(a) (1) The appropriate division of the Department of Human Services is authorized to establish and maintain an indigent medical care program.
(2) However, eligibility regulations for the ARKids First Program Act, § 20-77-1101 et seq., shall not include an assets or a resource test for children or families of children eighteen (18) years of age or younger.
(b) The Director of the Department of Human Services is further authorized to enter into separate agreements with the University of Arkansas for Medical Sciences and private institutions in order to provide maximum medical care for the indigent persons of this state.
(c) The director may enter into agreements with private or public entities to assist in the enforcement of rules and regulations of an indigent medical program, including:
(1) Utilization review; and
(2) Professional review of providers participating in the program.
(d) (1) The director shall ensure that any entity with whom the department contracts to assist in the enforcement of rules and regulations of an indigent medical program will fulfill its duties in accordance with state and federal law and regulations.
(2) The director may terminate any contractor who excessively burdens the State of Arkansas with the defense of appeals of sanctions or citations of deficiencies that are resolved in favor of the program provider.
(e) Nothing in this subchapter shall be construed to permit the department or any entity with whom it contracts to enforce any rules or regulations that are not lawfully promulgated pursuant to federal or state law, provided that the department and any entity with whom it contracts may rely on official publications of the United States Department of Health and Human Services for the administration of the Medicaid program and other rules, regulations, standards, guidance, or information that apply to the Medicaid program by reference in statute, promulgated regulation, rule, or official federal publication.
(f) The director shall ensure that the professional review of providers, except long-term care facilities and their reviewers, participating in the program comply with the following:
(1) The party conducting any professional reviews of providers participating in the program shall be knowledgeable in the specific areas of law and regulations being enforced;
(2) (A) Every citation or deficiency cited to a provider shall refer by source and number to the authority upon which the citation or deficiency is based.
(B) However, the requirement of subdivision (f)(2)(A) of this section does not limit the department and any entity with whom it contracts in the exercise and application of professional medical judgment in determining when and under what circumstances care is medically necessary;
(3) The professional review process shall include an informal dispute resolution process to allow the provider to challenge the citation or deficiency cited or sanction to a person other than the person making the citation as defined by the director;
(4) The director shall establish a system to ensure standard and consistent application of sanctions and citation or deficiencies among surveyors in different areas of the state; and
(5) The director shall establish a process for program providers to appeal a decision of a reviewer pursuant to the Arkansas Administrative Procedure Act, § 25-15-201 et seq.
Section: Previous 20-77-102 20-77-103 20-77-104 20-77-105 20-77-106 20-77-107 20-77-108 20-77-109 20-77-110 20-77-111 20-77-115 20-77-119 20-77-120 20-77-121 NextLast modified: November 15, 2016