§ 23-61-1004 — Administration

(a) (1) The Department of Human Services, in coordination with the State Insurance Department and other state agencies, as necessary, shall: (A) Provide healthcare coverage under this subchapter to eligible individuals; (B) Create and administer the Arkansas Health and Opportunity for Me Program by: (i) Applying for any federal waivers, Medicaid state plan amendments, or other authority necessary to implement the Arkansas Health and Opportunity for Me Program in a manner consistent with this subchapter; and (ii) Administering the Arkansas Health and Opportunity for Me Program as approved by the Centers for Medicare & Medicaid Services; (C) (i) Administer the economic independence initiative designed to reduce the short-term effects of the work penalty and the long-term effects of poverty on health outcomes among program participants through incentives and disincentives. (ii) The Department of Human Services shall align the economic independence initiative with other state-administered work-related programs to the extent practicable; (D) Screen, refer, and assist eligible individuals through community bridge organizations under agreements with the Department of Human Services; (E) Offer incentives to promote personal responsibility, individual health, and economic independence through individual qualified health insurance plans and community bridge organizations; and (F) Seek a waiver to reduce the period of retroactive eligibility for an eligible individual under this subchapter to thirty (30) days before the date of the application. (2) The Governor shall request the assistance and involvement of other state agencies that he or she deems necessary for the implementation of the Arkansas Health and Opportunity for Me Program. (b) Healthcare coverage under this subchapter shall be provided through enrollment in: (1) An individual qualified health insurance plan through a health insurer; (2) A risk-based provider organization; (3) An employer-sponsored health insurance coverage; or (4) The fee-for-service Arkansas Medicaid Program. (c) Annually, the Department of Human Services shall develop purchasing guidelines that: (1) Describe which individual qualified health insurance plans are suitable for purchase in the next demonstration year, including without limitation: (A) The level of the plan; (B) The amounts of allowable premiums; (C) Cost sharing; (D) Auto-assignment methodology; and (E) The total per-member-per-month enrollment range; and (2) Ensure that: (A) Payments to an individual qualified health insurance plan do not exceed budget neutrality limitations in each demonstration year; (B) The total payments to all of the individual qualified health insurance plans offered by the health insurers for eligible individuals combined do not exceed budget targets for the Arkansas Health and Opportunity for Me Program in each demonstration year that the Department of Human Services may achieve by: (i) Setting in advance an enrollment range to represent the minimum and a maximum total monthly number of enrollees into all individual qualified health insurance plans no later than April 30 of each demonstration year in order for the individual qualified health insurance plans to file rates for the following demonstration year; (ii) Temporarily suspending auto-assignment into the individual qualified health insurance plans at any time in a demonstration year if necessary, to remain within the enrollment range and budget targets for the demonstration year; and (iii) Developing a methodology for random auto-assignment of program participants into the individual qualified health insurance plans after a suspension period has ended; (C) Individual qualified health insurance plans meet and report quality and performance measurement targets set by the Department of Human Services; and (D) At least two (2) health insurers offer individual qualified health insurance plans in each county in the state. (d) (1) The Department of Human Services, the State Insurance Department, and each of the individual qualified health insurance plans shall enter into a memorandum of understanding that shall specify the duties and obligations of each party in the operation of the Arkansas Health and Opportunity for Me Program, including provisions necessary to effectuate the purchasing guidelines and reporting requirements, at least thirty (30) calendar days before the annual open enrollment period. (2) If a memorandum of understanding is not fully executed with a health insurer by January 1 of each new demonstration year, the Department of Human Services shall suspend auto-assignment of new members to the health insurers until the first day of the month after the new memorandum of understanding is fully executed. (3) The memorandum of understanding shall include financial sanctions determined appropriate by the Department of Human Services that may be applied if the Department of Human Services determines that an individual qualified health insurance plan has not met the quality and performance measurement targets or any other condition of the memorandum of understanding. (4) (A) If the Department of Human Services determines that the individual qualified health insurance plans have not met the quality and health performance targets for two (2) years, the Department of Human Services shall develop additional reforms to achieve the quality and health performance targets. (B) If legislative action is required to implement the additional reforms described in subdivision (d)(4)(A) of this section, the Department of Human Services may take the action to the Legislative Council or the Executive Subcommittee of the Legislative Council for immediate action. (e) The Department of Human Services shall: (1) Adopt premiums and cost-sharing levels for individuals enrolled in the Arkansas Health and Opportunity for Me Program, not to exceed aggregate limits under 42 C.F.R. § 447.56 ; (2) (A) Establish and maintain a process for premium payments, advanced cost-sharing reduction payments, and reconciliation payments to health insurers. (B) The process described in subdivision (e)(2)(A) of this section shall attribute any unpaid member liabilities as solely the financial obligation of the individual member. (C) The Department of Human Services shall not include any unpaid individual member obligation in any payment or financial reconciliation with health insurers or in a future premium rate; and (3) (A) Calculate a total per-member-per-month amount for each individual qualified health insurance plan based on all payments made by the Department of Human Services on behalf of an individual enrolled in the individual qualified health insurance plan. (B) (i) The amount described in subdivision (e)(3)(A) of this section shall include premium payments, advanced cost-sharing reduction payments for services provided to covered individuals during the demonstration year, and any other payments accruing to the budget neutrality target for plan-enrolled individuals made during the demonstration year and the member months for each demonstration year. (ii) The total per-member-per-month upper limit is the budget neutrality per-member-per-month limit established in the approved demonstration for each demonstration year. (C) If the Department of Human Services calculates that the total per-member-per-month limit for an individual qualified health insurance plan for that demonstration year exceeds the budget neutrality per-member-per-month limit for that demonstration year, the Department of Human Services shall not make any additional reconciliation payments to the health insurer for that individual qualified health insurance plan. (D) If the Department of Human Services determines that the budget neutrality limit has been exceeded, the Department of Human Services shall recover the excess funds from the health insurer for that individual qualified health insurance plan. (f) (1) If the federal medical assistance percentages for the Arkansas Health and Opportunity for Me Program are reduced to below ninety percent (90%), the Department of Human Services shall present to the Centers for Medicare & Medicaid Services a plan within thirty (30) days of the reduction to terminate the Arkansas Health and Opportunity for Me Program and transition eligible individuals out of the Arkansas Health and Opportunity for Me Program within one hundred twenty (120) days of the reduction. (2) An eligible individual shall maintain coverage during the process to implement the plan to terminate the Arkansas Health and Opportunity for Me Program and the transition of eligible individuals out of the Arkansas Health and Opportunity for Me Program. (g) (1) A health insurer that is providing an individual qualified health insurance plan or employer health insurance coverage for an eligible individual shall submit claims and enrollment data to the Department of Human Services to facilitate reporting required under this subchapter or other state or federally required reporting or evaluation activities. (2) A health insurer may utilize existing mechanisms with supplemental enrollment information to fulfill requirements under this subchapter, including without limitation the state's all-payer claims database established under the Arkansas Healthcare Transparency Initiative Act of 2015, § 23-61-901 et seq., for claims and enrollment data submission. (h) (1) The Governor shall request a block grant under relevant federal law and regulations for the funding of the Arkansas Medicaid Program as soon as practical if the federal law or regulations change to allow the approval of a block grant for this purpose. (2) The Governor shall request a waiver under relevant federal law and regulations for a work requirement as a condition of maintaining coverage in the Arkansas Medicaid Program as soon as practical if the federal law or regulations change to allow the approval of a waiver for this purpose.

Legislative History

Amended by Act 2021, No. 530,§ 1, eff. on and after January 1, 2022. Amended by Act 2019, No. 910,§ 601, eff. 7/1/2019. Amended by Act 2019, No. 910,§ 600, eff. 7/1/2019. Amended by Act 2017EX1, No. 6,§ 5, eff. 12/31/2017. Amended by Act 2017EX1, No. 3,§ 5, eff. 12/31/2017. Added by Act 2016EX2, No. 2,§ 1, eff. 4/8/2016. Added by Act 2016EX2, No. 1,§ 1, eff. 4/8/2016.