AR SB135

Prohibits Arkansas Department of Human Services from using reimbursement models that limit payments to a predetermined aggregate amount based solely on diagnosis or pay claims on any basis other than a predetermined unit rate for medically necessary care actually rendered and documented.

Requires the department to obtain a particularized finding subject to administrative appeal before recovering any reimbursement, with grounds limited to ineligible providers, services not actually rendered as claimed, improper documentation, or services subject to recoupment under prior authorization or medical necessity rules.

Mandates the department submit state plan amendments or seek federal waivers as needed to implement the new reimbursement restrictions.

Requires the department to conduct and successfully complete a pilot program before implementing any healthcare payment reform or payment initiative.

Amends the Health Care Independence Program to allow health insurance carriers to participate in applicable healthcare reforms or healthcare initiatives, specifically including primary care clinician assignment, patient-centered medical home support, and access to clinical performance data for providers.