§ 20-77-1704 - Provider administrative appeals allowed.
20-77-1704. Provider administrative appeals allowed.
(a) The General Assembly finds it necessary to:
(1) Clarify its intent that providers have the right to administrative appeals; and
(2) Emphasize that this right of appeal is to be liberally construed and not limited through technical or procedural arguments by the Department of Human Services.
(b) (1) In response to an adverse decision, a provider may appeal on behalf of the recipient or on its own behalf, or both, under the Arkansas Administrative Procedure Act, 25-15-201 et seq., regardless of whether the provider is an individual or a corporation.
(2) The provider may appear:
(A) In person or through a corporate representative; or
(B) With prior notice to the department, through legal counsel.
(3) (A) A Medicaid recipient may attend any hearing related to his or her care, but the department may not make his or her participation a requirement for provider appeals.
(B) The department may compel the recipient's presence via subpoena, but failure of the recipient to appear shall not preclude the provider appeal.
(c) A provider does not have standing to appeal a nonpayment decision if the provider has not furnished any service for which payment has been denied.
(d) Providers, like Medicaid recipients, have standing to appeal to circuit court unfavorable administrative decisions under the Arkansas Administrative Procedure Act, 25-15-201 et seq.
(e) If an administrative appeal is filed by both provider and recipient concerning the same subject matter, then the department may consolidate the appeals.
(f) This subchapter shall apply to all pending and subsequent appeals that have not been finally resolved at the administrative or judicial level as of April 5, 2005.