(a) A healthcare insurer shall not require step therapy protocols or fail first protocols of a lesser device or healthcare service for a prescription or order of a healthcare professional for a noninvasive ventilator if:(1) The noninvasive ventilator requires frequent or substantial servicing as classified by the Centers for Medicare & Medicaid Services and determined by a healthcare professional;(2) There is clinical evidence or enrollee history that suggests the alternative treatments required under the step therapy protocol or fail first protocol will:(A) Be less effective for an enrollee; or(B) Cause an adverse reaction to the enrollee; or(3) The noninvasive ventilator is deemed medically necessary by the United States Food and Drug Administration.
(1) The noninvasive ventilator requires frequent or substantial servicing as classified by the Centers for Medicare & Medicaid Services and determined by a healthcare professional;
(2) There is clinical evidence or enrollee history that suggests the alternative treatments required under the step therapy protocol or fail first protocol will:(A) Be less effective for an enrollee; or(B) Cause an adverse reaction to the enrollee; or
(A) Be less effective for an enrollee; or
(B) Cause an adverse reaction to the enrollee; or
(3) The noninvasive ventilator is deemed medically necessary by the United States Food and Drug Administration.
(b) The Secretary of the Department of Human Services shall require Medicaid managed care organizations to reimburse for a noninvasive ventilator at no less than one hundred percent (100%) of the fee schedule of the Arkansas Medicaid Program for a ventilator.