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016.06.36-203.290. Physician's Role in the Ventilator Program.

AR ADC 016.06.36-203.290Arkansas Administrative Code

West's Arkansas Administrative Code
Title 016. Department of Human Services
Division 06. Division of Medical Services
Rule 36. Physician/Independent Lab/Crna/Radiation Therapy Center Provider Manual (Refs & Annos)
Section 203.000. Physician's Role in the Medicaid Program.
Ark. Admin. Code 016.06.36-203.290
016.06.36-203.290. Physician's Role in the Ventilator Program.
Currentness
A. Ventilator equipment is covered for eligible Medicaid recipients in the recipient's place of residence when determined medically necessary and prescribed by the patient's PCP or attending physician. “Place of residence” is defined as the recipient's dwelling or skilled nursing facility. Ventilator equipment is not covered in a boarding home, intermediate care facility or a residential care facility.
B. Ventilator equipment is covered for an eligible recipient who:
1. Is medically dependent on a ventilator for life support at least 6 hours per day;
2. Has been dependent for at least 20 consecutive days as an inpatient in a hospital, skilled nursing facility or intermediate care facility;
3. But for the availability of the respiratory care services (ventilator equipment), would require respiratory care on an inpatient basis for which Medicaid would pay;
4. Has adequate social support services to be cared for at home;
5. Wishes to be cared for at home and
6. Receives services under the direction of a physician who is familiar with the technical and medical components of home ventilator support and who has medically determined that in-home care is safe and feasible for the individual.
C. Prior authorization is required. The ventilator provider completes the request for prior authorization and the physician who prescribes the equipment must sign the request form.
<Editor’s Note: Nonfunctioning links so in original.>
Current with amendments received through February 15, 2024. Some sections may be more current, see credit for details.
Ark. Admin. Code 016.06.36-203.290, AR ADC 016.06.36-203.290
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