20-77-107. Program for indigent medical care — Rules.

20-77-107. Program for indigent medical care — Rules. (a)(1) The appropriate division of the Department of Human Services is authorized to establish and maintain an indigent medical care program. (2) However, eligibility rules for the ARKids First Program Act, § 20-77-1101 et seq., shall not include an assets or a resource test for children or families of children eighteen (18) years of age or younger. (b) The Secretary of the Department of Human Services is further authorized to enter into separate agreements with the University of Arkansas for Medical Sciences and private institutions in order to provide maximum medical care for the indigent persons of this state. (c) The secretary may enter into agreements with private or public entities to assist in the enforcement of rules of an indigent medical program, including: (1) Utilization review; and (2) Professional review of providers participating in the program. (d)(1) The secretary shall ensure that any entity with whom the Department of Human Services contracts to assist in the enforcement of rules of an indigent medical program will fulfill its duties in accordance with state and federal law, rules, and regulations. (2) The secretary may terminate any contractor who excessively burdens the State of Arkansas with the defense of appeals of sanctions or citations of deficiencies that are resolved in favor of the program provider. (e) Nothing in this subchapter shall be construed to permit the Department of Human Services or any entity with whom it contracts to enforce any rules or regulations that are not lawfully promulgated pursuant to federal or state law, provided that the Department of Human Services and any entity with whom it contracts may rely on official publications of the United States Department of Health and Human Services for the administration of the Arkansas Medicaid Program and other rules, regulations, standards, guidance, or information that apply to the Arkansas Medicaid Program by reference in statute, promulgated regulation, rule, or official federal publication. (f) The secretary shall ensure that the professional review of providers, except long-term care facilities and their reviewers, participating in the program complies with the following: (1) The party conducting any professional reviews of providers participating in the program shall be knowledgeable in the specific areas of law, rules, and regulations being enforced; (2)(A) Every citation or deficiency cited to a provider shall refer by source and number to the authority upon which the citation or deficiency is based. (B) However, the requirement of subdivision (f)(2)(A) of this section does not limit the Department of Human Services and any entity with whom it contracts in the exercise and application of professional medical judgment in determining when and under what circumstances care is medically necessary; (3) The professional review process shall include an informal dispute resolution process to allow the provider to challenge the citation or deficiency cited or sanction to a person other than the person making the citation as defined by the secretary; (4) The secretary shall establish a system to ensure standard and consistent application of sanctions and citations or deficiencies among surveyors in different areas of the state; and (5) The secretary shall establish a process for program providers to appeal a decision of a reviewer pursuant to the Arkansas Administrative Procedure Act, § 25-15-201 et seq.