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ArkansasHB13012025 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

6 provisions identified: 4 benefits, 0 costs, 2 mixed.

Provider groups gain prior approval exemptions

Insurers must extend an exemption to providers sharing one tax identification number when an insurer or provider elects group coverage. An owner-provider must not object, or an Arkansas-licensed hospital’s chief executive must agree. For each service, providers are excluded if fewer than 80% of their requests were approved or approvable during the latest six-month review. When insurers elect group coverage, each affected provider gets at least 60 days’ advance notice. The same notice applies before insurers change or end that election.

Providers can request patients’ plan types

When a provider asks, insurers or pharmacy benefits managers must send an eligibility file identifying the patient’s plan type. Categories include self-insured plans governed by federal employee-benefit law, fully insured or self-funded plans, and qualified Arkansas Marketplace plans. Marketplace notifications distinguish incomes up to 400% of the federal poverty level from incomes above that level.

Providers get more time to respond

Insurers must give providers at least 30 days’ notice before ending a prior approval exemption, up from 25 days. Providers also get at least 60 days to supply medical records requested under the exemption review process. That records deadline increases from 30 days.

Qualifying providers can skip prior approvals

Insurers must waive prior approval for a service when at least 90% of a provider’s requests were approved or approvable. The threshold uses the applicable six-month review period. Insurers evaluate exemptions every 12 months, using the applicable 12-month window. Providers denied an exemption can request another review 12 months after their latest denial.

Drug approval waivers gain board oversight

Gold card rules cover prescription drugs, medicines, biological products, and related pharmaceutical services unless they are exempt from the program. Insurers or pharmacy benefits managers must review providers under gold card rules for products and services that are not exempt. Insurers and pharmacy benefits managers can request an exemption in writing, explaining why an item should be excluded. Arkansas’s Pharmacy and Medical boards jointly decide requests using criteria that include cost and safety; decisions bind all insurers and pharmacy benefits managers. The Pharmacy Board must post exempt items, and approved exemptions last two years from the notice date.

Health plans face approval reduction requirements

Covered Medicaid care programs, Arkansas Health and Opportunity for Me, and qualifying Marketplace plans must work to reduce or end prior approvals. The Marketplace rule covers people with incomes up to 400% of the federal poverty level; successor health programs are included. To keep their exemption, programs must submit effectiveness data and any remaining approval-reduction initiatives at least every two years. Submissions go to the Arkansas Insurance Department for Legislative Council approval, and providers get the complete submission and at least 30 days to comment. Beginning January 1, 2025, programs that fail to submit or follow a compliant program face provider-level gold card rules.

Sponsors & Cosponsors

Sponsors

  • Missy Irvin

    Republican • Senate

  • Lee Johnson

    Republican • House

Cosponsors

There are no cosponsors for this bill.

Roll Call Votes

All Roll Calls

Yes: 127 • No: 0

Senate vote • 4/3/2025

Senate Vote - Thursday, April 3, 2025 4:46:01 PM

Yes: 32 • No: 0

House vote • 3/17/2025

House Vote - Monday, March 17, 2025 2:14:14 PM

Yes: 95 • No: 0 • Other: 1

Actions Timeline

  1. Notification that HB1301 is now Act 511

    4/10/2025House

  2. Correctly enrolled and ordered transmitted to the Governor's Office.

    4/4/2025House

  3. TO BE ENROLLED

    4/3/2025House

  4. Returned from the Senate as passed.

    4/3/2025House

  5. Returned to the House as passed.

    4/3/2025Senate

  6. Read the third time and passed.

    4/3/2025Senate

  7. Returned by the Committee, with the recommendation that it Do Pass

    4/1/2025Senate

  8. Read first time, rules suspended, read second time, referred to INSURANCE & COMMERCE - SENATE

    3/17/2025Senate

  9. Received from the House.

    3/17/2025Senate

  10. Read the third time and passed and ordered transmitted to the Senate.

    3/17/2025House

  11. REPORTED CORRECTLY ENGROSSED

    3/13/2025House

  12. Amendment No. 3 read and adopted and the bill ordered engrossed.

    3/13/2025House

  13. Placed on second reading for the purpose of amendment.

    3/13/2025House

  14. Returned by the Committee with the recommendation that it do pass as amended 3

    3/12/2025House

  15. REPORTED CORRECTLY ENGROSSED

    2/20/2025House

  16. Amendment No. 2 read and adopted and the bill ordered engrossed.

    2/20/2025House

  17. Placed on second reading for the purpose of amendment.

    2/20/2025House

  18. REPORTED CORRECTLY ENGROSSED

    2/5/2025House

  19. Amendment No. 1 read and adopted and the bill ordered engrossed.

    2/5/2025House

  20. Placed on second reading for the purpose of amendment.

    2/5/2025House

  21. Read the first time, rules suspended, read the second time and referred to the Committee on INSURANCE & COMMERCE- HOUSE

    1/29/2025House

  22. Filed

    1/29/2025House

Bill Text

  • HB1301 - Introduced

    1/29/2025

    PDF

  • Act Version

    PDF

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