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016.06.71-212.100. Service Budget Limit (SBL)

AR ADC 016.06.71-212.100Arkansas Administrative CodeEffective: October 1, 2022

West's Arkansas Administrative Code
Title 016. Department of Human Services
Division 06. Division of Medical Services
Rule 71. Archoices in Homecare (Archoices) Home and Community-Based Services (Hcbs) Waiver
Section 210.000. Program Coverage
Effective: October 1, 2022
Ark. Admin. Code 016.06.71-212.100
016.06.71-212.100. Service Budget Limit (SBL)
Currentness
Definition:
SERVICE BUDGET LIMIT (SBL) means the limit on the maximum dollar amount of waiver services that may be authorized for and received by each specific participant.
Methodology for Determining the SBL:
A. An Independent Assessment Contractor will perform independent assessments that gather functional information about each applicant using the approved instrument. This assessment is used as part of the process to make a final determination of eligibility and, if the applicant is determined to be eligible, to be used to determine the SBL.
B. For participants, an evaluation is initiated at least every twelve (12) months. Based on the review of the evaluation, should a change of medical condition be present, a referral is made to the Independent Assessment Contractor to complete a reassessment using the approved instrument. This information is used as part of the process to make a final determination of continued eligibility and, if the participant is determined to be eligible, to be used to determine the SBL.
C. The three SBLs are:
1. Intensive: The participant requires total dependence or extensive assistance from another person in all three (3) areas of mobility, feeding and toileting. The maximum SBL for services is $34,000 annually.
2. Intermediate: The participant requires total dependence or extensive assistance from another person in two (2) of the areas of mobility, feeding and toileting. The maximum SBL for services is $23,000 annually.
3. Preventative: The participant meets the functional need eligibility requirements for ARChoices but does not meet the criteria for the ISB Levels of Intensive or Intermediate. The maximum SBL for services is $6,000 annually.
If the projected cost of services identified in the PCSP is less than the applicable SBL amount, this shall not be construed to permit, suggest, or justify approval, coverage, or reimbursement of different or additional waiver services (including changes in amount, frequency, or duration); coverage and reimbursement of any medically unnecessary Medicaid State Plan or waiver services; or other actions to increase spending to use the remaining “unused” portion of the SBL amount.
DHS will monitor and take steps necessary to update these SBL amounts when waiver rates change.

Credits

Adopted Oct. 1, 2022.
Current with amendments received through May 15, 2024. Some sections may be more current, see credit for details.
Ark. Admin. Code 016.06.71-212.100, AR ADC 016.06.71-212.100
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