Ark. Code Ann. » Title 20 Chapter 77
Arkansas Code Annotated

Ark. Code Ann. § 20-77-1708 (2020)

Medical necessity

✓ Arkansas Code release r76: Acts through about 2020 (2021-2025 sessions missing)
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  1. There is a presumption in favor of the medical judgment of the performing or prescribing physician in determining medical necessity of treatment.
  2. If an administrative law judge finds that the Department of Human Services has overcome the presumption under subsection (a) of this section, he or she shall state the manner by which the presumption was overcome.

History. Acts 2005, No. 1758, § 1; 2007, No. 596, § 3; 2013, No. 562, § 5.

Amendments. The 2013 amendment added the (a) designation and added (b).

Case Notes

Presumption.

This section makes it clear that the presumption in favor of a treating physician in determining medical necessity is rebuttable by directing the administrative law judge to “state the manner by which the presumption was overcome”; therefore, in a Medicaid dispute involving a hospice provider, an administrative law judge complied with this section by making specific findings as to each patient whether the presumption had been overcome by the evidence and testimony. Odyssey Healthcare Operating A. LP v. Ark. Dep't of Human Servs., 2015 Ark. App. 459, 469 S.W.3d 381 (2015).

Notes of Decisions
Cited in 2 cases (1 in the last 5 years), 2015–2022 · leading case: Odyssey Healthcare Operating A. LP v. Arkansas Dep't of Human Servs., 2015 Ark. App. 459, 469 S.W.3d 381.
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Odyssey Healthcare Operating A. LP v. Arkansas Dep't of Human Servs., 2015 Ark. App. 459, 469 S.W.3d 381. · cites it 6× “Presumption Next, Odyssey argues that the ALJ failed to comply with the Medicaid Fairness Act by not applying the presumption in favor of the treating physician found in Ark. Code Ann. § 20-77-1708 (a). Under this statute, there is a rebuttable presumption in favor of the…”
Arkansas Dep't of Human Servs. v. Nw. Arkansas Hosp., Springdale, 2022 Ark. App. 312. · cites it 4× “Ark. Code Ann. § 20-77-1708 (a) (Repl. 2018).”
Ark. Code Ann. § 20-77-1708(b): 1 case
Odyssey Healthcare Operating A. LP v. Arkansas Dep't of Human Servs., 2015 Ark. App. 459, 469 S.W.3d 381. “Presumption Next, Odyssey argues that the ALJ failed to comply with the Medicaid Fairness Act by not applying the presumption in favor of the treating physician found in Ark. Code Ann. § 20-77-1708 (a). Under this statute, there is a rebuttable presumption in favor of the…”
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