Shown verbatim: the complete text as captured from the official PDF posted by the Arkansas General Assembly, fetched 2026-07-23. Page and line markers are part of the official record; nothing is edited or removed. The official bill page.
Stricken language would be deleted from and underlined language would be added to present law.
1 State of Arkansas As Engrossed: H3/17/25
2 95th General Assembly
A Bill
3 Regular Session, 2025 HOUSE BILL 1622
4
5 By: Representatives Gramlich, L. Johnson
6 By: Senator J. Boyd
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8 For An Act To Be Entitled
9 AN ACT TO AMEND THE MEDICAID FAIRNESS ACT; TO MODIFY
10 THE DEFINITION OF "ADVERSE DECISION" UNDER THE
11 MEDICAID FAIRNESS ACT; TO PROVIDE FOR ADMINISTRATIVE
12 RECONSIDERATION UNDER THE MEDICAID FAIRNESS ACT; AND
13 FOR OTHER PURPOSES.
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15
16 Subtitle
17 TO AMEND THE MEDICAID FAIRNESS ACT; TO
18 MODIFY THE DEFINITION OF "ADVERSE
19 DECISION" UNDER THE MEDICAID FAIRNESS
20 ACT; AND TO PROVIDE FOR ADMINISTRATIVE
21 RECONSIDERATION UNDER THE MEDICAID
22 FAIRNESS ACT.
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24 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF ARKANSAS:
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26 SECTION 1. Arkansas Code � 20-77-1702(2), concerning the definition of
27 "adverse decision" within the Medicaid Fairness Act, is amended to read as
28 follows:
29 (2)(A) "Adverse decision" means any decision by the Department
30 of Human Services or its reviewers or contractors that adversely affects a
31 Medicaid provider or recipient in regard to:
32 (i) Receipt of and payment for Medicaid claims and
33 services, including, but not limited to, decisions as to:
34 (a) Appropriate level of care or coding;
35 (b) Medical necessity;
36 (c) Prior authorization;
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1 (d) Concurrent reviews;
2 (e) Retrospective reviews;
3 (f) Least restrictive setting;
4 (g) Desk audits;
5 (h) Field audits and onsite audits; and
6 (i) Inspections or surveys; and
7 (ii) Payment amounts due to or from a particular
8 provider resulting from gain sharing, risk sharing, incentive payments, or
9 another reimbursement mechanism or methodology, including calculations that
10 affect or have the potential to affect payment; and
11 (iii) Imposition of corrective action plans.
12 (B) To constitute an adverse decision, an agency decision
13 need not have a monetary penalty attached but must have or a direct monetary
14 consequence to the provider.
15 (C) "Adverse decision" does not include the design of or
16 changes to an element of a reimbursement methodology or payment system that
17 is of general applicability and implemented through the rulemaking process;
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19 SECTION 2. Arkansas Code � 20-77-1704(a) and (b), concerning the
20 allowance of a provider administrative appeal under the Medicaid Fairness
21 Act, are amended to read as follows:
22 (a) The General Assembly finds it necessary to:
23 (1) Clarify its intent that providers have the right to
24 administrative reconsideration and fair and impartial administrative appeals;
25 and
26 (2) Emphasize that this right of administrative reconsideration
27 and appeal is to be liberally construed and not limited through technical or
28 procedural arguments by the Department of Human Services.
29 (b)(1)(A) In response to an adverse decision, a provider may request
30 an administrative reconsideration with the Department of Human Services and
31 may appeal to the Office of Medicaid Provider Appeals with the Department of
32 Health on behalf of the recipient or on its own behalf, or both, regardless
33 of whether the provider is an individual or a corporation.
34 (B)(i) A provider appeal shall be governed by the Arkansas
35 Administrative Procedure Act, � 25-15-201 et seq., except as otherwise
36 provided in this subchapter.
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1 (ii) Multiple appeals by the same provider may be
2 consolidated.
3 (C) An administrative law judge employed by the Department
4 of Health shall conduct all Medicaid provider administrative appeals of
5 adverse decisions under this subchapter.
6 (2) The provider may appear:
7 (A) In person or through a corporate representative; or
8 (B) With prior notice to the Department of Health, through
9 legal counsel.
10 (3)(A) A Medicaid recipient may attend any hearing related to
11 his or her care, but the Department of Health may not make his or her
12 participation a requirement for provider appeals.
13 (B) The Department of Health may compel the recipient's
14 presence via subpoena, but failure of the recipient to appear shall not
15 preclude the provider appeal.
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17 /s/Gramlich
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3 03-17-2025 12:00:57 JMB333Every fact on this page links to its source, starting with the official bill record.