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HB 1314

TO AMEND THE LAW CONCERNING CERTAIN AUDITS OF HEALTHCARE PROVIDERS; AND TO CREATE THE ARKANSAS MEDICAL AUDIT BILL OF RIGHTS ACT.

2025 Regular Session Introduced by Missy Irvin and 1 co-sponsor

Arkansas' Medical Audit Bill of Rights Act protects healthcare providers by ensuring fair audits, limiting claims, and allowing appeals, fostering transparency and equity.

Notification that HB1314 is now Act 512
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Bill Summary · HB 1314

Summary of House Bill 1314: Arkansas Medical Audit Bill of Rights Act

Bill Number: HB 1314
Status: Now Act 512
Introduced: January 29, 2025
Sponsored by: Representative L. Johnson and Senator Irvin

Purpose and Intent

House Bill 1314 aims to amend existing laws regarding audits of healthcare providers in Arkansas and establish the "Arkansas Medical Audit Bill of Rights Act." The intent of this legislation is to protect healthcare providers during the audit process, ensuring fair treatment and transparency while maintaining the integrity of healthcare services.

Key Provisions

The bill introduces several critical provisions under a new subchapter in the Arkansas Code, specifically addressing the rights of healthcare providers during audits:

  1. Notice Requirement: Auditors must provide at least one week's notice before conducting an initial audit.

  2. Specialty Consultation: Audits requiring clinical judgment must involve a healthcare provider of the same specialty as the one being audited.

  3. Clerical Errors: Clerical or recordkeeping errors will not be classified as fraud and cannot incur criminal penalties without proof of intent.

  4. Limitations on Audits:

    • Audits must be limited to a specific number of claims (either 50 claims or 0.25% of the claims billed in the previous year).
    • Auditors cannot initiate more than two audits of a healthcare provider in a calendar year.

  5. Recoupment Rules:

    • Recoupments can only occur after correcting a claim and must be based on actual overpayments.
    • Providers have 60 days to file corrected claims after receiving a notice of overpayment.

  6. Audit Duration: The audit period cannot exceed 24 months from the date a claim was submitted.

  7. Reporting Timelines:

    • Preliminary audit reports must be delivered within 120 days of the audit's conclusion.
    • Final reports must be provided within six months after the preliminary report.

  8. Extrapolation Prohibition: Auditors are prohibited from using extrapolation methods to calculate recoupments or penalties.

  9. Appeals Process: An established appeals process allows healthcare providers to contest unfavorable audit findings.

  10. Exemptions: The provisions do not apply to audits conducted on behalf of the Arkansas Medicaid Program or those involving allegations of fraud or abuse.

Impact

The Arkansas Medical Audit Bill of Rights Act is designed to enhance the rights of healthcare providers by ensuring a fair and transparent audit process. It aims to reduce the burden of audits on providers, protect them from unjust penalties, and foster a more equitable healthcare environment. This legislation will primarily affect licensed healthcare providers in Arkansas, including hospitals and clinics, while excluding pharmacies under specific regulations.

Procedural Timeline

  • January 29, 2025: Bill filed and introduced.
  • March 18, 2025: Amendments adopted and bill engrossed.
  • April 8, 2025: Passed by the Senate and returned to the House.
  • April 10, 2025: Notification that HB 1314 is now Act 512.

This summary provides an overview of HB 1314, highlighting its purpose, key provisions, and the expected impact on healthcare providers in Arkansas.

Compiled from official sources — confirm details with the bill’s official record.

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