A. For clients twenty-one (21) years of age or older, services provided in a physician's office, advanced practice registered nurse's (APRN) office, a patient's home, or nursing home are limited to sixteen (16) visits per state fiscal year (July 1 through June 30).
Clients under twenty-one (21) years of age in the Child Health Services/Early and Periodic, Screening, Diagnosis, and Treatment (EPSDT) Program are not subject to this benefit limit.
The following services are counted toward the service benefit limits:
1. Services of physicians in the office, client's home, or nursing facility.
2. Medical services provided by a dentist.
3. Medical services furnished by an optometrist.
4. Certified nurse-midwife services.
5. APRN services in the office, client's home, or nursing facility.
6. Rural health clinic (RHC) encounters.
7. Federally qualified health center (FQHC) encounters.
B. Extensions of this benefit are considered when documentation verifies medical necessity. Refer to Sections 229.100 through 229.120 of the manual for procedures on obtaining extension of benefits for Primary Care Provider (PCP) services.
C. The Arkansas Medicaid Program exempts the following diagnoses from the extension of benefit requirements when the diagnosis is entered as the primary diagnosis:
1. Malignant neoplasm (View ICD Codes.).
2. HIV infection or AIDS (View ICD Codes.).
3. Renal failure (View ICD Codes.).
4. Pregnancy [FN*](View ICD Codes.).
5. Opioid Use Disorder when treated with MAT (View ICD OUD Codes.)
When a Medicaid client's primary diagnosis is one (1) of those listed above and the client has exhausted the Medicaid established benefit for physician, APRN, and physician assistant services, outpatient hospital services, or laboratory and X-ray services, a request for extension of benefits is not required.
