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 SENATE BILL 257 3
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By: Senator C. Penzo 5
By: Representative Lundstrum 6
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For An Act To Be Entitled 8
AN ACT TO AMEND THE MEDICAID FAIRNESS ACT; TO EXTEND 9
THE APPEAL PERIOD FOR PROVIDERS IN THE ARKANSAS 10
MEDICAID PROGRAM; TO REQUIRE COMPREHENSIVE 11
INFORMATION IN NOTICES OF ADVERSE DECISIONS; TO 12
MANDATE PUBLICATION OF ALL POLICIES, PROTOCOLS, AND 13
REQUIREMENTS USED IN MAKING AN ADVERSE DECISION; AND 14
FOR OTHER PURPOSES. 15
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Subtitle 18
TO AMEND THE MEDICAID FAIRNESS ACT; TO 19
EXTEND THE APPEAL PERIOD FOR PROVIDERS 20
IN THE ARKANSAS MEDICAID PROGRAM; AND TO 21
REQUIRE COMPREHENSIVE INFORMATION IN 22
NOTICES OF ADVERSE DECISIONS. 23
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BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF ARKANSAS: 25
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SECTION 1. DO NOT CODIFY. Legislative findings and intent. 27
(a) The General Assembly finds that: 28
(1) The Department of Human Services currently allows providers 29
thirty-five (35) days to appeal an adverse determination before the 30
determination becomes final under 20 CAR § 706 -404(a)(5); 31
(2) The thirty-five (35) day period is overly restrictive and 32
does not align with the operational realities of providers' business offices, 33
where adverse determinations arrive via mail and require time to be reviewed, 34
processed, and responded to appropriately; 35
(3) The current notice process lacks necessary details, 36 SB257
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sometimes failing to include citations to specific policies, protocols, or 1
procedures, which hinders providers from adequately investigating and 2
appealing adverse decisions; and 3
(4) The inefficiency of the current process burdens both the 4
department and its contracted vendors by increasing unnecessary phone calls, 5
claims reopenings, and resubmissions which create additional administrative 6
costs and delays. 7
(b) It is the intent of the General Assembly to improve efficiency and 8
transparency in the Medicaid provider appeals process by: 9
(1) Extending the appeal period for providers; 10
(2) Requiring that notices of adverse decisions contain 11
comprehensive information, including citations to applicable policies and 12
procedures; 13
(3) Mandating the publication of all policies, protocols, and 14
procedural requirements utilized in making adverse decisions; and 15
(4) Ensuring that these requirements apply to the department and 16
any third-party vendors administering portions of the appeals process. 17
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SECTION 2. Arkansas Code § 20 -77-1702, concerning the definitions 19
within the Medicaid Fairness Act, is amended to add an addition subdivision 20
to read as follows: 21
(20) “Third-party entity” means a vendor or other similar entity 22
contracted by the Department of Human Services to administer any part of the 23
Medicaid appeals process. 24
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SECTION 3. Arkansas Code § 20 -77-1705 is amended to read as follows: 26
20-77-1705. Explanations for adverse decisions required. 27
(a) Each denial or other deficiency that the Department of Human 28
Services makes against a Medicaid provider shall be prepared in writing and 29
shall specify: 30
(1) The nature of the adverse decision; 31
(2) The statutory provision or specific rule alleged to have 32
been violated; and 33
(3) The facts and grounds that form the basis for the adverse 34
decision. 35
(b) A notice of an adverse decision sent to a provider shall contain 36 SB257
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at a minimum: 1
(1) A clear and detailed explanation of the rationale for the 2
adverse decision; 3
(2) Citations to all specific protocols, procedures, or policy 4
manual references that were relied upon in making the adverse decision; and 5
(3) Any additional information necessary to allow the provider 6
to fully understand and respond to the adverse decision. 7
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SECTION 4. Arkansas Code § 20 -77-1712 is amended to read as follows: 9
20-77-1712. Notices. 10
(a) When the Department of Human Services sends letters or other forms 11
of notice with deadlines to providers or recipients, the deadline shall not 12
begin to run before the next business day following the date of the postmark 13
on the envelope, the facsimile transmission confirmation sheet, or the 14
electronic record confirmation, unless otherwise required by federal statute 15
or regulation. 16
(b) The Department of Human Services shall allow a provider no less 17
than sixty-five (65) days from the date of notice to the provider to appeal 18
an adverse decision, whether through administrative reconsideration, 19
administrative appeal, or any equivalent process. 20
21
SECTION 5. Arkansas Code Title 20, Chapter 77, Subchapter 17, is 22
amended to add additional sections to read as follows: 23
20-77-1719. Publication of protocols, procedures, and requirements. 24
(a) The Department of Human Services shall publish and maintain all 25
protocols, procedures, and requirements used in making adverse decisions on 26
the website of the department. 27
(b) The publication shall include: 28
(1) The current version of each protocol, procedure, or 29
requirement; 30
(2) Prior versions of each protocol, procedure, or requirement 31
maintained in an archive for reference for a period equivalent to state law 32
and rule regarding retention of medical records; 33
(3) A unique citation number for each protocol, procedure, or 34
requirement; and 35
(4) An effective date for each version of the protocol, 36 SB257
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procedure, or requirement to ensure providers have access to historical and 1
current policy requirements. 2
(c)(1) The department shall not use or enforce any policy, protocol, 3
or requirement that is not publicly disclosed and accessible to providers. 4
(2) Any internal, undisclosed, or unpublished protocol, 5
procedure, or requirement shall be deemed invalid for the purpose of making 6
an adverse decision. 7
(3) Subdivisions (c)(1) and (c)(2) of this section do not apply 8
to any information, protocol, procedure, or requirement for which disclosure 9
is prohibited by state law or rule or by federal law or regulation. 10
11
20-77-1720. Third-party entity compliance. 12
A third-party entity shall comply with the requirements in this 13
subchapter, including appeal periods, notice requirements, and publication of 14
protocols, procedures, and requirements. 15
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SECTION 6. DO NOT CODIFY. Implementation. 17
The Department of Human Services shall: 18
(1) Implement this act within ninety (90) days of the effective 19
date of this act; 20
(2) Revise all policies, manuals, and procedural guidelines to 21
conform with this act; and 22
(3) Conduct periodic audits to ensure compliance with this act 23
and publish audit findings under this section annually. 24
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