(1) As used in this subchapter:(1) “Ambulatory surgery center” means an entity certified by:(A) Medicare as an ambulatory surgical center that operates for the purpose of providing surgical services to patients and that is eligible to receive reimbursement from Medicaid for ambulatory surgery services;(B) The Joint Commission, an entity for the accreditation of healthcare organizations;(C) The Accreditation Association for Ambulatory Health Care; or(D) The American Association for Accreditation of Ambulatory Surgery Facilities;(2) (A) “Breast reconstruction surgery” means all stages of surgery to repair physical defects caused by the extirpation or medical treatment of diseased breast tissue and all stages of surgery to reconstruct a breast mound or to create a new breast mound and to reestablish symmetry between two (2) breasts:(i) Following: (a) Trauma; (b) The loss of breast tissue due to congenital or noncongenital diseases; or (c) A mastectomy; or(ii) For prophylaxis against a future disease of the breast.(B) “Breast reconstruction surgery” includes without limitation:(i) Augmentation, reduction, and mastectomy and all procedures for a contralateral breast necessary for symmetry;(ii) All breast reconstruction modalities, including without limitation implant-based breast reconstruction, tissue-based breast reconstruction, and any breast reconstruction modalities that are developed subsequent to August 5, 2025, that are recognized within Level I of the Healthcare Common Procedure Coding System codes and are determined by rule of the Insurance Commissioner to qualify under this subchapter;(iii) All types of breast reconstruction contained within the modalities under subdivision (2)(B)(ii) of this section, including without limitation: (a) Immediate implant-based breast reconstruction; (b) Delayed implant-based breast reconstruction; (c) Myocutaneous flap tissue-based breast reconstruction; (d) Microvascular free flap tissue-based breast reconstruction; (e) Structural fat grafting tissue-based breast reconstruction; (f) Combined implant-based and tissue-based breast reconstruction; and (g) Any type of breast reconstruction that is developed subsequent to August 5, 2025, that is recognized within Level I of the Healthcare Common Procedure Coding System codes and is determined by rule of the commissioner to qualify under this subchapter;(iv) All procedural variations, iterations, or approaches associated with the breast reconstruction types under subdivision (2)(B)(iii) of this section, as noted within the short descriptor or the description for the Level I Healthcare Common Procedure Coding System code covering the modalities and types of breast reconstruction;(v) Chest wall reconstruction, including without limitation an aesthetic flat closure;(vi) Custom fabricated breast prostheses, including without limitation replacement of such breast prostheses; and(vii) Coverage for the mechanical, medical, and surgical treatment of physical complications of a mastectomy, breast reconstruction surgery, chest wall reconstruction, radiation, and lymph node surgery;(3) “Enrollee” means an individual entitled to coverage of healthcare services from a healthcare insurer;(4) “Facility reimbursement rate” means the amount paid to a healthcare facility by a healthcare insurer for certain procedures and includes the costs of healthcare services;(5) (A) “Health benefit plan” means:(i) An individual, blanket, or group plan, policy, or contract for healthcare services issued, renewed, or extended in this state by a healthcare insurer, health maintenance organization, hospital medical service corporation, or self-insured governmental or church plan in this state; and(ii) Any health benefit program receiving state or federal appropriations from the State of Arkansas, including the Arkansas Medicaid Program and the Arkansas Health and Opportunity for Me Program established by the Arkansas Health and Opportunity for Me Act of 2021, § 23-61-1001 et seq.(B) “Health benefit plan” includes:(i) Indemnity and managed care plans; and(ii) Plans providing health benefits to state and public school employees under § 21-5-401 et seq.(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) Medical payments 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 other than a cancer insurance plan or cancer supplemental policy; or(x) A long-term-care-only plan;(6) “Healthcare facility” means:(A) An ambulatory surgery center;(B) A hospital; or(C) An outpatient surgery center;(7) (A) “Healthcare insurer” means any insurance company, hospital and medical service corporation, health maintenance organization, or a nonprofit agricultural membership organization as defined under § 23-60-104 that issues or delivers health benefit plans in this state.(B) “Healthcare insurer” does not include an entity that provides only dental benefits or eye and vision care benefits;(8) “Healthcare professional” means a person who is licensed, certified, or otherwise authorized by the laws of this state to administer health care in the ordinary course of the practice of his or her profession;(9) “Healthcare professional reimbursement rate” means the amount paid to a healthcare professional by a healthcare insurer for procedures and includes the costs of healthcare services;(10) “Healthcare service” means an item or service provided to an individual for the purposes of alleviating, curing, healing, or preventing human illness, injury, or physical disability;(11) “Hospital” means a facility licensed as a hospital by the Division of Health Facilities Services under § 20-9-213;(12) “Mastectomy” means the removal of all or part of the breast for medically necessary reasons as determined by a healthcare professional;(13) “Out-of-network provider” means a healthcare professional that provides healthcare services to an enrollee but is not a participating provider;(14) (A) “Outpatient surgery center” means a facility in which surgical services are offered that require the use of general or intravenous anesthetics, and where, in the opinion of the attending physician, hospitalization, as defined in the present licensure law, is not necessary.(B) “Outpatient surgery center” does not include:(i) A medical office owned and operated by a physician or more than one (1) physician licensed by the Arkansas State Medical Board, if the medical office does not bill a facility fee to a third-party payor; or(ii) A dental office that has a Moderate Sedation Facility Permit or a Deep Sedation-General Anesthesia Facility Permit issued by the Arkansas State Board of Dental Examiners; and(15) “Participating provider” means a healthcare professional that has a healthcare contract with a contracting entity to provide healthcare services to an enrollee with the expectation of receiving payment either directly from the contracting entity or from a healthcare insurer affiliated with the contracting entity.
(1) “Ambulatory surgery center” means an entity certified by:(A) Medicare as an ambulatory surgical center that operates for the purpose of providing surgical services to patients and that is eligible to receive reimbursement from Medicaid for ambulatory surgery services;(B) The Joint Commission, an entity for the accreditation of healthcare organizations;(C) The Accreditation Association for Ambulatory Health Care; or(D) The American Association for Accreditation of Ambulatory Surgery Facilities;
(A) Medicare as an ambulatory surgical center that operates for the purpose of providing surgical services to patients and that is eligible to receive reimbursement from Medicaid for ambulatory surgery services;
(B) The Joint Commission, an entity for the accreditation of healthcare organizations;
(C) The Accreditation Association for Ambulatory Health Care; or
(D) The American Association for Accreditation of Ambulatory Surgery Facilities;
(2) (A) “Breast reconstruction surgery” means all stages of surgery to repair physical defects caused by the extirpation or medical treatment of diseased breast tissue and all stages of surgery to reconstruct a breast mound or to create a new breast mound and to reestablish symmetry between two (2) breasts:(i) Following: (a) Trauma; (b) The loss of breast tissue due to congenital or noncongenital diseases; or (c) A mastectomy; or(ii) For prophylaxis against a future disease of the breast.(B) “Breast reconstruction surgery” includes without limitation:(i) Augmentation, reduction, and mastectomy and all procedures for a contralateral breast necessary for symmetry;(ii) All breast reconstruction modalities, including without limitation implant-based breast reconstruction, tissue-based breast reconstruction, and any breast reconstruction modalities that are developed subsequent to August 5, 2025, that are recognized within Level I of the Healthcare Common Procedure Coding System codes and are determined by rule of the Insurance Commissioner to qualify under this subchapter;(iii) All types of breast reconstruction contained within the modalities under subdivision (2)(B)(ii) of this section, including without limitation: (a) Immediate implant-based breast reconstruction; (b) Delayed implant-based breast reconstruction; (c) Myocutaneous flap tissue-based breast reconstruction; (d) Microvascular free flap tissue-based breast reconstruction; (e) Structural fat grafting tissue-based breast reconstruction; (f) Combined implant-based and tissue-based breast reconstruction; and (g) Any type of breast reconstruction that is developed subsequent to August 5, 2025, that is recognized within Level I of the Healthcare Common Procedure Coding System codes and is determined by rule of the commissioner to qualify under this subchapter;(iv) All procedural variations, iterations, or approaches associated with the breast reconstruction types under subdivision (2)(B)(iii) of this section, as noted within the short descriptor or the description for the Level I Healthcare Common Procedure Coding System code covering the modalities and types of breast reconstruction;(v) Chest wall reconstruction, including without limitation an aesthetic flat closure;(vi) Custom fabricated breast prostheses, including without limitation replacement of such breast prostheses; and(vii) Coverage for the mechanical, medical, and surgical treatment of physical complications of a mastectomy, breast reconstruction surgery, chest wall reconstruction, radiation, and lymph node surgery;
(A) “Breast reconstruction surgery” means all stages of surgery to repair physical defects caused by the extirpation or medical treatment of diseased breast tissue and all stages of surgery to reconstruct a breast mound or to create a new breast mound and to reestablish symmetry between two (2) breasts:(i) Following: (a) Trauma; (b) The loss of breast tissue due to congenital or noncongenital diseases; or (c) A mastectomy; or(ii) For prophylaxis against a future disease of the breast.
(i) Following: (a) Trauma; (b) The loss of breast tissue due to congenital or noncongenital diseases; or (c) A mastectomy; or
(a) Trauma;
(b) The loss of breast tissue due to congenital or noncongenital diseases; or
(c) A mastectomy; or
(ii) For prophylaxis against a future disease of the breast.
(B) “Breast reconstruction surgery” includes without limitation:(i) Augmentation, reduction, and mastectomy and all procedures for a contralateral breast necessary for symmetry;(ii) All breast reconstruction modalities, including without limitation implant-based breast reconstruction, tissue-based breast reconstruction, and any breast reconstruction modalities that are developed subsequent to August 5, 2025, that are recognized within Level I of the Healthcare Common Procedure Coding System codes and are determined by rule of the Insurance Commissioner to qualify under this subchapter;(iii) All types of breast reconstruction contained within the modalities under subdivision (2)(B)(ii) of this section, including without limitation: (a) Immediate implant-based breast reconstruction; (b) Delayed implant-based breast reconstruction; (c) Myocutaneous flap tissue-based breast reconstruction; (d) Microvascular free flap tissue-based breast reconstruction; (e) Structural fat grafting tissue-based breast reconstruction; (f) Combined implant-based and tissue-based breast reconstruction; and (g) Any type of breast reconstruction that is developed subsequent to August 5, 2025, that is recognized within Level I of the Healthcare Common Procedure Coding System codes and is determined by rule of the commissioner to qualify under this subchapter;(iv) All procedural variations, iterations, or approaches associated with the breast reconstruction types under subdivision (2)(B)(iii) of this section, as noted within the short descriptor or the description for the Level I Healthcare Common Procedure Coding System code covering the modalities and types of breast reconstruction;(v) Chest wall reconstruction, including without limitation an aesthetic flat closure;(vi) Custom fabricated breast prostheses, including without limitation replacement of such breast prostheses; and(vii) Coverage for the mechanical, medical, and surgical treatment of physical complications of a mastectomy, breast reconstruction surgery, chest wall reconstruction, radiation, and lymph node surgery;
(i) Augmentation, reduction, and mastectomy and all procedures for a contralateral breast necessary for symmetry;
(ii) All breast reconstruction modalities, including without limitation implant-based breast reconstruction, tissue-based breast reconstruction, and any breast reconstruction modalities that are developed subsequent to August 5, 2025, that are recognized within Level I of the Healthcare Common Procedure Coding System codes and are determined by rule of the Insurance Commissioner to qualify under this subchapter;
(iii) All types of breast reconstruction contained within the modalities under subdivision (2)(B)(ii) of this section, including without limitation: (a) Immediate implant-based breast reconstruction; (b) Delayed implant-based breast reconstruction; (c) Myocutaneous flap tissue-based breast reconstruction; (d) Microvascular free flap tissue-based breast reconstruction; (e) Structural fat grafting tissue-based breast reconstruction; (f) Combined implant-based and tissue-based breast reconstruction; and (g) Any type of breast reconstruction that is developed subsequent to August 5, 2025, that is recognized within Level I of the Healthcare Common Procedure Coding System codes and is determined by rule of the commissioner to qualify under this subchapter;
(a) Immediate implant-based breast reconstruction;
(b) Delayed implant-based breast reconstruction;
(c) Myocutaneous flap tissue-based breast reconstruction;
(d) Microvascular free flap tissue-based breast reconstruction;
(e) Structural fat grafting tissue-based breast reconstruction;
(f) Combined implant-based and tissue-based breast reconstruction; and
(g) Any type of breast reconstruction that is developed subsequent to August 5, 2025, that is recognized within Level I of the Healthcare Common Procedure Coding System codes and is determined by rule of the commissioner to qualify under this subchapter;
(iv) All procedural variations, iterations, or approaches associated with the breast reconstruction types under subdivision (2)(B)(iii) of this section, as noted within the short descriptor or the description for the Level I Healthcare Common Procedure Coding System code covering the modalities and types of breast reconstruction;
(v) Chest wall reconstruction, including without limitation an aesthetic flat closure;
(vi) Custom fabricated breast prostheses, including without limitation replacement of such breast prostheses; and
(vii) Coverage for the mechanical, medical, and surgical treatment of physical complications of a mastectomy, breast reconstruction surgery, chest wall reconstruction, radiation, and lymph node surgery;
(3) “Enrollee” means an individual entitled to coverage of healthcare services from a healthcare insurer;
(4) “Facility reimbursement rate” means the amount paid to a healthcare facility by a healthcare insurer for certain procedures and includes the costs of healthcare services;
(5) (A) “Health benefit plan” means:(i) An individual, blanket, or group plan, policy, or contract for healthcare services issued, renewed, or extended in this state by a healthcare insurer, health maintenance organization, hospital medical service corporation, or self-insured governmental or church plan in this state; and(ii) Any health benefit program receiving state or federal appropriations from the State of Arkansas, including the Arkansas Medicaid Program and the Arkansas Health and Opportunity for Me Program established by the Arkansas Health and Opportunity for Me Act of 2021, § 23-61-1001 et seq.(B) “Health benefit plan” includes:(i) Indemnity and managed care plans; and(ii) Plans providing health benefits to state and public school employees under § 21-5-401 et seq.(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) Medical payments 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 other than a cancer insurance plan or cancer supplemental policy; or(x) A long-term-care-only plan;
(A) “Health benefit plan” means:(i) An individual, blanket, or group plan, policy, or contract for healthcare services issued, renewed, or extended in this state by a healthcare insurer, health maintenance organization, hospital medical service corporation, or self-insured governmental or church plan in this state; and(ii) Any health benefit program receiving state or federal appropriations from the State of Arkansas, including the Arkansas Medicaid Program and the Arkansas Health and Opportunity for Me Program established by the Arkansas Health and Opportunity for Me Act of 2021, § 23-61-1001 et seq.
(i) An individual, blanket, or group plan, policy, or contract for healthcare services issued, renewed, or extended in this state by a healthcare insurer, health maintenance organization, hospital medical service corporation, or self-insured governmental or church plan in this state; and
(ii) Any health benefit program receiving state or federal appropriations from the State of Arkansas, including the Arkansas Medicaid Program and the Arkansas Health and Opportunity for Me Program established by the Arkansas Health and Opportunity for Me Act of 2021, § 23-61-1001 et seq.
(B) “Health benefit plan” includes:(i) Indemnity and managed care plans; and(ii) Plans providing health benefits to state and public school employees under § 21-5-401 et seq.
(i) Indemnity and managed care plans; and
(ii) Plans providing health benefits to state and public school employees under § 21-5-401 et seq.
(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) Medical payments 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 other than a cancer insurance plan or cancer supplemental policy; or(x) A long-term-care-only plan;
(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) Medical payments 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 other than a cancer insurance plan or cancer supplemental policy; or
(x) A long-term-care-only plan;
(6) “Healthcare facility” means:(A) An ambulatory surgery center;(B) A hospital; or(C) An outpatient surgery center;
(A) An ambulatory surgery center;
(B) A hospital; or
(C) An outpatient surgery center;
(7) (A) “Healthcare insurer” means any insurance company, hospital and medical service corporation, health maintenance organization, or a nonprofit agricultural membership organization as defined under § 23-60-104 that issues or delivers health benefit plans in this state.(B) “Healthcare insurer” does not include an entity that provides only dental benefits or eye and vision care benefits;
(A) “Healthcare insurer” means any insurance company, hospital and medical service corporation, health maintenance organization, or a nonprofit agricultural membership organization as defined under § 23-60-104 that issues or delivers health benefit plans in this state.
(B) “Healthcare insurer” does not include an entity that provides only dental benefits or eye and vision care benefits;
(8) “Healthcare professional” means a person who is licensed, certified, or otherwise authorized by the laws of this state to administer health care in the ordinary course of the practice of his or her profession;
(9) “Healthcare professional reimbursement rate” means the amount paid to a healthcare professional by a healthcare insurer for procedures and includes the costs of healthcare services;
(10) “Healthcare service” means an item or service provided to an individual for the purposes of alleviating, curing, healing, or preventing human illness, injury, or physical disability;
(11) “Hospital” means a facility licensed as a hospital by the Division of Health Facilities Services under § 20-9-213;
(12) “Mastectomy” means the removal of all or part of the breast for medically necessary reasons as determined by a healthcare professional;
(13) “Out-of-network provider” means a healthcare professional that provides healthcare services to an enrollee but is not a participating provider;
(14) (A) “Outpatient surgery center” means a facility in which surgical services are offered that require the use of general or intravenous anesthetics, and where, in the opinion of the attending physician, hospitalization, as defined in the present licensure law, is not necessary.(B) “Outpatient surgery center” does not include:(i) A medical office owned and operated by a physician or more than one (1) physician licensed by the Arkansas State Medical Board, if the medical office does not bill a facility fee to a third-party payor; or(ii) A dental office that has a Moderate Sedation Facility Permit or a Deep Sedation-General Anesthesia Facility Permit issued by the Arkansas State Board of Dental Examiners; and
(A) “Outpatient surgery center” means a facility in which surgical services are offered that require the use of general or intravenous anesthetics, and where, in the opinion of the attending physician, hospitalization, as defined in the present licensure law, is not necessary.
(B) “Outpatient surgery center” does not include:(i) A medical office owned and operated by a physician or more than one (1) physician licensed by the Arkansas State Medical Board, if the medical office does not bill a facility fee to a third-party payor; or(ii) A dental office that has a Moderate Sedation Facility Permit or a Deep Sedation-General Anesthesia Facility Permit issued by the Arkansas State Board of Dental Examiners; and
(i) A medical office owned and operated by a physician or more than one (1) physician licensed by the Arkansas State Medical Board, if the medical office does not bill a facility fee to a third-party payor; or
(ii) A dental office that has a Moderate Sedation Facility Permit or a Deep Sedation-General Anesthesia Facility Permit issued by the Arkansas State Board of Dental Examiners; and
(15) “Participating provider” means a healthcare professional that has a healthcare contract with a contracting entity to provide healthcare services to an enrollee with the expectation of receiving payment either directly from the contracting entity or from a healthcare insurer affiliated with the contracting entity.