D.8.a DHS DDS Autism Svcs for Children on Medicaid and REPEALS - Summary, Autism Waiver Renewal, ABA Therapy Manual, and Form DMS-641 ER/TP

Sep 20, 2026

Summary of Arkansas Medicaid rate rebasing and program updates for the Autism Waiver, including an approved 5-year renewal effective July 1, 2024. The document details the independent rate model, planned cost-neutral impact when combined with an ABA therapy services Medicaid manual, and revisions to waiver rules. It adds ABA therapy to the Arkansas Medicaid state plan, defines eligibility, clinician qualifications, supervision, service delivery, documentation, billing, and benefit limits, and introduces ABA-specific referral and prescription forms DMS-641 ER and DMS-641 TP for physician use, while listing repeals tied to Executive Order 23-02.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages25

Reading Time1 h 3 min

AccessFree to download

Summary

Autism Waiver Renewal

ABA Therapy Addition to State Plan

Repeals Pursuant to Executive Order 23-02

Arkansas Division of Medical Services (DMS)

Applied Behavior Analysis (ABA) Therapy Services for Medicaid Beneficiaries Under Age 21

Initial Evaluation Referral (DMS-641 ER)

Instructions for Completing Form DMS-641 ER

RECEIVED BLR 14 NOV 2024 Summary The Arkansas Medicaid rates for the Autism Waiver program will be rebased. The rate study considered direct wages (using Arkansas-specific May 2021 Bureau of Labor Statistics data), indirect and transportation costs, employee related expenses, and supervisor time, and used an independent rate model approach that captured the average expected costs a reasonably efficient Arkansas provider would incur while delivering services under each program. Ultimately, it was determined that a rebasing of Arkansas Medicaid rates for the Autism Waiver program was appropriate. The newly rebased rates are reflected throughout the Autism Waiver rules detailed below. It is anticipated that the financial impact of the rebasing of the Autism Waiver rates in conjunction with the establishment of an ABA therapy services Medicaid manual would be cost neutral. Autism Waiver Renewal 1. The Autism Waiver 5-year renewal was approved by CMS with an effective date of July 1, 2024. The renewal includes required updates that have occurred since the last amendment, updated cost neutrality demonstration based on the rebasing of rates, and other clarifying information throughout; and 2. The Autism Waiver Medicaid Manual is revised to include the updates and changes included within the approved Autism Waiver during the renewal process. ABA Therapy Addition to State Plan 1. A new ABA Therapy Medicaid Manual establishes eligibility, clinician qualifications, supervision, service delivery, service delivery documentation, billing, extension of benefit, and benefit limit parameters in connection with the performance of ABA therapy services; 2. Inclusion of ABA Therapy services as an Arkansas Medicaid state plan service; and 3. New ABA Therapy specific forms DMS-641 ER and DMS-641 TP will be created for physicians to use for all referrals for evaluations and treatment prescriptions for ABA therapy services. The forms are included here for reference and review but will not be promulgated as forms are not rules. Repeals pursuant to the Governor’s Executive Order 23-02: 1. FBI Background Check Form 2. First Connections Program Under Part C of the Individuals with Disabilities Act Arkansas Division of Medical Services (DMS) Applied Behavior Analysis (ABA) Therapy Services for Medicaid Eligible Beneficiaries under Age 21 INITIAL EVALATUION REFERRAL (DMS-641 ER) The primary care provider (PCP) or substitute/affiliated physician must use this form to refer patients for the evaluation required to demonstrate initial eligibility for applied behavior analysis (ABA) therapy services. *A DMS-641 ER referral is only required for a patient’s initial evaluation referral for ABA therapy services. A DMS-641 ER is not required for providers to perform required reevaluations for patients currently receiving ABA therapy services pursuant to an active treatment prescription (DMS-641 TP). Patient Name: Medicaid ID \#: Patient Date ofBirth: Date Patient Last Seen In Office: PCP or Substitute/Affiliated Physician Name (Please Print) Provider Medicaid ID \# Is the referring practitioner the patient’s Arkansas Medicaid assigned PCP? Yes (one must be checked) No If “No,” include the assigned PCPs name/Medicaid \# and reason unavailable: _______________________________________________________________________________________________ _______________________________________________________________________________________________ Diagnosis related to ABA Therapy: Primary Diagnosis: Autism Spectrum Disorder ICD 10 Code: F84.0 Secondary Diagnosis: ICD 10 Code: (if applicable) ICD 10 Code: ______________________________ (if applicable) Licensed Professionals who Diagnosed Autism Spectrum Disorder (ASD): Please indicate the licensed professional who diagnosed the patient’s ASD by checking the appropriate boxes (at least 2 boxes must be checked): Physician (PCP must be a physician

FAQs

Why were Arkansas Medicaid rates for the Autism Waiver rebased, and what method was used?

The rates were rebased because a rate study determined it was appropriate for the Autism Waiver program. The study considered direct wages, indirect and transportation costs, employee-related expenses, and supervisor time, using an independent rate model to capture expected average costs for reasonably efficient providers.

What changes are included in the approved 5-year Autism Waiver renewal effective July 1, 2024?

The renewal includes required updates made since the last amendment, an updated cost-neutrality demonstration based on the rebased rates, and additional clarifying information throughout. The Autism Waiver Medicaid Manual is revised to reflect these updates.

What is the purpose of Form DMS-641 ER and when is it required?

Form DMS-641 ER is used by the PCP or substitute/affiliated physician to refer patients for the evaluation required to demonstrate initial eligibility for ABA therapy services. It is required for initial evaluation referrals but is not required for providers to perform reevaluations for patients already receiving ABA therapy under an active treatment prescription (DMS-641 TP).

Sep 20, 2026

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