The Division of Medical Services is the administrative arm of Arkansas Medicaid, overseeing provider enrollment, billing, pharmacy, beneficiary support, and fee-for-service and managed care programs funded by Medicaid. Arkansas Medicaid, which is jointly funded and operated by DHS and the Centers for Medicare and Medicaid Services (CMS), provides medically necessary health care services for eligible Arkansans from birth through end-of-life.
The Division is divided into four units:
- Plan Partnerships oversees contract and managed care programs, including the Provider-Led Arkansas Shared Savings Entity (PASSE) for Medicaid clients with complex behavioral health, developmental, or intellectual disabilities, Non-Emergency Transportation services, the dental managed care program called Health Smiles, and the Arkansas Independent Assessment system that is used to perform a functional-needs assessment to assist in the development of an individual’s Person-Centered Service Plan (PCSP), personal care services plan.
- Fee for Service oversees provider enrollment, prior authorizations and utilization review, the Electronic Visit Verification system, rate reviews, the voluntary performance-based incentive program known as Patient-Centered Medical Home (PCMH), Primary Care Case Management (PCCM) program in which physicians agree to monitor the care of their Medicaid clients, and the policy analysis unit, which plans develops, and implements policy changes within Medicaid.
- Administration & Operations oversees contracts, reporting, and technology systems and works with the DHS shared services offices, including Human resources and Finance. The goal of Administration & Operations is to facilitate the smooth and efficient operation of those other areas and the programs they administer.
- Pharmacy serves Arkansas Medicaid clients needing prescription services from Medicaid-enrolled providers, both enrolled prescribers and enrolled pharmacies. Pharmacy develops clinical drug criteria, and is staffed by clinical pharmacists who review cases needing prior authorization. The Pharmacy Vendor for the Arkansas Medicaid Pharmacy Department helps develop clinical criteria, rebate invoicing and collection, and has clinical pharmacy staff to review cases needing prior authorization.
DMS oversees several programs, including: