016.06.05 Ark. Code R. 043 - Developmental Rehabilitation Services Update Transmittal #14

Section II Developmental Rehabilitation Services

201.000 Arkansas Medicaid Participation Requirements for Developmental Rehabilitation Services

Providers of developmental rehabilitation services must meet the following requirements to be eligible to participate in the Arkansas Medicaid Program:

A. Providers must be certified as First Connections Program participants by the Arkansas Division of Developmental Disabilities Services (DDS) to provide early intervention services.

B. A provider must complete and submit to the Medicaid Provider Enrollment Unit a provider application (form DMS-652), a Medicaid contract (form DMS-653) and a Request for Taxpayer Identification Number and Certification (Form W-9). View or print a provider application (form DMS-652), a Medicaid contract (form DMS-653) and a Request for Taxpayer Identification Number and Certification (Form W-9).

C. Verification of current certification from DDS must accompany the provider application and the Medicaid contract.

The Arkansas Department of Health and Human Services must approve the provider application and the Medicaid contract as a condition of participation in the Medicaid program.

D. Subsequent certifications must be forwarded to the Medicaid Provider Enrollment Unit within 30 days of issuance. If the renewal document(s) have not been received within this timeframe, the provider will have an additional and final 30 days to comply.

E. Failure to timely submit verification of certification renewals will result in termination of enrollment in the Arkansas Medicaid Program.

Notes

016.06.05 Ark. Code R. 043

8/5/2005