§ 20-48-703 - Eligibility. - Arkansas Statutes

20-48-703. Eligibility.

(a) Eligibility for services and appropriate placement in the least restrictive environment for individuals with developmental disabilities under any of the service models included in the state's Medicaid plan with the Health Care Financing Administration of the United States Department of Health and Human Services or for services covered from state general revenue dollars shall be made by the interdisciplinary team composed in keeping with federal and state laws pertaining to individuals with special needs. This section does not negate nor preclude the rights of individuals with developmental disabilities under existing federal and state laws.

(b) Subject to approval by the administration, the Department of Human Services will accept an individualized family service plan or an individualized program plan developed in conformity with all applicable state and federal laws as prior authorization for Medicaid-covered therapies provided to persons with developmental disabilities. Prior authorization does not preclude postpayment reviews or other utilization control measures.

(c) For individuals with developmental disabilities who, pursuant to the diagnosis, evaluation, and assessments conducted by the interdisciplinary team, in conformity with all applicable federal and state laws, are found to fall within the eligibility guidelines adopted pursuant to this subchapter, and where the individual's primary care physician, independent of the service provider, serves as the gatekeeper and prescribes day treatment services, referred to as developmental day treatment services under the present developmental day treatment clinic services model, prior approval is not required for up to five (5) hours of daily services. Should the funding model for the day treatment services be changed in the state's Medicaid plan with the administration, the five (5) hours per day shall remain the floor to afford those families who choose to keep their disabled child or adult in the community, thereby bearing a considerable responsibility for the care and expenses related to the treatment and care.