteria of medical necessity, AFMC will, when applicable, review the CAH's
justification for retaining a patient instead of transferring the patient to a
hospital.
1) AFMC may retrospectively review
inpatient stays of any length for medical necessity.
2) AFMC may retrospectively review inpatient
stays of any length for justification for retaining a patient instead of
transferring the patient to a hospital.
3. Medicaid recipients under age one (1) at
the time of admission are exempt from the 96-hour inpatient stay limitation and
the MUMP policy for dates of service before their first birthday.
4. A CAH may provide medically necessary
acute inpatient care for a period that does not exceed, as determined on an
annual average basis, 96 hours per patient.
a.
Discharges and average stays are identified and calculated by the Medicare
fiscal intermediary and are the same as are used for Medicare
purposes.
b. The CAH's average
length of stay will be reported to the HCFA regional office by the Medicare
fiscal intermediary.
1) If a CAH exceeds the
average length of stay limit, it will be required to develop and implement a
corrective action plan acceptable to the HCFA regional office.
2) If the CAH fails to implement the
corrective action plan, the CAH will be subject to termination of its Medicaid
provider agreement and other sanctions established under Title XVIII of the
Social Security Act.
C. Exclusions
1. Services excluded from coverage in the
Arkansas Medicaid Hospital Program are also excluded from the Arkansas Medicaid
Critical Access Hospital Program, unless stated otherwise in official Program
documentation or correspondence.
2.
Medicaid does not cover nursing facility beds ("swing-beds") in hospitals or in
CAHs.
IV.
Benefit Limits
A.
Inpatient stays, non-emergency outpatient visits and laboratory, radiology and
diagnostic machine test coverage in CAHs are subject to the same benefit limits
that apply to facilities enrolled in the Arkansas Medicaid Hospital Program and
the Arkansas Medicaid Rehabilitative Hospital Program.
B. Benefit-limited services received in CAHs
are counted with benefit-limited services received in hospitals enrolled in the
Arkansas Medicaid Hospital Program and the Arkansas Medicaid Rehabilitative
Hospital Program to calculate a Medicaid-eligible individual's benefit
status.
V.
Reimbursement
A.
Inpatient Reimbursement
1. CAH inpatient
reimbursement is by interim per diem rates with year-end cost settlement.
a. Allowable costs and cost settlements are
determined in accordance with Title XVIII (Medicare) CAH cost principles and
applicable cost settlement procedures and calculations.
b. A CAH's initial interim per diem rate will
be the most recent interim per diem rate it received under its prior enrollment
in the Arkansas Medicaid Hospital Program; or the interim per diem calculated
from the most recent full year's cost report it submitted under its prior
enrollment in the Arkansas Medicaid Hospital Program.
c. In the event that a hospital enrolled in
the Arkansas Medicaid Hospital Program converts to a CAH before it has had an
interim per diem rate in effect for a full cost reporting period, the State
will set the facility's CAH interim per diem rate at the mathematical mean of
established CAHs' per diem rates in effect on the date Medicaid establishes as
the facility's date of enrollment in the Arkansas Medicaid Critical Access
Hospital Program.
d. A hospital
that converts to a CAH, and whose effective date of Medicaid enrollment as a
CAH is a date other than the day following the last day of the facility's
established cost reporting period under its enrollment in the Arkansas Medicaid
Hospital Program, must submit partial-year cost reports under each program in
which it maintained enrollment during the cost reporting period.
2. Interim per diem rates are
calculated annually in the same manner as are the interim per diem rates of
hospitals enrolled in the Arkansas Medicaid Hospital Program.
B. Outpatient Reimbursement
1. CAH outpatient reimbursement consists of
interim fee-for-service payment in accordance with the Arkansas Medicaid
Program outpatient hospital fee schedule (at the lesser of the billed charge or
the fee schedule maximum) with year-end cost settlements.
2. Allowable costs and cost settlements are
determined in accordance with Title XVIII (Medicare) CAH cost principles and
applicable cost settlement procedures and calculations.
If you need this material in an alternative format, such as
large print, please contact our Americans with Disabilities Act Coordinator at
(501) 682-1461 (voice) or at (501) 682-6789 and 1-877-708 -8191 (TDD).
If you have questions regarding this notice, please
contact the EDS Provider Assistance Center at In-State WATS 1 - 800-457-4454,
or locally and Out-of-State at (501) 376-2211.
Thank you for your participation in the Arkansas Medicaid
Program.
Ray Hanley, Director
Arkansas Medicaid provider manuals (including update
transmittals), official notices and remittance advice (RA) messages are
available for downloading from the Arkansas Medicaid website: www.medicaid.state.ar.us.
