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What does ARKids pay?

The following tables summarize the benefits offered under ARKids A and ARKids B.

ARKids A (copayment not required)
Program	Coverage limits	Prior authorization
Ambulance (emergency only)	Medical necessity	None
Ambulatory Surgical Center	Medical necessity	PCP referral
Chiropractor	Medical necessity	PCP referral
Dental Care (orthodontia included)	Medical necessity	PA required for some procedures
Durable Medical Equipment	Medical necessity	PA required for some equipment
Emergency Room Services	Medical necessity	None
EPSDT Screens	All per protocol	PCP or ADH administered
Family Planning	Family Planning services only	None
Federally Qualified Health Center	Medical necessity	See Physician Service
Hearing Services	Medical necessity	PCP referral
Home Health	Medical necessity	PCP Rx required
Hospice	Medical necessity	Physician certification
Immunizations	All per protocol	PCP or ADH administered
Inpatient Hospital	Medical necessity	PA for stays of more than 4 days
Inpatient Psych	Medical necessity	PA required
Laboratory and XRay	Medical necessity	PCP referral
Medical Supplies	Medical necessity	PCP Rx required
Nurse Midwife	Medical necessity	None
Outpatient Mental and Behavioral Health	Medical necessity	PCP Rx required
Physician Services	Medical necessity	PCP referral to specialists. Patient must use PCP for access to all services, including the professional component of services rendered in inpatient settings.
Psychology Services	Medical necessity	Physician Rx required
Podiatry	Medical necessity	PCP referral
Prescription Drugs	Medical necessity	Prescription (must use generic and rebate mfg. when available)
Rural Health Clinic	Medical necessity	See Physician Services
Therapy Services--Speech, Occupational, and Physical	Medical necessity	PCP referral and prescription required
Transportation	For Medicaid-covered services only	None
Vision Care	1 eye exam and 1 pair of eyeglasses per 12 months	None

ARKids B (copayment required)
Program	Coverage limits	Prior authorization	Copayment*
Ambulance (emergency only)	Medical necessity	None	$10 per trip
Ambulatory Surgical Center	Medical necessity	PCP referral	$10 per visit
Chiropractor	Medical necessity	PCP referral	$10 per visit
Dental Care (no orthodontia)	Medical necessity	Some restorative services	$10 per visit
Durable Medical Equipment	$500 per year	PCP prescription plus referral	20% per DME item
Emergency Room Services	Medical necessity	None	$10 per visit
Family Planning	Family Planning services only	None	None
Federally Qualified Health Center	Medical necessity	None	$10 per visit
Home Health	Medical necessity	PCP referral (limited to 10 visits per State Fiscal Year)	$10 per visit
Immunizations	All per protocol	PCP or ADH administered	None
Inpatient Hospital	Medical necessity	Prior approval for stays of more than 4 days	20% of first inpatient day
Laboratory and XRay	Medical necessity	PCP referral	$10 per visit
Medical Supplies	Medical necessity	PCP prescriptions (limited to $125 per month, with extension based on medical necessity)	None
Nurse Midwife	Medical necessity	None	$10 per visit
Outpatient Mental and Behavioral Health	$2,500 limit	PCP referral	$10 per visit
Physician Services	Medical necessity	PCP referral to specialists. Patient must use PCP for access to all services, including the professional component of services rendered in inpatient settings.	$10 per visit
Podiatry	Medical necessity	PCP referral	$10 per visit
Prescription Drugs	Medical necessity	Prescription	$5 per prescription (must use generic and rebate mfg. when available)
Preventive Health Screening	All per protocol	PCP or ADH administered	None
Rural Health Clinic	Medical necessity	None	$10 per visit
Speech Therapy	Medical necessity	PCP referral	$10 per visit
Vision Care	1 eye exam and 1 pair of eyeglasses per 12 months	Routine exams and diagnostic	$10 per visit

* Effective July 1, 2006, DHS will set an annual cap on cost-sharing (co-payments and coinsurance) for ARKids B families. The annual cost-sharing cap is 5% of the family’s annual gross (before taxes) income. For example, if a family of four (4) has annual gross income of $40,000.00: $40,000.00 x 5%=$2,000.00. Therefore, the family’s maximum amount of cost-sharing is $2,000.00 for the year.