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Arkansas House Bill HB1818

Arkansas 2025 Regular Session

Arkansas House Bill HB1818 Compare Versions

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11 Stricken language would be deleted from and underlined language would be added to present law.
22 *JMB530* 03/17/2025 8:53:04 AM JMB530
33 State of Arkansas 1
44 95th General Assembly A Bill 2
55 Regular Session, 2025 HOUSE BILL 1818 3
66 4
77 By: Representative L. Johnson 5
88 By: Senator B. Davis 6
99 7
1010 For An Act To Be Entitled 8
1111 AN ACT TO CREATE THE MEDICAID PROVIDER -LED CARE 9
1212 TRANSPARENCY AND ACCOUNTABILITY ACT; AND FOR OTHER 10
1313 PURPOSES. 11
1414 12
1515 13
1616 Subtitle 14
1717 TO CREATE THE MEDICAID PROVIDER -LED CARE 15
1818 TRANSPARENCY AND ACCOUNTABILITY ACT. 16
1919 17
2020 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF ARKANSAS: 18
2121 19
2222 SECTION 1. Arkansas Code Title 20, Chapter 77 is amended to add an 20
2323 additional subchapter to read as follows: 21
2424 22
2525 Subchapter 30 — Medicaid Provider-Led Care Transparency and Accountability 23
2626 Act 24
2727 25
2828 20-77-3001. Title 26
2929 This subchapter shall be known and may be cited as the "Medicaid 27
3030 Provider-Led Care Transparency and Accountability Act". 28
3131 29
3232 20-77-3002. Workgroup for risk -based provider organization quality and 30
3333 effectiveness of care. 31
3434 (a) The Department of Human Services shall create a workgroup 32
3535 comprised of representatives of Medicaid beneficiaries who are enrolled with 33
3636 a risk-based provider organization and providers for intellectual and 34
3737 developmental disabilities and behavioral health services to help develop 35
3838 appropriate standards for risk -based provider organizations to follow to 36 HB1818
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4141 improve the quality and effectiveness of care. 1
4242 (b) The workgroup described in this section may be a subcommittee of 2
4343 the Medicaid Advisory Committee. 3
4444 4
4545 20-77-3003. Care coordination. 5
4646 (a) A risk-based provider organization shall pay a direct service 6
4747 provider for care coordination from the capitated rate that the Department of 7
4848 Human Services pays the risk -based provider organization. 8
4949 (b) A risk-based provider organization may subcontract with direct 9
5050 service providers, with appropriate compensation, any care coordination 10
5151 duties assigned to the risk -based provider organization as long as the 11
5252 assignment does not include the federal conflict -free functions that include 12
5353 eligibility evaluations, assessments of functional needs, and person -centered 13
5454 care plan development. 14
5555 (c) In consultation with the workgroup established under § 20 -77-3002, 15
5656 a risk-based provider organization shall develop enhanced education and 16
5757 training for care coordinators, including behavior supports. 17
5858 (d) A care coordinator of a risk -based provider organization shall 18
5959 ensure that meetings for development of person -centered service plans align 19
6060 with provider care plan renewal dates except when unavoidable. 20
6161 21
6262 20-77-3004. Gag clause prohibited. 22
6363 (a) A risk-based provider organization or affiliated entity shall not 23
6464 prohibit a direct service provider who is an investor in the risk -based 24
6565 provider organization or an affiliated entity from taking positions or 25
6666 advocating publicly on agency rules, legislation, or other matters of public 26
6767 interest that conflict with the position or interests of the risk -based 27
6868 provider organization. 28
6969 (b) If a contract between a risk -based provider organization and a 29
7070 direct service provider contains a provision that conflicts with subsection 30
7171 (a) of this section, the provision of the contract is void. 31
7272 32
7373 20-77-3005. Quality initiatives. 33
7474 (a) The Department of Human Services shall require a contracted 34
7575 external quality review organization to collect data with specific quality 35
7676 metrics for risk-based provider organizations aimed at improving services for 36 HB1818
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7979 individuals with intellectual and developmental disabilities, including 1
8080 appropriate measures from the Home - and Community-Based Services Quality 2
8181 Measure Set. 3
8282 (b) The contracted external quality review organization shall consult 4
8383 with the workgroup established under § 20 -77-3002. 5
8484 (c)(1) For individuals diagnosed with an intellectual or developmental 6
8585 disability, the department shall require a risk -based provider organizations 7
8686 to initiates services through an intellectual or developmental disability 8
8787 services provider within sixty (60) days of the individual’s assignment to a 9
8888 risk-based provider organization. 10
8989 (2) If the risk-based provider organization does not comply with 11
9090 subdivision (c)(1) of this section, the department shall impose penalties 12
9191 upon the risk-based provider organization. 13
9292 (d)(1) The department shall authorize the use of assistive and 14
9393 enabling technology, including smart home technology, as a recognized service 15
9494 delivery method for home - and community-based services. 16
9595 (2) The authorization under subdivision (d)(1) of this section 17
9696 shall extend to the provision of services through remote staffing models 18
9797 where appropriate and in accordance with applicable rules. 19
9898 (e) In consultation with the workgroup, the department shall 20
9999 establish: 21
100100 (1) Value-based payment initiatives for intellectual and 22
101101 developmental disabilities and behavioral health providers who meet quality 23
102102 of care targets; 24
103103 (2) New evidence-based treatment services to aid high-utilizing 25
104104 members assessed with behavioral health needs to access appropriate care; and 26
105105 (3) A non-medical transportation billing code or modifier for 27
106106 use under supported employment categories separate from transportation under 28
107107 supported living categories. 29
108108 (f) In recognition of the higher intensity of services required by 30
109109 individuals with complex conditions in the Community Support System Provider 31
110110 Program, a risk-based provider organization shall determine appropriate 32
111111 direct service provider rates for services required by individuals with 33
112112 complex conditions in the Community Support System Provider Program rather 34
113113 than defaulting to supported living category rates. 35
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117117 20-77-3006. Credentialing. 1
118118 (a) The Department of Human Services shall require the risk -based 2
119119 provider organizations to standardize credentialing across all risk -based 3
120120 provider organizations. 4
121121 (b)(1) A risk-based provider organization shall obtain credentialing 5
122122 information on therapists, including speech -language therapists, physical 6
123123 therapists, occupational therapists, and board -certified behavior analysists, 7
124124 through the Medicaid portal where providers enter credentialing information. 8
125125 (2) If additional information is required, a risk -based provider 9
126126 organization shall use the Council for Affordable Quality Healthcare National 10
127127 Database to obtain the additional information. 11
128128 12
129129 20-77-3007. Audit fairness. 13
130130 (a) The Department of Human Services, risk -based provider 14
131131 organizations, and contracted entities conducting audits of providers shall 15
132132 establish secure online portals for providers to submit information and may 16
133133 not make duplicate requests. 17
134134 (b) Until the portal is established or if the portal is down, a risk -18
135135 based provider organization shall cover the provider’s reasonable costs of 19
136136 copying records at no less than twenty cents ($0.20) per page, plus postage 20
137137 and shipping costs. 21
138138 (c) A risk-based provider organization shall: 22
139139 (1) Make no more than two (2) audit requests per calendar year 23
140140 from a direct service provider unless a complaint has been lodged or there is 24
141141 reasonable suspicion of fraud or abuse; 25
142142 (2) Allow a provider at least sixty (60) days to supply records 26
143143 requested by the risk -based provider organization, except in an emergency; 27
144144 and 28
145145 (3) Allow a provider at least sixty (60) days following receipt 29
146146 of the preliminary audit report in which to produce documentation to address 30
147147 any discrepancy found during the audit. 31
148148 (d) The period covered by an audit shall not exceed twelve (12) months 32
149149 from the date the claim was submitted to a risk -based provider organization. 33
150150 (e) The Medicaid Fairness Act, § 20 -77-1701 et seq., shall continue to 34
151151 apply to the risk-based provider organizations. 35
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155155 20-77-3008. Transparency and reporting. 1
156156 (a)(1)(A) Annually on or before March 1, a risk -based provider 2
157157 organization shall file with the Department of Human Services a full and true 3
158158 statement of the financial condition, transactions, and affairs of the risk -4
159159 based provider organization as of December 31 of the preceding year. 5
160160 (B) The department may grant an extension of time to file 6
161161 the statement required under subdivision (a)(1)(A) of this section for good 7
162162 cause if a written application for an extension of time is received at least 8
163163 five (5) business days before the filing due date. 9
164164 (2) The statement required under subdivision (a)(1)(A) of this 10
165165 section shall: 11
166166 (A) Be prepared according to the companion National 12
167167 Association of Insurance Commissioners’ Annual and Quarterly Statement 13
168168 Instructions and follow those accounting principles and procedures prescribed 14
169169 by the companion National Association of Insurance Commissioners’ Accounting 15
170170 Practices and Procedures Manual; and 16
171171 (B) Include the following information of the risk -based 17
172172 provider organization: 18
173173 (A) Total assets; 19
174174 (B) Total liabilities; 20
175175 (C) Total reserves; 21
176176 (D) Net premium income; 22
177177 (E) Total claims paid; 23
178178 (F) Total claims denied; 24
179179 (G) Payments to or from the state under a risk 25
180180 corridor; 26
181181 (H) The amount paid by the Arkansas Medicaid Program 27
182182 to the risk-based provider organization for the previous period of January 1 28
183183 through December 31; 29
184184 (I) The amount that the risk -based provider 30
185185 organization paid to in -network providers from the previous period of January 31
186186 1 through December 31; 32
187187 (J) The amount that the risk -based provider 33
188188 organization paid to out -of-network providers from the previous period of 34
189189 January 1 through December 31; 35
190190 (K) A list of any underwriting, auditing, actuarial, 36 HB1818
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193193 financial analysis, treasury, and investment expenses; 1
194194 (L) A list of any marketing and sales expenses, 2
195195 including without limitation advertising, member relations, member 3
196196 enrollment, and all expenses associated with producers, brokers, and benefit 4
197197 consultants; 5
198198 (M) A list of any claims operations expenses, 6
199199 including without limitation expenses for adjudication, appeals, settlements, 7
200200 and expenses associated with paying claims; 8
201201 (N) A list of any medical administration expenses, 9
202202 including without limitation disease management, utilization review, and 10
203203 medical management; 11
204204 (O) A list of any network operations expenses, 12
205205 including without limitation expenses for contracting, hospital and physician 13
206206 relations, and medical policy procedures; 14
207207 (P) A list of any charitable expenses, including 15
208208 without limitation contributions to tax -exempt foundations and community 16
209209 benefits; 17
210210 (Q) The amount of state insurance premium taxes 18
211211 paid; 19
212212 (R) The fees related to depreciation; 20
213213 (S) A list of miscellaneous expenses described in 21
214214 detail by expense, including any expense not previously included in this 22
215215 section; and 23
216216 (T) Any other information required by the 24
217217 department. 25
218218 (b) A risk-based provider organizations shall file an executive 26
219219 summary of the statement required under subdivision (a)(1)(A) of this section 27
220220 with: 28
221221 (1) The House Committee on Public Health, Welfare, and Labor; 29
222222 and 30
223223 (2) The Senate Committee on Public Health, Welfare, and Labor. 31
224224 (c) Annually, between thirty (30) and sixty (60) days before the 32
225225 initial date of open enrollment in a risk -based provider organization, a 33
226226 risk-based provider organization shall prominently display on its website the 34
227227 report required under subdivision (a)(1)(A) of this section and the executive 35
228228 summary of the report required under subdivision (b) of this section. 36 HB1818
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231231 1
232232 20-77-3009. Legislative oversight. 2
233233 (a) Before submitting the quarterly reports required under § 20 -77-3
234234 2707 to the Legislative Council, the Department of Human Services shall 4
235235 submit the quarterly reports required under § 20 -77-2707 for review to: 5
236236 (1) The Senate Committee on Public Health, Welfare, and Labor; 6
237237 and 7
238238 (2) The House Committee on Public Health, Welfare, and Labor. 8
239239 (b) The Senate Committee on Public Health, Welfare, and Labor and the 9
240240 House Committee on Public Health, Welfare, and Labor shall jointly provide 10
241241 ongoing oversight of the Medicaid Provider -Led Organized Care Act, § 20 -77-11
242242 2701 et seq. 12
243243 (c)(1) The department shall commission an annual actuarial report 13
244244 concerning rate setting for risk -based provider organizations that addresses 14
245245 the projected costs and necessary rates for direct service providers as part 15
246246 of the capitated rate development to the same extent as the annual actuarial 16
247247 report addresses costs and other allowances for the risk -based provider 17
248248 organizations. 18
249249 (2) The Legislative Council, or the Joint Budget Committee if 19
250250 the General Assembly is in session, shall favorably review the annual 20
251251 actuarial report under subdivision (c)(1) of this section before submission 21
252252 to the Centers for Medicare & Medicaid Services. 22
253253 23
254254 20-77-3010. Private right of action. 24
255255 An enrollee or direct service provider may file suit for equitable 25
256256 relief against the Department of Human Services or a risk -based provider 26
257257 organization in a court of competent jurisdiction and is entitled to collect 27
258258 reasonable attorneys’ fees and costs. 28
259259 29
260260 20-77-3010. Rules. 30
261261 The Department of Human Services may promulgate rules to implement this 31
262262 subchapter. 32
263263 33
264264 SECTION 2. DO NOT CODIFY. SEVERABILITY CLAUSE. If any provision of 34
265265 this act or the application of this act to any person or circumstance is held 35
266266 invalid, the invalidity shall not affect other provisions or applications of 36 HB1818
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269269 this act which can be given effect without the invalid provision or 1
270270 application, and to this end, the provisions of this act are declared 2
271271 severable. 3
272272 4
273273 SECTION 3. DO NOT CODIFY. TEMPORARY LANGUAGE. Implementation of this 5
274274 act. 6
275275 (a) The requirements in § 20 -77-3004(a) shall begin on January 1, 7
276276 2026. 8
277277 (b) Within sixty (60) days of the effective date of this subchapter, 9
278278 the department shall submit all required applications, amendments, and 10
279279 supporting documentation to the Centers for Medicare & Medicaid Services for 11
280280 approval to ensure compliance with federal requirements and facilitate the 12
281281 implementation of these service delivery methods, including without 13
282282 limitation: 14
283283 (1) An amendment to the state Medicaid plan; and 15
284284 (2) Any necessary modifications to existing waiver programs. 16
285285 (c) The initial standardization of credentialing under § 20 -77-3007(a) 17
286286 shall occur within three (3) months of the effective date of this act. 18
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