HB1165
To Prohibit Different Reimbursement Rates For Services Performed By The Same Type Of Provider In Different Settings Within The Arkansas Medicaid Program.
AI-Generated Summary
This bill, House Bill 1165, aims to prohibit the Arkansas Medicaid Program from reimbursing providers at different rates for the same services when rendered in different settings. The legislation specifically addresses a perceived discrepancy where physicians are paid more for services provided in their own offices compared to when those same services are performed at a behavioral health agency or a certified support services provider agency, even if identical billing codes are used. The General Assembly finds that these varying reimbursement rates disadvantage the provision of behavioral health services. The bill mandates that the Arkansas Medicaid Program will not differentiate reimbursement based solely on the setting of service delivery for the same type of provider using the same billing codes. To implement these changes, the Department of Human Services is required to seek any necessary federal waivers, state plan amendments, or other authorizations. The overall purpose is to standardize reimbursement rates for identical services by the same provider type across different practice locations within the Medicaid program.
Potential Impact Analysis
Who Might Benefit?
The primary beneficiaries of this bill, if enacted, would be behavioral health agencies and certified support services provider agencies. These entities, which currently receive lower reimbursement rates for physician services provided within their settings, would likely see an increase in payments to match the rates physicians receive for the same services in their own offices. Additionally, physicians who provide services in these alternative settings may benefit from more equitable compensation for their work, potentially leading to increased access to their services within behavioral health and support service environments.
Who Might Suffer?
The entity most directly and negatively impacted by this bill, if enacted, would be the Arkansas Medicaid Program and, by extension, the Arkansas Department of Human Services. The bill would necessitate a restructuring of reimbursement policies, potentially leading to increased overall program expenditures if physician services previously reimbursed at a lower rate are now paid at a higher rate. The requirement to seek federal waivers or amendments could also introduce administrative burdens and uncertainties regarding approval and implementation timelines. While not directly stated, any entities that benefit from the current differential in reimbursement rates, such as physician-owned practices that do not contract with behavioral health agencies, might also be indirectly impacted by a more standardized payment structure.