Arkansas Code Title 20, Subtitle 5, Chapter 77, Subchapter 17 - Medicaid Fairness Act

• § 20-77-1701 - Legislative Findings and Intent.
  (a) The General Assembly finds that: (1) Health care providers who serve Medicaid recipients are an indispensable and vital link in serving this state's...
• § 20-77-1702 - Definitions.
  As used in this subchapter: (1) "Abuse" means a pattern of provider conduct that is inconsistent with sound fiscal, business, or medical practices and...
• § 20-77-1703 - Recoupment.
  (a) (1) The Department of Human Services shall not use a technical deficiency as grounds for recoupment unless identifying the technical deficiency as an...
• § 20-77-1704 - Provider Administrative Appeals Allowed.
  (a) The General Assembly finds it necessary to: (1) Clarify its intent that providers have the right to fair and impartial administrative appeals; and...
• § 20-77-1705 - Explanations for Adverse Decisions Required.
  Each denial or other deficiency that the Department of Human Services makes against a Medicaid provider shall be prepared in writing and shall specify:...
• § 20-77-1706 - Reimbursement At an Alternate Level Instead of Complete Denial.
  (a) (1) (A) Subject to § 20-77-1707 for retrospective reviews, if the Department of Human Services has sufficient documentation to determine that some level...
• § 20-77-1707 - Prior Authorizations -- Retrospective Reviews.
  If the Department of Human Services requires a provider to justify the medical necessity of a service through prior authorization, the department shall not...
• § 20-77-1708 - Medical Necessity.
  (a) There is a presumption in favor of the medical judgment of the performing or prescribing physician in determining medical necessity of treatment.(b) If...
• § 20-77-1709 - Promulgation Before Enforcement.
  (a) The Department of Human Services may not use state policies, guidelines, manuals, or other such criteria in enforcement actions against providers unless the...
• § 20-77-1710 - Delivery of Files.
  (a) If the Department of Human Services makes an adverse decision in a Medicaid case and a provider then lodges an administrative appeal, the...
• § 20-77-1711 - Copies of Records to Be Supplied to Department -- Exception.
  (a) Except as provided in subsection (b) of this section, providers must supply records to the Department of Human Services at their own cost.(b)...
• § 20-77-1712 - Notices.
  When the Department of Human Services sends letters or other forms of notice with deadlines to providers or recipients, the deadline shall not begin...
• § 20-77-1713 - Deadlines.
  (a) The Department of Human Services may not issue a claim denial or demand for recoupment to providers for missing a deadline if the...
• § 20-77-1714 - Hospital Claims.
  (a) When more than one (1) hospital provides services to a recipient and the amount of claims exceeds the recipient's benefit limit, then the...
• § 20-77-1715 - Federal Law.
  (a) If any provision of this subchapter is found to conflict with current federal law, including promulgated federal regulations, the federal law shall override...
• § 20-77-1716 - Promulgation of Rules.
  The Department of Human Services may promulgate rules to implement this subchapter.
• § 20-77-1717 - Timelines for Audits.
  (a) If a Medicaid provider audit by the federal Medicaid Integrity Program or Audit Medicaid Integrity Contractors is conducted, the Department of Human Services...
• § 20-77-1718 - Termination -- Appeals.
  (a) A Medicaid provider that is aggrieved by an adverse decision of the Department of Human Services with respect to termination of the provider's...

Last modified: November 15, 2016