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Gold Card Notification

Date: 12/20/24

In 2023, the Arkansas General Assembly passed Act 575, amending the 2015 Prior Authorization Transparency Act. Act 575 exempts particular healthcare providers who administer healthcare services from prior authorization requirements. This letter outlines Arkansas Total Care prior authorization requirements beginning January 1, 2025, and contains details of your status regarding exemptions from prior authorization requirements for our Medicaid line of business.

Since the beginning of the PASSE program, Arkansas Total Care has had the following provisions in place to ensure open access to care for members:

  • No prior authorization/referrals needed to obtain primary care services
  • No prior authorization/referrals needed to obtain specialty provider services
  • No prior authorization/referrals needed for physical, occupational, speech, and behavioral health therapy services
  • To ensure open access to care, Arkansas Total Care has removed the following limits, typically applied by Fee for Service Medicaid:
    • Visit limits on physician services
    • Dollar CAPs on Imaging and DME services
    • Pharmacy Script Limits
  • Expanded services to offer wellness benefits to all adults
  • Continued to perform annual reviews of services that require a prior authorization to determine if a prior authorization is still needed to manage risk

Are there any services excluded from the Gold Card?

The PASSE program focuses specifically on a LTSS/Special Needs population centered around two Home and Community 1915 waivers for services only available to PASSE members. Arkansas Total Care has a fiduciary responsibility to administer the program in a manner that ensures Medicaid spending is controlled, taxpayer dollars are spent efficiently, and members receive the appropriate services to support them in the community. To ensure the continued viability of the PASSE program and to support the program requirements, Arkansas Total Care is excluding the following services from Gold Card consideration:

  • 1915(c) and 1915(i) Waiver services
  • Residential Treatment Center (RTC) services
  • Residential Treatment Unit (RTU) services
  • Short-term Skilled Nursing Stays
  • Personal care services
  • Home health services
  • Institution of Mental Disease (IMD) services
  • Intermediate Care Facility (ICF) services
  • Pharmacy services

If I am exempt, what are my requirements?

Exempt healthcare providers will not be required to obtain prior authorizations from the services listed as exempt above. Exempt providers will still be required to obtain authorizations for any excluded services as well as any they have not been granted exemption from.

If I am non-exempt, what are my requirements?

Non-exempt healthcare providers will be required to obtain prior authorizations from Arkansas Total Care, when necessary. You may review our prior authorization requirements as well as medical policies at ArkansasTotalCare.com. If you wish to appeal your exemption status, you must submit your appeal within 30 days of the receipt of this letter. To submit an appeal, contact the Arkansas Total Care Grievance & Appeals office at 1-866-282-6280 (TTY: 711). You may also mail your appeal to:

Arkansas Total Care
Attn: Grievance & Appeals
P.O. Box 25010
Little Rock, AR 72221

Thank you for your continued partnership in helping Arkansas live better. If you have any questions or concerns about this notice, to update your contact information, or to update your delivery address, please contact our Provider Services team at 1-866-282-6280 (TTY: 711).