Judges: MIKE BEEBE, Attorney General
Filed Date: 5/7/2004
Status: Precedential
Modified Date: 7/5/2016
The Honorable Bill Scrimshire State Representative 1712 Haltom Road Malvern, AR 72104
Dear Representative Scrimshire:
You have presented the following question for my opinion:
Since the rules concerning prior authorization for Medicaid ElderChoices were identical to those in effect for nursing homes on the effective date of
Act 136 of 2003 , is any further action required by Act 136?
RESPONSE
As an initial matter, I must point out that the term "prior authorization" is a Medicaid term of art that is defined in the various Medicaid provider manuals as follows:
The approval by the Arkansas Division of Medical Services or a designee of the Arkansas Division of Medical Services for specified services for a specified recipient to a specified provider before the requested services may be performed and before payment will be made.
See, e.g., ElderChoices Provider Manual, § IV (Glossary).
When I address your question giving the term "prior authorization" the above quoted meaning, I must conclude that the rules and regulations concerning prior authorization for the Medicaid ElderChoices program are essentially identical to those in effect for nursing homes on the effective date of
Before explaining my conclusion, I will set forth the pertinent language of
(e) To the extent not prohibited by federal law or regulation, the Department of Human Services shall promulgate rules concerning prior authorization for Medicaid ElderChoices, a community-based service, that are identical to those in effect for nursing homes on July 16, 2003.
A.C.A. §
The ElderChoices program that is referred to above is a Medicaid program that is administered by the Arkansas Department of Human Services, Division of Aging and Adult Services. It is designed to provide in-home assistance to adults who, for medical or other reasons, would otherwise have to reside in nursing homes. The Division of Aging and Adult Services of the Department of Human Services is charged with the responsibility of promulgating rules and regulations for the ElderChoices program. See
A.C.A. §
Services provided under the ElderChoices Program do not require prior authorization.
ElderChoices Provider Manual, § 240.000.
The Division of Medical Services of the Department of Human Services is charged with the responsibility of promulgating rules and regulations for nursing homes. See A.C.A. §
Accordingly, if I read your question and Act 136 giving the term "prior authorization" its defined meaning under the Medicaid regulations, I must conclude that to the extent that the rules and regulations concerning prior authorization for the ElderChoices program can be meaningfully compared to those in effect for nursing homes, they are currently essentially identical to those rules. Neither set of rules imposes a general prior authorization requirement, as that term is defined. Therefore, the rules and regulations for the ElderChoices program are in this respect already in compliance with the requirements of A.C.A. §
This reading, quite obviously, renders Act 136 meaningless — a result that is to be avoided if possible. See Yarbrough v. Witty,
For this reason, I have opted to take your question at face value, and therefore conclude that because the rules and regulations concerning prior authorization for the Medicaid ElderChoices program are essentially identical to those in effect for nursing homes on the effective date of
Assistant Attorney General Suzanne Antley prepared the foregoing opinion, which I hereby approve.
Sincerely,
MIKE BEEBE Attorney General