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§ 20-77-802. Medicaid payment

AR Code § 20-77-802 (2018) (N/A)
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(a) The Medicaid payment shall not exceed an amount equal to the lesser of the qualified provider's usual and customary charges for such services or the reimbursement schedule established under subsection (b) of this section when determined medically necessary by the Arkansas Medicaid Program.

(b) (1) The Department of Human Services shall establish a reimbursement schedule for the following:

(A) Home intravenous antibiotics;

(B) Chemotherapy;

(C) Pain management;

(D) Total parenteral nutrition; and

(E) Other home intravenous therapies.

(2) A reimbursement schedule established under this section shall be on a per diem basis.

(3) Service per diem rates shall include the following:

(A) Pharmacy sterile compounding fees;

(B) Intravenous pole, infusion pumps, and pump cassettes;

(C) All required intravenous supplies such as syringes, tubing, catheter care kits, etc.; and

(D) Other related services necessary for home intravenous drug services.

(4) The Medicaid reimbursement shall be the average wholesale cost of drug and solution plus a service per diem not to exceed the fortieth percentile of average daily Medicaid per diem to Arkansas hospitals, or the usual and customary reimbursement, whichever is lower.

(c) Reimbursement under this section shall not be subject to the Medicaid pharmacy benefits limits.

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§ 20-77-801. Definitions
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§ 20-77-803. Physician clinical management fees