Stricken language would be deleted from and underlined language would be added to present law.
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State of Arkansas 1
95th General Assembly A Bill 2
Regular Session, 2025 HOUSE BILL 1622 3
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By: Representatives Gramlich, L. Johnson 5
By: Senator J. Boyd 6
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For An Act To Be Entitled 8
AN ACT TO AMEND THE MEDICAID FAIRNESS ACT; TO MODIFY 9
THE DEFINITION OF "ADVERSE DECISION" UNDER THE 10
MEDICAID FAIRNESS ACT; TO PROVIDE FOR ADMINISTRATIVE 11
RECONSIDERATION UNDER THE MEDICAID FAIRNESS ACT; AND 12
FOR OTHER PURPOSES. 13
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Subtitle 16
TO AMEND THE MEDICAID FAIRNESS ACT; TO 17
MODIFY THE DEFINITION OF "ADVERSE 18
DECISION" UNDER THE MEDICAID FAIRNESS 19
ACT; AND TO PROVIDE FOR ADMINISTRATIVE 20
RECONSIDERATION UNDER THE MEDICAID 21
FAIRNESS ACT. 22
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BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF ARKANSAS: 24
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SECTION 1. Arkansas Code § 20-77-1702(2), concerning the definition of 26
"adverse decision" within the Medicaid Fairness Act, is amended to read as 27
follows: 28
(2)(A) “Adverse decision” means any decision by the Department 29
of Human Services or its reviewers or contractors that adversely affects a 30
Medicaid provider or recipient in regard to: 31
(i) Receipt of and payment for Medicaid claims and 32
services, including, but not limited to, decisions as to: 33
(a) Appropriate level of care or coding; 34
(b) Medical necessity; 35
(c) Prior authorization; 36 HB1622
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(d) Concurrent reviews; 1
(e) Retrospective reviews; 2
(f) Least restrictive setting; 3
(g) Desk audits; 4
(h) Field audits and onsite audits; and 5
(i) Inspections or surveys; and 6
(ii) Payment amounts due to or from a particular 7
provider resulting from gain sharing, risk sharing, incentive payments, or 8
another reimbursement mechanism or methodology, including calculations that 9
affect or have the potential to affect payment ; and 10
(iii) Corrective action plans . 11
(B) To constitute an adverse decision, an agency decision 12
need not have a monetary penalty attached but must have or a direct monetary 13
consequence to the provider. 14
(C) “Adverse decision” does not include the design of or 15
changes to an element of a reimbursement methodology or payment system that 16
is of general applicability and implemented through the rulemaking process; 17
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SECTION 2. Arkansas Code § 20 -77-1704(a) and (b), concerning the 19
allowance of a provider administrative appeal under the Medicaid Fairness 20
Act, are amended to read as follows: 21
(a) The General Assembly finds it necessary to: 22
(1) Clarify its intent that providers have the right to 23
administrative reconsideration and fair and impartial administrative appeals; 24
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(2) Emphasize that this right of administrative reconsideration 26
and appeal is to be liberally construed and not limited through technical or 27
procedural arguments by the Department of Human Services. 28
(b)(1)(A) In response to an adverse decision, a provider may request 29
an administrative reconsideration and may appeal on behalf of the recipient 30
or on its own behalf, or both, regardless of whether the provider is an 31
individual or a corporation. 32
(B)(i) A provider appeal shall be governed by the Arkansas 33
Administrative Procedure Act, § 25 -15-201 et seq., except as otherwise 34
provided in this subchapter. 35
(ii) Multiple appeals by the same provider may be 36 HB1622
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consolidated. 1
(C) An administrative law judge employed by the Department 2
of Health shall conduct all Medicaid provider administrative appeals of 3
adverse decisions under this subchapter. 4
(2) The provider may appear: 5
(A) In person or through a corporate representative; or 6
(B) With prior notice to the Department of Health, through 7
legal counsel. 8
(3)(A) A Medicaid recipient may attend any hearing related to 9
his or her care, but the Department of Health may not make his or her 10
participation a requirement for provider appeals. 11
(B) The Department of Health may compel the recipient's 12
presence via subpoena, but failure of the recipient to appear shall not 13
preclude the provider appeal. 14
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