The bill amends the Arkansas Medicaid Program regulations by requiring additional approvals before the Department of Human Services (DHS) can take certain actions. Specifically, it mandates that DHS must seek and receive approval from both the Governor and the Chief Fiscal Officer of the State before increasing reimbursement rates or adopting any rules that would obligate state general revenues. Furthermore, the bill stipulates that any expansion of coverage or increase in costs to the state must be approved by a two-thirds vote from either the Legislative Council or the Joint Budget Committee if the General Assembly is in session.

Key changes in the bill include the insertion of language that specifies the need for legislative approval for any actions that would expand Medicaid coverage or increase costs, as well as the requirement for DHS to report to the Legislative Council if reimbursement rates are decreased. The bill also clarifies that existing Medicaid state plan amendments or federal waivers are not affected by these new requirements. Overall, the legislation aims to enhance oversight and control over the financial implications of the Arkansas Medicaid Program.