Browse Arkansas Code titles and sections
20-77-125. Contingency fee audits prohibited — Definitions.
Arkansas Code — all titles (historical 2020) · legal_authorities
20-77-125. Contingency fee audits prohibited — Definitions.
(a) As used in this section:
(1) “Healthcare provider” means a person enrolled to provide health or medical care services or goods authorized under Medicaid;
(2) “Medicaid” means the medical assistance program provided in this state under Title XIX of the Social Security Act of 1965, 42 U.S.C. § 1396 et seq., including components of the program;
(3) “Medicaid integrity audit contract” means a contract required under federal law between the Department of Human Services and a Medicaid integrity audit program contractor to:
(A) Review the actions of healthcare providers furnishing services or goods for which payment may be made under the Arkansas Medicaid Program to determine whether fraud, waste, or abuse has occurred or is likely to occur, or whether fraud, waste, or abuse has the potential for resulting in an expenditure of Medicaid funds that is not intended under the Arkansas Medicaid Program;
(B) Audit Medicaid claims to ensure proper payments were made; or
(C) Identify overpayments made to individuals or entities receiving Medicaid funds; and
(4) “Person” means any individual, company, firm, organization, association, corporation, or other legal entity.
(b) The Division of Medical Services of the Department of Human Services shall not enter into a Medicaid integrity audit contract that authorizes all or part of an auditor's compensation to be based, directly or indirectly, on the amount of overpayments identified or collected by the auditor.
(c)(1) Within forty-five (45) days after April 11, 2013, the division shall seek a waiver from the Centers for Medicare & Medicaid Services of the requirement that recovery audit contractors, as identified in 42 U.S.C. § 1396a(a)(42)(B), be paid on a
Source: Arkansas Code — historical release 78 (November 6, 2020) · 20-77-125
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Stable record: arkansas_code:legal_authorities:20-77-125
Source file: gov.ar.code.title.20.odt
Pages: Not recorded – Not recorded
Passage SHA-256: cc18f197cf017a8739150407fc847d72b775addf695136e51c58e4bc227aa4da
Source location: content.xml paragraph 35748
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20-77-125. Contingency fee audits prohibited — Definitions.
(a) As used in this section:
(1) “Healthcare provider” means a person enrolled to provide health or medical care services or goods authorized under Medicaid;
(2) “Medicaid” means the medical assistance program provided in this state under Title XIX of the Social Security Act of 1965, 42 U.S.C. § 1396 et seq., including components of the program;
(3) “Medicaid integrity audit contract” means a contract required under federal law between the Department of Human Services and a Medicaid integrity audit program contractor to:
(A) Review the actions of healthcare providers furnishing services or goods for which payment may be made under the Arkansas Medicaid Program to determine whether fraud, waste, or abuse has occurred or is likely to occur, or whether fraud, waste, or abuse has the potential for resulting in an expenditure of Medicaid funds that is not intended under the Arkansas Medicaid Program;
(B) Audit Medicaid claims to ensure proper payments were made; or
(C) Identify overpayments made to individuals or entities receiving Medicaid funds; and
(4) “Person” means any individual, company, firm, organization, association, corporation, or other legal entity.
(b) The Division of Medical Services of the Department of Human Services shall not enter into a Medicaid integrity audit contract that authorizes all or part of an auditor's compensation to be based, directly or indirectly, on the amount of overpayments identified or collected by the auditor.
(c)(1) Within forty-five (45) days after April 11, 2013, the division shall seek a waiver from the Centers for Medicare & Medicaid Services of the requirement that recovery audit contractors, as identified in 42 U.S.C. § 1396a(a)(42)(B), be paid on a contingent fee basis by submitting an amendment to the Medicaid state plan to implement the requirements of this section.
(2)(A) Except as under subdivision (c)(2)(B) of this section, this section does not apply to:
(i) A contract with a Medicaid integrity audit contractor entered into before the state plan amendment is approved by the Centers for Medicare & Medicaid Services; or
(ii) An existing contingent fee contract entered into before July 1, 2013.
(B) An existing contingent fee contract shall not be renewed from and after July 1, 2013, April 11, 2013, or the date a waiver from the Centers for Medicare & Medicaid Services becomes effective, whichever is later.
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Federal law — U.S. Code and appendices · legal_authorities
**(a) Establishment** There is hereby established the Medicaid and CHIP Payment and Access Commission (in this section referred to as “MACPAC”).
**(b) Duties**
(1) **Review of access policies for all States and annual reports** — MACPAC shall—
(A) review policies of the Medicaid program established under this subchapter (in this section referred to as “Medicaid”) and the State Children’s Health Insurance Program established under subchapter XXI (in this section referred to as “CHIP”) affecting access to covered items and services, including topics described in paragraph (2);
(B) make recommendations to Congress, the Secretary, and States concerning such access policies;
(C) by not later than March 15 of each year (beginning with 2010), submit a report to Congress containing the results of such reviews and MACPAC’s recommendations concerning such policies; and
(D) by not later than June 15 of each year (beginning with 2010), submit a report to Congress containing an examination of issues affecting Medicaid and CHIP, including the implications of changes in health care delivery in the United States and in the market for health care services on such programs.
(2) **Specific topics to be reviewed** — Specifically, MACPAC shall review and assess the following:
(A) *Medicaid and CHIP payment policies* — Payment policies under Medicaid and CHIP, including—
(i) the factors affecting expenditures for the efficient provision of items and services in different sectors, including the process for updating payments to medical, dental, and health professionals, hospitals, residential and long-term care providers, providers of home and community based services, Federally-qualified health centers and rural health clinics, managed care entities, and providers of ot
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1396
Stored review status: release_metadata_unconfirmed. The source passage cites 42 U.S.C. § 1396. This identifies an authority to review, not proof of applicability.
Federal law — U.S. Code and appendices · legal_authorities
Page 4009
TITLE 42—THE PUBLIC HEALTH AND WELFARE
§ 1396
of the enactment of this Act [Oct. 6, 2014], the Sec-
retary shall develop and report to Congress on a stra-
tegic plan for collecting or otherwise accessing data on
race and ethnicity for purposes of specifying quality
measures and resource use and other measures under
subsections (c) and (d) of section 1899B of the Social Se-
curity Act, as added by subsection (a), and, as the Sec-
retary determines appropriate, other similar provisions
of, including payment adjustments under, title XVIII of
such Act (42 U.S.C. 1395 et seq.).’’
SUBCHAPTER XIX—GRANTS TO STATES
FOR MEDICAL ASSISTANCE PROGRAMS
§ 1396. Medicaid and CHIP Payment and Access
Commission
(a) Establishment
There is hereby established the Medicaid and
CHIP Payment and Access Commission (in this
section referred to as ‘‘MACPAC’’).
(b) Duties
(1) Review of access policies for all States and
annual reports
MACPAC shall—
(A) review policies of the Medicaid pro-
gram established under this subchapter (in
this section referred to as ‘‘Medicaid’’) and
the State Children’s Health Insurance Pro-
gram established under subchapter XXI (in
this section referred to as ‘‘CHIP’’) affecting
access to covered items and services, includ-
ing topics described in paragraph (2);
(B) make recommendations to Congress,
the Secretary, and States concerning such
access policies;
(C) by not later than March 15 of each year
(beginning with 2010), submit a report to
Congress containing the results of such re-
views and MACPAC’s recommendations con-
cerning such policies; and
(D) by not later than June 15 of each year
(beginning with 2010), submit a report to
Congress
containing
an
examination
of
issues affecting Medicaid and CHIP, includ-
ing the impli
Source: Supplied 2024 U.S. Code historical extraction · 42 U.S.C. § 1396
Stored review status: historical_2024_not_currentness_verified. The source passage cites 42 U.S.C. § 1396. This identifies an authority to review, not proof of applicability.
Federal law — U.S. Code and appendices · legal_authorities
**(a) Contents** A State plan for medical assistance must—
(1) provide that it shall be in effect in all political subdivisions of the State, and, if administered by them, be mandatory upon them;
(2) provide for financial participation by the State equal to not less than 40 per centum of the non-Federal share of the expenditures under the plan with respect to which payments under [section 1396b of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1396b&num=0&edition=prelim) are authorized by this subchapter; and, effective July 1, 1969, provide for financial participation by the State equal to all of such non-Federal share or provide for distribution of funds from Federal or State sources, for carrying out the State plan, on an equalization or other basis which will assure that the lack of adequate funds from local sources will not result in lowering the amount, duration, scope, or quality of care and services available under the plan;
(3) provide for granting an opportunity for a fair hearing before the State agency to any individual whose claim for medical assistance under the plan is denied or is not acted upon with reasonable promptness;
(4) provide (A) such methods of administration (including methods relating to the establishment and maintenance of personnel standards on a merit basis, except that the Secretary shall exercise no authority with respect to the selection, tenure of office, and compensation of any individual employed in accordance with such methods, including provision for utilization of professional medical personnel in the administration and, where administered locally, supervision of administration of the plan, and, subject to [section 1396b(i) of this title](https://uscode.house.gov/view.xhtml?req=granulei
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1396a
Stored review status: release_metadata_unconfirmed. The source passage cites 42 U.S.C. § 1396a. This identifies an authority to review, not proof of applicability.
Federal law — U.S. Code and appendices · legal_authorities
Page 4015
TITLE 42—THE PUBLIC HEALTH AND WELFARE
§ 1396a
‘‘(1) work with States, pediatric dentists, and other
dental providers (including providers that are, or are
affiliated with, a school of dentistry) to include, not
later than 6 months after the date of the enactment
of this Act [Feb. 4, 2009], on the Insure Kids Now
website (http://www.insurekidsnow.gov/) and hotline
(1–877–KIDS–NOW) (or on any successor websites or
hotlines) a current and accurate list of all such den-
tists and providers within each State that provide
dental services to children enrolled in the State plan
(or waiver) under Medicaid or the State child health
plan (or waiver) under CHIP, and shall ensure that
such list is updated at least quarterly; and
‘‘(2) work with States to include, not later than 6
months after the date of the enactment of this Act,
a description of the dental services provided under
each State plan (or waiver) under Medicaid and each
State child health plan (or waiver) under CHIP on
such Insure Kids Now website, and shall ensure that
such list is updated at least annually.’’
DEADLINE FOR INITIAL APPOINTMENTS
Pub. L. 111–3, title V, § 506(b), Feb. 4, 2009, 123 Stat. 95,
provided that: ‘‘Not later than January 1, 2010, the
Comptroller General of the United States shall appoint
the initial members of the Medicaid and CHIP Payment
and Access Commission established under section 1900
of the Social Security Act [42 U.S.C. 1396] (as added by
subsection (a)).’’
ANNUAL REPORT
Pub. L. 111–3, title V, § 506(c), Feb. 4, 2009, 123 Stat. 95,
provided that: ‘‘Not later than January 1, 2010, and an-
nually thereafter, the Secretary [of Health and Human
Services], in consultation with the Secretary of the
Treasury, the Secretary of Labor, and the States (as
d
Source: Supplied 2024 U.S. Code historical extraction · 42 U.S.C. § 1396a
Stored review status: historical_2024_not_currentness_verified. The source passage cites 42 U.S.C. § 1396a. This identifies an authority to review, not proof of applicability.