Arkansas Administrative Code

23 CAR § 146-110. MAC appeals. (a) In responding to a MAC complaint for complaints to the State Insurance Department, the PBM shall be subject to the same time period for responding to the complaint as described in Unfair Claims Settlement Practices, 23 CAR pt. 15, for health car…

23 CAR § 146-111. Arkansas Pharmacy Audit Bill of Rights. (a) PBMs shall comply with the Arkansas Pharmacy Audit Bill of Rights, Arkansas Code § 17-92-1201. (b) Notwithstanding any other law, when an audit of the records of a pharmacy is conducted by a managed-care company, an in…

23 CAR § 146-112. Compliance with bulletins. In addition to compliance with statutory and regulatory authorities applicable to PBMs, PBMs shall reasonably strive to follow all standards announced by the Insurance Commissioner through publication of bulletins.

23 CAR § 146-113. Penalties. (a) The penalty provisions under this section apply to PBMs administrating health benefit plans or for healthcare payors under Arkansas Code § 23-92-503(2) and (3) that are permitted to be regulated by the state and are not prohibited from state regul…

23 CAR § 146-114. Provisions in this part applicable to all healthcare payors. Any language in the provisions of this part referring to or referencing requirements of an insurer, a healthcare insurer, or a health maintenance organization shall include health benefit plans issued …

23 CAR § 147-101. Purpose. The purpose of this part is to establish requirements for licensing and operations of self-funded MEWAs and to explain registration requirements for fully insured MEWAs.

23 CAR § 147-102. Applicability and scope. (a) This section and 23 CAR §§ 147-103 – 147-117 apply to self-funded multiple-employer welfare plans formed on or after the effective date of this part. (b) 23 CAR § 147-119 applies to fully insured MEWAs.

23 CAR § 147-103. Definitions. The following words and terms, when used in this part, shall have the following meanings, unless the context clearly indicates otherwise: (1) "Board" means the board of trustees or directors, as applicable, of a multiple-employer welfare arrangement…

23 CAR § 147-104. Forms for licensure of self-funded MEWAs. (a) The State Insurance Department adopts by reference standard forms for use in the administrative regulation of self-funded multiple-employer welfare arrangements. (b) Applicants and licensed self-funded multiple-emplo…

23 CAR § 147-105. Application process for self-funded MEWAs. (a) Any person wishing to establish a multiple-employer welfare arrangement, on or after the effective date of this part, that is not fully insured, must apply for and obtain a license pursuant to this part prior to con…

23 CAR § 147-106. Required application documentation. (a) The Insurance Commissioner shall promptly review the documentation submitted by the applicant and shall have the power to conduct any investigation that may be necessary and to examine under oath any persons interested or …

23 CAR § 147-107. Bond and funding reports for self-funded MEWAs. (a) A multiple-employer welfare arrangement shall file an application on the prescribed form and furnish such information as may be required by the Insurance Commissioner. (b) The application shall include only tho…

23 CAR § 147-108. Appeal process for denials of self-funded MEWA applications. (a)(1) If the Insurance Commissioner refuses to grant a certificate of authority to an applicant that fails to meet the requirements of this part, notice of refusal shall be in writing. (2) Such notice…

23 CAR § 147-109. Filing fees for self-funded MEWA licensure applications. The Insurance Commissioner shall collect, and the applicant affected shall pay to the commissioner, the following fees: (1) Filing fee for filing an application for a certificate of authority, one thousand…

23 CAR § 147-110. Benefits provided by self-funded MEWAs. (a)(1) A multiple-employer welfare arrangement licensed pursuant to the provisions of this part shall be limited to providing benefits for health benefit plans, as defined under 23 CAR § 147-103, and any other benefit auth…

23 CAR § 147-111. Notice to participants in self-funded MEWAs. (a) Unless such notice is otherwise provided to a participating employee or former employee pursuant to another provision of this part, a multiple-employer welfare arrangement, in connection with an employee welfare b…

23 CAR § 147-112. Similarity of names for self-funded MEWAs. (a) No multiple-employer welfare arrangement licensed under this part shall take any name that is the same as or closely resembles the name of any other multiple-employer welfare arrangement possessing a certificate of …

23 CAR § 147-113. Annual statements of self-funded MEWAs and renewal requirements. (a) Each self-funded multiple-employer welfare arrangement transacting business in this state shall file annually with the Insurance Commissioner statements and reports described in subdivisions (a…

23 CAR § 147-114. Examinations of self-funded MEWAs. (a)(1) The Insurance Commissioner or any person appointed by the commissioner shall have the power to examine the affairs and conduct of any multiple-employer welfare arrangement and for such purposes shall have free access to …

23 CAR § 147-115. Duties of trustees and officers of self-funded MEWAs. (a)(1) The trustees or directors of a multiple-employer welfare arrangement shall give the attention and exercise the vigilance, diligence, care, and skill that prudent persons use in like or similar circumst…

23 CAR § 147-116. Operational requirements of self-funded MEWAs. The application, formation, financial, and reporting requirements in this part, 23 CAR §§ 147-105 – 147-115, or as modified annually at renewal, shall be maintained at all times during the active operations of a sel…

23 CAR § 147-117. Participation and premium charges for self-funded MEWAs. (a) A multiple-employer welfare arrangement may charge premiums in accordance with this section to the group of employees or dependents who: (1) Meet the participation criteria; and (2) Do not decline cove…

23 CAR § 147-118. Suspension, revocation, or limitation of certificate of authority for self-funded MEWAs and other remedies. The Insurance Commissioner may suspend, revoke, or limit the certificate of authority of a multiple-employer welfare arrangement if the commissioner finds…

23 CAR § 147-119. Fully insured MEWA registration requirements. Fully insured MEWAs shall continue to register with the State Insurance Department filing the form and attachments required in AID Form Rev 2/16, Instructions For Registration of Self-Funded Single Employer Plans, Co…

23 CAR § 147-120. Penalties. Violations of this part may constitute an unfair or deceptive act under Arkansas Code § 23-66-206.

23 CAR § 148-101. Definitions. (a) Unless otherwise defined in this section, the definitions in the Arkansas Pharmacy Benefits Manager Licensure Act, Arkansas Code § 23-92-501 et seq., shall apply to the provisions in this part. (b) As used in this part: (1) “Fair and reasonable …

23 CAR § 148-102. Applicability. (a) This part applies to all: (1) Health benefit plans as defined in Arkansas Code § 23-92-503(2); and (2) Healthcare payors as defined in Arkansas Code § 23-92-503(3). (b) The requirements of this part shall not apply to: (1) Federally regulated …

23 CAR § 148-103. Fair and reasonable reimbursements. (a)(1) Pursuant to Arkansas Code § 23-92-506(a)(1), the Insurance Commissioner may review and approve the compensation program of a pharmacy benefits manager (PBM) from a health benefit plan to ensure that the reimbursement fo…

23 CAR § 148-104. Violations. Violations of any provision of this part shall be subject to the fines or penalties under Arkansas Code § 23-92-508.

23 CAR § 149-101. Purpose. (a) This part implements Acts 2021, No. 97, and Acts 2021, No. 645, which amends a definition within Acts 2021, No. 97. (b) Acts 2021, No. 97, requires healthcare insurers to base medication step therapy protocols on appropriate clinical practice guidel…

23 CAR § 149-102. Applicability. This part applies to a group health benefit plan or health insurance coverage offered in connection with a group health plan that provides coverage of a prescription drug under a policy that meets the definition of a medication step therapy protoc…

23 CAR § 149-103. Definitions. As used in this part: (1) "Clinical practice guidelines" means a systematically developed statement derived from peer-reviewed published medical literature, evidence-based research, and widely accepted medical practice to assist decision-making by h…

23 CAR § 149-104. Development of clinical review criteria. (a) Health insurers shall base clinical review criteria used to establish step therapy protocols on appropriate clinical practice guidelines or peer-reviewed published medical literature. (b) For step therapy protocols ba…

23 CAR § 149-105. Access to clinical review criteria. (a) Upon written request, a healthcare insurer, pharmacy benefit manager, or utilization review organization shall provide all specific written clinical review criteria relating to the particular condition or disease, includin…

23 CAR § 149-106. Access to step therapy protocol exception process. (a) If coverage of a prescription drug for the treatment of any medical condition is restricted for use by a healthcare insurer, health benefit plan, or utilization review organization through the use of a step …

23 CAR § 149-107. Response to requests for step therapy protocol exceptions. (a) A healthcare insurer, health benefit plan, or utilization review organization shall expeditiously grant a step therapy protocol exception if: (1) A required prescription drug is contraindicated or wi…

23 CAR § 149-108. Appealing a denial of a request for exception. (a)(1) A patient covered by a healthcare insurer under a health benefit plan may appeal the denial of a request for a step therapy protocol exception. (2) The health benefit plan shall grant or deny the appeal withi…

23 CAR § 149-109. Enforcement. (a) Violations of this part shall constitute an unfair or deceptive act under Arkansas Code § 23-66-206. (b) Therefore, the penalties, actions, or orders, including but not limited to monetary fines, suspension, or revocation of license, as authoriz…

23 CAR § 150-101. Applicability and scope. This part shall apply to all entities defined by Arkansas Code § 23-79-2202 as "healthcare insurers" that provide coverage for prescription eye drops under a health benefit plan to a covered person on and after January 1, 2022.

23 CAR § 150-102. Definitions. The following words and terms, when used in this part, shall have the following meanings, unless the context clearly indicates otherwise: (1) "Covered person" means a person who is and continues to remain eligible for coverage under a health benefit…

23 CAR § 150-103. Requirements to provide early refills of prescription eye drops. A healthcare insurer that provides coverage for prescription eye drops under a health benefit plan shall provide coverage for early refills of prescription eye drops to a covered person on and afte…

23 CAR § 150-104. Enforcement. (a) Violations of this part shall constitute an unfair or deceptive act under Arkansas Code § 23-66-206. (b) Therefore, the penalties, actions, or orders, including, but not limited to, monetary fines, suspension, or revocation of license, as author…

23 CAR § 151-101. 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 in Arkansas Code § 23-79-1905: (1) "Healthcare service" means …

23 CAR § 151-102. Coverage requirement review. (a) Pursuant to Arkansas Code § 23-79-1905(c), a health benefit plan that is offered, issued, provided, or renewed in this state shall provide coverage for off-label use of intravenous immunoglobin (IVIG) to treat individuals diagnos…

23 CAR § 151-103. United States Food and Drug Administration approval and reporting. (a) Upon approval by the United States Food and Drug Administration of the use of intravenous immunoglobulin to treat individuals diagnosed with pediatric acute-onset neuropsychiatric syndrome or…

23 CAR § 151-104. Coding fee for evaluation. Every health benefit plan shall permit appropriate claims, coding fees, or charges for related healthcare services, including evaluations, performed by medical providers in association or collaboration with the Postinfectious Autoimmun…

23 CAR § 151-105. Enforcement and penalties. (a) Pursuant to Arkansas Code § 23-61-103 et seq., the Insurance Commissioner shall have the power and authority expressly conferred or reasonably implied by the Arkansas Insurance Code. (b) This includes, but is not limited to, the po…