016.06.04 Ark. Code R. § 024 - State Child Health Insurance Program (SCHIP) State Plan Amendment
Preamble
Section 4901 of the Balanced Budget Act of 1997 (BBA) amended the Social Security Act (the Act) by adding a new title XXI, the State Children's Health Insurance Program (SCHIP). Title XXI provides funds to states to enable them to initiate and expand the provision of child health assistance to uninsured, low-income children in an effective and efficient manner. To be eligible for funds under this program, states must submit a state plan, which must be approved by the Secretary. A state may choose to amend its approved state plan in whole or in part at any time through the submittal of a plan amendment.
This model application template outlines the information that must be included in the state child health plan, and any subsequent amendments. It has been designed to reflect the requirements as they exist in current regulations, found at 42 CFR part 457. These requirements are necessary for state plans and amendments under Title XXI.
The Department of Health and Human Services will continue to work collaboratively with states and other interested parties to provide specific guidance in key areas like applicant and enrollee protections, collection of baseline data, and methods for preventing substitution of Federal funds for existing state and private funds. As such guidance becomes available, we will work to distribute it in a timely fashion to provide assistance as states submit their state plans and amendments.
MODEL APPLICATION TEMPLATE FOR STATE CHILD HEALTH PLAN UNDER TITLE XXI OF THE SOCIAL SECURITY ACT STATE CHILDREN'S HEALTH INSURANCE PROGRAM
(Required under 4901 of the Balanced Budget Act of 1997 (New section 2101(b)))
State/Territory:___ ARKANSAS ______________________________________________________
(Name of State/Territory)
As a condition for receipt of Federal funds under Title XXI of the Social Security Act, ( 42 CFR, 457.40(b) )
_______________________________________________________________________________
Roy Jeffus, Director, DMS (Signature of Governor, or designee, of State/Territory, Date Signed)
submits the following State Child Health Plan for the State Children's Health Insurance Program and hereby agrees to administer the program in accordance with the provisions of the approved State Child Health Plan, the requirements of Title XXI and XIX of the Act (as appropriate) and all applicable Federal regulations and other official issuances of the Department.
The following state officials are responsible for program administration and financial oversight ( 42 CFR 457.40(c) ):
Name: Kurt Knickrehm Position/Title: Director, Department of Human Services (DHS) Name: Roy Jeffus Position/Title: Director, DHS Division of Medical Services (DMS)
Name: Position/Title:
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-0707. The time required to complete this information collection is estimated to average 160 hours per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, N 2-14-26, Baltimore, Maryland 21244.
( 42 CFR 457.70 ):
Arkansas has aggressively pursued health care for children by covering optional benefits and categories that benefit children and developing Medicaid 1115 demonstrations. For example, Arkansas has elected to provide the full range of EPSDT services to children without requiring the EPSDT screen. Also Arkansas was one of the first states in the nation to cover the TEFRA-134 children, authorized by the Tax Equity and Fiscal Responsibility Act of 1982.
Effective 1-1-03, the State began covering TEFRA children in a TEFRA-like 1115 demonstration in which the parents pay a premium based on a sliding scale; some parents are not required to pay a premium. The TEFRA-like demonstration provides for the care of a child in its home, if he/she would qualify for Medicaid as a resident in a Title XIX institution, e.g., a nursing facility or an Intermediate Care Facility for the Mentally Retarded, etc. Parental income and resources are not counted in the child's eligibility determination, however parental income is counted in the premium amount calculation. The eligibility income limit for this demonstration is three times the SSI limit. The TEFRA-like 1115 demonstration makes Medicaid available to a large segment of the state's chronically ill children.
In its quest to provide health care for children, the State also opted to cover uninsured children through a Medicaid 1115 demonstration, ARKids First. This demonstration is discussed in item B, below.
SCHIP Phase I, a Medicaid expansion, was approved August 6, 1998 and implemented October 1, 1998. This was a small SCHIP Medicaid expansion in which the last of the eligible children aged-out of the program September 30, 2002. SCHIP Phase II is a separate SCHIP program that was approved February 16, 2001 but not implemented. Phase III supersedes Phase II. Phase III will cover some of the children in the State's Medicaid 1115 demonstration, ARKids B, as an SCHIP Medicaid expansion and cover unborn children as a separate child health program.
In 1997, Arkansas' Governor, the Arkansas State legislature, the President and Congress were all addressing the issue of health care for vast numbers of uninsured children. Governor Mike Huckabee supported enabling state legislation and an appropriations bill in the 1997 legislative session that created and funded ARKids First, a Medicaid 1115 demonstration. The Arkansas Legislature passed both bills and Governor Mike Huckabee signed both bills into law by on March 10, 1997 (see Attachments A and B). Effective August 4, 2000, the 1115 demonstration was renamed ARKids B.
Ray Hanley, then Director, Division of Medical Services (DMS), formed and chaired an ARKids First work group, which was composed of individuals from the following: the Governor's Office (the Department of Human Services liaison), Arkansas Children's Hospital, Arkansas Department of Health, Catholic Social Services, Arkansas Advocates for Children and Families, Easter Seals, Communities in School of Arkansas, Arkansas Chapter for American Academy of Pediatrics, Electronic Data Systems (Arkansas Medicaid's fiscal agent), and various individuals in the Department of Human Services (DHS), including Tom Dalton, then Department Director. The first meeting was held February 7, 1997, one day after President Clinton announced his FFY98 budget package which included a proposal to expand health insurance access for poor children in families that earn too much for Medicaid but not enough to afford private health insurance. Additional ARKids First meetings were held as needed. Most of the discussion and concerns involved eligibility factors and the benefit package.
The Arkansas legislation, though not as detailed, mirrors the SCHIP legislation in its purpose, i.e., to provide health insurance coverage for uninsured children under 19 whose family income is at or below 200% of the poverty level. The ARKids First program was designed as an SCHIP program, but used the Medicaid 1115 demonstration process for implementation since the SCHIP legislation had not been passed at the time Arkansas' program was under development. The ARKids First Medicaid 1115 demonstration was approved by CMS on August 19, 1997 and implemented on September 1, 1997; only days after the SCHIP legislation was signed by the President.
The State developed the ARKids First Program with the thought that it would be able to roll the ARKids First Medicaid 1115 demonstration into an SCHIP program. However, the State recognizes that as the ARKids First (now ARKids B) Medicaid demonstration and the SCHIP legislation were developing, they didn't make completely parallel steps. Therefore, ARKids B enrollees, who do not meet the definition of an SCHIP targeted low-income child, will continue to receive their health care services through Title XIX federal funding. Children in ARKids B who meet the definition of an SCHIP targeted low-income child may receive their services through either Title XIX
or Title XXI federal funding, at the discretion of the State. All of the ARKids B children will remain in the Medicaid 1115 demonstration regardless of the funding source. The children who do not meet the definition of an SCHIP targeted low-income child are the children of state employees and the children who meet the eligibility requirements for regular Medicaid.
The ARKids First application form and the promotional materials identify the program as ARKids First. (Effective August 4, 2000, ARKids First became an umbrella for ARKids A, regular children's Medicaid, and ARKids B, the 1115 demonstration.) Applications may be made by mail, and a toll free number is available to clients. Applications in English or Spanish may be printed from the ARKids First web site at www.arkidsfirst.com.
The ARKids B benefit package and copayments are comparable to insurance offered to state employees. The State elected a copayment as the only cost sharing requirement, because it is the most equitable form of cost sharing. The State did not want to assess an enrollment fee nor monthly premiums because it wanted the family's cost sharing responsibility to be related solely to usage. The State will keep the current copayment structure in place for ARKids B enrollees without regard to the funding source (XIX or XXI).
The application form, the benefit package, and the identification card will be the same for all ARKids B enrollees without regard to the funding source.
It is possible for Arkansas to pursue this SCHIP Medicaid expansion for the ARKids B 1115 demonstration because section 2110(b)(II) of the SCHIP legislation and CMS Q&A 14(a) provide that states, which expanded Medicaid through an 1115 demonstration after June 1, 1997 may claim the enhanced match rate for such children. The ARKids B program was implemented on September 1, 1997.
The Arkansas Department of Human Services administers regular Medicaid and the ARKids B demonstration, which will be funded by Titles XIX and XXI.
The essential elements of the ARKids B program, without regard to the funding source, are as follows:
[GREATER THAN] Covers children under 19.
[GREATER THAN] Family income must be at or below 200% of the poverty level.
[GREATER THAN] There is no asset test.
[GREATER THAN] Children must have been uninsured for the preceding 6 months or insurance was lost through "no-fault" such as parent is no longer employed and health insurance was lost.
[GREATER THAN] The benefit package is the Secretary approved Medicaid 1115 demonstration benefit package granted for ARKids B. The benefit package will be the same for all ARKids B enrollees without regard to the funding source.
[GREATER THAN] Cost-sharing is required for services that are not categorized as well-health.
Notes: Generally, in this document, the 1115 demonstration is referenced as ARKids B, even though it was known as ARKids First until August 4, 2000.
The Division of Medical Services (DMS) and the Division of County Operations (DCO) are divisions of the Department of Human Services. DMS is responsible for the administration of the Medicaid and SCHIP programs except for eligibility, which is the responsibility of DCO.
The SCHIP definition of a targeted low-income child excludes children of state employees and children who meet the eligibility criteria for regular Medicaid, however these children are covered in the ARKids B program. The State will not use Title XXI funding for these children.
The Arkansas Department of Human Services administers the SCHIP unborn child program.
The essential elements of the program are:
[GREATER THAN] Medical verification of the pregnancy is required.
[GREATER THAN] Applicant must have no other insurance that covers the pregnancy.
[GREATER THAN] Net income must be at or below 200% FPL.
[GREATER THAN] The resource limit is the same as the resource limit for the SOBRA pregnant women category under Medicaid.
[GREATER THAN] The benefits will be the same as the SOBRA pregnant women category under Medicaid.
The State assures that expenditures for child health assistance will not be claimed prior to the time that the State has legislative authority to operate the State plan or plan amendment as approved by CMS.
The state assures that it complies with all applicable civil rights requirements, including title VI of the Civil Rights Act of 1964, title II of the Americans with Disabilities Act of 1990, section 504 of the Rehabilitation Act of 1973, the Age Discrimination Act of 1975, 45 CFR part 80, part 84, and part 91, and 28 CFR part 35.
Effective date: Medicaid expansion - Phase I: 10-1-98
Separate State SCHIP - Phase II: Not Implemented Medicaid expansion (ARKids B) - Phase III: 1-1-01 Unborn Child Coverage - Phase III: 7-1-04.
Implementation date: Medicaid expansion - Phase I: 10-1-98
Separate State SCHIP - Phase II: Not Implemented
Medicaid expansion (ARKids B) - Phase III: The State implemented
retroactively to 1-1-01. Unborn Child Coverage - Phase III: The target implementation date is
July 1, 2004.
As of the October/December 2003 quarter, there were 274,062 children enrolled in regular Medicaid. The racial break out is as follows: 154,695 (56.5%) white; 90,294 (33%) black; 16,205 (6%) Hispanic; 596 (.3%) Native American; 946 (.4%) Asian; and 11,326 (4.2%) other and unknown. The poverty level breakout shows that 91.7% were below poverty while only 8.3% were above the poverty level.
There were 64,065 children enrolled in the ARKids B category as of the October/December 2003 quarter. The racial breakout is as follows: 45,818 (71.5%) white; 14,121 (22%) black; 3002 (4.7%) Hispanic; 131 (.2%) Native American; and 772 (1.2%) other and unknown. The poverty level breakout shows that 11.1% are at or below the poverty level and 88.9% are above the poverty level.
Please see Attachments C and D for the racial breakout by age for regular Medicaid categories and for ARKids B, respectively.
Attachments E and F show eligibles by age by county for regular Medicaid categories and for ARKids B, respectively, for the October-December 2003 quarter.
Attachments G and H show a breakout of expenditures by State Category of Service for regular Medicaid categories and for ARKids B, respectively for the October-December 2003 quarter.
Phase I, was implemented 10-1-98. Phase I was a Medicaid expansion, which added children under 19 born after 9-30-82 and before 10-1-83. The last child aged out of the Medicaid expansion on 9-30-02.
Phase II, a separate SCHIP, was approved 2-16-01, but was not implemented. The separate state SCHIP would have covered a portion of the ARKids B children.
Phase III, is a combination program: The Medicaid expansion is a subset of the ARKids B Medicaid 1115 demonstration (implemented retroactively to 1-1-01 ); the separate child health program covers the unborn child. Phase III supersedes Phase II.
Arkansas has located two studies relevant to this issue. Information from each study is listed below:
The source of the estimates of uninsured children is the Current Population Survey. Uninsured means the lack of any health insurance, including Medicaid, for an entire year. The data were prepared by the Urban Institute using data specifications submitted by the Southern Institute on Children and Families for 1989 and 1993.
The State does not have a public-private partnership. The State does not have a BC/BS Caring Program for Children.
Medicaid
The State has been extremely active in its effort to identify and enroll uncovered children who are eligible to participate in the Arkansas Medicaid Program.
The State has cooperative agreements with 35 hospitals, clinics, and organizations throughout the state to place out-stationed DHS Medicaid eligibility workers in their facilities. This has simplified the application process and has encouraged individuals and families to apply for Medicaid when otherwise they might not have done so.
DHS also has an agreement with the Federally Qualified Health Centers for 19 staff who cover their 36 sites. These FQHC staff members assist in the application process.
Medicaid outreach is also furthered by a contract between the Arkansas Department of Human Services and the Arkansas Department of Health (ADH) for ConnectCare, the Arkansas Primary Care Case Management program. ConnectCare provides outreach through statewide television and radio advertisements to inform both current eligibles and potential eligibles about the merits of primary medical coverage through Arkansas Medicaid.
DHS also has an agreement with ADH to establish Presumptive Eligibility for Pregnant Women in the SOBRA category. Arkansas was one of the first states in the nation to employ the Presumptive Eligibility process for this group.
State-only Child Health Insurance
The State does not have any State-only child health insurance programs.
The State does not have a public-private partnership. The State does not have a BC/BS Caring Program for Children.
Children currently covered in the 1115 demonstration, ARKids B, will be covered for health coverage funded through Title XIX or Title XXI.
Targeted to Uninsured Children
The ARKids B program is designed to provide health insurance coverage for uninsured children under age 19. Uninsured is defined as not having group or employer sponsored primary comprehensive health insurance within the previous 6 months, unless such insurance was lost through no-fault. An example of no-fault would be if the child(ren) had had health insurance through a parent's employment and the parent is no longer employed. Also children who have inaccessible health insurance are considered to be uninsured. For example, a child has inaccessible health insurance if the child has an out of state, noncustodial parent with HMO insurance for his/her child(ren) but the HMO network does not contain medical providers where the child resides.
Coordination With Medicaid
On August 4, 2000 Arkansas began using the ARKids First name as an umbrella for the 1115 demonstration and certain Medicaid categories. ARKids First is divided into ARKids A, regular Medicaid, and ARKids B, the 1115 demonstration (to be funded by Titles XIX and XXI) . The application form is an ARKids First umbrella application, which asks applicants to check one of three blocks to show their application preference - either ARKids program, ARKids A only, or ARKids B only. The application form contains a chart, which shows the services and cost sharing requirements in each program. The same chart is used for reapplications. Parents are not required to receive regular Medicaid for their children, if they prefer to receive ARKids B. Children in ARKids B, who are eligible for regular Medicaid, will not be funded by Title XXI.
The following is paraphrased from Arkansas Medical Services Policy Manual Policy Directive Number MS 00-8 dated August 4, 2000:
However if the applicant selects "ARKids A only" and the children are not eligible for ARKids A but they are eligible for ARKids B, the caseworker will take the following steps:
Note: ARKids B will be funded by Titles XIX and XXI. Title XXI will only be used for those ARKids B children who meet the SCHIP definition of a targeted low-income child.
Coordination with Children's Medical Services
The Department of Human Services operates a Children's Medical Services Program which provides care coordination and/or specialized medical care and rehabilitation for children with special health care needs whose families are partially or wholly unable to provide for such services and who meet the agency's criteria. Children's Medical Services are funded by federal (Title V) and state funds. The Children's Medical Services staff coordinate closely with Medicaid/SCHIP, especially with regard to the TEFRA-like Medicaid 1115 demonstration, to ensure that the children they serve receive the widest range of services to which they are entitled. Please reference Section 1.1.3.A., for more information regarding the TEFRA-like demonstration.
Coordination with Maternal and Child Health
The Title V Maternal and Child Health (MCH) programs are administered by the Arkansas Department of Health. Preventive health services are available to women, children, adolescents and families in 100 service sites in the state's 75 counties. Preventive services provided include well child screens, immunizations, prenatal care, family planning, hearing and vision screening, newborn screening, blood lead screening and follow-up. Over 250,000 Arkansans receive some level of Title V MCH services each year. Services to children with Special Health Care Needs are coordinated with DHS.
D Check here if the state elects to use funds provided under Title XXI only to provide expanded eligibility under the state's Medicaid plan, and continue on to Section 4
The utilization controls will be the same as under Title XIX.
(Section 2102)(a)(4) ( 42CFR 457.490(b) )
The utilization controls will be the same as under Title XIX.
n Check here if the state elects to use funds provided under Title XXI only to provide expanded eligibility under the state's Medicaid plan, and continue on to Section 5
Conception to age 19; conception-to-birth enrollees are covered in the separate child health program; birth to 19 are covered in the Medicaid expansion.
At or below 200% FPL.
The resource test for the separate child health program is the same as applied to the SOBRA pregnant women category under Medicaid. There is no resource test for the Medicaid expansion.
Enrollees must be current Arkansas residents with the intent to remain in the State.
Not applicable.
SCHIP enrollees cannot be eligible for Medicaid. SCHIP enrollees cannot have access to a state health benefits program. ARKids B enrollees cannot be covered under a group health plan; enrollees in the separate child health program (unborn child) may not have health insurance that covers pregnancy related services.
Same as Medicaid.
A Social Security Number is required for Medicaid expansion enrollees. There no SSN requirement for the separate child health program to cover unborn children.
(Section 2102)(b)(2)) ( 42CFR 457.350 )
The methods of establishing eligibility and continuing enrollment are the same as under Title XIX.
(Section 2106(b)(7)) ( 42CFR 457.305(b) )
M Check here if this section does not apply to your state.
2102(b)(3)(A) and 2110(b)(2)(B)) ( 42 CFR 457.310(b) ( 42CFR 457.350(a)(1) ) 457.80(c)(3))
Medicaid Expansion: At eligibility determination and redetermination, applications are reviewed for coverage under a group health plan. ARKids B children who meet Medicaid eligibility criteria and those whose parents are state employees are coded in the system; these children are funded by Medicaid - they are not funded by SCHIP.
State Children's Health Program: At eligibility determination and redetermination, applications are reviewed for coverage under a group health plan or health insurance coverage, that covers pregnancy related services, for access to a state health benefits plan and for Medicaid eligibility prior to enrollment in the State's separate child health program.
Medicaid Expansion: The ARKids First application is a combined application for ARKids A (Medicaid) and ARKids B (Medicaid 1115 demonstration). Reference 2.3 above for more information related to the screening process.
State Children's Health Program: Screening procedures identify any applicant or enrollee who would be potentially eligible for Medicaid services based on the eligibility of his or her mother under one of the poverty level groups described in section 1902 (1) of the Act, section 1931 of the Act, or a Medicaid demonstration project approved under section 1115 of the Act.
Medicaid Expansion: The ARKids First application is a combined application for ARKids A (Medicaid) and ARKids B (Medicaid 1115 demonstration). Reference 2.3 above for more information related to the screening process.
State Children's Health Program: Any applicant or enrollee who is found ineligible for Medicaid services (based on the eligibility of his or her mother) is automatically reviewed for SCHIP Medicaid expansion or separate child health plan eligibility.
describe the methods of monitoring substitution.
Medicaid Expansion: The uninsured requirement for ARKids B (Medicaid and SCHIP) is that the child must have been uninsured for a minimum of six months to prevent substitution of coverage.
State Child Health Insurance Program: Coverage for the unborn child covers only those who do not qualify for Medicaid although the income and resource limit is the same as the SOBRA pregnant women's Medicaid category; the difference is that the unborn child coverage does not require the pregnant woman to meet Medicaid citizenship requirements. The state child health program requires that the pregnant woman has no health insurance coverage for the pregnancy. Also the unborn child benefit package is limited to services related to the pregnancy and is of a temporary nature. Due to the above factors, the State does not think there will be substitution of coverage.
FPL: describe how substitution is monitored and identify specific strategies to limit substitution if levels become unacceptable.
describe:
The minimum period without coverage under a group health plan, including any allowable exceptions to the waiting period.
The minimum employer contribution.
The cost-effectiveness determination.
American Indian and Alaska Native children are eligible for Arkansas' SCHIP Medicaid expansion or separate child health program on the same basis as any other children in the State, regardless of whether they may be eligible for or served by Indian Health Services-funded care.
Describe the procedures used by the state to accomplish:
Outreach to families of children likely to be eligible for child health assistance or other public or private health coverage to inform them of the availability of the programs, and to assist them in enrolling their children in such a program: (Section 2102(c)(1)) ( 42CFR 457.90 )
Arkansas developed a comprehensive outreach strategy for ARKids B*. The strategy applies equally to the title XIX and the SCHIP components of ARKids B*. Outreach for the separate child health insurance program is through the ConnectCare contract with ADH and through the ADH pregnant women's program, including presumptive eligibility.
Media Campaign
In addition to the regular Medicaid outreach, Arkansas developed outreach geared specifically to the ARKids B* Program. Governor Mike Huckabee held a gala press conference on September 11, 1997, to launch the ARKids B* Program. This has been followed by an extensive media campaign, including television, radio, print, and distribution of brochures in such places as McDonald's® food sacks. A key factor in the success of this campaign to date has been the active role Governor Huckabee has taken by appearing in television and radio public service announcements, as well as in the printed materials and on the ARKids B website: www.ARKidsfirst.com.
The media campaign has been modified to incorporate the changes in the use of the ARKids First name; ARKids First is now composed of ARKids A (Medicaid) and ARKids B, the 1115 demonstration. The SCHIP eligibles will be part of the ARKids B component.
Coordination With Public and Private Entities
The outreach effort has been further advanced by working in cooperation with a broad range of public and private entities. These include Arkansas Children's Hospital (they co-sponsored an ARKids First (ARKids B) newspaper insert with DHS), Arkansas Advocates for Children and Families, and several public schools, day care centers, hospitals, clinics, churches, and community centers. Arkansas Department of Human Services (DHS) county offices have widely distributed ARKids First application forms to these organizations. Arkansas Advocates for Children and Families has been particularly instrumental in providing outreach by successfully writing a foundation grant proposal to conduct targeted outreach efforts in key parts of the state.
A supply of ARKids First applications was given to the Arkansas Department of Health (ADH) for distribution in their WIC clinics and to give to pregnant women for whom they are establishing presumptive eligibility in the Pregnant Women, Infants and Children category of Medicaid (SOBRA). ADH will be a primary intake point for the separate child health insurance program.
Contracts
The State has a contract with Arkansas Advocates for Children and Families, the State's leading child advocacy agency, to provide a targeted outreach campaign for ARKids First (ARKids A and both the Title XIX and SCHIP components of ARKids B). This organization has an established statewide network of local community resources such as local Health Community Coalitions, volunteers, schools, and other organizations, which are in daily contact with the targeted population, to perform outreach. This contract targets working families and families who are less likely to have been exposed to the direct media campaign, and more likely to face barriers to health care access (e.g., employment restrictions, inadequate or no transportation, language and /or communication barriers). Examples of how the outreach system functions include the following:
[GREATER THAN] Training sessions with local coalitions made up of community health care centers, private health care providers, school district personnel, local businesses and Chambers of Commerce, and faith-based organizations.
[GREATER THAN] Setting up information tables/booths at school, city or county health fairs and other special events.
[GREATER THAN] Gathering information for local coalition members and program recipients about ways to eliminate real or perceived barriers to access.
The State also has a contract with the Arkansas Department of Health (ADH) to provide information to recipients/applicants through a media campaign and a 24 hour toll-free telephone Help Line Service. The Help Line Service responds to questions received from Medicaid and ARKids First (ARKids A and ARKids B) applicants/recipients and providers by telephone concerning eligibility, access, enrollment, rights and responsibilities and other issues. The ADH media campaign publicizes the telephone Help Line, promotes appropriate usage of the medical care system, and uses the most cost-effective strategies, as determined by ADH with DHS approval. The campaign may include television and radio advertising, direct mail, print media, telemarketing and other viable methods that target children.
Website
The ARKids First website address is www.arkidsfirst.com. The site has six subject links:
The Arkansas Medicaid website is located at www.medicaid.state.ar.us. This site contains a link to the ARKids First site.
[] Check here if the state elects to use funds provided under Title XXI only to provide expanded eligibility under the state's Medicaid plan, and continue on to Section 7.
(If checked, attach copy of the plan.)
Conception through birth: the State covers the same services that it covers in the Medicaid state plan for SOBRA pregnant women.
Birth through age 18: the coverage is the secretary approved benefit package for the ARKids B 1115 demonstration.
(Check all that apply. If an item is checked, describe the coverage with respect to the amount, duration and scope of services covered, as well as any exclusions or limitations) (Section 2110(a)) ( 42CFR 457.490 )
For the unborn child, the State covers pregnancy related services and services that if not treated could complicate the pregnancy, i.e., the State covers the same services that it covers for the Medicaid SOBRA pregnant women category. For the SCHIP Medicaid expansion child, birth through 18, the State covers the following:
Primary Care Physician (PCP) referral is required. Prior authorization is required on stays over 4 days, per admission; must meet medical necessity.
A PCP referral and medical necessity are required. Outpatient hospital benefits do not include take home drugs and supplies. (See prescription drugs, 6.2.6, and disposable medical supplies, 6.2.13)
Based on medical necessity. A PCP referral is required for a specialist, and for inpatient professional services.
PCP referral is required. Coverage is for medically necessary surgery as follows: office, inpatient hospital, outpatient hospital or ambulatory surgical center For some surgeries, the procedure must be performed on an outpatient basis unless the physician receives approval for inpatient surgical services.
A PCP referral and medical necessity are required. Clinic services are covered in Ambulatory Surgical Centers, Federally Qualified Health Centers and Rural Health Clinics.
Medical necessity and a prescription are required. There is no limit on the number of prescriptions per month. Family planning prescriptions are unlimited. Pharmacists must fill prescriptions with a generic drug unless the brand name is the only one available or the prescribing physician certifies that the brand name is medically necessary.
A selected list of over-the-counter medications is covered, with a prescription.
Medical necessity and a PCP referral are required.
Medical necessity is required. A PCP referral is not required. Family planning is limited as follows: one basic family planning visit, and three follow-up visits per state fiscal year (July 1 - June 30).
Medical necessity and PCP referral are required. Currently this service is covered only in an acute care hospital; it is not provided in an inpatient psychiatric category of service. There is no limit on the number of days. Substance abuse treatment will be included only when the primary diagnosis is mental health.
Arkansas does not have any Institutions for Mental Diseases.
Medical necessity and PCP referral are required.
Substance abuse treatment will be included when the primary diagnosis is mental health.
(such as prosthetic devices, implants, eyeglasses, hearing aids, dental devices, and adaptive devices) (Section 2110(a)(12))
Services must be medically necessary. Coverage includes prosthetic devices. A PCP referral and prescription are required. The DME limit is $500 per state fiscal year (July 1 - June 30).
Eyeglasses are covered separately - see "Other Services".
Must be medically necessary and a PCP prescription is required; limited to $125 per month. A benefit extension may be granted, if medically necessary.
2110(a)(14))
Medical necessity and a PCP referral are required. Nurse practitioners and certified nurse midwifes are covered.
Must be medically necessary and prior authorization is required. A PCP referral is not required.
Dental services are limited to: routine dental care; one initial oral exam, bite-wings, scalings and prophlaxis/fluoride treatment per state fiscal year (SFY July 1 - June 30); one dental screen per SFY (subsequent screen provided with medical necessity).
Oral surgery is covered under physician's services and is based upon medical necessity.
Inpatient substance abuse treatment services are combined with mental health services. See 6.2.10
Outpatient substance abuse treatment services are combined with mental health services. See 6.2.11.
Speech therapy must be medically necessary and a PCP referral is required. There is no limit on speech therapy, as long as it is medically necessary and there is a PCP referral.
Physical and Occupational therapy are NOT covered.
therapeutic, or rehabilitative services. (See instructions) (Section 2110(a)(24))
Medical necessity is required, however PCP referral is not required. Coverage is for ambulance only (emergency only).
(See instructions) (Section 2110(a)(27))
OTHER SERVICES (Birth through 18)
Chiropractor: Medical necessity and PCP are required. Covers only manipulation of the spine to correct a dislocation, and an X-ray, when necessary.
Emergency Department Services: Medical necessity is required. PCP referral is not required for an emergency, but is required for non-emergency services provided in an emergency department.
Eyeglasses: One pair every 12 months, if medically indicated. A PCP referral is not required.
Home Health: Ten visits per State Fiscal Year. Home Health services may be provided by a registered nurse or a licensed practical nurse, or a combination of the two.
Immunizations: ARKids B uses the schedule of immunizations approved by the Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP).
Podiatry: Medical necessity and a PCP referral are required.
Preventive Health Screenings: Preventive health screenings, which are performed at the intervals recommended by the American Academy of Pediatrics, are covered. The PCP must complete the screen or make a referral for the screen.
Vision: One routine eye exam (refraction) every 12 months.
EXCLUDED SERVICES (Birth through 18)
Audiological Services
Child Health Management Services
Developmental Day Treatment Clinic Services
Diapers, Underpads and Incontinence Supplies
Domiciliary Care
End Stage Renal Disease
Hearing Aids
Hospice
Hyperalimentation
Inpatient Psychiatric Services for Under Age 21
Non-emergency Transportation
Nursing Facilities
Occupational Therapy
Orthodontia
Orthotic Appliances
Personal Care
Physical Therapy
Private Duty Nursing Services
Prosthetic Devices
Rehabilitative Services for Persons with Physical Disabilities
Rehabilitative Therapy for Chemical Dependency
Targeted Case Management
Ventilator Services
Describe the coverage provided by the alternative delivery system The state may cross reference section 6.2.1 - 6.2.28.
(Section 2105(c)(2)(B)(i)) ( 42CFR 457.1005(b) )
2105(c)(2)(B)(ii)) ( 42CFR 457.1005(b) )
Describe the community based delivery system. (Section 2105(c)(2)(B)(iii)) ( 42CFR 457.1005(a) )
Check here if the state elects to use funds provided under Title XXI only to provide expanded eligibility under the state's Medicaid plan, and continue on to Section 8.
Will the state utilize any of the following tools to assure quality?
(Check all that apply and describe the activities for any categories utilized.)
The methods used to assure quality and appropriateness of care, are the same as under Title XIX.
The methods used to assure quality and appropriateness of care, are the same as under Title XIX.
The methods used to monitor and assure access to care, including well-care, are the same as under Title XIX.
The methods used to monitor and assure access to care, including emergency services, are the same as under Title XIX.
The methods used to monitor and treat enrollees "with chronic, complex, or serious medical conditions, including access to an adequate number of visits to specialists experienced in treating the specific medical condition", are the same as under Title XIX.
Decisions related to the prior authorization of health services are in accordance with Title XIX.
D Check here if the state elects to use funds provided under Title XXI only to provide expanded eligibility under the state's Medicaid plan, and continue on to Section 9
Cost sharing is required in the Medicaid expansion for children from birth through age 18. However, no cost sharing is required in the separate child health insurance program that covers the unborn child.
(Section 2103(e)(1)(A)) ( 42CFR 457.505(a), 457.510(b) &(c), 457.515(a)&(c))
Medicaid Expansion:
Many services require a small coinsurance or copayment. The amount is the same for all ARKids B enrollees (Medicaid and SCHIP Medicaid expansion). The coinsurance is 20% of the Medicaid allowed amount per item for Durable Medical Equipment; and 20% of the Medicaid amount for the first Medicaid inpatient day for hospitalization. The copayment is $10.00 per medical visit; and $5.00 per prescription (must use generic and rebate manufacturer, if available).
Well-health care services are exempt from cost sharing.
Separate Child Health Insurance Program (unborn child): There is no cost-sharing requirement.
Medicaid Expansion:
The cost sharing requirements for ARKids B (including the Medicaid expansion) are published on the ARKids B web site. The public is notified in advance via public notice when cost sharing requirements change.
State Child Health Insurance Program:
N/A. There are no cost-sharing requirements.
Cost-sharing applies only to the SCHIP Medicaid expansion children. These children are included in the ARKids B Medicaid 1115 demonstration, in which the secretary approved cost-sharing requirements apply to all eligibles.
There are no cost-sharing requirements for the State Child Health Insurance Program coverage of the unborn child.
The cost-sharing rules, which were approved by CMS for the ARKids B Medicaid 1115 demonstration, are applied to the Medicaid expansion.
The cost-sharing rules, which were approved by CMS for the ARKids B Medicaid 1115 demonstration, are applied to the Medicaid expansion.
N/A. Neither premiums nor deductibles are required. The only recipient cost-sharing is paid by the recipient to the provider at the point of service.
N/A. The State does not disenroll children for reasons related to cost-sharing.
[] State has established a process that gives enrollees reasonable notice of and an opportunity to pay past due premiums, copayments, coinsurance, deductibles or similar fees prior to disenrollment. ( 42CFR 457.570(a) )
The State does not disenroll recipients due to not meeting cost sharing requirements.
[] The disenrollment process affords the enrollee an opportunity to show that the enrollee's family income has declined prior to disenrollment for non payment of cost-sharing charges. ( 42CFR 457.570(b) )
The State does not disenroll recipients due to not meeting cost sharing requirements.
[] In the instance mentioned above, that the state will facilitate enrolling the child in Medicaid or adjust the child's cost-sharing category as appropriate. ( 42CFR 457.570(b) )
The State does not disenroll recipients due to not meeting cost sharing requirements.
[X] The state provides the enrollee with an opportunity for an impartial review to address disenrollment from the program. ( 42CFR 457.570(c) )
(Section 2105(d)(1)) ( 42CFR 457.622(b)(5) )
(except as described above). (Section 2105)(c)(7)(A)) ( 42CFR 457.475 )
Performance Goal for Objective I:
Effective upon implementation of the SCHIP state plan, the State will have in place:
Performance Goal for Objective II:
Mechanisms to conduct outreach have been developed and implemented, and are ongoing. The outreach does not specifically reference SCHIP since the SCHIP Medicaid expansion program is part of ARKids B and the separate child health insurance program to cover unborn children will be linked to the Medicaid SOBRA pregnant women category. However, the outreach is specifically geared toward families whose family income is at or below 200% of the federal poverty level. This, of course, includes the SCHIP population. Please reference section 5, above.
Performance Goal for Objective III:
As children are enrolled in the SCHIP component of ARKids B, their parents will be asked to select a primary care physician (PCP) of their choice. As pregnant women are enrolled in the state health insurance program for coverage of their unborn child, they will be asked to select a PCP. The Division of Medical Services' Primary Care Case Management Program, ConnectCare, offers over 1800 physicians statewide, who have caseload availability of approximately 1,000,000 patients. Access availability is five to one. ConnectCare will apply equally to the Title XIX and Title XXI children.
Performance Goal for Objective IV:
Upon implementation of the SCHIP state plan, the health status of the children in the SCHIP Medicaid expansion and in the separate state child health insurance program will be improved through increased access to the health care system and through having a health care home. Also the ConnectCare program provides information that promotes preventive health care.
(Section 2107(a)(4)(A),(B)) ( 42CFR 457.710(d) )
Measurement of Performance Goal for Objective I:
The State will monitor the data system to ensure that current cases were converted and new cases are assigned to the Title XXI and Title XIX components, as appropriate. Statistical and financial reports will be generated which will reflect cases and expenditures in each component of ARKids B and for the SCHIP unborn child group. The State will also monitor timeliness and quality of case processing.
Measurement of Performance Goal for Objective II:
Weekly, monthly and quarterly management reports will be used to measure enrollment in ARKids B (Titles XIX and XXI) and in the separate state child health insurance program.
Measurement of Performance Goal for Objective III:
Arkansas Medicaid's Primary Care Case Management Program, Connect Care, has in place an extensive quality evaluation plan (QEP) operated through the Arkansas Foundation for Medical Care, Inc. (AFMC), the state certified Quality Improvement Organization (QIO). The purpose of the QEP is to improve the quality of services to Medicaid and Title XXI recipients within the ConnectCare program resulting in an overall improvement of the recipient's health status. Arkansas will also measure performance through claims data and individual PCP performance measurements.
Measurement of Performance Goal for Objective V:
AFMC measures health status, including immunizations and well child visits, based on both claims data and Arkansas Department of Health statistics (Titles XIX and XXI). Arkansas will also measure performance in the Medicaid expansion through an ARKids B recipient satisfaction survey.
Check the applicable suggested performance measurements listed below that the state plans to use: (Section 2107(a)(4))
Medicaid.
Immunizations Well child care Adolescent well visits Satisfaction with care
Secretary at the times and in the standardized format that the Secretary requires.
(Section 2107(b)(1)) ( 42CFR 457.720 )
The State has an approved Section 1915(b) waiver for Primary Care Case Management (PCCM). The State is responsible for assessment and evaluation under the PCCM waiver and intends to use the same contract for the SCHIP Medicaid expansion and the separate state child health insurance program. The contractor evaluates data including number of office visits, continuity of care, and hospitalizations, etc.
The ARKids B work group and the Arkansas Advocates for Children and Families agency agreed that Arkansas should pursue funding appropriate ARKids B children through Title XXI. The separate state child health insurance program to cover unborn children is supported by the Arkansas Advocates for Children and Families, the Arkansas Department of Health and the Arkansas Center for Health Improvement.
Changes in Medicaid expansion and the separate state child health insurance program will be promulgated as required by the State's Administrative Procedures Act (APA). The APA requires that the agency publish a notice, regarding proposed rules, in a newspaper with statewide circulation. As a part of the APA process, DMS also notifies "interested persons" and appropriate Medicaid providers of proposed rules to solicit comments and input. The APA process requires the review of new and revised rules by the Administrative Rules and Regulations Subcommittee of the Arkansas Legislative Council.
There is no American Indian Nation, Tribe or reservation in Arkansas. However, we were able to locate a private-not-for-profit organization in Little Rock called the American Indian Center of Arkansas. They have agreed to cooperate with us in providing information to targeted low-income children who are Indians. We will provide them with ARKids First applications and pamphlets.
Amendments relating to eligibility or benefits, including cost sharing and enrollment procedures will be promulgated according to the State's Administrative Procedures Act. The Act requires a public notice in a statewide newspaper with a 30-day comment period.
* Planned use of funds, including --
- Projected amount to be spent on health services;
- Projected amount to be spent on administrative costs, such as outreach, child health initiatives, and evaluation; and
- Assumptions on which the budget is based, including cost per child and expected enrollment.
* Projected sources of non-Federal plan expenditures, including any requirements for cost-sharing by enrollees.
The source of the non-Federal share is State General Revenue.
SCHIP Budget Plan Template
|
Enhanced FMAP rate |
Federal Fiscal Year Costs |
|
82.31% 1 |
|
|
Insurance payments |
|
|
Managed care |
|
|
per member/per month rate @ # of eligibles |
$ 17,496.00 |
|
Fee for Service |
$ 3,259,854.72 |
|
Total Benefit Costs |
$ 3,277,350.72 2 |
|
(Offsetting beneficiary cost sharing payments) |
|
|
Net Benefit Costs |
|
|
Outreach |
$ 49,100.00 |
|
Reporting |
$ 49,100.00 |
|
Quality Assurance |
$ 25,000.00 |
|
Assessment |
$ 28,300.00 |
|
Eligibility |
$ 176,235.08 |
|
Other |
|
|
Total Administration Costs |
$ 327,735.08 |
|
10% Administrative Cost Ceiling |
$ 360,508.58 |
|
Federal Share (multiplied by SCHIP-FMAP rate) |
$ 2,967,556.42 |
|
State Share |
$ 637,529.38 |
|
$ 3,605,085.802 |
See Attachments I and J for supporting documentation.
1This is a weighted percentage (i.e., 3 months at 82.27% and 9 months at 82.32%).
2These program estimates are only for the coverage of unborn children.
[] Check here if the state elects to use funds provided under Title XXI only to provide expanded eligibility under the states Medicaid plan, and continue to Section 12
Security Act will apply under Title XXI, to the same extent they apply to a state under Title XIX : (Section 2107(e)) ( 42CFR 457.935(b) ) The items below were moved from section 9.8. (Previously items 9.8.6. - 9.8.9)
[]Check here if the state elects to use funds provided under Title XXI only to provide expanded eligibility under the state's Medicaid plan(Sections 2101(a))
Eligibility and Enrollment Matters
The review process for eligibility and enrollment matters is the same as the Medicaid Fair Hearing process.
Health Services Matters
The review process for health service matters is the same as the Medicaid Fair Hearing process.
Premium Assistance Programs
N/A
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.