The following are links to information and required forms to help school districts in order to bill Medicaide for providing PT/OT/ST to students in their district.  For questions related to PT/OT/ST please This email address is being protected from spambots. You need JavaScript enabled to view it..

Resources and Links

ARMedicaid MMIS Portal

DMS-653 Form - Medicaid Participation Contract

DMS-689 Form - Medicaid Disclosure Form

DMS-675 Form - Ownership and Conviction Disclosure Form

DMS-673 Form - Provider Address Change Form

DMS-640 Form - Prescription/Referral Form

Medicaid Application Directions for School District Employed Therapists

EXAMPLE - Medicaid Therapist Application

Medicaid Application - Access Arkansas

Medicaid Application Directions/Checklist for Schools

DHS - FAQ - Applying for Medicaid

Health Services Consent Form - Condensed

Health Services Consent Form - Condensed - Spanish

LEA-Parental Consent Notice to Access Public Insurance

LEA- Parental Consent Notice to Access Pubic Insurance - Spanish

Back To Services