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The Provider-led Arkansas Shared Savings Entity (PASSE) is a new model of organized care that will address the needs of certain Medicaid beneficiaries who have complex behavioral health and intellectual and developmental disabilities service
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Timely Information from Arkansas Medicaid
EIDT and ADDT Claims
Below are changes to EIDT and ADDT billing for claims. These changes are effective for claims with dates of service on or after January 1st, 2020.
- All EIDT and ADDT services will require place of service 49 (Independent Clinic). In addition to the place of service, the day habilitation unit rate (one unit equals one hour) also increased by 11% for services on or after 01/01/2020.
- The fee schedules and reimbursement rules will be changing for all nursing EIDT and ADDT services (T1002 and T1003). For EIDT providers, all nursing services are limited to 12 units per date of service, but does allow for extension of benefits.
- The following services can now be provided by EIDT providers: 96112 with U6 and UC modifiers, 96113 with U6 and UC modifiers. 96112 is limited to 1 unit per state fiscal year, but does allow for extension of benefits. 96113 is limited to 2 units per state fiscal year, but does allow for extension of benefits.
- The following services can now be provided by ADDT providers: 96112 with U6 and UC modifiers, 96113 with U6 and UC modifiers. 96112 is limited to 1 unit per state fiscal year, but does allow for extension of benefits. 96113 is limited to 2 units per state fiscal year, but does allow for extension of benefits.
Change in Use of Modifiers on Claims (Services) Requiring Prior Authorizations
Effective 11/1/19, Prior Authorization (PA) requests are required to include ALL modifiers that will be used or needed on (for) the claim (service). This includes payment impacting, anatomical, and informational modifiers. If the system does not find an exact match on the procedure code/modifier combination, the PA will not be found and the claim (service) will either cut back or deny.
MUMP Prior Authorization Extensions
Beginning 01/29/2020 the process that providers currently use to request additional days on an existing Inpatient Stay Prior Authorization will change. After 01/28/2020 providers will no longer use the PA process Type “Inpatient Extensions” when needing to request additional days be added to an existing PA. The provider will now go to the current approved Inpatient Stay PA and request additional days by adding a line item for the additional days being requested.
Current Demonstration Waiver Projects
The Division of Medical Services will provide public notice and allow input processes for its intent to submit written applications, renewals or amendments to any 1115(a) demonstration waiver projects that will be sent to the Centers of Medicare
and Medicaid Services. Learn more about current demonstration waiver projects.
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