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 1818 3
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By: Representative L. Johnson 5
By: Senator B. Davis 6
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For An Act To Be Entitled 8
AN ACT TO CREATE THE MEDICAID PROVIDER -LED CARE 9
TRANSPARENCY AND ACCOUNTABILITY ACT; AND FOR OTHER 10
PURPOSES. 11
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Subtitle 14
TO CREATE THE MEDICAID PROVIDER -LED CARE 15
TRANSPARENCY AND ACCOUNTABILITY ACT. 16
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BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF ARKANSAS: 18
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SECTION 1. Arkansas Code Title 20, Chapter 77 is amended to add an 20
additional subchapter to read as follows: 21
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Subchapter 30 — Medicaid Provider-Led Care Transparency and Accountability 23
Act 24
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20-77-3001. Title 26
This subchapter shall be known and may be cited as the "Medicaid 27
Provider-Led Care Transparency and Accountability Act". 28
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20-77-3002. Workgroup for risk -based provider organization quality and 30
effectiveness of care. 31
(a) The Department of Human Services shall create a workgroup 32
comprised of representatives of Medicaid beneficiaries who are enrolled with 33
a risk-based provider organization and providers for intellectual and 34
developmental disabilities and behavioral health services to help develop 35
appropriate standards for risk -based provider organizations to follow to 36 HB1818
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improve the quality and effectiveness of care. 1
(b) The workgroup described in this section may be a subcommittee of 2
the Medicaid Advisory Committee. 3
4
20-77-3003. Care coordination. 5
(a) A risk-based provider organization shall pay a direct service 6
provider for care coordination from the capitated rate that the Department of 7
Human Services pays the risk -based provider organization. 8
(b) A risk-based provider organization may subcontract with direct 9
service providers, with appropriate compensation, any care coordination 10
duties assigned to the risk -based provider organization as long as the 11
assignment does not include the federal conflict -free functions that include 12
eligibility evaluations, assessments of functional needs, and person -centered 13
care plan development. 14
(c) In consultation with the workgroup established under § 20 -77-3002, 15
a risk-based provider organization shall develop enhanced education and 16
training for care coordinators, including behavior supports. 17
(d) A care coordinator of a risk -based provider organization shall 18
ensure that meetings for development of person -centered service plans align 19
with provider care plan renewal dates except when unavoidable. 20
21
20-77-3004. Gag clause prohibited. 22
(a) A risk-based provider organization or affiliated entity shall not 23
prohibit a direct service provider who is an investor in the risk -based 24
provider organization or an affiliated entity from taking positions or 25
advocating publicly on agency rules, legislation, or other matters of public 26
interest that conflict with the position or interests of the risk -based 27
provider organization. 28
(b) If a contract between a risk -based provider organization and a 29
direct service provider contains a provision that conflicts with subsection 30
(a) of this section, the provision of the contract is void. 31
32
20-77-3005. Quality initiatives. 33
(a) The Department of Human Services shall require a contracted 34
external quality review organization to collect data with specific quality 35
metrics for risk-based provider organizations aimed at improving services for 36 HB1818
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individuals with intellectual and developmental disabilities, including 1
appropriate measures from the Home - and Community-Based Services Quality 2
Measure Set. 3
(b) The contracted external quality review organization shall consult 4
with the workgroup established under § 20 -77-3002. 5
(c)(1) For individuals diagnosed with an intellectual or developmental 6
disability, the department shall require a risk -based provider organizations 7
to initiates services through an intellectual or developmental disability 8
services provider within sixty (60) days of the individual’s assignment to a 9
risk-based provider organization. 10
(2) If the risk-based provider organization does not comply with 11
subdivision (c)(1) of this section, the department shall impose penalties 12
upon the risk-based provider organization. 13
(d)(1) The department shall authorize the use of assistive and 14
enabling technology, including smart home technology, as a recognized service 15
delivery method for home - and community-based services. 16
(2) The authorization under subdivision (d)(1) of this section 17
shall extend to the provision of services through remote staffing models 18
where appropriate and in accordance with applicable rules. 19
(e) In consultation with the workgroup, the department shall 20
establish: 21
(1) Value-based payment initiatives for intellectual and 22
developmental disabilities and behavioral health providers who meet quality 23
of care targets; 24
(2) New evidence-based treatment services to aid high-utilizing 25
members assessed with behavioral health needs to access appropriate care; and 26
(3) A non-medical transportation billing code or modifier for 27
use under supported employment categories separate from transportation under 28
supported living categories. 29
(f) In recognition of the higher intensity of services required by 30
individuals with complex conditions in the Community Support System Provider 31
Program, a risk-based provider organization shall determine appropriate 32
direct service provider rates for services required by individuals with 33
complex conditions in the Community Support System Provider Program rather 34
than defaulting to supported living category rates. 35
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20-77-3006. Credentialing. 1
(a) The Department of Human Services shall require the risk -based 2
provider organizations to standardize credentialing across all risk -based 3
provider organizations. 4
(b)(1) A risk-based provider organization shall obtain credentialing 5
information on therapists, including speech -language therapists, physical 6
therapists, occupational therapists, and board -certified behavior analysists, 7
through the Medicaid portal where providers enter credentialing information. 8
(2) If additional information is required, a risk -based provider 9
organization shall use the Council for Affordable Quality Healthcare National 10
Database to obtain the additional information. 11
12
20-77-3007. Audit fairness. 13
(a) The Department of Human Services, risk -based provider 14
organizations, and contracted entities conducting audits of providers shall 15
establish secure online portals for providers to submit information and may 16
not make duplicate requests. 17
(b) Until the portal is established or if the portal is down, a risk -18
based provider organization shall cover the provider’s reasonable costs of 19
copying records at no less than twenty cents ($0.20) per page, plus postage 20
and shipping costs. 21
(c) A risk-based provider organization shall: 22
(1) Make no more than two (2) audit requests per calendar year 23
from a direct service provider unless a complaint has been lodged or there is 24
reasonable suspicion of fraud or abuse; 25
(2) Allow a provider at least sixty (60) days to supply records 26
requested by the risk -based provider organization, except in an emergency; 27
and 28
(3) Allow a provider at least sixty (60) days following receipt 29
of the preliminary audit report in which to produce documentation to address 30
any discrepancy found during the audit. 31
(d) The period covered by an audit shall not exceed twelve (12) months 32
from the date the claim was submitted to a risk -based provider organization. 33
(e) The Medicaid Fairness Act, § 20 -77-1701 et seq., shall continue to 34
apply to the risk-based provider organizations. 35
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20-77-3008. Transparency and reporting. 1
(a)(1)(A) Annually on or before March 1, a risk -based provider 2
organization shall file with the Department of Human Services a full and true 3
statement of the financial condition, transactions, and affairs of the risk -4
based provider organization as of December 31 of the preceding year. 5
(B) The department may grant an extension of time to file 6
the statement required under subdivision (a)(1)(A) of this section for good 7
cause if a written application for an extension of time is received at least 8
five (5) business days before the filing due date. 9
(2) The statement required under subdivision (a)(1)(A) of this 10
section shall: 11
(A) Be prepared according to the companion National 12
Association of Insurance Commissioners’ Annual and Quarterly Statement 13
Instructions and follow those accounting principles and procedures prescribed 14
by the companion National Association of Insurance Commissioners’ Accounting 15
Practices and Procedures Manual; and 16
(B) Include the following information of the risk -based 17
provider organization: 18
(A) Total assets; 19
(B) Total liabilities; 20
(C) Total reserves; 21
(D) Net premium income; 22
(E) Total claims paid; 23
(F) Total claims denied; 24
(G) Payments to or from the state under a risk 25
corridor; 26
(H) The amount paid by the Arkansas Medicaid Program 27
to the risk-based provider organization for the previous period of January 1 28
through December 31; 29
(I) The amount that the risk -based provider 30
organization paid to in -network providers from the previous period of January 31
1 through December 31; 32
(J) The amount that the risk -based provider 33
organization paid to out -of-network providers from the previous period of 34
January 1 through December 31; 35
(K) A list of any underwriting, auditing, actuarial, 36 HB1818
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financial analysis, treasury, and investment expenses; 1
(L) A list of any marketing and sales expenses, 2
including without limitation advertising, member relations, member 3
enrollment, and all expenses associated with producers, brokers, and benefit 4
consultants; 5
(M) A list of any claims operations expenses, 6
including without limitation expenses for adjudication, appeals, settlements, 7
and expenses associated with paying claims; 8
(N) A list of any medical administration expenses, 9
including without limitation disease management, utilization review, and 10
medical management; 11
(O) A list of any network operations expenses, 12
including without limitation expenses for contracting, hospital and physician 13
relations, and medical policy procedures; 14
(P) A list of any charitable expenses, including 15
without limitation contributions to tax -exempt foundations and community 16
benefits; 17
(Q) The amount of state insurance premium taxes 18
paid; 19
(R) The fees related to depreciation; 20
(S) A list of miscellaneous expenses described in 21
detail by expense, including any expense not previously included in this 22
section; and 23
(T) Any other information required by the 24
department. 25
(b) A risk-based provider organizations shall file an executive 26
summary of the statement required under subdivision (a)(1)(A) of this section 27
with: 28
(1) The House Committee on Public Health, Welfare, and Labor; 29
and 30
(2) The Senate Committee on Public Health, Welfare, and Labor. 31
(c) Annually, between thirty (30) and sixty (60) days before the 32
initial date of open enrollment in a risk -based provider organization, a 33
risk-based provider organization shall prominently display on its website the 34
report required under subdivision (a)(1)(A) of this section and the executive 35
summary of the report required under subdivision (b) of this section. 36 HB1818
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1
20-77-3009. Legislative oversight. 2
(a) Before submitting the quarterly reports required under § 20 -77-3
2707 to the Legislative Council, the Department of Human Services shall 4
submit the quarterly reports required under § 20 -77-2707 for review to: 5
(1) The Senate Committee on Public Health, Welfare, and Labor; 6
and 7
(2) The House Committee on Public Health, Welfare, and Labor. 8
(b) The Senate Committee on Public Health, Welfare, and Labor and the 9
House Committee on Public Health, Welfare, and Labor shall jointly provide 10
ongoing oversight of the Medicaid Provider -Led Organized Care Act, § 20 -77-11
2701 et seq. 12
(c)(1) The department shall commission an annual actuarial report 13
concerning rate setting for risk -based provider organizations that addresses 14
the projected costs and necessary rates for direct service providers as part 15
of the capitated rate development to the same extent as the annual actuarial 16
report addresses costs and other allowances for the risk -based provider 17
organizations. 18
(2) The Legislative Council, or the Joint Budget Committee if 19
the General Assembly is in session, shall favorably review the annual 20
actuarial report under subdivision (c)(1) of this section before submission 21
to the Centers for Medicare & Medicaid Services. 22
23
20-77-3010. Private right of action. 24
An enrollee or direct service provider may file suit for equitable 25
relief against the Department of Human Services or a risk -based provider 26
organization in a court of competent jurisdiction and is entitled to collect 27
reasonable attorneys’ fees and costs. 28
29
20-77-3010. Rules. 30
The Department of Human Services may promulgate rules to implement this 31
subchapter. 32
33
SECTION 2. DO NOT CODIFY. SEVERABILITY CLAUSE. If any provision of 34
this act or the application of this act to any person or circumstance is held 35
invalid, the invalidity shall not affect other provisions or applications of 36 HB1818
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this act which can be given effect without the invalid provision or 1
application, and to this end, the provisions of this act are declared 2
severable. 3
4
SECTION 3. DO NOT CODIFY. TEMPORARY LANGUAGE. Implementation of this 5
act. 6
(a) The requirements in § 20 -77-3004(a) shall begin on January 1, 7
2026. 8
(b) Within sixty (60) days of the effective date of this subchapter, 9
the department shall submit all required applications, amendments, and 10
supporting documentation to the Centers for Medicare & Medicaid Services for 11
approval to ensure compliance with federal requirements and facilitate the 12
implementation of these service delivery methods, including without 13
limitation: 14
(1) An amendment to the state Medicaid plan; and 15
(2) Any necessary modifications to existing waiver programs. 16
(c) The initial standardization of credentialing under § 20 -77-3007(a) 17
shall occur within three (3) months of the effective date of this act. 18
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