Arkansas DHS and Medicaid present multiple rule changes on long-term care, pharmacy scope and mental‑health services

Mark White and Mary Franklin of the Department of Human Services summarized several rule changes affecting long-term services and Medicaid policy.

Mary Franklin said the Miller income trust rules will be revised so a client’s income is "no longer required to be transferred except to the extent that is needed to be transferred, to make the client income eligible." She added that the rules will allow court-ordered child and spousal support payments to be deducted from patient liability and that property transferred by beneficiary deed will no longer be subject to estate recovery as part of implementation of the cited Act.

Elizabeth Pittman, Director for the Division of Medical Services, presented five Medicaid rules and said the first implements Act 444 (the Non‑Emergency Medical Transportation Act). "The first rule we have for you today ... is to comply with Act 444. This is the Non Emergency Medical Transportation Act," she said, noting the item is pending CMS review as a State Plan Amendment where required. Pittman also described a rule expanding pharmacists’ scope to allow pharmacists to prescribe for oral contraceptives and common illnesses like flu and strep in certain circumstances.

Pittman outlined implementation of Act 886 to extend Tier 1 mental‑health counseling from 3 visits without a physician referral to 10 visits; she said the change was implemented retroactively to June 28, 2021, and mass adjustments to claims are underway. She also explained a lab and x‑ray rule (Act 891) creating separate $500 limits for laboratory services and for x‑ray services while excluding U.S. Preventive Services Task Force A and B recommendations (for example, mammograms and colorectal screening) from those limits.

On PANS/PANDAS, Pittman said the rule authorizes payment for treatment approved by the Centers for Excellence at UAMS, including off‑label IVIG where appropriate, and that CMS indicated the state plan need not be amended to implement the coverage; however, the statutory referral requirement to the Center for Excellence remains.

Martina Smith, director for the Division of Provider Services and Quality Assurance, presented rule updates driven by several 2021 Acts affecting behavioral health agency co‑location definitions, registry checks for in‑home caregivers, fee waivers for trainees who receive specified benefits, expanded staffing and ownership reporting for nursing homes and assisted living facilities, and a narrowed definition of long‑term care for services fewer than 4 hours twice a week. Each rule was presented and, without objection from the committee, "stood as reviewed."

White also provided an update on Medicaid provider rate reviews: the department has conducted multiple rounds over three years, plans to finish the current phase by year-end, and intends to review every provider at least once every four years. He said most rate changes that require CMS approval have not encountered problems, though rate adjustments tied to waivers (for example assisted‑living or DD services) involve additional federal oversight.

Committee members asked for fiscal impact information and death‑rate numbers in separate exchanges; DHS confirmed estimates had been built into the recent budget and offered to provide more granular mortality figures and program representatives for future meetings.