2020 Arkansas Code
Title 20 - Public Health and Welfare
Subtitle 5 - Social Services
Chapter 77 - Medical Assistance
Subchapter 1 - General Provisions
§ 20-77-127. Eligibility for long-term care

(a) The eligibility determination regarding every applicant for long-term care nursing facility placement shall be made according to the criteria exactly as set forth in:

1. (1) The Office of Long-Term Care Procedures for Determination of Medical Need for Nursing Home Services, as it existed on January 1, 2013; and

2. (2) The Medical Services Policy Manual of the Division of County Operations of the Department of Human Services, as it existed on January 1, 2013.

(b) The eligibility determination criteria established under subsection (a) of this section and any part of subsection (a) of this section shall not be modified, altered, amended, or changed before June 30, 2014.

(c)

1. (1)

   1. (A) Under 42 C.F.R. § 435.725, certain amounts of income may be deducted from income to:

      1. (i) Calculate the amount certain institutionalized recipients of long-term care Medicaid must contribute to the cost of their care; and

      2. (ii) Determine the amount by which the Medicaid payment to the institution is to be reduced.

   2. (B) The federal regulations also provide for deduction amounts for incurred expenses for “necessary medical or remedial care recognized under state law but not covered under the state's Medicaid plan, subject to reasonable limits the agency may establish on amounts of these expenses”, which are commonly referred to as “Medicaid income offsets”.

2. (2) The Department of Human Services shall clarify the proper administration of 42 C.F.R. § 435.725, as it existed on January 1, 2017, by creating and promulgating rules that:

   1. (A) Identify and define the types of expenses that are not covered by the Medicaid state plan that are potentially eligible for Medicaid income offsets;

   2. (B) Identify the types of expenses that are not eligible for Medicaid income offsets;

   3. (C) Define a process for determining whether the medical or remedial service is medically appropriate and necessary and not covered under the Medicaid state plan; and

   4. (D) Set reasonable limits on the amounts allowed for eligible Medicaid income offsets.