(1) “ADHS” means the Arkansas Department of Human Services;

(2) “Associated participant” means an organization or individual that is a member or contractor of a risk-based provider organization and provides necessary administrative functions, including without limitation claims processing, data collection, and outcome reporting;

(3) “Capitated” means an actuarially sound healthcare payment that is based on a payment per person that covers the total risk for providing healthcare services as provided in this subchapter for a person;

(5) “Carrier” means an organization that is licensed or otherwise authorized to provide health insurance or health benefit plans under § 23-85-101 or § 23-76-101;

(6) “Commissioner” means the Arkansas Insurance Commissioner;

(7) “Covered Medicaid beneficiary population” means a group of individuals with:

(8) “Department” means the Arkansas Insurance Department;

(9) “Direct service provider” means an organization or individual that delivers healthcare services to enrollable Medicaid beneficiary populations;

(10) “Enrollable Medicaid beneficiary population” means a group of individuals who are either:

(11) “Flexible services” means alternative services that are not included in the state plan or waiver of the Arkansas Medicaid Program and that are appropriate and cost-effective services that improve the health or social determinants of a member of an enrollable Medicaid beneficiary population that affect the health of the member of an enrollable Medicaid beneficiary population;

(12) “Global payment” means a population-based payment methodology that is actuarially sound and based on an all-inclusive per-person-per-month calculation for all benefits, administration, care management, and care coordination for enrollable Medicaid beneficiary populations;

(13) “Medicaid” means the programs authorized under Title XIX of the Social Security Act, 42 U.S.C. § 1396 et seq., and Title XXI of the Social Security Act, 42 U.S.C. § 1397aa et seq., as they existed on January 1, 2017, for the provision of healthcare services to members of enrollable Medicaid beneficiary populations;

(14) “NAIC” means the National Association of Insurance Commissioners;

(15) “Participating provider” means an organization or individual that is a member or has an ownership interest in of a risk-based provider organization and delivers healthcare services to enrollableMedicaid [FN1] beneficiary populations;

(16) “Quality incentive pool” means a funding source established and maintained by ADHS to be used to reward risk-based provider organizations that meet or exceed specific performance and outcome measures;

(17) “Risk assumption” or “risk sharing” means, for the purpose of this regulation, a transaction whereby the chance of loss, including the expenses for the delivery of service, with respect to the health care of a person, is transferred to or shared with another entity, in return for a consideration. Examples include but are not limited to, full or partial capitation agreements, withholds, risk corridors, and indemnity agreements;

(18) “Risk based capital” means the “RBC level” defined under Ark. Code Ann. § 23-63-1501 (8); and

(19) “Risk-based provider organization” means an entity that:

(20) “Voluntary Medicaid beneficiary populations” means individuals who are in need of behavioral health services or developmental disabilities services, not otherwise excluded in this subchapter, who are eligible for Medicaid and may elect to enroll in a risk-based provider organization.