Arkansas Administrative Code

23 CAR § 137-107. Submission timeline for network adequacy review. Health carriers will submit data for network adequacy review according to the timeline contained in the annual certification requirements bulletin.

23 CAR § 137-108. Enforcement. The penalties, license actions, or orders as authorized under Arkansas Code § 23-66-210 shall apply to violations of this part.

23 CAR § 138-101. Purpose. The purpose of this part is to provide standards for patient-centered medical home programs for health carriers in the Health Insurance Marketplace that issue qualified health plans on or after January 1, 2015.

23 CAR § 138-102. Applicability and scope. (a) This part applies to all health carriers issuing QHPs in the Health Insurance Marketplace on or after January 1, 2015. (b) Under Arkansas Code § 20-77-2406(d) [repealed], health carriers participating in the Health Insurance Marketpl…

23 CAR § 138-103. Definitions. The following definitions shall apply in this part, unless otherwise defined by HCIP: (1) "ADHS" means the Department of Human Services; (2) "AID" means the State Insurance Department; (3) "APII" means the Arkansas Payment Improvement Initiative, as…

23 CAR § 138-104. Requirements. For QHPs issued on or after January 1, 2015, health carriers shall adopt the following requirements and provide the opportunity for primary care physicians eligible to participate in the Arkansas PCMH Model to participate in a PCMH program accordin…

23 CAR § 138-105. Enforcement. The State Insurance Department shall review a health carrier’s compliance with the provisions of this part in its role of recommending approval or nonapproval for certification of qualified health plans sold in the Health Insurance Marketplace.…

23 CAR § 139-101. Purpose. (a) The purpose of this part is to require health benefit plans that are subject to Arkansas Code § 23-99-417 to update coverage for eligible charges for prosthetic and orthotic devices and services to no less than eighty percent (80%) of the Medicare a…

23 CAR § 139-102. Applicability and scope. This part applies to all health benefit plans as defined in Arkansas Code § 23-99-403(4).

23 CAR § 139-103. Reimbursement requirements. Health benefit plans shall provide coverage for eligible charges for prosthetic and orthotic devices and services of no less than eighty percent (80%) of Centers for Medicare & Medicaid Services CPT allowable amounts for such devices …

23 CAR § 139-104. Penalties. The Insurance Commissioner is permitted to impose penalties for violations of Arkansas Code § 23-99-417 et seq., under Arkansas Code § 23-99-415 for provisions governed under the Arkansas Health Care Consumer Act, Arkansas Code § 23-99-401 et seq., as…

23 CAR § 140-101. Purpose. The purpose of this part is to establish a fee for a transfer or cancellation of prepaid funeral benefits contracts when the transfer or cancellation is initiated by the policyholder.

23 CAR § 140-102. Definitions. As used in this part: (1) "Funding life insurance company" means the life insurance company that is responsible for funding the prepaid funeral benefits contract; (2) "Policyholder" means the contract purchaser; (3) "Seller" means the organization w…

23 CAR § 140-103. Fee. Either the seller or the funding life insurance company, but not both, is permitted to collect a fee not to exceed thirty-five dollars ($35.00) for the policyholder-initiated transfer of the contract to a substitute provider or, alternatively, for the cance…

23 CAR § 140-104. Requirements. (a) The purpose of the fee is to defray the administrative costs of the seller in effecting the policyholder-initiated transfer or cancellation. (b) The fee may be paid by either the policyholder or the substitute provider. (c) Any seller or fundin…

23 CAR § 141-101. Definitions. For purposes of this part, the following definitions will apply: (1) "Acquired craniofacial anomaly" means a craniofacial condition caused or brought on only by trauma or tumor; (2) "Craniofacial anomaly" means the abnormal development of the skull …

23 CAR § 141-102. Coverage requirements for health insurers under this part. (a) Health insurers shall be subject to all sections of this part. (b) Pursuant to Arkansas Code § 23-79-1502(b), a health benefit plan shall provide coverage for dental and vision care as approved by an…

23 CAR § 141-103. Medical provider office requirements for ACPA-approved teams. (a) For healthcare services that are recommended by a surgical member of a nationally approved cleft-craniofacial team, a request for written authorization shall be submitted to the health benefit pla…

23 CAR § 141-104. Medical provider office requirements for non-ACPA-approved team members. (a) A medical provider that is not on a nationally approved cleft-craniofacial team shall communicate and respond within two (2) working days from the request to any medical information req…

23 CAR § 141-105. Coding fee for evaluation. (a) Every health benefit plan covering residents or enrollees in this state shall cover charges for evaluations performed by a nationally approved cleft-craniofacial team in its review of proposed services under 23 CAR § 141-104. (b) T…

23 CAR § 141-106. Attestation or authorization form. For services to be reviewed under 23 CAR § 141-104, the medical provider that is not on a nationally approved cleft-craniofacial team shall use the attestation or authorization form, which shall be designated as Wendelyn's Cran…

23 CAR § 142-101. Definitions. Unless otherwise separately defined in this part and consistent with state law, the terms or phrases as used in this part shall follow the definitions of such terms or phrases as defined under Section 1 of the Vision Care Plan Act of 2015, now codif…

23 CAR § 142-102. Prohibited practices. (a)(1) Pursuant to Arkansas Code § 23-99-1003(a), a participating provider agreement between an insurer, vision care plan, or vision care discount plan and a vision care provider shall not establish a fee that a vision care provider shall c…

23 CAR § 142-103. Application of Vision Care Plan Act of 2015. (a) Pursuant to Arkansas Code § 23-99-1005(c), the Vision Care Plan Act of 2015, Arkansas Code § 23-99-1001 et seq., is applicable to all vision benefit plans or contracts issued, renewed, or recredentialed in this st…

23 CAR § 143-101. Definitions. As used in this part: (1) “Covered person” means a “covered person” as defined in Arkansas Code § 23-99-403(3); (2) “Health benefit plan” means a “health benefit plan” as defined in Arkansas Code § 23-99-1103(7); (3) “Healthcare insurer” means a “he…

23 CAR § 143-102. Pain medication authorizations. (a) If a prescription pain medication requires a prior authorization by a healthcare insurer or utilization review entity, a prior authorization for prescription pain medication shall not be denied to a covered person with a termi…

23 CAR § 144-101. Purpose. The purpose of this part is to implement Acts 2017, No. 815, of the 91st General Assembly, “An Act To Clarify Certain Provisions Of The Prior Authorization Transparency Act” (hereafter, the "Prior Authorization Transparency Act").

23 CAR § 144-102. Applicability and scope. This part applies to all health benefit plans as defined in Arkansas Code § 23-99-1103(7).

23 CAR § 144-103. Definitions. (a) Unless otherwise separately defined in this part, the terms or phrases as used in this part shall follow the definitions of such terms or phrases as defined in Arkansas Code § 23-99-1103, or as later amended in the Prior Authorization Transparen…

23 CAR § 144-104. Publication of prior authorization and nonmedical review criteria and statistics. (a) A utilization review entity shall follow the disclosure requirements under Arkansas Code § 23-99-1104. (b) Updating statistical reporting data required under Arkansas Code § 23…

23 CAR § 144-105. Deemer provisions. (a) Pursuant to Arkansas Code § 23-99-1116(a), if a healthcare insurer or utilization review entity fails to comply with the Prior Authorization Transparency Act, Arkansas Code § 23-99-1101 et seq., the requested healthcare services shall be d…

23 CAR § 144-106. Persons conducting reviews. A utilization review entity shall follow the requirements under Arkansas Code § 23-99-1111 related to the required qualifications for persons conducting prior authorization reviews.

23 CAR § 144-107. Retrospective denials on prior authorizations. A utilization review entity shall follow the provisions in Arkansas Code § 23-99-1109 related to permissible rescissions of prior authorizations.

23 CAR § 144-108. Accelerated prior authorizations. Nothing in the Prior Authorization Transparency Act, Arkansas Code § 23-99-1101 et seq., is intended to prohibit or restrict a utilization review entity from approving a prior authorization request from a healthcare provider in …

23 CAR § 144-109. Benefit inquiries subject to prior authorization requirements. (a) Pursuant to Arkansas Code § 23-99-1113(a)(2)(A), the following benefit inquiries are subject to the requirements of Arkansas Code § 23-99-1113. (b)(1) Any utilization review entity responding to …

23 CAR § 145-101. Purpose. (a) The purpose of this part is to establish licensure and solvency requirements of risk-based provider organizations (RBPOs) participating in the Medicaid Provider-Led Organized Care Act, Arkansas Code § 20-77-2701 et seq. (b) This part: (1) Provides a…

23 CAR § 145-102. Applicability and scope — Certificate of authority limited to participation in the Organized Care Act Program. (a) This part applies to the licensure and solvency standards of risk-based provider organizations (RBPOs), as defined in Arkansas Code § 20-77-2703(13…

23 CAR § 145-103. Definitions. As used in this part: (1) “ADHS” means the 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 func…

23 CAR § 145-104. Certificate of authority. (a) Requirement to be newly formed and organized. (1) Unless currently authorized or licensed by the State Insurance Department as a carrier as defined in Arkansas Code § 20-77-2703(4), no risk-based provider organization (RBPO) shall t…

23 CAR § 145-105. Certificate of authority application. (a) Requirements. (1)(A) A risk-based provider organization (RBPO) may apply for a certificate of authority on a form prescribed by the Insurance Commissioner. (B) Each application for a certificate of authority shall be ver…

23 CAR § 145-106. Solvency standards. (a)(1) All risk-based provider organizations (RBPOs) shall be responsible for meeting the following solvency standards under this section: (A) At the time of initial licensure; (B) In the evaluation of their application; and (C) Continuously …

23 CAR § 145-107. Market conduct related activities and network adequacy. (a) RBPO provider market conduct activities. (1) The Insurance Commissioner is primarily authorized to regulate the financial solvency and licensing of the risk-based provider organization (RBPO) under the …

23 CAR § 145-108. Confidentiality and workpapers. The confidentiality provisions in the Arkansas Insurance Code and rules, including, but not limited to, Arkansas Code § 23-61-103(d)(5), related to actuarial reports, Arkansas Code § 23-61-103(d), related to active investigations …

23 CAR § 145-109. Payment of premium taxes. (a) Pursuant to Arkansas Code § 26-57-603, a risk-based provider organization (RBPO) that is licensed under the Medicaid Provider-Led Organized Care Act, Arkansas Code § 20-77-2701 et seq., and participates in the Medicaid provider-led …

23 CAR § 146-101. Purpose. The purpose of this part is to implement the Arkansas Pharmacy Benefits Manager Licensure Act, Arkansas Code § 23-92-501 et seq., and to provide licensing, reporting, and activity standards for PBMs that provide claims processing services or other presc…

23 CAR § 146-102. Applicability — Scope. The provisions of this part shall apply to all PBMs administering or transacting pharmacy benefits plans or programs for health benefit plans to residents of this state.

23 CAR § 146-103. Definitions. As used in this part: (1) “Adverse impact” means the: (A) Participation of pharmacies is reduced by ten percent (10%) or more within the distance compliance requirements as specified in 23 CAR § 146-106(b); and (B) Reduction in participation is sole…

23 CAR § 146-104. Licensure and financial requirements. (a) Initial license. (1) An applicant for a PBM license shall apply for a license on a form prescribed by the Insurance Commissioner. (2) Each application for a license shall be verified by an officer or authorized represent…

23 CAR § 146-105. Contract review. (a) Contract review. (1) Prohibited contract language. No contract entered into by a PBM and a pharmacist or pharmacy that relates to participation or administration of a pharmacy benefits plan or program of a health benefit plan shall contain l…

23 CAR § 146-106. Pharmacy network adequacy and compensation. (a) The provisions of this section shall apply to healthcare insurers and healthcare payors, and PBMs administrating for such health benefit plans, as defined in Arkansas Code § 23-92-503(2) and (3) to the extent as pe…