The bill amends the Medicaid Fairness Act by modifying the definition of "adverse decision" and providing for administrative reconsideration. Specifically, it expands the definition of "adverse decision" to include the imposition of corrective action plans, in addition to existing criteria related to Medicaid claims and services. The bill clarifies that an adverse decision does not need to have a monetary penalty attached but must have a direct monetary consequence for the provider. Furthermore, it specifies that changes to reimbursement methodologies that are generally applicable and implemented through rulemaking do not constitute adverse decisions.

Additionally, the bill establishes the right for providers to request administrative reconsideration and appeal adverse decisions. It emphasizes that this right should be liberally construed and not limited by technical or procedural arguments from the Department of Human Services. Providers can appeal to the Office of Medicaid Provider Appeals and may do so on behalf of recipients or themselves. The appeals will be governed by the Arkansas Administrative Procedure Act, and an administrative law judge from the Department of Health will conduct the hearings. The bill also allows Medicaid recipients to attend hearings related to their care without making their participation a requirement for provider appeals.

Statutes affected:
Old version HB1622 Original - 2-27-2025 02:38 PM: 20-77-1702(2), 20-77-1704(a)
Old version HB1622 V2 - 3-17-2025 12:01 PM: 20-77-1702(2), 20-77-1704(a)
HB 1622: 20-77-1702(2), 20-77-1704(a)
Act 635: 20-77-1702(2), 20-77-1704(a)