If the Department of Human Services requires a provider to justify the medical necessity of a service through prior authorization, the department shall not later take the position that the services were not medically necessary, unless the retrospective review establishes that:
(1) The previous authorization was based upon misrepresentation by act or omission;
(2) The services billed were not provided; or
(3) An unexpected change occurred that rendered the prior-authorized care not medically necessary.
Structure Arkansas Code
Title 20 - Public Health and Welfare
Chapter 77 - Medical Assistance
Subchapter 17 - Medicaid Fairness Act
§ 20-77-1701. Legislative findings and intent
§ 20-77-1704. Provider administrative appeals allowed
§ 20-77-1705. Explanations for adverse decisions required
§ 20-77-1706. Reimbursement at an alternate level instead of complete denial
§ 20-77-1707. Prior authorizations — Retrospective reviews
§ 20-77-1708. Medical necessity
§ 20-77-1709. Promulgation before enforcement
§ 20-77-1710. Delivery of files
§ 20-77-1711. Copies of records to be supplied to department — Exception
§ 20-77-1716. Promulgation of rules