(a) (1) An organization or entity directly or indirectly providing a plan or services to patients under the Medicaid Provider-Led Organized Care Act, § 20-77-2701 et seq., or any other Medicaid-managed care program operating in this state is exempt from §§ 23-99-1120 — 23-99-1126 if the program, without limiting the program's application to any other plan or program, develops and conforms to a program to reduce or eliminate prior authorizations for a healthcare provider.(2) 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., or its successor program is exempt from §§ 23-99-1120 — 23-99-1126, provided that the Arkansas Health and Opportunity for Me Program, without limiting the Arkansas Health and Opportunity for Me Program's application to any other plan or program, develops and conforms to a program to reduce or eliminate prior authorizations for a healthcare provider.(3) A qualified health plan that is a health benefit plan under the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, and purchased on the Arkansas Health Insurance Marketplace created under the Arkansas Health Insurance Marketplace Act, § 23-61-801 et seq., for an individual up to four hundred percent (400%) of the federal poverty level, operating in this state is exempt from §§ 23-99-1120 — 23-99-1126 if the qualified health plan, without limiting the program's application to any other plan or program, develops and conforms to a program to reduce or eliminate prior authorizations for a healthcare provider.
(1) An organization or entity directly or indirectly providing a plan or services to patients under the Medicaid Provider-Led Organized Care Act, § 20-77-2701 et seq., or any other Medicaid-managed care program operating in this state is exempt from §§ 23-99-1120 — 23-99-1126 if the program, without limiting the program's application to any other plan or program, develops and conforms to a program to reduce or eliminate prior authorizations for a healthcare provider.
(2) 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., or its successor program is exempt from §§ 23-99-1120 — 23-99-1126, provided that the Arkansas Health and Opportunity for Me Program, without limiting the Arkansas Health and Opportunity for Me Program's application to any other plan or program, develops and conforms to a program to reduce or eliminate prior authorizations for a healthcare provider.
(3) A qualified health plan that is a health benefit plan under the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, and purchased on the Arkansas Health Insurance Marketplace created under the Arkansas Health Insurance Marketplace Act, § 23-61-801 et seq., for an individual up to four hundred percent (400%) of the federal poverty level, operating in this state is exempt from §§ 23-99-1120 — 23-99-1126 if the qualified health plan, without limiting the program's application to any other plan or program, develops and conforms to a program to reduce or eliminate prior authorizations for a healthcare provider.
(b) (1) (A) At least one (1) time every two (2) years, a program under subsection (a) of this section to reduce or eliminate prior authorization shall be:(i) Submitted to the State Insurance Department; and(ii) Subject to approval by the Legislative Council.(B) A program under subsection (a) of this section shall include:(i) Data, statistics, and other appropriate documentation demonstrating the effectiveness of the previously submitted program in reducing or eliminating prior authorizations for a healthcare provider; and(ii) For a program that does not eliminate prior authorizations for a healthcare provider, specific initiatives or elements of the program that reduce existing prior authorizations for a healthcare provider.(C) (i) Upon submitting the program under subdivision (b)(1)(A) of this section, the submitting entity shall provide notice to each healthcare provider that includes: (a) The complete program submission; (b) The deadline for a healthcare provider to comment on the program submission; and (c) Instructions on how a healthcare provider may comment on the program.(ii) A healthcare provider shall have at least thirty (30) days to comment on a program submitted under subdivision (b)(1)(A) of this section.(2) If a program is not submitted to the department and approved by the Legislative Council as required or does not conform to the requirements of this section, the Medicaid-managed care program operating in this state, 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., or its successor program, and qualified health plans under the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, and purchased on the Arkansas Health Insurance Marketplace created under the Arkansas Health Insurance Marketplace Act, § 23-61-801 et seq., for an individual up to four hundred percent (400%) of the federal poverty level, operating in this state shall be subject to §§ 23-99-1120 — 23-99-1126 and § 23-99-1128.
(1) (A) At least one (1) time every two (2) years, a program under subsection (a) of this section to reduce or eliminate prior authorization shall be:(i) Submitted to the State Insurance Department; and(ii) Subject to approval by the Legislative Council.(B) A program under subsection (a) of this section shall include:(i) Data, statistics, and other appropriate documentation demonstrating the effectiveness of the previously submitted program in reducing or eliminating prior authorizations for a healthcare provider; and(ii) For a program that does not eliminate prior authorizations for a healthcare provider, specific initiatives or elements of the program that reduce existing prior authorizations for a healthcare provider.(C) (i) Upon submitting the program under subdivision (b)(1)(A) of this section, the submitting entity shall provide notice to each healthcare provider that includes: (a) The complete program submission; (b) The deadline for a healthcare provider to comment on the program submission; and (c) Instructions on how a healthcare provider may comment on the program.(ii) A healthcare provider shall have at least thirty (30) days to comment on a program submitted under subdivision (b)(1)(A) of this section.
(A) At least one (1) time every two (2) years, a program under subsection (a) of this section to reduce or eliminate prior authorization shall be:(i) Submitted to the State Insurance Department; and(ii) Subject to approval by the Legislative Council.
(i) Submitted to the State Insurance Department; and
(ii) Subject to approval by the Legislative Council.
(B) A program under subsection (a) of this section shall include:(i) Data, statistics, and other appropriate documentation demonstrating the effectiveness of the previously submitted program in reducing or eliminating prior authorizations for a healthcare provider; and(ii) For a program that does not eliminate prior authorizations for a healthcare provider, specific initiatives or elements of the program that reduce existing prior authorizations for a healthcare provider.
(i) Data, statistics, and other appropriate documentation demonstrating the effectiveness of the previously submitted program in reducing or eliminating prior authorizations for a healthcare provider; and
(ii) For a program that does not eliminate prior authorizations for a healthcare provider, specific initiatives or elements of the program that reduce existing prior authorizations for a healthcare provider.
(C) (i) Upon submitting the program under subdivision (b)(1)(A) of this section, the submitting entity shall provide notice to each healthcare provider that includes: (a) The complete program submission; (b) The deadline for a healthcare provider to comment on the program submission; and (c) Instructions on how a healthcare provider may comment on the program.(ii) A healthcare provider shall have at least thirty (30) days to comment on a program submitted under subdivision (b)(1)(A) of this section.
(i) Upon submitting the program under subdivision (b)(1)(A) of this section, the submitting entity shall provide notice to each healthcare provider that includes: (a) The complete program submission; (b) The deadline for a healthcare provider to comment on the program submission; and (c) Instructions on how a healthcare provider may comment on the program.
(a) The complete program submission;
(b) The deadline for a healthcare provider to comment on the program submission; and
(c) Instructions on how a healthcare provider may comment on the program.
(ii) A healthcare provider shall have at least thirty (30) days to comment on a program submitted under subdivision (b)(1)(A) of this section.
(2) If a program is not submitted to the department and approved by the Legislative Council as required or does not conform to the requirements of this section, the Medicaid-managed care program operating in this state, 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., or its successor program, and qualified health plans under the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, and purchased on the Arkansas Health Insurance Marketplace created under the Arkansas Health Insurance Marketplace Act, § 23-61-801 et seq., for an individual up to four hundred percent (400%) of the federal poverty level, operating in this state shall be subject to §§ 23-99-1120 — 23-99-1126 and § 23-99-1128.
(c) Any state or local governmental employee plan is exempt from §§ 23-99-1120 — 23-99-1126 and § 23-99-1128.
(d) A health benefit plan provided by a trust established under §§ 14-54-101 and 25-20-104 to provide benefits, including accident and health benefits, death benefits, dental benefits, and disability income benefits, is exempt from §§ 23-99-1120 — 23-99-1126.
(e) Prescription drugs, medicines, biological products, pharmaceuticals, or pharmaceutical services are subject to the gold card program unless exempted from the gold card program under § 23-99-1128(b).
(f) (1) Upon request, a healthcare insurer or a pharmacy benefits manager shall send an eligibility file notification to a healthcare provider.(2) An eligibility file notification under subdivision (f)(1) of this section shall indicate whether a subscriber is enrolled in a:(A) Health benefit plan that is:(i) Self-insured under the Employee Retirement Income Security Act of 1974, Pub. L. No. 93-406;(ii) A fully insured health benefit plan; or(iii) A self-funded health benefit plan;(B) Qualified health benefit plan that is a health benefit plan under the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, and purchased on the Arkansas Health Insurance Marketplace created under the Arkansas Health Insurance Marketplace Act, § 23-61-801 et seq., for an individual up to four hundred percent (400%) of the federal poverty level, operating in this state; or(C) Qualified health benefit plan that is a health benefit plan under the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, and purchased as a health benefit plan under Arkansas Health Insurance Marketplace created under the Arkansas Health Insurance Marketplace Act, § 23-61-801 et seq., for an individual over four hundred percent (400%) of the federal poverty level.
(1) Upon request, a healthcare insurer or a pharmacy benefits manager shall send an eligibility file notification to a healthcare provider.
(2) An eligibility file notification under subdivision (f)(1) of this section shall indicate whether a subscriber is enrolled in a:(A) Health benefit plan that is:(i) Self-insured under the Employee Retirement Income Security Act of 1974, Pub. L. No. 93-406;(ii) A fully insured health benefit plan; or(iii) A self-funded health benefit plan;(B) Qualified health benefit plan that is a health benefit plan under the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, and purchased on the Arkansas Health Insurance Marketplace created under the Arkansas Health Insurance Marketplace Act, § 23-61-801 et seq., for an individual up to four hundred percent (400%) of the federal poverty level, operating in this state; or(C) Qualified health benefit plan that is a health benefit plan under the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, and purchased as a health benefit plan under Arkansas Health Insurance Marketplace created under the Arkansas Health Insurance Marketplace Act, § 23-61-801 et seq., for an individual over four hundred percent (400%) of the federal poverty level.
(A) Health benefit plan that is:(i) Self-insured under the Employee Retirement Income Security Act of 1974, Pub. L. No. 93-406;(ii) A fully insured health benefit plan; or(iii) A self-funded health benefit plan;
(i) Self-insured under the Employee Retirement Income Security Act of 1974, Pub. L. No. 93-406;
(ii) A fully insured health benefit plan; or
(iii) A self-funded health benefit plan;
(B) Qualified health benefit plan that is a health benefit plan under the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, and purchased on the Arkansas Health Insurance Marketplace created under the Arkansas Health Insurance Marketplace Act, § 23-61-801 et seq., for an individual up to four hundred percent (400%) of the federal poverty level, operating in this state; or
(C) Qualified health benefit plan that is a health benefit plan under the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, and purchased as a health benefit plan under Arkansas Health Insurance Marketplace created under the Arkansas Health Insurance Marketplace Act, § 23-61-801 et seq., for an individual over four hundred percent (400%) of the federal poverty level.