(1) As used in this subchapter:(1) “Acquired brain injury” means an injury to the brain that occurs after birth and may be caused by:(A) An infectious disease;(B) A metabolic disorder;(C) An endocrine disorder;(D) Diminished oxygen;(E) A brain tumor;(F) A toxin;(G) A disease that affects the blood supply to the brain;(H) A stroke; or(I) A traumatic brain injury;(2) “Adverse determination” means a determination by a clinical peer reviewer, upon review based on the clinical information provided, that an admission, extension of stay, or any other covered acquired brain injury service is not medically necessary;(3) “Clinical peer reviewer” means a healthcare professional who:(A) Specializes in and has experiences of the delivery of treatments and services for an individual with acquired brain injuries; and(B) (i) If applicable, possesses a current and valid license, certificate, or registration to provide treatments and services of an acquired brain injury.(ii) If a license, certificate, or registration is not required for treatments and services of an acquired brain injury, the healthcare professional shall be credentialed by the national accrediting body appropriate to the profession;(4) “Cognitive communication therapy” means treating a problem with communication that has an underlying cause in one (1) or more cognitive deficits rather than a primary language or speech deficit;(5) “Cognitive rehabilitation therapy” means a process of relearning cognitive skills essential for daily living through the coordinated, specialized, and integrated therapeutic treatments that are provided in dynamic settings designed for efficient and effective relearning following damage to brain cells or brain chemistry due to an acquired brain injury;(6) “Community reintegration services” means the provision of incremental guided real-world therapeutic training to develop skills essential for an enrollee to:(A) Participate in life;(B) Reenter employment;(C) Attend school and engage in other productive activity;(D) Safely live independently; and(E) Participate within his or her community while avoiding rehospitalization and long-term support needs;(7) “Enrollee” means an individual entitled to coverage of healthcare services from a healthcare insurer;(8) (A) “Functional rehabilitation therapy” means a structured approach that emphasizes learning by doing and focuses on relearning a specific task in a prescribed format with maximum opportunity for repeated corrective practice.(B) “Functional rehabilitation therapy” includes:(i) Compensatory strategies that are developed for relearning skills that are persistently impaired; and(ii) Training for individuals on daily implementation of the compensatory strategies, with a focus on relearning those skills essential for safe daily living in a home or community setting to ensure acquisition and use of the skills;(9) (A) “Health benefit plan” means an individual, blanket, or group plan or a policy or contract for healthcare services offered, issued, renewed, delivered, or extended in this state by a healthcare insurer.(B) “Health benefit plan” includes indemnity and managed care plans.(C) “Health benefit plan” does not include:(i) A plan that provides only dental benefits or eye and vision care benefits;(ii) A disability income plan;(iii) A credit insurance plan;(iv) Insurance coverage issued as a supplement to liability insurance;(v) A medical payment under an automobile or homeowners insurance plan;(vi) A health benefit plan provided under Arkansas Constitution, Article 5, § 32, the Workers' Compensation Law, § 11-9-101 et seq., or the Public Employee Workers' Compensation Act, § 21-5-601 et seq.;(vii) A plan that provides only indemnity for hospital confinement;(viii) An accident-only plan;(ix) A specified disease plan;(x) A long-term-care-only plan; or(xi) A plan providing health benefits to state and public school employees under § 21-5-401 et seq.;(10) (A) “Healthcare insurer” means an entity subject to the insurance laws of this state or the jurisdiction of the Insurance Commissioner that contracts or offers to contract to provide health insurance coverage, including without limitation an insurance company, a hospital and medical service corporation, a health maintenance organization, a self-insured governmental or church plan in this state, or a nonprofit agricultural membership organization as defined in § 23-60-104.(B) “Healthcare insurer” does not include an entity that provides only dental benefits or eye and vision care benefits;(11) “Medically necessary” means healthcare services that are consistent with generally accepted principles of professional medical practice;(12) “Neurobehavioral therapy” means a set of medical and therapeutic assessments and treatments focused on behavioral impairments associated with brain disease or an acquired brain injury and the amelioration of these impairments through the development of prosocial behavior;(13) “Neurocognitive therapy” means a treatment of disorders in which the primary clinical deficit is in cognitive function that has not been present since birth and is a decline from a previously attained level of function;(14) (A) “Neurofeedback therapy” means a direct training of brain function to enhance self-regulatory capacity or a patient's ability to exert control over behavior, thoughts, and feelings.(B) “Neurofeedback therapy” includes a form of biofeedback through which an enrollee can learn to control brain activity that is measured and recorded by an electroencephalogram;(15) “Neuropsychological testing” means a set of medical and therapeutic assessments and treatments focused on the amelioration of cognitive, emotional, psychosocial, and behavioral deficits caused by an acquired brain injury; and(16) (A) “Post-acute care residential treatment” means an integrated medical and therapeutic service, treatment, education, and skills training program provided in a home or community setting.(B) “Post-acute care residential treatment” includes treatment that is designed to create the maximum opportunity for correct practice of skill in the context of use to develop new neural pathways to enable the enrollee to avoid rehospitalization and long-term care.
(1) “Acquired brain injury” means an injury to the brain that occurs after birth and may be caused by:(A) An infectious disease;(B) A metabolic disorder;(C) An endocrine disorder;(D) Diminished oxygen;(E) A brain tumor;(F) A toxin;(G) A disease that affects the blood supply to the brain;(H) A stroke; or(I) A traumatic brain injury;
(A) An infectious disease;
(B) A metabolic disorder;
(C) An endocrine disorder;
(D) Diminished oxygen;
(E) A brain tumor;
(F) A toxin;
(G) A disease that affects the blood supply to the brain;
(H) A stroke; or
(I) A traumatic brain injury;
(2) “Adverse determination” means a determination by a clinical peer reviewer, upon review based on the clinical information provided, that an admission, extension of stay, or any other covered acquired brain injury service is not medically necessary;
(3) “Clinical peer reviewer” means a healthcare professional who:(A) Specializes in and has experiences of the delivery of treatments and services for an individual with acquired brain injuries; and(B) (i) If applicable, possesses a current and valid license, certificate, or registration to provide treatments and services of an acquired brain injury.(ii) If a license, certificate, or registration is not required for treatments and services of an acquired brain injury, the healthcare professional shall be credentialed by the national accrediting body appropriate to the profession;
(A) Specializes in and has experiences of the delivery of treatments and services for an individual with acquired brain injuries; and
(B) (i) If applicable, possesses a current and valid license, certificate, or registration to provide treatments and services of an acquired brain injury.(ii) If a license, certificate, or registration is not required for treatments and services of an acquired brain injury, the healthcare professional shall be credentialed by the national accrediting body appropriate to the profession;
(i) If applicable, possesses a current and valid license, certificate, or registration to provide treatments and services of an acquired brain injury.
(ii) If a license, certificate, or registration is not required for treatments and services of an acquired brain injury, the healthcare professional shall be credentialed by the national accrediting body appropriate to the profession;
(4) “Cognitive communication therapy” means treating a problem with communication that has an underlying cause in one (1) or more cognitive deficits rather than a primary language or speech deficit;
(5) “Cognitive rehabilitation therapy” means a process of relearning cognitive skills essential for daily living through the coordinated, specialized, and integrated therapeutic treatments that are provided in dynamic settings designed for efficient and effective relearning following damage to brain cells or brain chemistry due to an acquired brain injury;
(6) “Community reintegration services” means the provision of incremental guided real-world therapeutic training to develop skills essential for an enrollee to:(A) Participate in life;(B) Reenter employment;(C) Attend school and engage in other productive activity;(D) Safely live independently; and(E) Participate within his or her community while avoiding rehospitalization and long-term support needs;
(A) Participate in life;
(B) Reenter employment;
(C) Attend school and engage in other productive activity;
(D) Safely live independently; and
(E) Participate within his or her community while avoiding rehospitalization and long-term support needs;
(7) “Enrollee” means an individual entitled to coverage of healthcare services from a healthcare insurer;
(8) (A) “Functional rehabilitation therapy” means a structured approach that emphasizes learning by doing and focuses on relearning a specific task in a prescribed format with maximum opportunity for repeated corrective practice.(B) “Functional rehabilitation therapy” includes:(i) Compensatory strategies that are developed for relearning skills that are persistently impaired; and(ii) Training for individuals on daily implementation of the compensatory strategies, with a focus on relearning those skills essential for safe daily living in a home or community setting to ensure acquisition and use of the skills;
(A) “Functional rehabilitation therapy” means a structured approach that emphasizes learning by doing and focuses on relearning a specific task in a prescribed format with maximum opportunity for repeated corrective practice.
(B) “Functional rehabilitation therapy” includes:(i) Compensatory strategies that are developed for relearning skills that are persistently impaired; and(ii) Training for individuals on daily implementation of the compensatory strategies, with a focus on relearning those skills essential for safe daily living in a home or community setting to ensure acquisition and use of the skills;
(i) Compensatory strategies that are developed for relearning skills that are persistently impaired; and
(ii) Training for individuals on daily implementation of the compensatory strategies, with a focus on relearning those skills essential for safe daily living in a home or community setting to ensure acquisition and use of the skills;
(9) (A) “Health benefit plan” means an individual, blanket, or group plan or a policy or contract for healthcare services offered, issued, renewed, delivered, or extended in this state by a healthcare insurer.(B) “Health benefit plan” includes indemnity and managed care plans.(C) “Health benefit plan” does not include:(i) A plan that provides only dental benefits or eye and vision care benefits;(ii) A disability income plan;(iii) A credit insurance plan;(iv) Insurance coverage issued as a supplement to liability insurance;(v) A medical payment under an automobile or homeowners insurance plan;(vi) A health benefit plan provided under Arkansas Constitution, Article 5, § 32, the Workers' Compensation Law, § 11-9-101 et seq., or the Public Employee Workers' Compensation Act, § 21-5-601 et seq.;(vii) A plan that provides only indemnity for hospital confinement;(viii) An accident-only plan;(ix) A specified disease plan;(x) A long-term-care-only plan; or(xi) A plan providing health benefits to state and public school employees under § 21-5-401 et seq.;
(A) “Health benefit plan” means an individual, blanket, or group plan or a policy or contract for healthcare services offered, issued, renewed, delivered, or extended in this state by a healthcare insurer.
(B) “Health benefit plan” includes indemnity and managed care plans.
(C) “Health benefit plan” does not include:(i) A plan that provides only dental benefits or eye and vision care benefits;(ii) A disability income plan;(iii) A credit insurance plan;(iv) Insurance coverage issued as a supplement to liability insurance;(v) A medical payment under an automobile or homeowners insurance plan;(vi) A health benefit plan provided under Arkansas Constitution, Article 5, § 32, the Workers' Compensation Law, § 11-9-101 et seq., or the Public Employee Workers' Compensation Act, § 21-5-601 et seq.;(vii) A plan that provides only indemnity for hospital confinement;(viii) An accident-only plan;(ix) A specified disease plan;(x) A long-term-care-only plan; or(xi) A plan providing health benefits to state and public school employees under § 21-5-401 et seq.;
(i) A plan that provides only dental benefits or eye and vision care benefits;
(ii) A disability income plan;
(iii) A credit insurance plan;
(iv) Insurance coverage issued as a supplement to liability insurance;
(v) A medical payment under an automobile or homeowners insurance plan;
(vi) A health benefit plan provided under Arkansas Constitution, Article 5, § 32, the Workers' Compensation Law, § 11-9-101 et seq., or the Public Employee Workers' Compensation Act, § 21-5-601 et seq.;
(vii) A plan that provides only indemnity for hospital confinement;
(viii) An accident-only plan;
(ix) A specified disease plan;
(x) A long-term-care-only plan; or
(xi) A plan providing health benefits to state and public school employees under § 21-5-401 et seq.;
(10) (A) “Healthcare insurer” means an entity subject to the insurance laws of this state or the jurisdiction of the Insurance Commissioner that contracts or offers to contract to provide health insurance coverage, including without limitation an insurance company, a hospital and medical service corporation, a health maintenance organization, a self-insured governmental or church plan in this state, or a nonprofit agricultural membership organization as defined in § 23-60-104.(B) “Healthcare insurer” does not include an entity that provides only dental benefits or eye and vision care benefits;
(A) “Healthcare insurer” means an entity subject to the insurance laws of this state or the jurisdiction of the Insurance Commissioner that contracts or offers to contract to provide health insurance coverage, including without limitation an insurance company, a hospital and medical service corporation, a health maintenance organization, a self-insured governmental or church plan in this state, or a nonprofit agricultural membership organization as defined in § 23-60-104.
(B) “Healthcare insurer” does not include an entity that provides only dental benefits or eye and vision care benefits;
(11) “Medically necessary” means healthcare services that are consistent with generally accepted principles of professional medical practice;
(12) “Neurobehavioral therapy” means a set of medical and therapeutic assessments and treatments focused on behavioral impairments associated with brain disease or an acquired brain injury and the amelioration of these impairments through the development of prosocial behavior;
(13) “Neurocognitive therapy” means a treatment of disorders in which the primary clinical deficit is in cognitive function that has not been present since birth and is a decline from a previously attained level of function;
(14) (A) “Neurofeedback therapy” means a direct training of brain function to enhance self-regulatory capacity or a patient's ability to exert control over behavior, thoughts, and feelings.(B) “Neurofeedback therapy” includes a form of biofeedback through which an enrollee can learn to control brain activity that is measured and recorded by an electroencephalogram;
(A) “Neurofeedback therapy” means a direct training of brain function to enhance self-regulatory capacity or a patient's ability to exert control over behavior, thoughts, and feelings.
(B) “Neurofeedback therapy” includes a form of biofeedback through which an enrollee can learn to control brain activity that is measured and recorded by an electroencephalogram;
(15) “Neuropsychological testing” means a set of medical and therapeutic assessments and treatments focused on the amelioration of cognitive, emotional, psychosocial, and behavioral deficits caused by an acquired brain injury; and
(16) (A) “Post-acute care residential treatment” means an integrated medical and therapeutic service, treatment, education, and skills training program provided in a home or community setting.(B) “Post-acute care residential treatment” includes treatment that is designed to create the maximum opportunity for correct practice of skill in the context of use to develop new neural pathways to enable the enrollee to avoid rehospitalization and long-term care.
(A) “Post-acute care residential treatment” means an integrated medical and therapeutic service, treatment, education, and skills training program provided in a home or community setting.
(B) “Post-acute care residential treatment” includes treatment that is designed to create the maximum opportunity for correct practice of skill in the context of use to develop new neural pathways to enable the enrollee to avoid rehospitalization and long-term care.