20-48-702. Reimbursement rate structure.

20-48-702. Reimbursement rate structure. (a)(1) To provide viable options for an array of community-based services for individuals with developmental disabilities, the Department of Human Services, subject to state and federal funding restrictions, shall establish a reimbursement rate structure for contracting with community programs licensed by the Board of Developmental Disabilities Services that will cover costs of all federal and state mandates for which they are held responsible by the department and for any additionally required processes the department may elect to implement for cost containment and management purposes over and above the established reimbursement rates for costs of treatment services. (2) By January 1, 2002, the department will design and conduct a rate and cost-of-service review of the reasonable and efficient prospective costs necessarily incurred to provide Medicaid-covered and state-covered services within the community to individuals with developmental disabilities. Subject to federal and state funding restrictions, the department will fund Medicaid services for persons with developmental disabilities in accordance with findings contained in the review and provide state funds for those services to which the individuals are entitled under federal and state laws that are not covered by the Medicaid program. By June 30, 2002, the department will adopt regulations and standards, approved pursuant to this subchapter, which clearly define the state's responsibility to individuals eligible for services under federal laws, including, but not limited to, the Americans With Disabilities Act of 1990, Pub. L. No. 101-336; Section 504 of the Rehabilitation Act of 1973, Pub. L. No. 93-112; and state laws, including §§ 20-14-502, 20-48-101, and 20-48-603, and more specifically: (A) The categories of services and service limits on each category which will be provided through the Medicaid state plan; and (B) The categories of services and service limits which will be provided with state general revenue funds or funds that are applicable for provider client services, or both. (3) There shall be a quarterly progress report to the House Committee on Public Health, Welfare, and Labor and the Senate Committee on Public Health, Welfare, and Labor by the department on the categories of services and respective service limits, service eligibility guidelines for each service component, and the rate structure based on prospective costs. (4) Nothing in this subchapter shall be construed to imply the adoption of cost-reimbursement methodology as opposed to a reasonable and necessary rate structure based on prospective costs. However, in the event that the Division of Medical Services of the Department of Human Services develops a new funding mechanism for community-based services provided through the University of Arkansas for Medical Sciences which is a full-cost reimbursement methodology with additional state matching funds provided by existing revenues within that system: (A) The new service model shall be developed to interface with the existing community-based programs through interagency agreements that enhance and broaden the level of care without duplicating services in communities which already have an array of services for children from birth to twenty-one (21) years of age; and (B) The university will staff twelve (12) regional clinics, provided the pediatric specialists are available at the university. These will be conducted on a quarterly basis in coordination with local providers to provide diagnosis, evaluation, and consultation by the pediatric specialists employed by the university to the local professional staffs of community programs. The reimbursement for the costs of conducting these outreach clinics must be fully funded by the cost-reimbursement methodology under any new funding model developed for the university by the department. (b) Subject to state and federal funding restrictions, the reimbursement rates shall be revised annually with market-basket rate adjustments to provide resources to the community-based programs necessary to provide persons choosing community-based services quality care assurance in a safe, healthy environment.