MedicaidReimbursementHigh impact
Inpatient Hospitals – Criteria for Rehabilitation Services Provided in Acute Care Setting
Arkansas Medicaid·AR · Critical Care, PM&R (Physical Medicine & Rehab), Physical Therapy +1 more·Claims & Billing
Effective date
Sep 1, 2026
We identified it
Aug 29, 2026
Summary
Effective September 1, 2026, Arkansas Medicaid expanded coverage for Revenue Code 158 (REHAB/WARD) in acute care hospitals. Rehabilitation services provided in acute care settings will now be reimbursed at the same per diem rates as rehabilitation hospitals, subject to an upper limit with no cost settlement. Billing teams must update systems to apply these new rates and ensure prior authorization follows AFMC guidelines for inpatient rehabilitation stays.
Action Required
By August 31, 2026: (1) Billing team must update billing system to apply hospital-specific prospective per diem rates (from ON-044-26 reference document) to Revenue Code 158 claims for provider type 05 (all inpatient hospitals) when only rehabilitative services are provided in acute care settings. (2) Update claim submission protocols to reference the new per diem rates and ensure no cost settlement is applied. (3) Train billing and prior authorization staff on MCG clinical guidelines accessed via the MCG Transparency Portal to distinguish between acute care needs (using ISC guidelines) and rehabilitation-only services (using RFC guidelines). (4) For any inpatient stay extensions needed after September 1, 2026, ensure providers follow the MUMP process per ON-042-26 and contact AFMC for prior authorization at 1-800-426-2234. (5) For pediatric claims (beneficiaries under 21), flag for case-by-case EPSDT review as MCG criteria inform but do not replace EPSDT medical-necessity standards. Failure to properly classify and bill Revenue Code 158 claims with correct rates will result in underpayment or claim denials.