Arkansas 2025 Regular Session

Arkansas Senate Bill SB542 Compare Versions

Only one version of the bill is available at this time.

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1	1	Stricken language would be deleted from and underlined language would be added to present law.
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3	3	State of Arkansas 1
4	4	95th General Assembly A Bill 2
5	5	Regular Session, 2025 SENATE BILL 542 3
6	6	4
7	7	By: Senator B. Davis 5
8	8	By: Representative L. Johnson 6
9	9	7
10	10	For An Act To Be Entitled 8
11	11	AN ACT TO AMEND THE MEDICAID PROVIDER -LED ORGANIZED 9
12	12	CARE ACT; TO IMPROVE THE ENROLLMENT AND SELECTION 10
13	13	PROCESS IN RISK-BASED PROVIDER ORGANIZATIONS; TO 11
14	14	EMPOWER MEDICAID BENEFICIARIES WITH USEFUL 12
15	15	INFORMATION ABOUT RISK -BASED PROVIDER ORGANIZATIONS 13
16	16	AVAILABLE TO THEM; AND FOR OTHER PURPOSES. 14
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19	19	Subtitle 17
20	20	TO AMEND THE MEDICAID PROVIDER -LED 18
21	21	ORGANIZED CARE ACT; TO IMPROVE THE 19
22	22	ENROLLMENT AND SELECTION PROCESS IN 20
23	23	RISK-BASED PROVIDER ORGANIZATIONS; AND 21
24	24	TO EMPOWER BENEFICIARIES WITH 22
25	25	INFORMATION. 23
26	26	24
27	27	BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF ARKANSAS: 25
28	28	26
29	29	SECTION 1. Arkansas Code Title 20, Chapter 77, Subchapter 27, is 27
30	30	amended to add additional sections to read as follows: 28
31	31	20-77-2709. Quality rating system. 29
32	32	(a) The risk-based provider organizations shall have a basic quality 30
33	33	rating system that is accessible online that includes ratings for each risk -31
34	34	based provider organization based on data that includes at a minimum the 32
35	35	following measures that are currently collected by the risk -based provider 33
36	36	organization: 34
37	37	(1) The number of days before initial delivery of home - and 35
38	38	community-based services for individuals who have received a waiver slot in 36 SB542
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41	41	the Community and Employment Support Waiver; 1
42	42	(2) The care coordinator caseload ratios; 2
43	43	(3) The scores of a satisfaction survey of members of the risk -3
44	44	based provider organization that includes at least the following: 4
45	45	(A) The satisfaction of individuals assessed with 5
46	46	intellectual and developmental disabilities with their level of integration 6
47	47	into the community; 7
48	48	(B) The satisfaction of individuals assessed with 8
49	49	intellectual and developmental disabilities who report satisfaction with 9
50	50	their living arrangements; 10
51	51	(C) The numbers and percentages of enrollees assessed with 11
52	52	intellectual and developmental disabilities who are engaged in meaningful, 12
53	53	competitive employment; 13
54	54	(D) The satisfaction with care coordinators by individuals 14
55	55	assessed with intellectual and developmental disabilities and by intellectual 15
56	56	and developmental disabilities service providers; 16
57	57	(E) The satisfaction with care coordinators by individuals 17
58	58	assessed with behavioral health needs and by behavioral health providers; 18
59	59	(F) The satisfaction with the website or portal of the 19
60	60	risk-based provider organizations by individuals assessed with intellectual 20
61	61	and developmental disabilities and by intellectual and developmental 21
62	62	disabilities service providers; 22
63	63	(G) The satisfaction with the website or portal of the 23
64	64	risk-based provider organizations by individuals assessed with behavioral 24
65	65	health needs and by behavioral health providers; 25
66	66	(H) The overall satisfaction with the risk -based provider 26
67	67	organization by individuals assessed with intellectual and developmental 27
68	68	disabilities and by intellectual and developmental disabilities service 28
69	69	providers; and 29
70	70	(I) The overall satisfaction with the risk -based provider 30
71	71	organization by individuals assessed with behavioral health needs and by 31
72	72	behavioral health providers; 32
73	73	(4) The percentage of individuals assessed with intellectual and 33
74	74	developmental disabilities who receive follow -up care after an emergency 34
75	75	department visit within seven (7) days; 35
76	76	(5) The percentage of individuals assessed with behavioral 36 SB542
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79	79	health needs who receive follow -up care after an emergency department visit 1
80	80	within seven (7) days; 2
81	81	(6) The percentage of members between three (3) years age and 3
82	82	twenty-one (21) years of age who had at least one (1) comprehensive well -care 4
83	83	visit with a primary care provider or an obstetrician -gynecologist 5
84	84	practitioner during the measurement year; 6
85	85	(7) The percentage of newly enrolled members who receive an 7
86	86	initial contact with a care coordinator within fourteen (14) days; 8
87	87	(8) The percentage of enrolled members who receive monthly 9
88	88	contact with a care coordinator; and 10
89	89	(9) The incidence of enrollee complaints or grievances. 11
90	90	(b) The ratings shall be prominently displayed on the website of 12
91	91	Department of Human Services for risk -based provider organizations. 13
92	92	14
93	93	20-77-2710. Provider directories. 15
94	94	(a) Each risk-based provider organization shall provide to enrollees 16
95	95	real-time access to its provider network directory through a link on the 17
96	96	website of Department of Human Services and on the website of the risk -based 18
97	97	provider organization. 19
98	98	(b) The risk-based provider organizations shall ensure that the 20
99	99	provider directories are updated for the upcoming plan year so that enrollees 21
100	100	can make informed decisions. 22
101	101	(c) When an existing network provider’s status has or will change to 23
102	102	out-of-network, the risk-based provider organization shall make that change 24
103	103	in the provider directory within ten (10) business days of the change being 25
104	104	communicated to or from the risk -based provider organization. 26
105	105	27
106	106	20-77-2711. Beneficiary support office. 28
107	107	(a) The Department of Human Services shall have a dedicated 29
108	108	beneficiary support system that is adequately staffed and trained to meet the 30
109	109	requirements of 42 C.F.R. § 438.71, as existing on January 1, 2025. 31
110	110	(b) Enrollees and other members of the public shall be able to easily 32
111	111	contact the department for information about the risk -based provider 33
112	112	organization, including open enrollment, choice counseling, updated 34
113	113	information on provider networks, assistance in understanding how to use the 35
114	114	quality rating system to select a plan, and other pertinent information. 36 SB542
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117	117	(c) The ombudsman shall also have the authority to help enrollees 1
118	118	informally resolve issues between enrollees and risk -based provider 2
119	119	organizations. 3
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121	121	SECTION 2. DO NOT CODIFY. Rules. 5
122	122	The Department of Human Services may promulgate rules to implement this 6
123	123	act. 7
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125	125	SECTION 3. EFFECTIVE DATE. 9
126	126	This act shall be effective on January 1, 2026. 10
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