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2025 Regular Session Introduced by Brian Buchanan and 6 co-sponsors

HB 1172 enhances fairness for Arkansas Medicaid providers by clarifying definitions and ensuring all enforcement actions are appealable, improving transparency and accountability.

Senator Zay added as cosponsor

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Purpose and Intent

House Bill 1172 (HB 1172) aims to amend the Medicaid Fairness Act in Arkansas to clarify definitions related to "adverse actions" and "enforcement actions." The bill seeks to ensure that all rule enforcement actions taken by the Department of Human Services (DHS) against Medicaid providers are appealable, thereby enhancing transparency and fairness in the enforcement process.

Key Provisions

The bill introduces several important changes to the existing law:

Definition Amendments:

The definition of "adverse action" is modified to indicate that an agency decision does not need to involve a monetary penalty but must have a direct monetary consequence for the provider.
A new definition for "enforcement action" is added, describing it as any action or decision by the DHS that affects a Medicaid provider concerning rule enforcement.

Notice Requirements:

Providers must receive at least 48 hours' notice prior to a scheduled routine monitoring visit, which can occur once per licensing or certification period.
No notice is required for inspections related to complaints of non-compliance.

Reconsideration and Appeal Process:

Providers can challenge violations by submitting a reconsideration request, which must be ruled upon by the enforcement entity within 30 calendar days.
If the enforcement entity fails to respond within this timeframe, the violation is vacated by operation of law.
If the reconsideration request is denied, providers have the right to appeal the violation administratively.

Affected Parties

Medicaid Providers: The primary stakeholders affected by this bill are Medicaid providers in Arkansas, who will benefit from clearer definitions and a structured process for contesting enforcement actions.

Department of Human Services: The DHS will be responsible for implementing the new provisions and ensuring compliance with the updated definitions and processes.

Procedural Timeline

Introduced: January 16, 2025

Committee Actions:

The bill was read for the first time and referred to the Public Health, Welfare, and Labor Committee on January 16, 2025.
It was reported from the Labor Committee on February 13, 2025, with a recommendation for referral to the Finance Committee.

Withdrawn: The bill was withdrawn by the author on February 20, 2025.

Conclusion

HB 1172 seeks to enhance the fairness and transparency of the Medicaid enforcement process in Arkansas by providing clear definitions and establishing a structured appeal process for Medicaid providers. The bill's progression through the legislative process indicates a focus on improving the regulatory environment for healthcare providers serving Medicaid patients.

Bill