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Understanding the Arkansas Medicaid Primary Care Physician Management Program

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The Arkansas Medicaid Primary Care Physician Management Program (PCMH) is designed to enhance healthcare delivery for Medicaid beneficiaries. This program focuses on patient-centered care, aiming to improve health outcomes and manage healthcare costs effectively. For primary care practices in Arkansas looking to participate in this initiative, there are specific requirements that must be met to ensure eligibility and successful enrollment. This article outlines these key requirements and provides essential resources for those interested in joining the Arkansas PCMH program.

Eligibility Requirements for PCMH Enrollment

To be considered for enrollment in the Arkansas Medicaid PCMH program, healthcare providers must satisfy all of the following criteria:

  • Provider Entity Type: The applicant must be one of the recognized provider types under Arkansas Medicaid. This includes:

    • Individual Primary Care Physicians (PCPs) identified as Medicaid Provider Types 01 or 03.
    • Physician groups consisting of Primary Care Providers who are linked to a common group Medicaid identification number (Provider Types 02 or 04).
    • Rural Health Clinics (Medicaid Provider Type 29) as defined in the Rural Health Clinic Provider Manual, Section 201.000.
    • Area Health Education Centers (AHECs) recognized as Medicaid Provider Type 69.

  • ConnectCare Primary Care Case Management Program Participation: The practice must include PCPs who are already enrolled in the ConnectCare Primary Care Case Management program. This ensures alignment with existing care management frameworks within Arkansas Medicaid.

  • Non-participation in PCCM Shared Savings Program: Practices engaged in the PCCM Shared Savings Program, established under AR Act 1453 of 2013, are not eligible for the PCMH program. This is to avoid overlap and ensure focused participation in either shared savings or PCMH initiatives, but not both.

  • Minimum Attributed Beneficiary Count: At the time of enrollment, the practice must have a minimum of 125 attributed beneficiaries. This requirement ensures that participating practices have a substantial patient base within the Medicaid system, allowing for meaningful impact and program evaluation.

PCMH Manuals and Important Documents

For comprehensive details and policy updates regarding the Arkansas PCMH program, several key documents are available. These resources provide in-depth information on program guidelines, policy changes, and lists of participating PCPs. Below are links to these essential materials:

These documents are crucial for understanding the evolving policies and PCP participation lists associated with the Arkansas PCMH program.

Essential Forms for Participation

To participate in the PCMH program, several forms are required for enrollment and management. These forms facilitate the application process, updates, and any necessary changes in participation status:

  • DMS-844, Practice Participation Agreement/Update Change Form
  • DMS 845, Pooling Request Form
  • DMS 846, Practice Withdrawal Form

These forms are essential for practices to officially engage with the Arkansas Medicaid PCMH program and manage their involvement effectively.

Contact Information and Support Resources

For providers seeking assistance, having queries, or needing to submit enrollment applications, several support channels are available. These contacts are dedicated to helping providers navigate the PCMH program effectively:

Gainwell Technologies – PCMH Help Desk

  • Phone: 501.301.8311 or 866.322.4696
  • Fax: 501.374.0549
  • General Inquiries/Enrollment Applications: [[email protected]](mailto:[email protected])

Arkansas Foundation for Medical Care (AFMC)

  • Phone: 501.212.8600
  • Fax: 501.375.1201
  • Email: [[email protected]](mailto:[email protected])
  • Website: www.AFMC.org

Arkansas Foundation for Medical Care, Practice Transformation

  • Rhelinda McFadden, RN CPHIT, CPEHR
    • Manager, PCMHPT/Quality Consultant
    • 1020 West 4th Street, Suite 200, Little Rock, Arkansas 72201
    • Phone: 501.212.8733
    • Fax: 501.375.0705
    • Email: [[email protected]](mailto:[email protected])
    • Email: [[email protected]](mailto:[email protected])
    • Website: www.afmc.org

Arkansas Chapter American Academy of Pediatrics

  • Anna Strong
    • P. O. Box 251182, Little Rock, Arkansas 72225
    • Phone: 415.902.3927
    • Email: [[email protected]](mailto:[email protected])
    • Website: www.arkansasaap.org

Arkansas Chapter American Academy of Family Physicians

  • Carla Coleman
    • 500 Pleasant Valley Dr. Suite #102, Little Rock, AR 72227
    • Phone: 501.223.2272
    • Email: [[email protected]](mailto:[email protected])
    • Website: www.ArkansasAFP.org

Arkansas Office of Health Information Technology (OHIT) – AR SHARE

  • Anne Santifer

QualityCare Insight Help Desk

These contacts represent valuable resources for primary care providers in Arkansas seeking to engage with the Medicaid PCMH program, offering support from enrollment to ongoing participation.

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