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.
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1 State of Arkansas A Bill
2 95th General Assembly
3 Regular Session, 2025 HOUSE BILL 1818
4
5 By: Representative L. Johnson
6 By: Senator B. Davis
7
8 For An Act To Be Entitled
9 AN ACT TO CREATE THE MEDICAID PROVIDER-LED CARE
10 TRANSPARENCY AND ACCOUNTABILITY ACT; AND FOR OTHER
11 PURPOSES.
12
13
14 Subtitle
15 TO CREATE THE MEDICAID PROVIDER-LED CARE
16 TRANSPARENCY AND ACCOUNTABILITY ACT.
17
18 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF ARKANSAS:
19
20 SECTION 1. Arkansas Code Title 20, Chapter 77 is amended to add an
21 additional subchapter to read as follows:
22
23 Subchapter 30 -- Medicaid Provider-Led Care Transparency and Accountability
24 Act
25
26 20-77-3001. Title
27 This subchapter shall be known and may be cited as the "Medicaid
28 Provider-Led Care Transparency and Accountability Act".
29
30 20-77-3002. Workgroup for risk-based provider organization quality and
31 effectiveness of care.
32 (a) The Department of Human Services shall create a workgroup
33 comprised of representatives of Medicaid beneficiaries who are enrolled with
34 a risk-based provider organization and providers for intellectual and
35 developmental disabilities and behavioral health services to help develop
36 appropriate standards for risk-based provider organizations to follow to
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1 improve the quality and effectiveness of care.
2 (b) The workgroup described in this section may be a subcommittee of
3 the Medicaid Advisory Committee.
4
5 20-77-3003. Care coordination.
6 (a) A risk-based provider organization shall pay a direct service
7 provider for care coordination from the capitated rate that the Department of
8 Human Services pays the risk-based provider organization.
9 (b) A risk-based provider organization may subcontract with direct
10 service providers, with appropriate compensation, any care coordination
11 duties assigned to the risk-based provider organization as long as the
12 assignment does not include the federal conflict-free functions that include
13 eligibility evaluations, assessments of functional needs, and person-centered
14 care plan development.
15 (c) In consultation with the workgroup established under � 20-77-3002,
16 a risk-based provider organization shall develop enhanced education and
17 training for care coordinators, including behavior supports.
18 (d) A care coordinator of a risk-based provider organization shall
19 ensure that meetings for development of person-centered service plans align
20 with provider care plan renewal dates except when unavoidable.
21
22 20-77-3004. Gag clause prohibited.
23 (a) A risk-based provider organization or affiliated entity shall not
24 prohibit a direct service provider who is an investor in the risk-based
25 provider organization or an affiliated entity from taking positions or
26 advocating publicly on agency rules, legislation, or other matters of public
27 interest that conflict with the position or interests of the risk-based
28 provider organization.
29 (b) If a contract between a risk-based provider organization and a
30 direct service provider contains a provision that conflicts with subsection
31 (a) of this section, the provision of the contract is void.
32
33 20-77-3005. Quality initiatives.
34 (a) The Department of Human Services shall require a contracted
35 external quality review organization to collect data with specific quality
36 metrics for risk-based provider organizations aimed at improving services for
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1 individuals with intellectual and developmental disabilities, including
2 appropriate measures from the Home- and Community-Based Services Quality
3 Measure Set.
4 (b) The contracted external quality review organization shall consult
5 with the workgroup established under � 20-77-3002.
6 (c)(1) For individuals diagnosed with an intellectual or developmental
7 disability, the department shall require a risk-based provider organizations
8 to initiates services through an intellectual or developmental disability
9 services provider within sixty (60) days of the individual's assignment to a
10 risk-based provider organization.
11 (2) If the risk-based provider organization does not comply with
12 subdivision (c)(1) of this section, the department shall impose penalties
13 upon the risk-based provider organization.
14 (d)(1) The department shall authorize the use of assistive and
15 enabling technology, including smart home technology, as a recognized service
16 delivery method for home- and community-based services.
17 (2) The authorization under subdivision (d)(1) of this section
18 shall extend to the provision of services through remote staffing models
19 where appropriate and in accordance with applicable rules.
20 (e) In consultation with the workgroup, the department shall
21 establish:
22 (1) Value-based payment initiatives for intellectual and
23 developmental disabilities and behavioral health providers who meet quality
24 of care targets;
25 (2) New evidence-based treatment services to aid high-utilizing
26 members assessed with behavioral health needs to access appropriate care; and
27 (3) A non-medical transportation billing code or modifier for
28 use under supported employment categories separate from transportation under
29 supported living categories.
30 (f) In recognition of the higher intensity of services required by
31 individuals with complex conditions in the Community Support System Provider
32 Program, a risk-based provider organization shall determine appropriate
33 direct service provider rates for services required by individuals with
34 complex conditions in the Community Support System Provider Program rather
35 than defaulting to supported living category rates.
36
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1 20-77-3006. Credentialing.
2 (a) The Department of Human Services shall require the risk-based
3 provider organizations to standardize credentialing across all risk-based
4 provider organizations.
5 (b)(1) A risk-based provider organization shall obtain credentialing
6 information on therapists, including speech-language therapists, physical
7 therapists, occupational therapists, and board-certified behavior analysists,
8 through the Medicaid portal where providers enter credentialing information.
9 (2) If additional information is required, a risk-based provider
10 organization shall use the Council for Affordable Quality Healthcare National
11 Database to obtain the additional information.
12
13 20-77-3007. Audit fairness.
14 (a) The Department of Human Services, risk-based provider
15 organizations, and contracted entities conducting audits of providers shall
16 establish secure online portals for providers to submit information and may
17 not make duplicate requests.
18 (b) Until the portal is established or if the portal is down, a risk-
19 based provider organization shall cover the provider's reasonable costs of
20 copying records at no less than twenty cents ($0.20) per page, plus postage
21 and shipping costs.
22 (c) A risk-based provider organization shall:
23 (1) Make no more than two (2) audit requests per calendar year
24 from a direct service provider unless a complaint has been lodged or there is
25 reasonable suspicion of fraud or abuse;
26 (2) Allow a provider at least sixty (60) days to supply records
27 requested by the risk-based provider organization, except in an emergency;
28 and
29 (3) Allow a provider at least sixty (60) days following receipt
30 of the preliminary audit report in which to produce documentation to address
31 any discrepancy found during the audit.
32 (d) The period covered by an audit shall not exceed twelve (12) months
33 from the date the claim was submitted to a risk-based provider organization.
34 (e) The Medicaid Fairness Act, � 20-77-1701 et seq., shall continue to
35 apply to the risk-based provider organizations.
36
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1 20-77-3008. Transparency and reporting.
2 (a)(1)(A) Annually on or before March 1, a risk-based provider
3 organization shall file with the Department of Human Services a full and true
4 statement of the financial condition, transactions, and affairs of the risk-
5 based provider organization as of December 31 of the preceding year.
6 (B) The department may grant an extension of time to file
7 the statement required under subdivision (a)(1)(A) of this section for good
8 cause if a written application for an extension of time is received at least
9 five (5) business days before the filing due date.
10 (2) The statement required under subdivision (a)(1)(A) of this
11 section shall:
12 (A) Be prepared according to the companion National
13 Association of Insurance Commissioners' Annual and Quarterly Statement
14 Instructions and follow those accounting principles and procedures prescribed
15 by the companion National Association of Insurance Commissioners' Accounting
16 Practices and Procedures Manual; and
17 (B) Include the following information of the risk-based
18 provider organization:
19 (A) Total assets;
20 (B) Total liabilities;
21 (C) Total reserves;
22 (D) Net premium income;
23 (E) Total claims paid;
24 (F) Total claims denied;
25 (G) Payments to or from the state under a risk
26 corridor;
27 (H) The amount paid by the Arkansas Medicaid Program
28 to the risk-based provider organization for the previous period of January 1
29 through December 31;
30 (I) The amount that the risk-based provider
31 organization paid to in-network providers from the previous period of January
32 1 through December 31;
33 (J) The amount that the risk-based provider
34 organization paid to out-of-network providers from the previous period of
35 January 1 through December 31;
36 (K) A list of any underwriting, auditing, actuarial,
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1 financial analysis, treasury, and investment expenses;
2 (L) A list of any marketing and sales expenses,
3 including without limitation advertising, member relations, member
4 enrollment, and all expenses associated with producers, brokers, and benefit
5 consultants;
6 (M) A list of any claims operations expenses,
7 including without limitation expenses for adjudication, appeals, settlements,
8 and expenses associated with paying claims;
9 (N) A list of any medical administration expenses,
10 including without limitation disease management, utilization review, and
11 medical management;
12 (O) A list of any network operations expenses,
13 including without limitation expenses for contracting, hospital and physician
14 relations, and medical policy procedures;
15 (P) A list of any charitable expenses, including
16 without limitation contributions to tax-exempt foundations and community
17 benefits;
18 (Q) The amount of state insurance premium taxes
19 paid;
20 (R) The fees related to depreciation;
21 (S) A list of miscellaneous expenses described in
22 detail by expense, including any expense not previously included in this
23 section; and
24 (T) Any other information required by the
25 department.
26 (b) A risk-based provider organizations shall file an executive
27 summary of the statement required under subdivision (a)(1)(A) of this section
28 with:
29 (1) The House Committee on Public Health, Welfare, and Labor;
30 and
31 (2) The Senate Committee on Public Health, Welfare, and Labor.
32 (c) Annually, between thirty (30) and sixty (60) days before the
33 initial date of open enrollment in a risk-based provider organization, a
34 risk-based provider organization shall prominently display on its website the
35 report required under subdivision (a)(1)(A) of this section and the executive
36 summary of the report required under subdivision (b) of this section.
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1
2 20-77-3009. Legislative oversight.
3 (a) Before submitting the quarterly reports required under � 20-77-
4 2707 to the Legislative Council, the Department of Human Services shall
5 submit the quarterly reports required under � 20-77-2707 for review to:
6 (1) The Senate Committee on Public Health, Welfare, and Labor;
7 and
8 (2) The House Committee on Public Health, Welfare, and Labor.
9 (b) The Senate Committee on Public Health, Welfare, and Labor and the
10 House Committee on Public Health, Welfare, and Labor shall jointly provide
11 ongoing oversight of the Medicaid Provider-Led Organized Care Act, � 20-77-
12 2701 et seq.
13 (c)(1) The department shall commission an annual actuarial report
14 concerning rate setting for risk-based provider organizations that addresses
15 the projected costs and necessary rates for direct service providers as part
16 of the capitated rate development to the same extent as the annual actuarial
17 report addresses costs and other allowances for the risk-based provider
18 organizations.
19 (2) The Legislative Council, or the Joint Budget Committee if
20 the General Assembly is in session, shall favorably review the annual
21 actuarial report under subdivision (c)(1) of this section before submission
22 to the Centers for Medicare & Medicaid Services.
23
24 20-77-3010. Private right of action.
25 An enrollee or direct service provider may file suit for equitable
26 relief against the Department of Human Services or a risk-based provider
27 organization in a court of competent jurisdiction and is entitled to collect
28 reasonable attorneys' fees and costs.
29
30 20-77-3010. Rules.
31 The Department of Human Services may promulgate rules to implement this
32 subchapter.
33
34 SECTION 2. DO NOT CODIFY. SEVERABILITY CLAUSE. If any provision of
35 this act or the application of this act to any person or circumstance is held
36 invalid, the invalidity shall not affect other provisions or applications of
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1 this act which can be given effect without the invalid provision or
2 application, and to this end, the provisions of this act are declared
3 severable.
4
5 SECTION 3. DO NOT CODIFY. TEMPORARY LANGUAGE. Implementation of this
6 act.
7 (a) The requirements in � 20-77-3004(a) shall begin on January 1,
8 2026.
9 (b) Within sixty (60) days of the effective date of this subchapter,
10 the department shall submit all required applications, amendments, and
11 supporting documentation to the Centers for Medicare & Medicaid Services for
12 approval to ensure compliance with federal requirements and facilitate the
13 implementation of these service delivery methods, including without
14 limitation:
15 (1) An amendment to the state Medicaid plan; and
16 (2) Any necessary modifications to existing waiver programs.
17 (c) The initial standardization of credentialing under � 20-77-3007(a)
18 shall occur within three (3) months of the effective date of this act.
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8 03/17/2025 8:53:04 AM JMB530Every fact on this page links to its source, starting with the official bill record.