Arkansas 2025 Regular Session

Arkansas House Bill HB1622 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1	1		Stricken language would be deleted from and underlined language would be added to present law.
2		-	Act 635 of the Regular Session
3		-	JMB333 03-17-2025 12:00:57 JMB333
4		-
5		-	State of Arkansas As Engrossed: H3/17/25 1
	2	+	JMB333 02/27/2025 2:29:14 PM JMB333
	3	+	State of Arkansas 1
6	4		95th General Assembly A Bill 2
7	5		Regular Session, 2025 HOUSE BILL 1622 3
8	6		4
9	7		By: Representatives Gramlich, L. Johnson 5
10	8		By: Senator J. Boyd 6
11	9		7
12	10		For An Act To Be Entitled 8
13	11		AN ACT TO AMEND THE MEDICAID FAIRNESS ACT; TO MODIFY 9
14	12		THE DEFINITION OF "ADVERSE DECISION" UNDER THE 10
15	13		MEDICAID FAIRNESS ACT; TO PROVIDE FOR ADMINISTRATIVE 11
16	14		RECONSIDERATION UNDER THE MEDICAID FAIRNESS ACT; AND 12
17	15		FOR OTHER PURPOSES. 13
18	16		14
19	17		15
20	18		Subtitle 16
21	19		TO AMEND THE MEDICAID FAIRNESS ACT; TO 17
22	20		MODIFY THE DEFINITION OF "ADVERSE 18
23	21		DECISION" UNDER THE MEDICAID FAIRNESS 19
24	22		ACT; AND TO PROVIDE FOR ADMINISTRATIVE 20
25	23		RECONSIDERATION UNDER THE MEDICAID 21
26	24		FAIRNESS ACT. 22
27	25		23
28	26		BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF ARKANSAS: 24
29	27		25
30	28		SECTION 1. Arkansas Code § 20-77-1702(2), concerning the definition of 26
31	29		"adverse decision" within the Medicaid Fairness Act, is amended to read as 27
32	30		follows: 28
33	31		(2)(A) “Adverse decision” means any decision by the Department 29
34	32		of Human Services or its reviewers or contractors that adversely affects a 30
35	33		Medicaid provider or recipient in regard to: 31
36	34		(i) Receipt of and payment for Medicaid claims and 32
37	35		services, including, but not limited to, decisions as to: 33
38	36		(a) Appropriate level of care or coding; 34
39	37		(b) Medical necessity; 35
40		-	(c) Prior authorization; 36 ~~As Engrossed: H3/17/25~~ HB1622
	38	+	(c) Prior authorization; 36 HB1622
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44		-
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45	41		(d) Concurrent reviews; 1
46	42		(e) Retrospective reviews; 2
47	43		(f) Least restrictive setting; 3
48	44		(g) Desk audits; 4
49	45		(h) Field audits and onsite audits; and 5
50	46		(i) Inspections or surveys; and 6
51	47		(ii) Payment amounts due to or from a particular 7
52	48		provider resulting from gain sharing, risk sharing, incentive payments, or 8
53	49		another reimbursement mechanism or methodology, including calculations that 9
54	50		affect or have the potential to affect payment ; and 10
55		-	(iii) ~~Imposition of~~ corrective action plans. 11
	51	+	(iii) Corrective action plans . 11
56	52		(B) To constitute an adverse decision, an agency decision 12
57	53		need not have a monetary penalty attached but must have or a direct monetary 13
58	54		consequence to the provider. 14
59	55		(C) “Adverse decision” does not include the design of or 15
60	56		changes to an element of a reimbursement methodology or payment system that 16
61	57		is of general applicability and implemented through the rulemaking process; 17
62	58		18
63	59		SECTION 2. Arkansas Code § 20 -77-1704(a) and (b), concerning the 19
64	60		allowance of a provider administrative appeal under the Medicaid Fairness 20
65	61		Act, are amended to read as follows: 21
66	62		(a) The General Assembly finds it necessary to: 22
67	63		(1) Clarify its intent that providers have the right to 23
68	64		administrative reconsideration and fair and impartial administrative appeals; 24
69	65		and 25
70	66		(2) Emphasize that this right of administrative reconsideration 26
71	67		and appeal is to be liberally construed and not limited through technical or 27
72	68		procedural arguments by the Department of Human Services. 28
73	69		(b)(1)(A) In response to an adverse decision, a provider may request 29
74		-	an administrative reconsideration ~~with~~ the ~~Department of Human Services and~~ 30
75		-	~~may appeal to~~ the ~~Office of Medicaid~~ Provider ~~Appeals with the Department of~~ 31
76		-	~~Health on behalf of the recipient~~ or ~~on its own behalf, or both, regardless~~ 32
77		-	~~of whether~~ the ~~provider is an individual or a corporation.~~ 33
78		-	~~(B)(i) A provider appeal shall be governed by the Arkansas~~ 34
79		-	~~Administrative Procedure Act,~~ ~~§ 25 -15-201 et seq~~.~~, except as otherwise~~ 35
80		-	~~provided in this subchapter.~~ 36 ~~As Engrossed: H3/17/25~~ HB1622
	70	+	an administrative reconsideration and may appeal on behalf of the recipient 30
	71	+	or on its own behalf, or both, regardless of whether the provider is an 31
	72	+	individual or a corporation. 32
	73	+	(B)(i) A provider appeal shall be governed by the Arkansas 33
	74	+	Administrative Procedure Act, § 25 -15-201 et seq., except as otherwise 34
	75	+	provided in this subchapter. 35
	76	+	(ii) Multiple appeals by the same provider may be 36 HB1622
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83		-
84		-
85		-	(ii) Multiple appeals by the same provider may be 1
86		-	consolidated. 2
87		-	(C) An administrative law judge employed by the Department 3
88		-	of Health shall conduct all Medicaid provider administrative appeals of 4
89		-	adverse decisions under this subchapter. 5
90		-	(2) The provider may appear: 6
91		-	(A) In person or through a corporate representative; or 7
92		-	(B) With prior notice to the Department of Health, through 8
93		-	legal counsel. 9
94		-	(3)(A) A Medicaid recipient may attend any hearing related to 10
95		-	his or her care, but the Department of Health may not make his or her 11
96		-	participation a requirement for provider appeals. 12
97		-	(B) The Department of Health may compel the recipient's 13
98		-	presence via subpoena, but failure of the recipient to appear shall not 14
99		-	preclude the provider appeal. 15
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	79	+	consolidated. 1
	80	+	(C) An administrative law judge employed by the Department 2
	81	+	of Health shall conduct all Medicaid provider administrative appeals of 3
	82	+	adverse decisions under this subchapter. 4
	83	+	(2) The provider may appear: 5
	84	+	(A) In person or through a corporate representative; or 6
	85	+	(B) With prior notice to the Department of Health, through 7
	86	+	legal counsel. 8
	87	+	(3)(A) A Medicaid recipient may attend any hearing related to 9
	88	+	his or her care, but the Department of Health may not make his or her 10
	89	+	participation a requirement for provider appeals. 11
	90	+	(B) The Department of Health may compel the recipient's 12
	91	+	presence via subpoena, but failure of the recipient to appear shall not 13
	92	+	preclude the provider appeal. 14
	93	+	15
100	94		16
101		-	~~/s/Gramlich~~ 17
	95	+	17
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103	97		19
104		-	~~APPROVED: 4/16/25~~ 20
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