To ensure stakeholders have adequate public notice about upcoming changes in the Arkansas Medicaid program related to the unwinding of the public health emergency, below you will find a list of Disaster State Plan Amendments (DSPAs), Appendix Ks flexibilities for home and community-based services, and other flexibilities DHS received federal approval to implement during the public health emergency along with the date those flexibilities are expiring. The federal COVID-19 Public Health Emergency ends May 11, 2023, but Arkansas Medicaid is allowed and/or required to continue some flexibilities beyond that date.
Links to all Disaster SPAs, Appendix Ks and 1135s for Arkansas and other states can be found on the Center for Medicare and Medicaid Services’ (CMS) website. In addition to granting states flexibility upon review and request, CMS also issued a “blanket waiver” of certain Medicaid requirements, which will expired at the end of the public health emergency and can be found on CMS’s website.
Expiring 5/11/2023:
| DSPA Number | Detail |
| 20-0015 | Authorized Payment. COVID-19 diagnostic testing, a laboratory service, will be paid at $35.92 when CDC provided or $51.33 when not CDC provided. *This DSPA is being incorporated into AR 23-0005 (see below) as required by the American Rescue Plan Act, and this coverage will continue as is through September 30, 2024. |
| 20-0024 | In cases where vaccine administration is separately reimbursable at a fee amount, Arkansas will follow Medicare’s reimbursement guidance for the COVID-19 vaccine. All rates related to COVID-19 testing are posted on https://humanservices.arkansas.gov/covid-19/dhs-response-to-covid-19/updates-for-providers/ *This DSPA is being incorporated into a AR 23-0005 (see below) as required by the American Rescue Plan Act, and this coverage will continue as is through September 30, 2024. |
| 22-0011 | The state is requesting to waive any signature requirements for the dispensing of drugs during the Public Health Emergency. |
| 22-0016 | Incorporates use of Desk Reviews to help determine PASSE (BH and DD) tier level assignment for clients until the end of the COVID-19 PHE. An interview will be conducted for initial assessments, with the option of using telemedicine for re-assessments. *Temporarily extend telemedicine ONLY to 12/31/2023. |
| 20-0015 | For all Medicaid eligibility groups, deductibles, cost sharing, copayments, and coinsurance are waived for any services associated with the diagnosis or treatment of COVID-19. The state waives cost-sharing for testing services (including in vitro diagnostic products), testing-related services, and treatments for COVID-19, including vaccines, specialized equipment and therapies, for any quarter in which the temporary increased FMAP is claimed. *This DSPA is being incorporated into a AR 23-0005 (see below) as required by the American Rescue Plan Act, and this coverage will continue as is through September 30, 2024. |
| 20-0015 | Exempt physician visits, outpatient hospital visits, rural health clinic visits, and federally qualified health center visits from the twelve visit per year limit when the visit is associated with the diagnosis or treatment of COVID-19. *This DSPA is being incorporated into a AR 23-0005 (see below) as required by the American Rescue Plan Act, and this coverage will continue as is through September 30, 2024. |
Expiring 5/11/2023:
| Flexibility #1135 Waivers | Detail |
| 1.2 | Modify the timeframe for managed care entities to resolve appeals before an enrollee may request a state fair hearing to no less than one day. This allows managed care enrollees to almost immediately to proceed to a state fair hearing. Also, modify the timeframe for managed care enrollees to exercise their appeal rights so that any managed care enrollee for whom the 120-day deadline would have occurred between March 1, 2020, and the end of the PHE can get an additional 120 days to request a fair hearing |
| 1.3 | Temporarily enroll providers who are enrolled with another SMA or Medicare for the duration of the public health emergency (assuming outlined CMS requirements are met). |
| 1.4 | Reimburse out-of-state providers for multiple instances of care to multiple participants, so long as the criteria below are met: 1. The item or service is furnished by an institutional provider, individual practitioner, or pharmacy at an out-of-state/territory practice location– i.e., located outside the geographical boundaries of the reimbursing state/territory’s Medicaid plan, 2. The National Provider Identifier (NPI) of the furnishing provider is represented on the claim, 3. The furnishing provider is enrolled and in an “approved” status in Medicare or in another state/territory’s Medicaid plan, and 4. The claim represents services furnished. |
| 2.2 | Temporarily waive requirement to obtain beneficiary and provider signatures on HCBS PCSP. |
| 4.1 | Modify the deadline for conducting initial evaluations of eligibility and initial assessments of need to establish a care plan AND modify the deadline for annual redetermination of eligibility required for the 1915i state plan benefit and annual reassessment of need required for up to one year. |
| 4.4 | Not comply with the HCBS settings requirement at 42 CFR 441.301(c)(4)(vi (D) that individuals are able to have visitors of their choosing at any time, for settings added after March 17, 2014, to minimize the spread of infection during the COVID-19 pandemic. |
Expiring 5/15/2023:
| DPSA# | Description |
| 20-2019 | Licensed pharmacists with CLIA waiver certification on file will be allowed to provide diagnostic testing for COVID-19 within state scope of practice and associated rates. *This DPSA is being incorporated into AR 23-0005 (see below) as required by the American Rescue Plan Act, and this coverage will continue as is through September 30, 2024. |
| 21-0017 | Licensed Practical Nurses practicing within their scope of licensure under the other licensed practitioners section of the Medicaid state plan will administer COVID-19 vaccines to individuals who have difficulty leaving their homes or face challenges getting vaccinated. *The other section of this DSPA ended in January 2023. |
Expiring 11/11/2023:
| Appendix K # | Detail |
| AR.0188.R05.05 AR.0188.R06.02 CES Waiver | Not disenroll any Waiver participants from the CES Waiver until the end of the month of the quarter that the public health emergency declaration ends, not to exceed the end date of the Appendix K authority. |
| AR.0188.R05.05 AR.0188.R06.02 CES Waiver AR.0195.R05.03 AR.0195.R06.03 AR Choices AR.0400.R03.04 AR.0400.R04.05 Living Choices | The timeframes for the submission of the CMS 372s and the evidentiary package(s) will be extended as needed pursuant to the emergency. In addition, the state may suspend the collection of data for performance measures other than those identified for the Health and Welfare assurance and notes that as a result the data will be unavailable for this time frame in ensuing reports due to the circumstances of the pandemic. |
| AR.0188.R05.05 AR.0188.R06.02 CES Waiver AR.0195.R05.03 AR.0195.R06.03 AR Choices AR.0400.R03.04 AR.0400.R04.05 Living Choices | Allow an extension for reassessments and reevaluations for up to one year past the due date. |
| AR.0188.R05.05 AR.0188.R06.02 CES Waiver AR.0195.R05.03 AR.0195.R06.03 AR Choices AR.0400.R03.04 AR.0400.R04.05 Living Choices | Allow the option to conduct evaluations, assessments, and person-centered service planning meetings virtually/remotely in lieu of face-to-face meetings. |
| AR.0188.R05.05 AR.0188.R06.02 CES Waiver AR.0195.R05.03 AR.0195.R06.03 AR Choices AR.0400.R03.04 AR.0400.R04.05 Living Choices | Add an electronic method of signing off on required documents such as the person-centered service plan. |
| AR.0195.R05.03 AR.0195.R06.03 AR Choices AR.0400.R03.04 AR.0400.R04.05 Living Choices | For both Waivers (04.00R03 and 0195.R05), allow for the level of care evaluation or reevaluation to occur via telehealth (telemedicine) technology that has a video component, where appropriate and needed to ensure the beneficiary can remain on the applicable waiver. Technology used must be HIPAA compliant. |
| AR.0195.R05.03 AR.0195.R06.03 ARChoices AR.0400.R03.04 AR.0400.R04.05 Living Choices | Not comply with the HCBS settings requirement at 42 CFR 441.301(c)(4)(vi (D) that individuals are able to have visitors of their choosing at any time, for settings added after March 17, 2014, to minimize the spread of infection during the COVID-19 pandemic. |
| AR.0195.R05.03 AR.0195.R06.03 AR Choices AR.0400.R03.04 AR.0400.R04.05 Living Choices | Add an electronic method of service delivery (e.g., telephonic) allowing services to continue to be provided remotely in the home setting for: Monthly monitoring (i.e., to meet the reasonable indication of need for services requirement in 1915(c) waivers). |
| AR.0195.R05.03 AR.0195.R06.03 AR Choices AR.0400.R03.04 AR.0400.R04.05 Living Choices | Adjust prior approval/authorization elements approved in waiver. |
| AR 0195.R06.01 AR.0195.R06.03 ARChoices AR0400.R04.01 AR.0400.R04.05 Living Choices AR.0936.R01.05 AR.0936.R01.06 Autism Waiver | As outlined in Arkansas’ HCBS Spending Plan, the Workforce Stabilization Incentive Program allow providers to customize resources that best fit their organization’s size, operational needs, and business priorities. The money can be used for Hiring Bonuses, Longevity Bonuses, and Complex Care Longevity Bonuses. Workforce Stabilization Incentive Payments will be made as one-time payments to providers for them to utilize during the period of October 1, 2021, through March 31, 2024. The state will amend the base waivers to include Workforce Stabilization Incentive payments prior to the expiration of the Appendix K. |
| AR.0400.R04.04 Ar.0400.R04.05 Living Choices | We are increasing the rate for the Assisted Living Facilities in the Living Choices waiver from the current rate of $67.25 per person per day to $81.59 per person per day, with an additional 5% differential for rural facilities, which totals $85.67. The interim rate will be in effect for dates of service beginning January 1, 2022 to the end of the Appendix K. |
| AR.0936.R01.03 AR.0936.R01.06 Autism Waiver | Add an electronic method of service delivery (e.g., telephonic) allowing services to continue to be provided remotely in the home setting for: 2024 U3 Individual Assessment/Treatment Plan/ Development/ Monitoring |
Extension Request to 3/31/2024:
| DSPA Number | Detail |
| 22-0009 | These Workforce Stabilization Incentive Plan allows certain HCBS providers to expend funds to direct service workers in order to recruit and retain staff. Funds can only be used between October 1, 2021 and March 31, 2024. -Hiring Bonus -Longevity Bonus -Complex Care Longevity Bonus |
In addition to the DPSAs that are expiring, DHS also has requested and is awaiting federal approval to temporarily extend the following DSPAs
Extension Request to 12/31/23:
| SPA Number | Detail | End date requested |
| 22-0015 | A rate analysis of facility-based adult behavioral health services was conducted in the fall of 2021, and it was determined at that time that the current therapeutic communities’ rates were not sufficient to reimburse providers for the cost of providing the service. To establish a sufficient rate, the State looked at a similar service, inpatient services at the Arkansas State Hospital, and adjusted for differences in clinical intensity, staffing ratios, educational requirements, and service frequency. Rates were set as a percentage of Arkansas State Hospital Rates, as follows: -Therapeutic Community, Level 1: 70% of the ASH Rate -Therapeutic Community, Level 2: 50% of the ASH Rate •Effective October 1 through the end of the PHE therapeutic Community rates are: Therapeutic Community, Level 1: $500.00 per day Therapeutic Community, Level 2: $358.00 per day | 12/31/2023 |
| 22-0016 | Incorporates use of Desk Reviews to help determine PASSE (BH and DD) tier level assignment for clients until the end of the COVID-19 PHE. an interview will be conducted for initial assessments, with the option of using telemedicine for re-assessments. | 12/31/2023 (Telemedicine only; desk reviews will end May 11, 2023) |
| 22-0025 | The agency increases payment rates for the following services: •Individual Behavioral Health Counseling -30 minutes increases from $46.38 to $59.22 -45 minutes increases from $69.57 to $78.18 -60 minutes increases from $92.76 to $115.10 •Marital/Family Behavioral Health Counseling with Client Present -50 minutes increases from $77.28 to $78.58 •Mental Health Diagnosis increases from $114.43 to $137.38 Payment increases are targeted based on the following criteria The rates will be set at eighty (80) percent of the 2022 Medicare non-rural rate for the State of Arkansas. Rate increases have an effective date of October 1, 2022. | 12/31/2023 |
New Federal Vehicle Requested:
| SPA Number……. | Detail | End date requested |
| AR 23-0004 AR 23-0013 | This request allows physicians to administer a brief standardized emotional/behavioral screening to Medicaid clients with an office visit due to an increased prevalence of high stress and other extenuating factors occurring during the culmination of the COVID-19 Public Health Emergency. DSPA filed with required end date of May 11, 2023; extension DSPA immediately filed to extend end date to 12/31/23. | 12/31/23 |
| AR-23-0006 | This requests outlines that the Arkansas Children’s Health Insurance Program (CHIP) state plan is requested to demonstrate compliance with the American Rescue Plan Act provisions that require states to cover treatment (including treatment of a condition that may seriously complicate COVID-19 treatment), testing, and vaccinations for COVID-19 without cost sharing in CHIP. The effective date for this amendment was March 11, 2021. The state requested a waiver under Section 1135 of the Social Security Act to submit a CHIP state plan amendment (SPA) that took effect in a prior state fiscal year. | 9/30/24 |
| AR-23-0005 | This request continues coverage of COVID-19 testing, vaccination and treatment as they were written in our DSPAs. This is required by the American Rescue Plan Act Section 9811. | 9/30/24 |
Previously announced changes to Medicaid ending effective Dec. 31, 2022:
- Rescissions to the Arkansas’s Disaster Relief Policies for the COVID-19 National Emergency found in
- AR Choices in Homecare and Living Choices Appendix K
- Request for rescission of Section 1135 Waiver Flexibilities Related to Novel Coronavirus Disease (COVID-19) National Emergency/Public Health Emergency
COVID-19 Response Manuals
- Division of Aging, Adult and Behavioral Health Services (DAABHS) COVID-19 Response Manual
- Division of County Operations (DCO) COVID-19 Response Manual
- Division of Developmental Disabilities Services (DDS) COVID-19 Response Manual
- Department of Human Services (DHS) Telemedicine COVID-19 Response Manual
- Division of Medical Services (DMS) COVID-19 Response Manual
- Division of Provider Services & Quality Assurance (DPSQA) COVID-19 Response Manual
