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2017 Arkansas Code
Title 20 - Public Health and Welfare
Subtitle 5 - Social Services
Chapter 77 - Medical Assistance
Subchapter 27 - Medicaid Provider-Led Organized Care Act
§ 20-77-2707. Reporting and performance measures
Universal Citation: AR Code § 20-77-2707 (2017)
- (a) (1) On a quarterly basis, a risk-based provider organization shall submit to the Department of Human Services protected health information for each member of a covered Medicaid beneficiary population and a voluntary Medicaid beneficiary population enrolled with the risk-based provider organization in accordance with standards and procedures adopted by the department, including without limitation:
- (A) Claims data, including without limitation:
- (i) Denial rates; and
- (ii) Claims-paid rates;
- (B) Encounter data;
- (C) Unique identifiers;
- (D) Geographic and demographic information;
- (E) Patient satisfaction scores; and
- (F) Other information as required by the state.
- (2) Personally identifiable data submitted under this section shall be treated as confidential and is exempt from disclosure under the Freedom of Information Act of 1967, § 25-19-101 et seq.
- (A) Claims data, including without limitation:
- (b) The department shall use the data submitted under subsection (a) of this section to measure the performance of the risk-based provider organization in:
- (1) Delivery of services;
- (2) Patient outcomes;
- (3) Efficiencies achieved; and
- (4) Quality measures.
- (c) Performance measures established by the department shall at a minimum monitor:
- (1) Reduction in unnecessary hospital emergency department utilization;
- (2) Adherence to prescribed medication regimens;
- (3) Reduction in avoidable hospitalizations for ambulatory-sensitive conditions; and
- (4) Reduction in hospital readmissions.
- (d) The department shall issue funds from the quality incentive pool above the amount of the global payments initially provided to a risk-based provider organization that meets or exceeds specific performance and outcome measures established by the department.
- (e) On a quarterly basis, the department shall report to the Legislative Council, or to the Joint Budget Committee if the General Assembly is in session, available information regarding:
- (1) Risk-based provider organization membership enrollment and distribution;
- (2) Patient experience data; and
- (3) Financial performance, including demonstrated savings.
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