Legislators press DHS after CMS flags federal 'comparability' problems with dental, lab provisions of multiple acts

Department of Human Services officials told the Administrative Rule Subcommittee on Jan. 16 that federal reviewers at the Centers for Medicare & Medicaid Services have raised legal and technical concerns that may prevent Arkansas from implementing several recent laws as written, most notably parts of Act 10 25 that would change adult dental caps and increase pediatric dental rates.

DHS Secretary Janet Mann and Director Elizabeth Pittman said CMS cited 'comparability' rules that require the same Medicaid benefits be available to all eligible enrollees and consequently questioned provisions that would tie higher limits or different pay structures to specific diagnoses or provider types. "CMS has indicated that due to comparability ... we cannot implement as passed," Pittman said, adding that the agency is pursuing options and discussions with CMS to preserve the law’s intent.

Why it matters: The dispute affects statewide access to dental care, reimbursement for providers and the timeline for when rate increases would take effect. Dentists and families had anticipated changes beginning Sept. 1; DHS said waivers can take nine to 18 months and state-plan amendments (SPAs) are subject to a 90-day federal review clock that can be paused if CMS requests additional information.

What DHS told lawmakers: Pittman summarized four federal pathways DHS has considered after CMS’ written feedback: 1) apply the increased adult cap statewide and use medical-necessity criteria (which DHS estimates would raise costs by roughly $10–12 million above prior pediatric estimates); 2) pursue a 1915(c) or 1115 waiver for special-needs dental services (time-consuming and not retroactive); 3) redesign the adult dental benefit around the special-needs population (limited viability); and 4) the option DHS and stakeholders have discussed — split the package so pediatric and oral-surgeon rate increases proceed now while special-needs adult cap changes are pursued separately.

DHS officials said the lab-service change (Act 5 67) is a mandatory CMS service and therefore has fewer implementation options. Mann said DHS sent the committee a December letter to notify legislators of the challenges and to avoid later surprises about timing.

Dental association response: Billy Tarpley, executive director of the Arkansas State Dental Association, told the committee Act 10 25 is "workable" and urged the agency and legislators to separate the pediatric rate increase from the adult special-needs cap so the state can preserve the Sept. 1 effective date for pediatric changes while pursuing a waiver or alternative federal approval for the adult cap. "Dentists desperately want to continue in this program," Tarpley said, describing practices that added operatories or hired staff in reliance on the law.

Lawmakers’ concerns and committee action: Legislators pressed DHS for specifics on fiscal impact, timing and whether the $100 million Medicaid set‑aside could be used; DHS said it had not requested those funds and would need to coordinate with other state offices. Multiple members said they expected state agencies to pursue implementation and argued that DHS could have started waiver or SPA processes earlier. The subcommittee adopted a motion to deny DHS’s request to be excluded from reporting requirements for the four cited acts, preserving committee oversight and requiring DHS to continue reporting to the legislature.

What's next: DHS will continue discussions with CMS and stakeholders about splitting the package and pursuing waivers or alternative approaches. The committee asked DHS to return with additional reporting and separate updates on implementable provisions.