Arkansas – EPSDT

In Arkansas:
As of 2012, 424,337 individuals were eligible for EPSDT services in Arkansas through Arkansas Medicaid. According to CMS data from 2012, Arkansas achieved an EPSDT screening ratio of 64% and a participation ratio of 48%. 196,504 children received dental services of any kind, with 182,167 receiving preventive dental services.
Last updated May 2014
Medical Necessity
Arkansas has adopted the Federal statutory language in defining medical necessity in its EPSDT provider manual. In addition the state requires primary care physicians (PCPs) to complete both a PCP agreement and an EPSDT agreement. The EPSDT agreement requires adherence to billing and screening standards. The PCP provider agreement also does not define medical necessity, but it requires general adherence to, “all pertinent Medicaid policies, regulations and State Plan standards.”
For services that are not included in the Arkansas Medicaid State Plan, the PCP must complete form DMS-693, titled Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Prescription/Referral for Medically Necessary Services/Items Not Specifically Included in the Medicaid State Plan.
Initiatives to Improve Access
Arkansas created ARKids First health insurance to provide additional coverage options for more than 70,000 Arkansas children. ARKids A is Medicaid and offers children and their families a comprehensive package of benefits, including EPSDT services. ARKids B provides coverage for families with higher incomes.
Reporting & Data Collection
The Arkansas Foundation for Medical Care (AFMC) staffs Quality Improvement specialists that work with providers on a number of projects. A number of these quality improvement projects have focused on issues affecting children including: Adolescent Health, Attention Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Disorders, Pediatric Overweight, Breastfeeding Promotion, Pregnancy and Tobacco Use, Well Child Screening, and EPSDT.
For many of these quality improvement projects data and metrics are an important aspect of the initiative. For example, for the Well Child Screening initiative the QI teams are tracking indicators related to the number of well visits in the first 15 months of life, administration and documentation of immunizations in accordance with national recommendations, and completion of an EPSDT medical screening components according to age-specific schedule.  
Behavioral Health
Arkansas Medicaid and ARKids First partners with the Arkansas Division of Behavioral Health Services, which provides all public behavioral health services including: mental health and substance abuse prevention, treatment, and recovery services.
Support to Providers and Families
Support to Families
Arkansas Department of Human Services, which houses Medicaid, has an initiative called Healthy Families, a resource center aimed at families with children birth to age five. Health Families offers two free Baby Books, one prenatal – age 1, the other newborn – age 5. Healthy Families also offers a free Arkansas Healthy Children Handbook. The Handbook includes information on the different services offered by Arkansas for children, as well on information on health topics including child development, dental health, and prevention.
Support to Providers
The Medicaid Managed Care Services Division of the Arkansas Foundation for Medical Care has a Quality Improvement Team that works with Medicaid providers to implement quality improvement projects, including those described in Reporting & Data.
Care Coordination
Arkansas Medicaid and the Arkansas Foundation for Medical Care partnered in the Assuring Better Child Health and Development project to improve care coordination and linkages to services. Specifically, these two groups worked to improve the link between primary care and Early Intervention (First Connections – Arkansas Infant and Toddler Program). The state developed a standardized provider feedback and consent form that allows physicians to refer to and receive feedback from providers of Early Intervention services, with feedback on referrals to Early Intervention. Primary care providers can use this form to connect children to services including speech therapy, occupational therapy, and social work services, among others.
Arkansas also has an initiative called the Health Care Payment Improvement Initiative: Building a Healthier Future for all Arkansans. This initiative aims to move the Arkansas health system from a payment model that rewards volume to one that rewards quality and outcomes, and that aligns financial incentives for how care is delivered. The initiative is multi-payer and focuses heavily on Medicaid. The central payment and delivery system transformations of this initiative are Episodes of Care and Patient Centered Medical Homes, and the Health Home; all of which require increased levels of care coordination.
Oral Health
As noted in the Arkansas Medicaid Handbook, dental care is covered for children with ARKids First A and Medicaid. This includes orthodontic care such as braces, if medically necessary. Arkansas Medicaid must approve all orthodontic care before treatment. Children with ARKids First B can get some dental care, but not orthodontic care.