Title 20 — Public Health and Welfare

This subchapter shall be known and may be cited as the “Prescription Drug Access Improvement Act”.

The purpose and intent of this subchapter is to authorize a Medicaid waiver to provide affordable prescription drugs for eligible persons sixty-five (65) years of age and over.

(1) As used in this subchapter:(1) [Repealed.](2) “Medicaid” means the Arkansas program of medical assistance established under Title XIX of the Social Security Act;(3) “Prescription Drug Access Program” means the limited prescription drug benefit Medicaid waiver program establis…

(1) The Department of Human Services may apply to the Centers for Medicare & Medicaid Services for a limited prescription drug benefit Medicaid waiver for persons who:(1) Are sixty-five (65) years of age or over;(2) Have no prescription drug coverage; and(3) Have incomes and reso…

(1) Any waiver application submitted by the Department of Human Services shall include provisions for the department to:(1) (A) Establish an income eligibility standard not to exceed:(i) Eighty percent (80%) of the federal poverty guideline for the period July 1, 2001, through Ju…

(a) (1) The General Assembly finds that during the public health emergency caused by coronavirus 2019 (COVID-19), the Department of Human Services issued several memorandums authorizing certain reimbursement for behavioral and mental health services provided via telemedicine for …

(a) The General Assembly finds that:(1) Pediatric acute-onset neuropsychiatric syndrome, also known as “PANS”, is a clinically defined disorder characterized by the sudden onset of obsessive-compulsive symptoms or eating restrictions, accompanied by two (2) or more symptoms of ac…

(a) The General Assembly finds that:(1) The Arkansas Medicaid Program has historically delayed or denied access to new products and label expansions approved by the United States Food and Drug Administration during the time period after the products or label expansions have been …

(a) The Arkansas Medicaid Program shall reimburse for behavioral health services that are provided in a federally qualified health center by at a minimum:(1) A clinical psychologist;(2) A licensed certified social worker;(3) A licensed professional counselor;(4) A licensed mental…

(a) The Department of Human Services shall establish separate vagus nerve stimulation therapy system device reimbursement rates for all acute care hospitals that are Medicaid providers. (b) The vagus nerve stimulation therapy system device reimbursement rates for implantation of …

The Arkansas Medicaid Program shall not require a beneficiary to first obtain a referral from a primary care provider before receiving mental health counseling for the first ten (10) visits for mental health counseling.

(a) The General Assembly finds that:(1) The national coronavirus 2019 (COVID-19) emergency has emphasized the critical importance of laboratory testing for diagnosing disease and promoting health;(2) There is a disparity in the scope of laboratory testing services that are covere…

(a) As used in this section, “continuous glucose monitor” means an instrument or device, including repair and replacement parts, that:(1) Is designed and offered for the purpose of aiding an individual with diabetes;(2) Measures glucose levels at set intervals by means of a small…

(a) The Arkansas Medicaid Program shall reimburse for screening for behavioral health conditions and behavioral health services provided in:(1) A hospital outpatient clinic; or(2) A physician clinic. (1) A hospital outpatient clinic; or (2) A physician clinic. (b) The Department …

(a) The General Assembly finds that:(1) Prevention and early intervention in child health and well-being improves health outcomes and saves money in the long term;(2) A significant proportion of pediatric behavioral healthcare claims in Arkansas occur in primary care settings;(3)…

(a) The General Assembly finds that:(1) The State of Arkansas currently ranks forty-sixth among the fifty (50) states for having the least healthy population;(2) A major contributing factor to the state's low health ranking is its high percentage of uninsured persons;(3) There is…

(1) As used in this subchapter:(1) “Community-based” means based in, located in, or primarily relating to the community of geographically contiguous political subdivisions, as determined by the board of a community-based health cooperative, that will be or is served by the commun…

(a) A community-based health cooperative shall administer a community-based healthcare access program in a manner that:(1) Defines the population that may receive subsidized services provided through the community-based healthcare access program by limiting program eligibility to…

Whenever feasible, community-based health cooperatives shall participate actively with area health education center programs in developing and implementing recruitment, training, and retention programs directed at positively influencing the supply and distribution of healthcare p…

A community-based health cooperative may make donations for the public welfare or for charitable, scientific, or educational purposes, subject to such limitations, if any, as may be contained in its articles of incorporation or any amendment to the articles of incorporation.

(a) In order to demonstrate community-based healthcare access program viability and effectiveness, a community-based health cooperative shall collect data and, upon request, make available a report to the appropriate interim committees of the Senate and House of Representatives. …

No community-based health cooperative shall be deemed to be engaged in the corporate practice of medicine.

No liability on the part of and no cause of action of any nature shall arise against any member of the board of directors of a community-based health cooperative or against an employee or agent of a community-based health cooperative for any lawful action taken by them in the per…

(a) (1) Community-based health cooperatives shall not be considered or regulated as any type of entity governed by Title 23 of the Arkansas Code.(2) No program offered by a community-based health cooperative shall be subject to regulation under Title 23 of the Arkansas Code. (1) …

A.C.A. § 20-77-151Current through all legislation of the 2025 Regular Session.Arkansas Code of 1987 Annotated Official EditionCopyright © 2026 by the State of Arkansas All rights reserved

(a) The General Assembly finds that:(1) The Arkansas Medicaid Program currently covers long-acting reversible contraception;(2) Due to the payment model used by the program for coverage of pregnant women, healthcare providers have found that providing long-acting reversible contr…

(a) The Arkansas Medicaid Program shall redetermine eligibility for postpartum mothers receiving coverage under a Medicaid eligibility category within eight (8) weeks of giving birth and ensure the enrollment and transition of the postpartum mother into any available Medicaid eli…

(a) The General Assembly finds that:(1) The Arkansas Medicaid Program covers physical therapy to help beneficiaries improve their movement and physical function, manage pain and other chronic conditions, and recover from or prevent injury and chronic disease;(2) However, the prog…

(a) If authorized by a physician assistant's supervising physician, the Arkansas Medicaid Program shall recognize a physician assistant licensed by the Arkansas State Medical Board as a primary care provider authorized to carry out the following duties of a primary care case mana…

(a) As used in this section:(1) “Healthcare provider” means:(A) An oral and maxillofacial surgeon;(B) A dentist;(C) A dental specialist such as an endodontist, orthodontist, periodontist, or prosthodontist;(D) An anesthesiologist or other anesthesia provider;(E) A pediatric denti…

(a) The Arkansas Medicaid Program shall reimburse for the treatment of diseases and conditions caused by severe obesity. (b) The coverage under subsection (a) of this section shall include coverage for:(1) Bariatric surgery, as recognized by the American Society for Metabolic and…

(a) The General Assembly finds that:(1) Substance use disorder is a significant public health concern in this state;(2) Inpatient treatment for substance use disorders is an essential component of comprehensive care;(3) Currently, inpatient treatment for substance use disorder is…

(a) (1) The Arkansas Medicaid Program shall increase reimbursement rates for:(A) Oral and maxillofacial surgeons' dental services, including anesthesia;(B) Pediatric dental services, including anesthesia; and(C) Dental services for adults with special needs.(2) Beginning on Septe…

(a) The General Assembly finds that:(1) Healthcare providers who serve Medicaid recipients are an indispensable and vital link in serving this state's needy citizens; and(2) The Department of Human Services already has in place various provisions to:(A) Ensure the protection and …

(1) As used in this subchapter:(1) “Abuse” means a pattern of provider conduct that is inconsistent with sound fiscal, business, or medical practices and that results in:(A) An unnecessary cost to the Arkansas Medicaid Program; or(B) Reimbursement for services that are not medica…

(a) (1) The Department of Human Services shall not use a technical deficiency as grounds for recoupment unless identifying the technical deficiency as an overpayment is mandated by a specific federal statute or regulation or the state is required to repay the funds to the Centers…

(a) The General Assembly finds it necessary to:(1) Clarify its intent that providers have the right to administrative reconsideration and fair and impartial administrative appeals; and(2) Emphasize that this right of administrative reconsideration and appeal is to be liberally co…

(a) Each denial or other deficiency that the Department of Human Services makes against a Medicaid provider shall be prepared in writing and shall specify:(1) The nature of the adverse decision;(2) The statutory provision or specific rule alleged to have been violated; and(3) The…

(a) (1) (A) Subject to § 20-77-1707 for retrospective reviews, if the Department of Human Services has sufficient documentation to determine that some level of care other than the level that was claimed is medically necessary, then the department may recoup.(B) However, the provi…

(1) If the Department of Human Services requires a provider to justify the medical necessity of a service through prior authorization, the department shall not later take the position that the services were not medically necessary, unless the retrospective review establishes that…

(a) There is a presumption in favor of the medical judgment of the performing or prescribing physician in determining medical necessity of treatment. (b) If an administrative law judge finds that the Department of Human Services has overcome the presumption under subsection (a) o…

(a) The Department of Human Services may not use state policies, guidelines, manuals, or other such criteria in enforcement actions against providers unless the criteria have been promulgated. (b) Nothing in this section requires or authorizes the department to attempt to promulg…

(a) If the Department of Human Services makes an adverse decision in a Medicaid case and a provider then lodges an administrative appeal, the department shall deliver to the provider well in advance of the appeal its file on the matter so that the provider will have time to prepa…

(a) Except as provided in subsection (b) of this section, providers must supply records to the Department of Human Services at their own cost. (b) If the provider has supplied records to the department and the provider identifies to whom the records were supplied, the provider is…

(a) When the Department of Human Services sends letters or other forms of notice with deadlines to providers or recipients, the deadline shall not begin to run before the next business day following the date of the postmark on the envelope, the facsimile transmission confirmation…

(a) The Department of Human Services may not issue a claim denial or demand for recoupment to providers for missing a deadline if the department or its contractor contributed to the delay or the delay was reasonable under the circumstances, including, but not limited to:(1) Inter…

(a) When more than one (1) hospital provides services to a recipient and the amount of claims exceeds the recipient's benefit limit, then the hospitals are entitled to reimbursement based on the earliest date of service. (b) If the claims have been paid by Medicaid contrary to th…

(a) If any provision of this subchapter is found to conflict with current federal law, including promulgated federal regulations, the federal law shall override that provision. (b) If under Title XIX of the Social Security Act, 42 U.S.C. § 1396 et seq., or Title XXI of the Social…

The Department of Human Services may promulgate rules to implement this subchapter.

(a) If a Medicaid provider audit by the Medicaid Integrity Program or Audit Medicaid Integrity Contractors is conducted, the Department of Human Services or the contractor shall provide the audit report to the provider within one hundred fifty (150) days after the completion of t…