Personal Care Update

As we resume normal business practices, below are a few helpful reminders to ensure timely Personal Care Prior Authorizations: 
Initial Prior Authorization Requests are members who have not received Personal Care Services or an Arkansas Independent Assessment (ARIA) from OPTUM in the past. 


Renewal Prior Authorization Requests are for members who continue to require Personal Care Services and have previously received an Arkansas Independent Assessment from OPTUM. 

 

The Renewal Prior Authorization Request should be made a maximum of 90 days or at minimum 60 days prior to the Arkansas Independent Assessment Expiration Date. Arkansas Independent Assessments are valid for 365 calendar days or 1 year. OPTUM will contact the member and schedule the assessment. 

 

** Once our referral page states that the referral has been transmitted (“Transmission Complete”) the beneficiary or their guardian can reach out to OPTUM at 844-809-9538 to schedule their appointment if they desire.  

 

Upon completion of the Arkansas Independent Assessment (with a Tier 1 Determination) OPTUM will apply the Task and Hour tool to calculate the number of units per month. Please allow 2 Business Days from the completion date of the Renewal assessment and Task and Hour Tool for OPTUM to conduct internal Quality Assurance procedures.

 

The Prior Authorization Request will be completed within 9 Business Days of receipt of all required documentation, completed Arkansas Independent Assessment and Task and Hour Tool. The Prior Authorization will be retroactive to the start date of the request.

 

Extensions are available for an unexpected delay of the Arkansas Independent Renewal Assessment for timely Prior 

Authorization requests. If the assessment request was made at least 60-90 days prior to the expiration of the current Arkansas Independent Assessment and the Renewal Assessment has not been completed before the Prior Authorization end date, an extension review is warranted.

If the Renewal assessment request was made fewer than 60 days prior to the current Arkansas Independent Assessment expiration, an extension review is not warranted. We will follow normal Prior Authorizations processes.

 

If an untimely Independent Assessment request has not been scheduled or completed within 60 days of the request, submit a help ticket for investigation and a potential extension review. An extension review does not guarantee an extension will be approved.

 

Please submit a help ticket if you have questions or have not received a completed Prior Authorization after 11 Business Days from the Independent Assessment completion date with a Tier 1 Determination. Submitting Help Tickets will not expediate Prior Authorization completion, except in the above-mentioned scenario.

Personal Care Services

 

eQHealth Solutions, the QIO-like organization for the Arkansas Department of Human Services (DHS), provides utilization and quality control peer review for Personal Care services to qualifying Arkansas Medicaid beneficiaries of all ages.

 

eQHealth will review and process Personal Care PA Requests (including without limitation new, renewal, modification, closure, and provider change requests) for Medicaid beneficiaries who are not ARChoices Medicaid Waiver beneficiaries (only pertaining to ages 21 and up). For each request, eQHealth shall make determinations to approve or deny, in whole or in part. eQHealth will also refer each beneficiary with the request of Personal Care for an Independent Assessment.