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ArkansasHB13142025 Regular SessionHouse

TO AMEND THE LAW CONCERNING CERTAIN AUDITS OF HEALTHCARE PROVIDERS; AND TO CREATE THE ARKANSAS MEDICAL AUDIT BILL OF RIGHTS ACT.

Sponsored By: Missy Irvin (Republican), Lee Johnson (Republican)

Enacted

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Bill Overview

Analyzed Economic Effects

3 provisions identified: 3 benefits, 0 costs, 0 mixed.

Healthcare providers gain audit appeal rights

Providers have at least 60 days after receiving a preliminary audit report to submit documents addressing disputed findings. Auditors must deliver that report within 120 days after the audit ends. The final report is due within six months after receipt of the preliminary report or final appeal, whichever is later. Auditors must offer a process to appeal unfavorable preliminary findings. Findings ruled unsupported on appeal must be dismissed without further proceedings. Auditors must also provide final reports to health benefit plan sponsors after review.

Healthcare providers gain limits on audits

Arkansas sets audit rules for insurers, claims administrators, and other payor representatives reviewing healthcare providers’ claims. Auditors must give at least one week’s notice before the initial audit in each audit cycle. They generally cannot start more than two audits per provider each calendar year. That limit does not cover audits of a specific problem disclosed to the provider; those audits cover only claims identified by number. Other audits cover at most the greater of 50 claims or 0.25% of claims billed to that auditor in the previous calendar year. The audit lookback is limited to 24 months, measured from when a claim was submitted or decided. Auditors cannot estimate repayments or penalties by applying sample findings to other claims. Providers choose on-site, electronic, or the original audit method when additional claims need review. Clinical judgment reviews must involve a provider in the same specialty, and similar providers must face the same audit standards. These protections exclude pharmacies governed by separate audit rules, Medicaid audits by Arkansas DHS or its designee, and investigations involving alleged fraud, willful misrepresentation, or abuse. The Insurance Commissioner must issue rules to implement, administer, and enforce the law.

Healthcare providers gain repayment protections

Providers get at least 60 days after an overpayment notice to file a corrected claim. Auditors generally must wait for correction and can recover only payments above what the corrected claim allows. Disputed money cannot be recovered until the audit’s final internal decision, including appeals. An auditor can recover the full overpaid claim if payment for the corrected claim is issued on the same date. Repayment demands cannot rely on documentation or professional duties beyond state or federal law. Findings can use projections for similar patients, but recovery must reflect actual overpayments unless a projection is included in a provider settlement. Recovered money must be returned to the party responsible for payment. Auditors cannot reverse an approved service, provider, or patient eligibility unless the provider obtained approval through fraud or misrepresentation of claim details. Typing, recordkeeping, and computer errors in required claim records are not fraud without proof of intent to commit fraud. These errors can still require repayment, but criminal penalties require proof of fraudulent intent.

Sponsors & Cosponsors

Sponsors

  • Missy Irvin

    Republican • Senate

  • Lee Johnson

    Republican • House

Cosponsors

There are no cosponsors for this bill.

Roll Call Votes

All Roll Calls

Yes: 132 • No: 0

Senate vote • 4/7/2025

Senate Vote - Monday, April 7, 2025 5:43:14 PM

Yes: 34 • No: 0

House vote • 3/31/2025

House Vote - Monday, March 31, 2025 2:07:55 PM

Yes: 98 • No: 0

Actions Timeline

  1. Notification that HB1314 is now Act 512

    4/10/2025House

  2. Correctly enrolled and ordered transmitted to the Governor's Office.

    4/8/2025House

  3. TO BE ENROLLED

    4/7/2025House

  4. Returned from the Senate as passed.

    4/7/2025House

  5. Returned to the House as Passed.

    4/7/2025Senate

  6. Read the third time and passed.

    4/7/2025Senate

  7. Returned by the Committee, with the recommendation that it Do Pass

    4/3/2025Senate

  8. Read first time, rules suspended, read second time, referred to INSURANCE & COMMERCE - SENATE

    3/31/2025Senate

  9. Received from the House.

    3/31/2025Senate

  10. Read the third time and passed and ordered transmitted to the Senate.

    3/31/2025House

  11. Returned by the Committee Do Pass

    3/19/2025House

  12. REPORTED CORRECTLY ENGROSSED

    3/18/2025House

  13. Amendment No. 2 read and adopted and the bill ordered engrossed.

    3/18/2025House

  14. Placed on second reading for the purpose of amendment.

    3/18/2025House

  15. REPORTED CORRECTLY ENGROSSED

    2/27/2025House

  16. Amendment No. 1 read and adopted and the bill ordered engrossed.

    2/27/2025House

  17. Placed on second reading for the purpose of amendment.

    2/27/2025House

  18. Read the first time, rules suspended, read the second time and referred to the Committee on INSURANCE & COMMERCE- HOUSE

    1/29/2025House

  19. Filed

    1/29/2025House

Bill Text

  • HB1314 - Introduced

    1/29/2025

    PDF

  • Act Version

    PDF

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