Arkansas AR

Arkansas Medicaid expresses PA through versioned Microsoft Word (.doc) PROVIDER MANUALS hosted under humanservices.arkansas.gov/wp-content/uploads/, split per provider type into Section I (all-provider general rules, incl. 110.300 Utilization Review and 230.000 Prior Authorization process), Section II (provider-type-specific coverage + PA criteria, e.g. Physician 260-264, with 262 = procedure codes requiring PA, 263 drug PA, 264 appeals), and Section III. Authority is DHS Division of Medical Services (DMS) Utilization Review (UR) Section, which performs PA in-house for a defined service list (private duty nursing, hearing aids, medical supplies, etc.) AND monitors contractors for inpatient psych, hospitalization, therapy, DME, OBHS, transplants. AFMC (Arkansas Foundation for Medical Care, review.afmc.org) is the QIO/PA-review contractor. PASSEs administer BH+LTSS PA for intensive BH/IDD members; pharmacy PA is state-administered (Magellan FFS). The legacy fiscal-agent portal medicaid.mmis.arkansas.gov is RETIRED (redirects to the DHS site). NOTE: DHS page routes (/medical-services/...) hard-403 (nginx) to automated browsers, but the /wp-content/uploads/*.doc files themselves are NOT bot-walled and download cleanly with a real UA. Criteria are SECTIONS inside large per-provider-type Word docs, organized by provider type.

Current + prior fiscal agents. Tracks ACS-Inc → Conduent/Gainwell transitions so we know when *.acs-inc / *.conduent / *.xerox subdomains die.

Last award: None. Next due: 2026 (PASSE Agreement). Contracts extended through: 2026 (PASSE Agreement).

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## 1. How AR requires PA Arkansas Medicaid's prior authorization (PA) requirements are primarily expressed through versioned Microsoft Word (.doc) PROVIDER MANUALS hosted under `humanservices.arkansas.gov`. These manuals are segmented by provider type and consist of three main sections: Section I, which contains general rules applicable to all providers (including 110.300 Utilization Review and 230.000 Prior Authorization process); Section II, which details specific PA criteria for services; and Section III, which includes utilization review (UR) processes. For example, the AR Medicaid Prior-authorization for Autism Services manual requires documentation of diagnosis but does not apply step therapy. Specific CPT codes such as 97140 and 97152 may be covered under PA. The ARChoices (Section 105.110) manual also mandates prior authorization for services, with medical necessity criteria including clinical indication and appropriateness of service. However, some manuals lack detailed PA information. For instance, the HOSPITAL_II.doc document does not provide specific PA criteria or thresholds for hospital or critical access hospital (CAH) services, including end-stage renal disease (ESRD). Similarly, the RURLHLTH_II.doc and PHYSICN_II.doc documents do not specify PA requirements for Rural Health Clinic services and physician services, respectively. ## 2. How AR publishes and reports PA Arkansas Medicaid publishes its provider manuals on the `humanservices.arkansas.gov` website under the wp-content/uploads/ directory. These manuals are segmented by provider type (e.g., autism services, hospital services) and include versioned documents that reflect updates to PA policies and procedures. The state does not provide a centralized portal for prior authorization as of the findings provided, indicating a partial implementation status. This suggests that providers may need to refer to specific manual sections or contact relevant agencies directly for PA requirements. Reporting on PA processes is likely embedded within these manuals and any associated forms (e.g., DMS-679.doc for medical equipment). However, there is no explicit mention of a centralized reporting system or dashboard for tracking PA requests and approvals. ## 3. AR's CMS-0057-F and PA-reform compliance posture The findings do not specify Arkansas' compliance status with the CMS-0057-F form, which is used to report on prior authorization (PA) policies and procedures. The state's 1115 waiver, known as ARHOME (Arkansas Health and Opportunity for Me), indicates a carve-out structure where certain services are managed through specific programs or contractors. Given the fragmented nature of PA documentation across different provider manuals, it is unclear how Arkansas aligns with CMS-0057-F requirements. The state's fiscal agent history shows transitions from ACS-Inc to Conduent/Gainwell, which may impact reporting and compliance efforts. However, there is no explicit mention of ARHOME or other 1115 waiver programs in the PA documentation provided. ## 4. How AR runs its own program Arkansas Medicaid's prior authorization system is primarily managed through provider manuals that detail specific requirements for different service types. The state has a split LTSS (Long-Term Services and Supports) carve-out, indicating that certain long-term services are managed separately from the main Medicaid program. The pharmacy carve-out in Arkansas is described as hybrid, suggesting a combination of in-house management and third-party oversight for prescription drug coverage. Behavioral health (BH) services have a carve-out to Passe for high-need cases only, indicating that some BH services may be subject to different PA processes or thresholds compared to other service types. The state's MCO (Managed Care Organization) procurement cycle is set to occur annually, with the next award due in 2026 under the PASSE Agreement. This agreement also extends current contracts through 2026, ensuring continuity of care and coverage during the transition period. ## 5. Patterns, what's notable, and what's missing/uncertain ### Notable Patterns: - **Provider-Specific Manuals:** Arkansas Medicaid uses segmented provider manuals to detail PA requirements, which allows for tailored policies based on service type. - **Hybrid Carve-Outs:** The pharmacy carve-out is described as hybrid, indicating a balanced approach between in-house and third-party management. - **Behavioral Health Focus:** BH services have a specific carve-out for high-need cases, suggesting targeted oversight for these services. ### What's Missing/Uncertain: - **Centralized PA Portal:** The findings indicate a partial implementation of a centralized portal, but it is unclear what functionalities are available or how providers access this system. - **Gold Card Law:** There is no information provided about a Gold Card law in the source documents. - **WISeR:** Not applicable to Arkansas. WISeR = CMS "Wasteful and Inappropriate Service Reduction," a Medicare prior-authorization model running in only six states (AZ, NJ, OH, OK, TX, WA); the placeholder finding is not a signal. - **CMS-0057-F Compliance:** The state's compliance with CMS-0057-F requirements is not specified, making it difficult to assess alignment with federal guidelines. - **Foster Care Program Details:** The status of the foster-care MCO program is unspecified, leaving gaps in understanding how PA processes are managed for this population. - **Detailed PA Criteria:** Some manuals lack specific PA criteria or thresholds, such as those for hospital services and rural health clinics, which could lead to inconsistencies in provider interpretation and application. In summary, while Arkansas Medicaid has a structured approach to prior authorization through segmented provider manuals, there are several areas where additional information is needed to fully understand the state's PA system and its compliance with federal requirements.