§ 20-77-1707 - Prior authorizations -- Retrospective reviews. - Arkansas Statutes

20-77-1707. Prior authorizations -- Retrospective reviews.

The Department of Human Services may not retrospectively recoup or deny a claim from a provider if the department previously authorized the Medicaid care, unless:

(1) The retrospective review establishes that:

(A) The previous authorization was based upon misrepresentation by act or omission; and

(B) If the facts had been known, the specific level of care would not have been authorized; or

(2) (A) The previous authorization was based upon conditions that later changed, thereby rendering the Medicaid care medically unnecessary.

(B) Recoupments based upon lack of medical necessity shall not include payments for any Medicaid care that was delivered before the change of circumstances that rendered the care medically unnecessary.