Arkansas Administrative Code

23 CAR § 111-111. Solicitation. All sellers and their employees, agents, or anyone soliciting on their behalf are prohibited from undertaking any of the following practices when engaging in the solicitation of prepaid funeral benefits contracts from consumers: (1) The making of a…

23 CAR § 111-112. Annual report. Each seller shall file an annual report as provided in Arkansas Code § 23-40-119.

23 CAR § 111-113. Audit — Administration — Enforcement. (a) Sellers of prepaid funeral benefits contracts shall be subject to audits as provided for in Arkansas Code § 23-40-120. (b) The Insurance Commissioner for the State of Arkansas shall be responsible for the administration …

23 CAR § 113-101. Purpose. The purpose of this part is to implement and coordinate compliance with the Arkansas diabetes self-management benefits mandated for inclusion in insurance and HMO policies and contracts under the provisions of Acts 1997, No. 1249, effective August 1, 19…

23 CAR § 113-102. Applicability and scope. (a) Application. (1)(A) This part shall apply to every disability (health) insurer, hospital or medical service corporation, health maintenance organization (HMO), and fraternal benefit society licensed by the Insurance Commissioner. (B)…

23 CAR § 113-103. Definitions. As used in this part: (1) “Commissioner” means the Insurance Commissioner; (2) “Department” means the State Insurance Department; (3)(A) “Diabetes” means and shall include Type I, Type II, or gestational diabetes, diabetes insipidus, and other speci…

23 CAR § 113-104. Coverage mandated — Limitations. (a)(1) Pursuant to Acts 1997, No. 1249, § 2, every individual and group health insurance policy as defined in this part shall include coverage for one (1) per lifetime training program per insured for diabetes self-management tra…

23 CAR § 113-105. Standards for diabetes self-management training. The diabetes education process for self-management training shall include the following standards: (1) Needs assessment. (A) The healthcare provider shall conduct an individualized educational needs assessment wit…

23 CAR § 113-106. Equipment, supplies, and appliances. Health insurance policies shall provide coverage in accordance with 23 CAR § 113-104(c) for the equipment, supplies, and services listed in this section prescribed by an insured's physician licensed under Arkansas Code § 17-9…

23 CAR § 113-107. Penalties. Healthcare insurers who fail to comply with the provisions of this part shall be subject to investigations and administrative proceedings and penalties for trade practice violations enumerated in the Trade Practices Act, Arkansas Code § 23-66-201 et s…

23 CAR § 114-101. Purpose. The purpose of this part is to set forth standards for eligible healthcare insurers to follow in certifying that the application of the Arkansas Mental Health Parity Act, Acts 1997, No. 1020 (codified at Arkansas Code § 23-99-501 et seq.), to a particul…

23 CAR § 114-102. Scope. This part is intended to apply to health benefit plans as defined under Arkansas Code § 23-99-503(4).

23 CAR § 114-103. Increased cost exemption requirements. (a) State requirements. (1)(A) Pursuant to Arkansas Code § 23-99-505, the provisions of the Arkansas Mental Health Parity Act shall not apply to health benefit plans if the act’s application to such plans will result in an …

23 CAR § 115-101. Purpose. The purpose of this part is to require health carriers to provide full, written disclosure to covered persons of the availability of a dental point of service option in their health plans, where such health plans provide for dental benefits.

23 CAR § 115-102. Applicability and scope. This part applies to all health plans that provide dental benefits issued, renewed, extended, or modified by a health carrier.

23 CAR § 115-103. Definitions. As used in this part: (1) "Covered person" means a person defined in Arkansas Code § 23-99-603(2); (2) "Health carrier" means that company or organization defined in Arkansas Code § 23-99-603(5); and (3) "Health plan" means any contract, policy, or …

23 CAR § 115-104. Required notice. (a) Upon the issuance, extension, modification, or renewal of every health plan that provides dental benefits, the health carrier shall provide written notification to either the covered person, employer, or other purchaser of the health plan, o…

23 CAR § 116-101. Purpose. The purpose of this part is to provide that certain data elements appear on prescription drug information cards so that pharmacists have a consistent means of finding the necessary information to correctly submit prescription claims.

23 CAR § 116-102. Applicability and scope. This part is applicable to any entity issuing a health benefit plan unless such health benefit plan is exempted by Arkansas Code § 23-80-403.

23 CAR § 116-103. Compliance date. All prescription drug information cards issued, delivered, modified, or extended by health benefit plans shall comply with the terms of this part no later than April 9, 2003.

23 CAR § 116-104. Definitions. As used in this part: (1) “Card issuer” means the insurance company, hospital medical service corporation, health maintenance organization, or other entity issuing a health benefit plan that provides prescription drug benefits; (2) “Dual-use health …

23 CAR § 116-105. Stand-alone prescription drug information card. (a) A prescription drug information card shall include in a clear, readable, and understandable manner all information data elements set out in subsection (d) of this section that are necessary to process a claim f…

23 CAR § 116-106. Dual-use health benefit plan/prescription drug information card. (a) A health benefit plan that provides coverage for health services in addition to prescription drugs or devices may, at its option, include prescription drug claims information necessary to proce…

23 CAR § 117-101. Purpose and intent. The purpose of this part is to provide uniform standards for the establishment and maintenance of external review procedures to ensure that covered persons have the opportunity for an independent review of an adverse determination or final ad…

23 CAR § 117-102. Definitions. For purposes of this part: (1) “Adverse determination” means a determination by a health carrier or its designee utilization review organization that an admission, availability of care, continued stay, or other healthcare service that is a covered b…

23 CAR § 117-103. Applicability and scope. (a) Except as provided in subsection (b) of this section, this part shall apply to all health carriers. (b) The provisions of this part shall not apply to a policy or certificate that provides coverage only for a specified disease, speci…

23 CAR § 117-104. Notice of right to external review. (a)(1) A health carrier shall notify the covered person in writing of the covered person’s right to request an external review to be conducted pursuant to 23 CAR § 117-107, 23 CAR § 117-108, or 23 CAR § 117-109 and include the…

23 CAR § 117-105. Request for external review. (a)(1) Except for a request for an expedited external review as set forth in 23 CAR § 117-108, all requests for external review shall be made in writing to the Insurance Commissioner. (2) The commissioner may prescribe the form and c…

23 CAR § 117-106. Exhaustion of internal appeal process. (a)(1) Except as provided in subsection (b) of this section, a request for an external review pursuant to 23 CAR § 117-107, 23 CAR § 117-108, or 23 CAR § 117-109 shall not be made until the covered person has exhausted the …

23 CAR § 117-107. Standard external review. (a)(1) Within four (4) months after the date of receipt of a notice of an adverse determination or final adverse determination pursuant to 23 CAR § 117-104, a covered person or the covered person’s authorized representative may file a r…

23 CAR § 117-108. Expedited external review. (a) Except as provided in subsection (f) of this section, a covered person or the covered person’s authorized representative may make a request for an expedited external review with the Insurance Commissioner at the time the covered pe…

23 CAR § 117-109. External review of experimental or investigational treatment adverse determinations. (a)(1) Within four (4) months after the date of receipt of a notice of an adverse determination or final adverse determination pursuant to 23 CAR § 117-104 that involves a denia…

23 CAR § 117-110. Binding nature of external review decision. (a) An external review decision is binding on the health carrier except to the extent the health carrier has other remedies available under applicable state law. (b) An external review decision is binding on the covere…

23 CAR § 117-111. Approval of independent review organizations. (a) The Insurance Commissioner shall approve independent review organizations eligible to be assigned to conduct external reviews under this part. (b) In order to be eligible for approval by the commissioner under th…

23 CAR § 117-112. Minimum qualification for independent review organizations. (a) To be approved under 23 CAR § 117-111 to conduct external reviews, an independent review organization shall have and maintain written policies and procedures that govern all aspects of both the stan…

23 CAR § 117-113. Hold harmless for independent review organizations. No independent review organization or clinical reviewer working on behalf of an independent review organization or an employee, agent, or contractor of an independent review organization shall be liable in dama…

23 CAR § 117-114. External review reporting requirements. (a)(1) An independent review organization assigned pursuant to 23 CAR § 117-107, 23 CAR § 117-108, or 23 CAR § 117-109 to conduct an external review shall maintain written records in the aggregate by state and by health ca…

23 CAR § 117-115. Funding of external review. The health carrier against which a request for a standard external review or an expedited external review is filed shall pay the cost of the independent review organization for conducting the external review.

23 CAR § 117-116. Disclosure requirements. (a)(1) Each health carrier shall include a description of the external review procedures in or attached to the policy, certificate, membership booklet, outline of coverage, or other evidence of coverage it provides to covered persons. (2…

23 CAR § 118-101. Purpose. (a) The purpose of this part is to implement Acts 2003, No. 1358, that amended Arkansas Code § 23-86-505. (b) This part prescribes the form and manner of the written notice, required by the Small Employer Health Insurance Purchasing Group Act of 2001, A…

23 CAR § 118-102. Applicability and scope. This part shall apply to all health insurance purchasing groups, as defined in Arkansas Code § 23-86-502(7).

23 CAR § 118-103. Required written notice upon rejection of state-mandated health benefits. (a)(1) Every health insurance purchasing group that offers a health benefits plan that, either in whole or in part, will not have state-mandated health benefits, as defined in Arkansas Cod…

23 CAR § 118-104. Failure to provide required written notice of state-mandated health benefits. (a) Every health insurance purchasing group or health carrier contracted to provide the written notice under 23 CAR § 118-103 that fails, as a pattern or practice, to provide the writt…

23 CAR § 119-101. Purpose. (a) The purpose of this part is to implement Acts 2003, No. 1359, which amended Arkansas Code § 23-79-803(c). (b) This part prescribes the form and manner of written notices provided by organizations offering health benefits plans, as defined in Arkansa…

23 CAR § 119-102. Applicability and scope. This part shall apply to all organizations offering health benefits plans, as defined in Arkansas Code § 23-79-802(1).

23 CAR § 119-103. Required written notice upon rejection of state-mandated health benefits. (a)(1) Every organization that offers to its proposed insureds a health benefits plan that, either in whole or in part, does not have state-mandated health benefits, as defined in Arkansas…

23 CAR § 119-104. Failure to provide required written notice of state-mandated health benefits. (a) Every organization that fails, as a pattern or practice, to provide the written notice as required under 23 CAR § 119-103 shall be: (1) Deemed to have committed a violation of the …