Arkansas - Case Management Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-09

Targeted Case Management (TCM) in Arkansas is certified by the Division of Provider Services and Quality Assurance (DPSQA) and requires applicants to first hold an active Class A or Class B Home Health Agency or Private Care Agency license from the Arkansas Department of Health, unless operating as a government unit or specifically incorporated for case management. The service funds assessment, person-centered service planning, referral, and monitoring for specific target groups, including participants in the ARChoices in Homecare 1915(c) waiver.

Approval mandates demonstrating at least one year of recent experience providing case management to the specific target population before an application is accepted. Once certified by DPSQA, providers enroll through the Division of Medical Services using form DMS-652 to bill the Arkansas Medicaid program.

1. Service Definition and Scope

In Arkansas, Targeted Case Management (TCM) assists eligible Medicaid beneficiaries in gaining access to needed medical, social, educational, and other services. The service includes comprehensive assessment, development of a specific care plan, referral to related activities, and ongoing monitoring.

TCM is delivered under the Medicaid State Plan and specific waivers like ARChoices in Homecare. Case managers must monitor and follow up to make necessary adjustments in the care plan and service arrangements according to established program guidelines.

• Core Components: Assessment, care planning, referral, and monitoring/follow-up.
• Target Populations: Elderly individuals, adults with physical disabilities, and specific waiver participants.
• Monitoring Frequency: Requires regular contacts to ensure the care plan is effectively implemented and meets the beneficiary's needs.
• Excluded Activities: Direct delivery of medical, educational, or social services to which the beneficiary has been referred.

2. Regulatory and Oversight Agencies

The Arkansas Department of Human Services (DHS) is the umbrella agency overseeing Medicaid. Within DHS, the Division of Medical Services (DMS) administers the Medicaid program and sets policy.

The Division of Provider Services and Quality Assurance (DPSQA) handles the certification of TCM providers, while the Arkansas Department of Health (ADH) issues the foundational licenses required for most agencies.

• Arkansas Department of Human Services (DHS): https://humanservices.arkansas.gov/
• Division of Medical Services (DMS): https://humanservices.arkansas.gov/divisions-shared-services/medical-services/
• Division of Provider Services and Quality Assurance (DPSQA): https://humanservices.arkansas.gov/divisions-shared-services/provider-services-quality-assurance/
• Arkansas Department of Health (ADH): https://www.healthy.arkansas.gov/
• Arkansas Medicaid Provider Portal (Gainwell Technologies): https://portal.mmis.arkansas.gov/armedicaid/provider/Home/tabid/135/Default.aspx

3. Gatekeeping Prerequisites: Who Can Even Apply

Arkansas imposes strict structural and experience prerequisites for TCM providers. An entity cannot simply apply to be a TCM provider without first meeting foundational licensure and historical operating requirements.

The state requires applicants to prove existing operational history and specific experience with the target population, effectively barring newly formed, inexperienced entities from entering the TCM network.

• Base Licensure Gate: Must be licensed as a Class A or Class B Home Health Agency or Private Care Agency by the Arkansas Department of Health, OR be a unit of state government, OR be a private/public incorporated agency whose stated purpose is case management.
• General Experience Gate: Must demonstrate at least one year of experience in performing case management services within the past three years.
• Target Population Experience Gate: Must demonstrate at least one year of experience working specifically with individuals in the targeted group within the past three years.
• Geographic Gate: Must be physically located in the state of Arkansas.

4. Licensure and Certification Requirements

TCM providers must be certified by DPSQA on an annual basis. This certification verifies that the agency meets all administrative, financial, and experiential qualifications outlined in the Medicaid State Plan.

Agencies must maintain their underlying ADH license (if applicable) in good standing to retain their DPSQA certification.

• Certifying Body: Division of Provider Services and Quality Assurance (DPSQA).
• Administrative Capacity: Must demonstrate the capacity to ensure quality of services in accordance with state and federal requirements.
• Financial Capacity: Must have a financial management system that provides documentation of services and costs.
• Liability Insurance: Must demonstrate that the provider has current liability coverage.
• Renewal Cycle: Certification must be renewed on an annual basis, unless approved otherwise by DMS based on performance evaluations.

5. Medicaid Provider Enrollment

After obtaining DPSQA certification, providers must enroll with Arkansas Medicaid through the provider enrollment unit, managed by the state's fiscal agent, Gainwell Technologies.

Applicants must submit the standard provider application and sign the Medicaid contract, agreeing to all terms in the Targeted Case Management Provider Manual.

• Application Form: Provider Application (Form DMS-652).
• Contract Requirement: Must sign the Arkansas Medicaid Provider Contract.
• Identifier: Must obtain and report a National Provider Identifier (NPI) using Form DMS-683.
• Revalidation: Federal regulations require Arkansas Medicaid to revalidate enrollment at least every 5 years.
• Application Fee: Subject to the federal institutional provider application fee during initial enrollment and revalidation, unless waived.

6. Staffing, Training and Background Checks

Agencies must employ qualified case managers who meet specific geographic and professional standards. The state mandates rigorous background screening for all personnel paid with Medicaid funds.

Providers are strictly prohibited from employing individuals listed on state or federal exclusion registries.

• Residency Requirement: Case managers must reside in or near the area of responsibility.
• Federal Exclusions: Providers must screen all employees against the LEIE (OIG) and EPLS (SAM.gov) databases.
• State Registries: Employees must clear the Arkansas Adult and Child Maltreatment Central Registries.
• Criminal Background: Criminal background checks must be completed at least once every five years.
• Payment Restriction: Gainwell Technologies will block payments to any individual who fails the background check or appears on an excluded provider list.

7. Documentation, Policies and Records

TCM providers must maintain comprehensive case records that document the assessment, care plan, and all monitoring activities. Records must be available for audit by DMS, DPSQA, or the Medicaid Fraud Control Unit.

Documentation must clearly link the billed time to specific case management activities authorized in the beneficiary's care plan.

• Record Retention: Must maintain individual case records in accordance with state and federal requirements (typically 5 years).
• Required Documents: Copies of the Medicaid contract, DPSQA certification, and underlying ADH licenses.
• Service Logs: Must maintain detailed logs of all contacts, referrals, and monitoring visits.
• Plan of Care Verification: Requests to increase or decrease waiver services must be verified and justified by a DHS RN prior to changes.

8. Billing, Rates and Claims

TCM services are billed to Arkansas Medicaid using specific procedure codes and modifiers outlined in the TCM Provider Manual. Claims are processed through the MMIS operated by Gainwell Technologies.

Providers must ensure that billed services do not duplicate other case management or care coordination services the beneficiary receives.

• Billing System: Arkansas Medicaid Provider Portal (MMIS).
• Reimbursement: Paid on a fee-for-service basis according to the published Arkansas Medicaid fee schedule.
• Electronic Funds Transfer: Providers must complete the Authorization for Electronic Funds Transfer for automatic deposit.
• Non-Covered Activities: Testing a Personal Emergency Response System (PERS) unit during a monitoring visit is not a separately billable TCM service.

9. Approval Sequence and Timeline

The approval process is sequential and requires interacting with multiple state divisions. An agency cannot enroll in Medicaid without first securing the necessary licenses and certifications.

Processing times vary depending on the completeness of the application and the scheduling of any required ADH or DPSQA surveys.

• Step 1: Obtain a Class A or Class B Home Health or Private Care Agency license from ADH (if not a government unit or exempt incorporated entity).
• Step 2: Accumulate and document the required one year of case management experience with the target population.
• Step 3: Apply for and receive annual TCM certification from DPSQA.
• Step 4: Submit Form DMS-652 and the Medicaid contract to the Provider Enrollment Unit.
• Step 5: Receive Medicaid provider number and NPI linkage to begin billing.

10. Common Denials and Survey Findings

Applications are frequently delayed or denied when providers fail to meet the strict experience prerequisites or submit incomplete background check documentation.

During audits, recoupments often occur due to insufficient documentation linking the billed time to specific, allowable case management activities.

• Experience Deficit: Denials for failing to prove one year of experience within the past three years specifically with the target population.
• Licensure Lapses: Loss of DPSQA certification due to expiration or revocation of the underlying ADH license.
• Background Check Failures: Employing staff who have not cleared the Arkansas Maltreatment Central Registries or federal exclusion lists.
• Documentation Errors: Billing for monitoring visits without corresponding detailed service logs in the case record.

11. Key Contacts and Resources

Providers should utilize the official Arkansas DHS portals and manuals for the most current regulations, forms, and fee schedules.

The Provider Enrollment Unit handles all inquiries regarding application status and MMIS access.

• Arkansas Medicaid Provider Enrollment Unit: (501) 376-2211
• Provider Enrollment Portal: https://portal.mmis.arkansas.gov/armedicaid/provider/Home/tabid/135/Default.aspx
• DPSQA Certification Information: https://humanservices.arkansas.gov/divisions-shared-services/provider-services-quality-assurance/
• Arkansas Department of Health Licensing: https://www.healthy.arkansas.gov/
• OIG LEIE Database: http://www.oig.hhs.gov/fraud/exclusions.asp

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