Title 20, Public Health and Welfare

(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) 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…

(a) A Medicaid provider that is aggrieved by an adverse decision of the Department of Human Services with respect to termination of the provider's certification or Medicaid provider agreement or an action by the department that has the same effect as terminating the provider's ce…

(a) The Department of Human Services shall publish and maintain all protocols, procedures, and requirements used in making adverse decisions on the website of the department. (b) The publication shall include:(1) The current version of each protocol, procedure, or requirement;(2)…

A third-party entity shall comply with the requirements in this subchapter, including appeal periods, notice requirements, and publication of protocols, procedures, and requirements.

The General Assembly finds that in order to alleviate the financial burden on the state's Medicaid program, the state must encourage better access to and utilization of affordable long-term care insurance that will pay for some or all of the cost of long-term care services.

(1) As used in this subchapter:(1) “Long-term care facility” means a facility required to be licensed under § 20-10-224;(2) “Long-term care insurance” means the same as in § 23-97-304; and(3) “Long-term care services” means the following necessary services that originate in a set…

(a) The Arkansas Long-Term Care Partnership Program is created within the Department of Human Services. (b) The Department of Human Services in cooperation with the Insurance Commissioner shall submit applications to the United States Department of Health and Human Services neces…

This subchapter does not supersede the obligations under the Long-Term Care Insurance Act of 2005, § 23-97-301 et seq.

If this subchapter is repealed, any Medicaid asset protection afforded under § 20-77-1803 shall remain effective for the life of the individual receiving long-term care services under this subchapter.

(1) As used in this subchapter:(1) “Division” means the Division of Medical Services of the Department of Human Services;(2) “Hospital” means a health care facility licensed as a hospital by the Division of Health Facilities Services under § 20-9-213;(3) “Medicare Cost Report” me…

(a) (1) An assessment is imposed on each hospital except those exempted under § 20-77-1905 for each state fiscal year in an amount calculated as a percentage of each hospital's net patient revenue.(2) The assessment rate shall be determined annually based upon the percentage of n…

(a) The Director of the Division of Medical Services of the Department of Human Services shall administer the assessment program created in this subchapter. (b) (1) The Division of Medical Services of the Department of Human Services shall adopt rules to implement this subchapter…

(a) (1) There is created within the Arkansas Medicaid Program Trust Fund a designated account known as the “Hospital Assessment Account”.(2) The hospital assessments imposed under § 20-77-1902 shall be deposited into the Hospital Assessment Account. (1) There is created within th…

(a) The following hospitals shall be exempt from the assessment imposed under § 20-77-1902 unless the exemption is adjudged to be unconstitutional or otherwise determined to be invalid:(1) Hospitals that are not privately operated hospitals;(2) Hospitals licensed by the Departmen…