016.06.21 Ark. Code R. § 008 - State Plan Amendment 2021-0003 - Medication Assisted Treatment
1905(a)(29) Medication-Assisted Treatment (MAT)
ATTACHMENT 3.1-A identifies the medical and remedial services provided to the categorically needy.
MAT is covered under the Medicaid state plan for all Medicaid clients who meet the medical necessity criteria for receipt of the service for the period beginning October 1, 2020 and ending September 30, 2025.
The state covers the following counseling services and behavioral health therapies as part of MAT.
MAT is covered exclusively under section 1905(a)(29) for the period of 10/01/2020 through 9/30/2025.
Services available:
Physicians and Nurse Practitioners must be Arkansas Licensed and possess a current and valid X-DEA number from Substance Abuse and Mental Health Services Administration (SAMHSA).
Physician Assistants must have a legal agreement to practice under an Arkansas Licensed Physician per Arkansas statute and possess a current and valid X-DEA number from SAMHSA.
Licensed Psychologists (LP), Licensed Psychological Examiners - Independent (LPEI), Licensed Professional Counselors (LPC), Licensed Certified Social Workers (LCSW), and Licensed Marital and Family Therapists (LMFT) must possess a current and valid Arkansas license.
__X___ The state has drug utilization controls in place. (Check each of the following that apply)
_______ Generic first policy
___X__ Preferred drug lists
_______ Clinical criteria
___X__ Quantity limits
_______ The state does not have drug utilization controls in place.
Describe the state's limitations on amount, duration, and scope of MAT drugs, biologicals, and counseling and behavioral therapies related to MAT.
MAT drugs and biologicals are limited based on the FDA indication and manufacturers' prescribing guidelines. Some oral medications are also subject to status on the Preferred Drug List.
As of 1/1/2020 the preferred oral agents for MAT therapy no longer require a Prior Authorization.
The Arkansas Medicaid Pharmacy program removed the prior authorization for preferred Buprenorphine products on 1/1/2020, due to Arkansas State Law from Act 964 which prohibits a prior authorization for Medication Assisted Treatment of Opioid Use Disorder. The removal of prior authorization was for MAT treatment according to SAMHSA guidelines. In addition, on 1/22/2021, per section 505 of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 355 ), for all biological products licensed under section 351 of the Public Health Service Act ( 42 U.S.C. 262 ) to be covered, Arkansas instructed the pharmacy vendor to bypass the non-rebateparticipation, repackaged indicator, inner indicator, and prioritize coverage of all the pharmacy MAT products.
PRA Disclosure Statement - This information is being
collected to assist the Centers for Medicare & Medicaid Services in
implementing section 1006(b) of the SUPPORT for Patients and Communities Act (
P.L.
ATTACHMENT 3.1-B identifies the medical and remedial services provided to the medically needy.
MAT is covered under the Medicaid state plan for all Medicaid clients who meet the medical necessity criteria for receipt of the service for the period beginning October1, 2020, and ending September 30, 2025.
The state covers the following counseling services and behavioral health therapies as part of MAT.
MAT is covered exclusively under section 1905(a)(29) for the period of 10/01/2020 through 9/30/2025.
Services available:
Physicians and Nurse Practitioners must be Arkansas Licensed and possess a current and valid X-DEA number from Substance Abuse and Mental Health Administration (SAMHSA).
Physician Assistants must have a legal agreement to practice under an Arkansas Licensed Physician per Arkansas statute and possess a current and valid X-DEA number from SAMHSA.
Licensed Psychologists (LP), Licensed Psychological Examiners - Independent (LPEI), Licensed Professional Counselors (LPC), Licensed Certified Social Workers (LCSW), and Licensed Marital and Family Therapists (LMFT) must possess a current and valid Arkansas license.
__X___ The state has drug utilization controls in place. (Check each of the following that apply)
_______ Generic first policy
___X__ Preferred drug lists
_______ Clinical criteria
___X__ Quantity limits
_______ The state does not have drug utilization controls in place.
Describe the state's limitations on amount, duration, and scope of MAT drugs, biologicals, and counseling and behavioral therapies related to MAT.
MAT drugs and biologicals are limited based on the FDA indication and manufacturers' prescribing guidelines. Some oral medications are also subject to status on the Preferred Drug List.
As of 1/1/2020 the preferred oral agents for MAT therapy no longer require a PA.
The Arkansas Medicaid Pharmacy program removed the prior authorization for preferred Buprenorphine products on 1/1/2020, due to Arkansas State Law from Act 964 which prohibits a prior authorization for Medication Assisted Treatment of Opioid Use Disorder. The removal of prior authorization was for MAT treatment according to SAMHSA guidelines. In addition, on 1/22/2021, per section 505 of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 355 ), for all biological products licensed under section 351 of the Public Health Service Act ( 42 U.S.C. 262 ) to be covered, Arkansas instructed the pharmacy vendor to bypass the non-rebateparticipation, repackaged indicator, inner indicator, and prioritize coverage of all the pharmacy MAT products.
PRA Disclosure Statement - This information is being
collected to assist the Centers for Medicare & Medicaid Services in
implementing section 1006(b) of the SUPPORT for Patients and Communities Act (
P.L.
30. 1905(a)(29) Medication-Assisted Treatment (MAT)
Effective for dates of service on or after October 1, 2020 through September 30, 2025, reimbursement is based on the rate methodology used for individual MAT services provided within other sections of the Medicaid State Plan, Attachment 4.19-B:
* Pages 1aaa through 1aaaa:
* Rural Health Clinic Services and other ambulatory services that are covered under the plan and furnished by a rural health clinic
* Pages 1b through 1bbbb:
* Federally Qualified Health Center (FQHC) services and other ambulatory services that are covered under the plan and furnished by an FQHC in accordance with section 4231 of the State Medicaid Manual (HCFA-Pub-45-4) (continued)
* Pages 1c through 1ccc:
* Laboratory and X-ray Services and Other Tests
* Page 2, 2.1, 2c:
* Physician's Services
* Pages 4 through 4aaa:
* Reimbursement for unbundled prescribed drugs and biologicals used to treat opioid use disorder (OUD) will be reimbursed using the same methodology as described for prescribed drugs as referenced in Attachment 4.19-B, Pages 4-4aaa, Section 12.a. for both dispensed and administered prescribed drugs.
* Page 5aa:
* Outpatient Behavioral Health Services (Other diagnostic, screening, preventative and rehabilitative services)
* Page 14:
* Advance Practice Nurse and Registered Nurse Practitioner licensed as such by the Arkansas State Board of Nursing
Except as otherwise noted in the plan, state-developed fee schedule rates are the same for both governmental and private providers of Outpatient Behavioral Health Provider Agencies authorized to dispense unbundled prescribed drugs and biologicals used to treat opioid use disorder (OUD). The agency's fee schedule rate was set as of 5/27/2021 and is effective for services provided on or after that date. All rates are published on the agency's website: Fee Schedules - Arkansas Department of Human Services
Notes
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