Home care billing in Arkansas

Both. The PASSE program, statewide since October 1, 2017 under 1915(b) with 1915(c) and 1915(i) authority, is a managed care program with long-term services and supports, and CMS's 2024 tables list HCBS waiver services, state plan personal care, home health, private duty nursing and hospice in its benefit. Arkansas Total Care describes the PASSE as serving people with intellectual and developmental disabilities or behavioral health needs, with CES Waiver and 1915(i) providers in its network.² CMS's program notes say a member is enrolled in a PASSE when an independent assessment shows a tier 2 or tier 3 level of need. On CMS's waiver factsheet the CES Waiver runs with the PASSE's 1915(b) authority, ARChoices with 1915(j) self-directed attendant care and Living Choices with neither. For ARChoices, personal care, attendant care and respite billed to Arkansas Medicaid itself, DHS told providers in 2023 that EVV had replaced the earlier route of reporting and payment through the Medicaid Management Information System.

For PASSE members, Arkansas Total Care processes EVV through HHAeXchange: personal care and home health visits go through HHAeXchange or a third-party EVV system that aggregates with it, by a provider with a valid Arkansas Medicaid provider ID, and visits not submitted that way risk claim denials. Its manual dates EVV submission from dates of service on December 1, 2022.³ For visits billed to Arkansas Medicaid directly, DHS's 2021 provider training named Fiserv's AuthentiCare as the state's EVV system for personal care, attendant care and respite, with aggregator support for third-party vendors, and DHS began denying claims sent straight to MMIS without EVV on December 1, 2022. For home health, DHS opened a new EVV system on March 31, 2025, with Sandata as the state-sponsored system and alternate vendors feeding the Sandata Aggregator. CMS found Arkansas compliant for personal care EVV, adding 1915(j) self-directed personal attendant care as of April 1, 2021, but its December 29, 2023 letter found the state plan home health benefit non-compliant while the state secured an alternative vendor, and CMS's status page still lists Arkansas non-compliant for home health EVV.

Services under EVV¹¹

• Personal care
• Attendant care
• Respite care
• Home health

For PASSE members, through the PASSE care coordinator: Arkansas Total Care assigns a care coordinator who completes a health and service assessment and then meets the member in person to build the Person-Centered Service Plan, and CES Waiver services are authorized by the PASSE.³ DHS's Division of Aging, Adult and Behavioral Health Services told providers on October 24, 2025 that members in ARChoices, IndependentChoices, a PASSE or the CES Waiver keep receiving personal care through the ARIA independent assessment and RN authorization of services in the person-centered service plan. For State Plan Personal Care outside a waiver it described a new process, with no effective date given at the time: a PCP referral, a functional assessment and treatment plan by the personal care provider's RN instead of ARIA, a PCP prescription, and Acentra prior authorizations lasting 12 months, with the 64-hour monthly cap for adults 21 and over kept. Since August 5, 2025, under Act 853 of 2025, personal care, attendant care and respite providers need only a private care agency license from the Arkansas Department of Health.

For PASSE members, to the PASSE: Arkansas Total Care requires claims and encounters within 365 calendar days of the date of service, the inpatient discharge date or the date the provider learned the member's PASSE, and within 365 days of the primary payer's EOP when it is the secondary payer.³ For services billed to Arkansas Medicaid directly, DHS's 2023 training says claims sent straight to MMIS without EVV have been denied since December 1, 2022, so personal care, attendant care and respite claims start from the EVV record. Federal rules require the state to make providers submit every claim within 12 months of the date of service under 42 CFR 447.45(d)(1). Arkansas DHS's 2025 billing training says initial provider enrollment applications are filed electronically through the provider portal and revalidation is required every five years.

Palmetto GBA, LLC, as the Jurisdiction M A/B MAC, processes Medicare home health and hospice claims for Arkansas and fifteen other states from Alabama to Texas, among them Louisiana, Mississippi, Oklahoma and Tennessee.⁸ For Medicaid, the PASSE benefit includes home health and hospice. CMS's December 29, 2023 letter applied federal match reductions to Arkansas home health spending from the first quarter of 2024 because the 1905(a)(7) home health benefit was not EVV compliant, and CMS still lists the state non-compliant for home health EVV even after DHS opened its Sandata home health system on March 31, 2025.