AR SB273

Prohibits the Department from using "episodes of care" or similar reimbursement models that limit payments to a predetermined aggregate amount based solely on beneficiary diagnosis.

Requires reimbursement to be based on a predetermined unit rate for medically necessary care actually rendered to individual beneficiaries and properly documented.

Exempts certain reimbursement methods from the prohibition, including tiered daily service rates for residential and assisted living facilities, capitated rates for PACE organizations, and negotiated rates for home and community-based services waivers.

Prohibits the Department from recovering, recouping, or withholding reimbursements unless it provides a particularized finding that the claim was fraudulent, services were not in compliance with department rules, or services were not medically necessary.