Arkansas Medicaid to Recognize PAs as Rendering and Billing Providers, PCPs

On November 1, Arkansas’ fee-for-service Medicaid program enacted several changes to the way it recognizes PAs.

One of the most substantial changes establishes Arkansas as the 50th state to authorize PAs to enroll as rendering providers in the Arkansas Medicaid program. This milestone follows more than a decade of effort by the Arkansas Academy of PAs (ARAPA) and AAPA and concludes a long-standing state-by-state campaign by advocates across the country.

Rendering provider status authorizes PAs to include their name/national provider identifier (NPI) number on a claim form in the section that identifies which health professional provided the service. Prior to the granting of this status, services provided by PAs were instead attributed to a physician with whom a PA worked. This inaccurate identification of the provider of care inhibited transparency of care provision and often resulted in detrimental consequences such as obscuring PA contributions to care, patient confusion when a different provider of care was noted on Explanation of Benefits, an inaccurate reflection in data regarding workforce utilization, and more.

Additionally, Arkansas Medicaid now enrolls PAs as billing providers. While rendering provider status allows for the identification of which health professional provided the service, billing provider status allows for a PA’s name and NPI to be placed in a section on the claim form that indicates who should receive direct payment/reimbursement for services provided. While most PAs will continue to reassign their reimbursements to their employer, just as most physicians and nurse practitioners do, the opportunity to directly bill will allow those in less-traditional employment relationships to receive direct payment for the care they render.

Finally, Arkansas Medicaid now recognizes PAs as primary care providers (PCPs) under the Primary Care Case Management (PCCM) program, if authorized by the physician with whom the PA works. PCP status allows PAs to provide care to patients that are required to have a primary care visit. In Arkansas, Medicaid generally only authorizes patients to receive specialty provider services if a referral is made.

This status will also increase patient access, especially in rural areas, by increasing the number of PCPs available to patients, as PCPs under Arkansas Medicaid currently have a maximum caseload that they cannot exceed. Medicaid authorizing this status may also act as an example to private payers in the state that may not recognize PAs as PCPs and, as a result, may reduce patient out-of-pocket costs. This is because some payers charge a lower co-payment for seeing a PCP as opposed to a “specialist”, which, without PCP status, PAs have sometimes been identified as.

For more information regarding requirements pertaining to these new authorizations, please consult the Arkansas Medicaid final rule. To learn more about the various levels of enrollment, see AAPA’s Levels of Enrollment Reimbursement Brief. To learn more about PCP status, see AAPA’s PCP Reimbursement Brief.

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