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HB 1943

TO AMEND THE MEDICAID PROVIDER-LED ORGANIZED CARE ACT; TO IMPROVE THE ENROLLMENT AND SELECTION PROCESS IN RISK-BASED PROVIDER ORGANIZATIONS; AND TO EMPOWER BENEFICIARIES WITH INFORMATION.

2025 Regular Session Introduced by Breanne Davis and 1 co-sponsor

House Bill 1943 empowers Medicaid beneficiaries by improving access to information, establishing quality ratings for providers, and enhancing support services starting January 2026.

Notification that HB1943 is now Act 962
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WeVote Research Nonpartisan
Bill Summary · HB 1943

Summary of House Bill 1943 (Act 962)

Bill Title: To Amend the Medicaid Provider-Led Organized Care Act; To Improve the Enrollment and Selection Process in Risk-Based Provider Organizations; and To Empower Beneficiaries with Information.

Bill Number: HB 1943
Status: Now Act 962
Introduced: March 31, 2025
Effective Date: January 1, 2026

Purpose and Intent

House Bill 1943 aims to enhance the Medicaid Provider-Led Organized Care Act by improving the enrollment and selection processes for risk-based provider organizations. The bill seeks to empower Medicaid beneficiaries by providing them with better access to information regarding available services and quality ratings of these organizations.

Key Provisions

1. Quality Rating System

  • Establishment of a Quality Rating System: Risk-based provider organizations will be required to implement a quality rating system that is accessible online. This system will include ratings based on various performance measures, such as:
    • Time taken for initial delivery of home- and community-based services.
    • Care coordinator caseload ratios.
    • Satisfaction survey scores from beneficiaries, particularly those with intellectual and developmental disabilities and behavioral health needs.
    • Follow-up care percentages after emergency department visits.
    • Monthly contact with care coordinators for enrolled members.

2. Provider Directories

  • Real-Time Access: Each risk-based provider organization must provide enrollees with real-time access to its provider network directory via the Department of Human Services (DHS) website and its own website.
  • Timely Updates: Provider directories must be updated promptly, especially when a provider's status changes to out-of-network.

3. Beneficiary Support Office

  • Dedicated Support System: The DHS will establish a dedicated beneficiary support office to assist enrollees with information about risk-based provider organizations, including:
    • Open enrollment details.
    • Choice counseling.
    • Understanding the quality rating system.
  • Ombudsman Authority: The ombudsman will have the authority to help resolve issues between enrollees and provider organizations informally.

Impact

Who Will Be Affected?

  • Medicaid Beneficiaries: The primary beneficiaries of this bill will be individuals enrolled in Medicaid, particularly those with intellectual and developmental disabilities and behavioral health needs, who will gain better access to information and support.
  • Risk-Based Provider Organizations: These organizations will need to comply with the new requirements for quality ratings and provider directory updates.

Procedural Aspects

  • The bill was passed through various legislative stages, including committee reviews and votes in both the House and Senate, before being signed into law.
  • The Department of Human Services is authorized to promulgate rules to implement the provisions of this act.

Conclusion

House Bill 1943 represents a significant step towards improving the Medicaid system in Arkansas by enhancing transparency, accountability, and support for beneficiaries. By establishing a quality rating system and ensuring better access to information, the bill aims to empower individuals to make informed choices regarding their healthcare providers. The act will take effect on January 1, 2026, allowing time for the necessary preparations and implementations.

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

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