Title 20, Public Health and Welfare

(a) The Division of Medical Services of the Department of Human Services shall file with the Centers for Medicare & Medicaid Services a state plan amendment to implement the requirements of this subchapter, including the payment of hospital access payments under § 20-77-1908, no …

(1) The General Assembly finds that:(1) Almost two-thirds (⅔) of the state's uninsured children are already eligible for either ARKids First A or B, but many are not enrolled or do not remain enrolled;(2) Twenty thousand (20,000) children annually are dropped from the ARKids Firs…

(a) In administering the ARKids First A and B programs, the Department of Human Services shall:(1) Work to increase enrollment among eligible uninsured children under nineteen (19) years of age;(2) Work to improve retention of coverage among eligible uninsured children under nine…

(a) The Department of Human Services shall perform the initiatives under subsection (b) of this section to increase ARKids First enrollment and renewals and position the state to compete for a performance bonus payment under the Children's Health Insurance Program Reauthorization…

(a) The Department of Human Services shall establish and maintain the Medicaid Eligibility Verification System that is designed to prevent fraud in the establishment and maintenance of Medicaid eligibility. (b) (1) In establishing the Medicaid Eligibility Verification System, the…

(a) Except when prohibited by federal law, the Department of Human Services shall adopt the following procedures to verify Medicaid eligibility for participation in the Arkansas Medicaid Program or receipt of benefits in the Arkansas Medicaid Program:(1) All conditions of eligibi…

(a) Unless required under federal law, the Department of Human Services shall not:(1) Designate itself as a qualified health entity for the purpose of making presumptive eligibility determinations or for any purpose not expressly authorized by state law;(2) Accept self-attestatio…

(a) The General Assembly finds that:(1) Although a direct-care worker in the State of Arkansas who serves a Medicaid-reimbursable client must undergo a forty-hour training program, a direct-care worker who serves a client in his or her home and who is not Medicaid-reimbursable ha…

(1) As used in this subchapter:(1) “Caregiver services” means services provided to an individual in the State of Arkansas to assist the recipient of the services in the activities of daily living, and the recipient of services is fifty (50) years of age or older at the time the s…

(a) A person who applies for employment to provide caregiver services in this state for compensation shall provide documentation to an in-home services agency of successful completion of training as a trained in-home assistant under this subchapter. (b) A person qualifies as a tr…

(1) An individual may provide caregiver services without the training required under this subchapter if the person is a:(1) Certified Nursing Assistant;(2) Licensed practical nurse;(3) Parent, grandparent, child, grandchild, or sibling of the recipient of the services;(4) Physici…

The Department of Health shall adopt rules to implement this subchapter.

(1) The purpose of this subchapter is to:(1) Consolidate staff and other Medicaid fraud detection, prevention, and recovery functions from the relevant governmental entities into a single office;(2) Create a more efficient and accountable structure;(3) Reorganize and streamline t…

(1) As used in this subchapter:(1) (A) “Abuse” means provider practices that are inconsistent with sound fiscal, business, or medical practices and result in an unnecessary cost to the Medicaid program or in reimbursement for services that are not medically necessary or that fail…

The Office of Medicaid Inspector General is created within the Department of Inspector General and is independent from the Department of Human Services.

(a) (1) The Medicaid Inspector General shall be appointed by the Governor, with the advice and consent of the Senate.(2) The inspector general shall serve at the pleasure of the Governor. (1) The Medicaid Inspector General shall be appointed by the Governor, with the advice and c…

(1) The Office of Medicaid Inspector General shall:(1) Prevent, detect, and investigate fraud and abuse within the medical assistance program;(2) Refer appropriate cases for criminal prosecution;(3) Recover improperly expended medical assistance funds;(4) Audit medical assistance…

(1) The Medicaid Inspector General shall, in consultation with the Secretary of the Department of Inspector General:(1) Hire deputies, directors, assistants, and other officers and employees needed for the performance of his or her duties and prescribe the duties of deputies, dir…

(a) (1) The Medicaid Inspector General shall request information, assistance, and cooperation from a federal, state, or local governmental department, board, bureau, commission, or other agency or unit of an agency to carry out the duties under this section.(2) A state or local a…

(a) The duties, functions, records, personnel, property, unexpended balances of appropriations, allocations, or other funds of the Department of Human Services necessary to the operations of the Office of Medicaid Inspector General under § 20-77-2505 are transferred to the office…

(a) The Medicaid Inspector General shall, no later than October 1 of each year, submit to the Secretary of the Department of Inspector General, the President Pro Tempore of the Senate, the Speaker of the House of Representatives, Arkansas Legislative Audit, the Legislative Counci…

(a) The Department of Human Services shall consult with the Office of Medicaid Inspector General regarding an activity undertaken by a fiscal intermediary or fiscal agent pertaining to suspected fraud, waste, or abuse. (b) The department, in consultation with the office, shall:(1…

(a) The General Assembly finds that:(1) Medical assistance providers potentially are able to detect and correct payment and billing mistakes and fraud if required to develop and implement compliance programs;(2) A provider compliance program makes it possible to organize provider…

The Medicaid Fairness Act, § 20-77-1701 et seq., applies to this subchapter.

(a) To realize savings to the Arkansas Medicaid Program and taxpayers as soon as possible, within ninety (90) days after July 1, 2014, the Office of Medicaid Inspector General shall establish a program known as the “Enterprise Fraud Program” that is focused on fraud, waste, abuse…

This act shall be known and may be cited as the “Arkansas Lay Caregiver Act”.

(1) As used in this subchapter:(1) “Aftercare” means assistance that:(A) Is provided by a caregiver to a patient after the discharge of the eligible patient from a hospital;(B) Is related to the condition of the patient at the time of discharge; and(C) Does not require a professi…

(a) (1) A hospital shall provide each patient or, if applicable, the patient's legal guardian, with an opportunity to designate a caregiver following the patient's admission into a hospital and before the discharge of the patient to the residence of the patient.(2) Before dischar…

(a) A caregiver designated under this subchapter shall not accept compensation in exchange for aftercare provided to the patient. (b) This subchapter does not prevent an individual who is a licensed medical professional under Arkansas Code Title 17, Subtitle 3, or has completed t…

(a) If a patient has designated a caregiver, the hospital shall notify the designated caregiver of the patient concerning the discharge or transfer of the patient to another licensed facility as soon as possible before discharge or transfer. (b) In the event that the hospital is …

(a) (1) As soon as practicable before the discharge of the patient, the hospital shall attempt to consult with the designated caregiver to prepare the caregiver to provide for the aftercare needs of the patient.(2) As part of the consultation under subdivision (a)(1) of this sect…

(a) This subchapter shall not:(1) Confer upon the caregiver any authority to make healthcare decisions on behalf of the patient;(2) Create a private right of action against a hospital, hospital employee, or duly authorized agent of the hospital; or(3) Remove the obligation of a t…

This subchapter shall be known and may be cited as the “Medicaid Provider-Led Organized Care Act”.

(a) As the single state agency for administration of the medical assistance programs established under Title XIX of the Social Security Act, 42 U.S.C. § 1396 et seq., and Title XXI of the Social Security Act, 42 U.S.C. § 1397aa et seq., the Department of Human Services is authori…

(1) As used in this subchapter:(1) “Associated participant” means an organization or individual that is a member or contractor of a risk-based provider organization and provides necessary administrative functions, including without limitation claims processing, data collection, a…

(a) The Insurance Commissioner may license for participation in the Medicaid provider-led organized care system one (1) or more risk-based provider organizations that satisfactorily meet licensure requirements and are capable of coordinating the delivery and payment of healthcare…

(a) Except as provided in subsection (b) of this section, all healthcare services delivered through the Medicaid provider-led organized care system shall:(1) Be available for all members of covered Medicaid beneficiary populations; and(2) Be comparable in amount, duration, or sco…

(a) A risk-based provider organization shall:(1) Be authorized to conduct business in the state;(2) Hold a valid certificate of authority issued by the Secretary of State;(3) Have an ownership interest of not less than fifty-one percent (51%) by participating providers; and(4) In…

(a) (1) On a quarterly basis, a risk-based provider organization shall submit to the Department of Human Services protected health information for each member of a covered Medicaid beneficiary population and a voluntary Medicaid beneficiary population enrolled with the risk-based…

(1) The Department of Human Services:(1) Shall submit an application for any federal waivers, federal authority, or state plan amendments necessary to implement this subchapter; and(2) May promulgate rules as necessary to implement this subchapter. (1) Shall submit an application…

(a) It is the intent of the General Assembly to ensure that potential and actual enrollees in a risk-based provider organization have a right to know:(1) Whether a direct service provider is or will be in-network with a particular risk-based provider organization; and(2) The cons…

(a) The Department of Human Services shall implement an abbreviated independent assessment process for beneficiaries who have been previously approved for services through an independent assessment, including without limitation a desk review, for beneficiaries who have chronic, l…

(a) The risk-based provider organizations shall have a basic quality rating system that is accessible online that includes ratings for each risk-based provider organization based on data that includes at a minimum the following measures that are currently collected by the risk-ba…

(a) Each risk-based provider organization shall provide to enrollees real-time access to its provider network directory through a link on the website of the Department of Human Services and on the website of the risk-based provider organization. (b) The risk-based provider organi…

(a) The Department of Human Services shall have a dedicated beneficiary support system that is adequately staffed and trained to meet the requirements of 42 C.F.R. § 438.71, as existing on January 1, 2025. (b) Enrollees and other members of the public shall be able to easily cont…

(a) (1) An allowance within the capitation rates for a risk-based provider organization shall not be less than the amount needed to pay providers the rates arrived at through a rate study to be completed by October 1, 2025.(2) The rates from a rate study as described in subdivisi…