TO REQUIRE CERTAIN REIMBURSEMENT RATES FOR HOME- AND COMMUNITY-BASED SERVICES WITHIN RISK-BASED PROVIDER ORGANIZATIONS.

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

SB 543 aimed to establish fair reimbursement rates for home- and community-based Medicaid services, ensuring quality care and access for beneficiaries in Arkansas.

Died in Senate Committee at Sine Die adjournment.

Purpose and Intent

Senate Bill 543 (SB 543) was introduced in the Arkansas General Assembly to establish specific reimbursement rates for home- and community-based services provided by risk-based provider organizations under the Medicaid Provider-Led Organized Care Act. The bill aimed to ensure that these reimbursement rates are fair, promote quality care, and maintain equal access for Medicaid beneficiaries.

Key Provisions

SB 543 proposed several amendments to existing Arkansas law, specifically targeting reimbursement and policy-setting processes for direct service providers. The main provisions included:

Reimbursement Rate Determination:

Reimbursement rates paid by risk-based provider organizations to direct service providers would be determined by mutual agreement, without being bound by Medicaid provider rates set by the Department of Human Services (DHS), provided they meet or exceed minimum rates established under Arkansas Code § 20-77-2709.

Healthcare Service Policies:

Policies and procedures regarding healthcare services provided by direct service providers would also be determined through mutual agreement, ensuring they align with the same standards of efficiency, economy, and quality for both Medicaid beneficiaries and non-Medicaid individuals.

Rate Study Requirement:

A rate study was mandated to be completed by October 1, 2025, to establish minimum reimbursement rates for home- and community-based services. This study would cover specific services under the Community and Employment Support 1915(c) waiver and the Community Support System Provider program.

Cost Factors and Rate Adjustments:

The DHS was tasked with developing cost factors for the rate study, with input from service providers. If the study indicated a rate increase of more than 10%, the DHS could phase in the increase over two years, subject to state appropriations.

Ongoing Rate Review:

The DHS was required to conduct regular reviews of provider rates to ensure they remain adequate and aligned with actual service costs.

Affected Parties

The bill primarily impacted:
- Direct Service Providers: Organizations and individuals providing home- and community-based services under Medicaid.
- Medicaid Beneficiaries: Individuals enrolled in the Arkansas Medicaid Program who rely on these services.
- Risk-Based Provider Organizations: Entities managing care and reimbursement for Medicaid services.

Procedural Aspects

Introduced: March 20, 2025

Legislative Actions:

The bill was read for the first time and referred to the Public Health, Welfare and Labor Committee in the Senate.
It ultimately died in the Senate Committee at Sine Die adjournment on May 5, 2025, meaning it did not progress to a vote or further consideration.

Conclusion

While SB 543 aimed to enhance the reimbursement framework for home- and community-based services in Arkansas, it did not advance through the legislative process. The proposed changes reflected ongoing efforts to improve service delivery and financial sustainability within the state's Medicaid system.

Bill