Title 23 — Public Utilities and Regulated Industries

95 chapters · 4,024 sections in this title.

166 sectionsFiltered byTitle 23 Ch 99

Ark. Code Ann. § 23-99-1001 Title
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This subchapter shall be known and may be cited as the “Vision Care Plan Act of 2015”.
Ark. Code Ann. § 23-99-1002 Definitions
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(1) As used in this subchapter:(1) “Covered materials” means materials for which reimbursement from the insurer, vision benefit manager, vision care plan, or vision care discount plan is provided to a vision care provider by an individual's vision benefit plan or contract and tha…
Ark. Code Ann. § 23-99-1003 Prohibited practices — Agreements
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(a) A participating provider agreement between an insurer, vision benefit manager, vision care plan, or vision care discount plan and a vision care provider shall not establish a fee that a vision care provider shall charge for services or materials that are not covered by a visi…
Ark. Code Ann. § 23-99-1004 Private civil action
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(a) A vision care provider adversely affected by any violation of this subchapter by an insurer, vision care plan, or a vision care discount plan may bring a civil action in a court of competent jurisdiction against the insurer, vision care plan, or a vision care discount plan fo…
Ark. Code Ann. § 23-99-1005 Rules — Enforcement — Effective date
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(a) The State Insurance Department shall develop and promulgate rules for the implementation and administration of this subchapter. (b) The Insurance Commissioner shall enforce this subchapter and may seek injunctive relief for violations of this subchapter. (c) This subchapter i…
Ark. Code Ann. § 23-99-1101 Title
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This subchapter shall be known and may be cited as the “Prior Authorization Transparency Act”.
Ark. Code Ann. § 23-99-1102 Legislative findings and intent
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(a) The General Assembly finds that:(1) A physician-patient relationship is paramount and should not be subject to third-party intrusion; and(2) Prior authorizations can place attempted cost savings ahead of optimal patient care. (1) A physician-patient relationship is paramount …
Ark. Code Ann. § 23-99-1103 Definitions
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(1) As used in this subchapter:(1) (A) “Adverse determination” means a decision by a utilization review entity to deny, reduce, or terminate coverage for a healthcare service furnished or proposed to be furnished to a subscriber on the basis that the healthcare service is not med…
Ark. Code Ann. § 23-99-1104 Disclosure required
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(a) (1) (A) A utilization review entity shall disclose all of its prior authorization requirements, clinical criteria, and restrictions in a publicly accessible manner on its website.(B) The disclosure under subdivision (a)(1)(A) of this section shall be explained in detail and i…
Ark. Code Ann. § 23-99-1105 Prior authorization — Nonurgent healthcare service
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(a) If a utilization review entity requires prior authorization of a nonurgent healthcare service, the utilization review entity shall make an authorization or adverse determination and notify the subscriber and the subscriber's nonurgent healthcare provider of the decision withi…
Ark. Code Ann. § 23-99-1106 Prior authorization — Urgent healthcare service
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(a) A utilization review entity shall render an expedited authorization or adverse determination concerning an urgent healthcare service and notify the subscriber and the subscriber's healthcare provider of that expedited prior authorization or adverse determination no later than…
Ark. Code Ann. § 23-99-1107 Prior authorization — Emergency healthcare service
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(a) A utilization review entity shall not require prior authorization for prehospital transportation or for provision of an emergency healthcare service. (b) (1) A utilization review entity shall allow a subscriber and the subscriber's healthcare provider a minimum of twenty-four…
Ark. Code Ann. § 23-99-1108 Subscribers with terminal illness — Denial of prior authorization for covered prescription pain medication prohibited
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If a subscriber's covered prescription pain medication requires a prior authorization, then the prior authorization shall not be denied if the subscriber has a terminal illness.
Ark. Code Ann. § 23-99-1109 Rescission of prior authorizations — Denial of payment for prior authorized services — Limitations
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(a) A decision on a request for prior authorization by a utilization review entity shall include a determination as to whether or not the individual is covered by a health benefit plan and eligible to receive the requested service under the health benefit plan. (b) (1) A utilizat…
Ark. Code Ann. § 23-99-1110 Waiver prohibited
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(a) The provisions of this subchapter shall not be waived by contract. (b) Any contractual arrangements or actions taken in conflict with this subchapter or that purport to waive any requirements of this subchapter are void.
Ark. Code Ann. § 23-99-1111 Requests for prior authorization — Qualified persons authorized to review and approve — Adverse determinations to be made only by Arkansas-licensed physicians — Opportunity to discuss treatment before adverse determination
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(a) The initial review of information submitted in support of a request for prior authorization may be conducted by a qualified person employed or contracted by a utilization review entity. (b) (1) A request for prior authorization may be approved by a qualified person employed o…
Ark. Code Ann. § 23-99-1112 Application of subchapter
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(1) This subchapter applies to a healthcare insurer, whether or not the healthcare insurer is:(1) Acting directly or indirectly through a private utilization review entity; or(2) Located in this state. (1) Acting directly or indirectly through a private utilization review entity;…
Ark. Code Ann. § 23-99-1113 Benefit inquiries authorized
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(a) (1) An in-network or out-of-network healthcare provider may submit a benefit inquiry to a healthcare insurer or utilization review entity for a healthcare service not yet provided to determine whether or not the healthcare service meets medical necessity and all other require…
Ark. Code Ann. § 23-99-1114 Limitation on step therapy — Definitions
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(a) An insurance policy shall not limit or exclude coverage under the health benefit plan for a drug approved by the United States Food and Drug Administration that is on the prescription drug formulary of the insurance policy by mandating that a covered person undergo step thera…
Ark. Code Ann. § 23-99-1115 Notice requirements — Process for appealing adverse determination and restriction or denial of healthcare service
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(a) (1) Notice of an adverse determination shall be provided to the healthcare provider that initiated the prior authorization.(2) Notice may be made by electronic mail, fax, or hard copy letter sent by regular mail, or verbally, as requested by the subscriber's healthcare provid…
Ark. Code Ann. § 23-99-1116 Failure to comply with subchapter — Enforcement — Fines
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(a) (1) For any provision of this subchapter that relates to a specific request from a healthcare provider for a prior authorization, if a healthcare insurer or utilization review entity fails to comply with this subchapter, the requested healthcare services shall be deemed autho…
Ark. Code Ann. § 23-99-1117 Standardized form required for prescription drug benefits
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(a) On and after January 1, 2017, to establish uniformity in the submission of prior authorization forms for prescription drugs, a utilization review entity shall utilize only a single standardized prior authorization form for obtaining approval in written or electronic form for …
Ark. Code Ann. § 23-99-1118 Rules
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The State Insurance Department may promulgate rules for the implementation of this subchapter.
Ark. Code Ann. § 23-99-1119 Medication-assisted treatment for opioid addiction
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(a) A healthcare insurer, including Medicaid, shall not:(1) Require prior authorization in order for a patient to obtain coverage of buprenorphine, naloxone, naltrexone, methadone, and their various formulations and combinations approved by the United States Food and Drug Adminis…
Ark. Code Ann. § 23-99-1120 Initial exemption from prior authorization requirements for healthcare providers providing certain healthcare services
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(a) Except as provided under subsection (c) of this section or § 23-99-1125, a healthcare insurer that uses a prior authorization process for healthcare services shall not require a healthcare provider to obtain prior authorization for a particular healthcare service that a healt…
Ark. Code Ann. § 23-99-1121 Duration of prior authorization exemption
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(a) Unless a prior authorization exemption is continued for a longer period of time by a healthcare insurer under § 23-99-1120(c), a healthcare provider's exemption from prior authorization requirements under § 23-99-1120 remains in effect until the later of:(1) The thirtieth day…
Ark. Code Ann. § 23-99-1122 Denial or rescission of prior authorization exemption
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(a) A healthcare insurer may rescind an exemption from prior authorization requirements of a healthcare provider under § 23-99-1120 only if:(1) The healthcare insurer makes a determination that, on the basis of a retrospective review of a random sample of claims selected by the h…
Ark. Code Ann. § 23-99-1123 Independent review of exemption determination
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(a) (1) A healthcare provider has a right to a review of an adverse determination regarding a prior authorization exemption within twelve (12) months of receiving proper notice of recission from a healthcare insurer to be conducted by an independent review organization.(2) A heal…
Ark. Code Ann. § 23-99-1124 Effect of appeal of independent review organization determination
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(a) A healthcare insurer is bound by an appeal or independent review organization determination that does not affirm the determination made by the healthcare insurer to rescind a prior authorization exemption. (b) A healthcare insurer shall not retroactively deny a healthcare ser…
Ark. Code Ann. § 23-99-1125 Eligibility for prior authorization exemption following finalized exemption rescission or denial
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(a) After a final determination or review affirming the rescission or denial of an exemption for a specific healthcare service under § 23-99-1120, a healthcare insurer shall conduct another evaluation to determine whether or not the exemption should be granted or reinstated based…
Ark. Code Ann. § 23-99-1126 Effect of prior authorization exemption
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(a) (1) A healthcare insurer shall not deny or reduce payment to a healthcare provider for a healthcare service for which the healthcare provider has qualified for an exemption from prior authorization requirements under § 23-99-1120, including a healthcare service performed or s…
Ark. Code Ann. § 23-99-1127 Applicability
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(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…
Ark. Code Ann. § 23-99-1128 Prescription drugs, medicines, biological products, pharmaceuticals, or pharmaceutical services
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(a) If a prescription drug, medicine, biological product, pharmaceutical, or pharmaceutical service is not exempt from the gold card program under subsection (b) of this section, then a healthcare provider shall be reviewed by a healthcare insurer or pharmacy benefits manager und…
Ark. Code Ann. § 23-99-1129 Appeals process for disallowance of prior authorization
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(a) If the Arkansas State Board of Pharmacy and the Arkansas State Medical Board, jointly, disallow a prior authorization of a prescription drug, medicine, biological product, pharmaceutical, or pharmaceutical service requested under § 23-99-1128, a healthcare insurer, pharmacy b…
Ark. Code Ann. § 23-99-1130 HIV pre-exposure prophylaxis and HIV post-exposure prophylaxis — Definitions
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(a) As used in this section:(1) “AIDS” means acquired immunodeficiency syndrome; and(2) “HIV” means the human immunodeficiency virus or any other identified causative agent of acquired immunodeficiency syndrome. (1) “AIDS” means acquired immunodeficiency syndrome; and (2) “HIV” m…
Ark. Code Ann. § 23-99-1201 Title
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This subchapter shall be known and may be cited as the “Healthcare Contracting Simplification Act”.
Ark. Code Ann. § 23-99-1202 Definitions
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(1) As used in this subchapter:(1) “Affiliate” means an entity that controls, is controlled by, or is under common control with a healthcare insurer;(2) “All-products clause” means a provision in a healthcare contract that requires a healthcare provider, as a condition of partici…
Ark. Code Ann. § 23-99-1203 All-products clause — Prohibition
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(a) Except as provided in subsections (b) and (d) of this section, a contracting entity shall not:(1) Offer to a healthcare provider a healthcare contract that includes an all-products clause;(2) Enter into a healthcare contract with a healthcare provider that includes an all-pro…
Ark. Code Ann. § 23-99-1204 Prohibition — Most favored nation clause
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(a) A contracting entity shall not:(1) Offer to a healthcare provider a healthcare contract that includes a most favored nation clause;(2) Enter into a healthcare contract with a healthcare provider that includes a most favored nation clause; or(3) Amend or renew an existing heal…
Ark. Code Ann. § 23-99-1205 Contracting process
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(a) (1) A material amendment to a healthcare contract is allowed if a contracting entity provides to a participating healthcare provider the material amendment at least ninety (90) days before the effective date of the material amendment and in writing.(2) The notice required und…
Ark. Code Ann. § 23-99-1206 Freedom of contract
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(a) A contracting entity shall not, directly or indirectly, offer or enter into a healthcare contract that:(1) Prohibits a participating healthcare provider from entering into a healthcare contract with another contracting entity; or(2) Prohibits a contracting entity from enterin…
Ark. Code Ann. § 23-99-1207 Enforcement
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(a) A contracting entity is subject to the Trade Practices Act, § 23-66-201 et seq. (b) The State Insurance Department shall enforce this subchapter.
Ark. Code Ann. § 23-99-1208 Rules
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(a) The Insurance Commissioner shall promulgate rules necessary to ensure compliance with this subchapter. (b) (1) When adopting the initial rules to ensure compliance with this subchapter, the final rule shall be filed with the Secretary of State for adoption under § 25-15-204(f…
Ark. Code Ann. § 23-99-1209 Effective date
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(a) This subchapter applies to the activities of risk-based provider organizations on and after January 1, 2021. (b) Except as provided in subsection (a) of this section, this subchapter is effective on and after September 1, 2019.
Ark. Code Ann. § 23-99-1210 Healthcare contract or provider network — Prohibition
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(a) A contracting entity shall not:(1) Lease, rent, or sell a healthcare contract or provider network of a health benefit plan to another contracting entity, healthcare insurer, or third-party administrator; or(2) In any manner allow the use of a healthcare contract or provider n…
Ark. Code Ann. § 23-99-1211 Notice required for downcode of claim
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A contracting entity that downcodes a claim submitted by a healthcare provider shall provide notice to the healthcare provider of the downcoding within thirty (30) days of processing the claim.
Ark. Code Ann. § 23-99-1212 Waiver prohibited
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(a) This subchapter shall not be waived by contract. (b) A contractual arrangement or action taken in conflict with this subchapter or that purports to waive a requirement of this subchapter is void.
Ark. Code Ann. § 23-99-1301 Definitions
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(1) As used in this subchapter:(1) “Contracting entity” means a healthcare insurer or any subcontractor, affiliate, or other entity that contracts directly or indirectly with a healthcare provider for the delivery of healthcare services to enrollees;(2) “Enrollee” means a person …
Ark. Code Ann. § 23-99-1302 Assignment of benefits — Consent and notice required
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(a) An enrollee, through an assignment of benefits, may assign to a healthcare provider the enrollee's right to receive reimbursement for any healthcare service rendered by a healthcare provider regardless of whether the healthcare provider is a participating provider or an out-o…
Ark. Code Ann. § 23-99-1303 Waiver prohibited
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(a) This subchapter shall not be waived by contract. (b) A contractual arrangement or actions taken in conflict with this subchapter or that purport to waive any requirement of this subchapter are void.