All Roll Calls
Yes: 125 • No: 1
ArkansasHB13002025 Regular SessionHouseWALLET
TO AMEND THE PRIOR AUTHORIZATION TRANSPARENCY ACT.
Sponsored By: Missy Irvin (Republican), Lee Johnson (Republican)
Enacted
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Bill Overview
Analyzed Economic Effects
7 provisions identified: 6 benefits, 1 costs, 0 mixed.
Approval violations give patients a remedy
When an insurer or review entity violates the Act on a specific approval request, the requested service counts as approved. After provider notice, the entity has two days to issue approval, resend an unanswered information request, or refer the issue to the Arkansas Insurance Department. After notice, investigation, and a hearing, the commissioner may order approval, hearing costs, and fines. Fines can reach $1,000 per violation and $10,000 total; knowing or reasonably knowable violations allow $5,000 per violation and $50,000 in six months. Payments for services approved through this process cannot be taken back through an audit.
More protection for patients continuing treatment
Approved care must cover the full treatment course, with dates and a medically reasonable and necessary length. Any limits on units, visits, or treatments must allow enough for that course. For courses longer than one year, review entities may limit approval to one year. Insurers must also pay medical-benefit claims without prior approval during a patient’s first 60 days of coverage, including day 60. That care must continue treatment begun before coverage; this protection does not apply to pharmacy benefits.
Stronger payment protection for approved care
Insurers must pay claims for approved care, regardless of what the review entity or plan calls its approval process. The law removes the exception for approval granted more than 90 days before care. Exceptions remain for care not given, late claims, benefits exhausted after approval, or material misrepresentation, fraud, or abuse. Approvals must disclose that benefits can run out.
Clearer coverage rules for patients and providers
Health review entities must post clear, computer-readable approval rules, clinical criteria, service names, billing codes, and policy start and end dates. Downloadable lists must keep services that no longer need approval for two years. Even when approval is unnecessary, entities must disclose medical-need reviews, try-first treatment rules, care-location, provider-type and benefit-category limits, clinical exclusions, and post-care review, information-request or audit duties. They must publish approval and denial statistics by review entity, physician specialty, drug, test or procedure, medical reason, and denial reason. Websites must be updated before changes take effect, and contracted providers must get at least 60 days’ written notice of new or materially changed requirements or criteria. Protected criteria may use secure access; out-of-network providers must get timely electronic or phone access without delays caused by access restrictions.
More health reviews follow approval rules
Arkansas expands which services and health plan reviews fall under its prior approval rules. Covered services include drugs, drug services, and durable medical equipment identified by CPT, HCPCS, or National Drug Codes. Prior approval includes required steps that patients or providers must complete for coverage or payment. These include reviews before admission or treatment, certification, advance coverage decisions, ongoing reviews, medical-need checks, and advance notice requirements. They also include rules requiring patients to try another treatment first.
Stronger oversight of health approval rules
For violations outside the specific-request process, entities have one business day after provider notice to correct past and future problems or refer them to the Arkansas Insurance Department. Providers and patients may also file complaints with the Department. When repeated violations show a general business practice, the commissioner must order corrections and may fine up to $5,000 daily, capped at $100,000. Fines under the Act fund a new trust fund, administered by the commissioner, only for provider and patient education, compliance checks, and enforcement improvements. Fund money is protected from deductions, taxes, levies, and other assessments.
Limits on insurers’ violations and fines
An insurer or review entity is not in violation when a provider fails to send properly requested additional information. The insurer or pharmacy benefit manager must have made the request in compliance with the Act. After imposing a fine under this Act, the commissioner cannot impose another state-law fine for the same act or omission. The duplicate-fine limit does not change patients’ coverage or payment rights.
Sponsors & Cosponsors
Sponsors
Missy Irvin
Republican • Senate
Lee Johnson
Republican • House
Cosponsors
There are no cosponsors for this bill.
Roll Call Votes
Senate vote • 4/3/2025
Senate Vote - Thursday, April 3, 2025 4:43:33 PM
Yes: 32 • No: 0
House vote • 3/17/2025
House Vote - Monday, March 17, 2025 2:13:07 PM
Yes: 93 • No: 1 • Other: 3
Actions Timeline
Notification that HB1300 is now Act 510
4/10/2025HouseCorrectly enrolled and ordered transmitted to the Governor's Office.
4/4/2025HouseTO BE ENROLLED
4/3/2025HouseReturned from the Senate as passed.
4/3/2025HouseReturned to the House as passed.
4/3/2025SenateRead the third time and passed.
4/3/2025SenateReturned by the Committee, with the recommendation that it Do Pass
4/1/2025SenateRead first time, rules suspended, read second time, referred to INSURANCE & COMMERCE - SENATE
3/17/2025SenateReceived from the House.
3/17/2025SenateRead the third time and passed and ordered transmitted to the Senate.
3/17/2025HouseREPORTED CORRECTLY ENGROSSED
3/13/2025HouseAmendment No. 3 read and adopted and the bill ordered engrossed.
3/13/2025HousePlaced on second reading for the purpose of amendment.
3/13/2025HouseReturned by the Committee with the recommendation that it do pass as amended 3
3/12/2025HouseREPORTED CORRECTLY ENGROSSED
3/3/2025HouseAmendment No. 2 read and adopted and the bill ordered engrossed.
3/3/2025HousePlaced on second reading for the purpose of amendment.
3/3/2025HouseREPORTED CORRECTLY ENGROSSED
2/20/2025HouseAmendment No. 1 read and adopted and the bill ordered engrossed.
2/20/2025HousePlaced on second reading for the purpose of amendment.
2/20/2025HouseRead the first time, rules suspended, read the second time and referred to the Committee on INSURANCE & COMMERCE- HOUSE
1/29/2025HouseFiled
1/29/2025House
Bill Text
HB1300 - Introduced
1/29/2025
Act Version
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