Title 23, Public Utilities and Regulated Industries

(1) As used in this subchapter:(1) “Air ambulance” means an aircraft, fixed or rotary wing, utilized for on-scene responses or transports licensed by the Department of Health;(2) “Air ambulance services” means those services authorized and licensed by the department to provide ca…

(a) An ambulance provider may contract directly or indirectly with a contracting entity as a network provider of ambulance services. (b) An ambulance provider shall not be required to participate as an in-network provider of a transportation benefit manager.

(a) A contracting entity shall not require prior authorization for:(1) Ground or air prehospital transportation; or(2) Ground or air emergent or urgent ambulance transportation from one (1) hospital or medical facility to another hospital or medical facility in order to obtain me…

(a) A contracting entity shall pay a claim for ambulance services for which prior authorization was received regardless of the terminology used by the transportation benefit manager or health benefit plan within thirty (30) days of receipt of the claim from an ambulance provider,…

(a) A contracting entity is subject to the Trade Practices Act, § 23-66-201 et seq. (b) The expenses of implementing this subchapter shall not be used as justification to increase premiums or decrease payments to any ambulance provider or medical facility. (c) The Insurance Commi…

(1) As used in this subchapter:(1) “Enrollee” means an individual who is entitled to receive healthcare services under the terms of a health benefit plan;(2) “Ground ambulance services” means services authorized and licensed by the Department of Health to provide care and transpo…

(a) (1) The minimum allowable reimbursement rate under any health benefit plan issued by a healthcare insurer to a participating ground ambulance service provider or an out-of-network ground ambulance service provider shall be at the rates approved or contracted between the ambul…

(1) As used in this subchapter:(1) “Crisis stabilization unit” means the same as defined in § 20-47-803;(2) (A) “Health benefit plan” means any individual, blanket, or group plan, policy, or contract for healthcare services issued or delivered by a healthcare insurer in this stat…

A health benefit plan shall not require prior authorization or precertification for a healthcare service provided by a healthcare provider to an individual who is suffering a mental health crisis.

(a) Except as provided in subsection (b) of this section, the Insurance Commissioner may promulgate rules to implement this subchapter. (b) The State Board of Finance may promulgate rules to implement this subchapter that may apply to the State and Public School Life and Health I…

This subchapter shall be known and may be cited as the “Arkansas Medical Audit Bill of Rights Act”.

(1) As used in this subchapter:(1) “Audit” means an investigation or review of a claim submitted by a healthcare provider if the investigation or review:(A) Is conducted by an auditor; and(B) Involves records, documents, or information other than the filed claim;(2) “Auditor” mea…

(a) Notwithstanding any other law, when an audit is conducted by an auditor, the audit shall be conducted according to the following bill of rights:(1) An auditor conducting the initial audit shall give the healthcare provider notice of the audit at least one (1) week before cond…

This subchapter may be cited as the “Patient Protection Act of 1995”.

The General Assembly finds that patients should be given the opportunity to see the healthcare provider of their choice. In order to assure the citizens of the State of Arkansas the right to choose the provider of their choice, it is the intent of the General Assembly to provide …

(a) (1) “Copayment” means a type of cost sharing whereby insured or covered persons pay a specified predetermined amount per unit of service or percentage of healthcare costs with their healthcare insurer paying the remainder of the charge.(2) The copayment is incurred at the tim…

(a) A healthcare insurer shall not, directly or indirectly:(1) (A) Impose a monetary advantage or penalty under a health benefit plan that would affect a beneficiary's choice among those healthcare providers who participate in the health benefit plan according to the terms offere…

(a) Nothing in this subchapter shall be construed to require any healthcare insurer to cover any specific healthcare service. (b) Provided, however, no condition or measure shall have the effect of excluding any type or class of provider qualified under § 23-99-204(a)(3) to provi…

It is a violation of this subchapter for any healthcare insurer or other person or entity to provide any health benefit plan providing for healthcare services to residents of this state that does not conform to this subchapter, but nothing in this subchapter shall constitute a vi…

To the extent permitted by the Employee Retirement Income Security Act of 1974, as amended, 29 U.S.C. § 1001 et seq., any provider adversely affected by a violation of this subchapter may sue in circuit court only for injunctive relief against the healthcare insurer, but not for …

(a) To avoid impairment of existing contracts, this subchapter shall only apply to contracts issued or renewed after July 28, 1995. (b) Any provision in a health benefit plan which is executed, delivered, or renewed, or otherwise contracts for provision of services in this state …

The provisions of this subchapter shall not apply to self-funded or other health benefit plans that are exempt from state regulation by virtue of the Employee Retirement Income Security Act of 1974, as amended.

A healthcare insurer shall not exclude a physician as a participating healthcare provider in a health benefit plan based solely on an adverse professional review action, including those described in the Arkansas Peer Review Fairness Act, § 20-9-1301 et seq., unless a hospital's p…

(a) As used in this subchapter:(1) “Contracting entity” means a healthcare insurer or a subcontractor, affiliate, or other entity that contracts directly or indirectly with a healthcare provider for the delivery of healthcare services to patients;(2) (A) “Drug” means a substance …

(a) (1) A contracting entity shall provide a reasonable administrative appeal procedure to allow a healthcare provider to challenge the reimbursement for a specific drug as being below the healthcare provider's drug acquisition cost.(2) The reasonable administrative appeal proced…

(a) As used in this section:(1) “Pharmacist” means an individual licensed as a pharmacist by the Arkansas State Board of Pharmacy;(2) “Pharmacy” means the place licensed by the board in which drugs, chemicals, medicines, prescriptions, and poisons are compounded, dispensed, or so…

(1) As used in this subchapter:(1) “Crisis stabilization unit” means the same as defined in § 20-47-803;(2) (A) “Health benefit plan” means any individual, blanket, or group plan, policy, or contract for healthcare services issued or delivered by a healthcare insurer in this stat…

(a) Except as provided in subsection (b) of this section, a health benefit plan shall not impose or apply any behavioral or medical management utilization limitations, measures, or controls for healthcare services by a crisis stabilization unit unless the behavioral or medical ma…

A health benefit plan shall not require prior authorization or precertification for a healthcare service provided by a crisis stabilization unit unless the healthcare service requires a prior authorization by rule of the Insurance Commissioner.

The Insurance Commissioner may promulgate rules to implement this subchapter.

This subchapter shall be known and may be cited as the “Pharmacy Services Administrative Organization Act”.

(1) As used in this subchapter:(1) (A) “Administrative services” means a service provided by a pharmacy services administrative organization.(B) “Administrative services” includes without limitation:(i) Assistance with a claim;(ii) Assistance with an audit;(iii) Assistance with a…

(a) (1) A person or organization shall not establish or operate as a pharmacy services administrative organization in Arkansas for health benefit plans without obtaining a license from the Insurance Commissioner under this subchapter.(2) The commissioner shall prescribe the appli…

(a) A pharmacy services administrative organization-pharmacy contract shall include a provision that requires a pharmacy services administrative organization to provide to a pharmacy a copy of the pharmacy services administrative organization-pharmacy contract, amendment, payment…

(a) A pharmacy services administrative organization that owns or is owned by, in whole or in part, an entity that manufactures, sells, or distributes prescription drugs, biologicals, or medical devices, as a condition of entering into a pharmacy services administrative organizati…

(a) A pharmacy services administrative organization-pharmacy contract shall provide that if there is a dispute between a pharmacy and a pharmacy benefits manager or a third-party payer, the pharmacy services administrative organization shall ensure and facilitate timely communica…

(a) The Insurance Commissioner shall enforce this subchapter. (b) (1) The commissioner may examine or audit the books and records of a pharmacy services administrative organization providing claims administrative services for a pharmacy to determine if the pharmacy services admin…

This subchapter shall be known and may be cited as the “Primary Eye Care Provider Act”.

(1) As used in this subchapter:(1) “Covered persons” means any individual or family that is enrolled in a health benefit plan or policy from a healthcare insurer and on whose behalf the healthcare insurer is obligated to pay for or provide eye and/or vision care benefits;(2) “Cov…

(1) A health benefit plan that includes, or may include, eye and/or vision care benefits shall:(1) Include all primary eye care providers who are selected by covered persons of the health benefit plan for the provision of all eye and/or vision care benefits provided by the health…

Nothing in this subchapter shall prevent any person covered by a health benefit plan from receiving emergency eye care nor shall it prevent any person from exercising his or her right to receive treatment from his or her personal doctor and being reimbursed in accordance with the…

Any person adversely affected by a violation of this subchapter may bring action in a court of competent jurisdiction for injunctive relief against the healthcare insurer and, upon prevailing, in addition to such injunctive relief, shall recover damages not less than one thousand…

This subchapter shall be known and may be cited as the “Arkansas Health Care Consumer Act”.

As the state's insurance sector becomes increasingly dominated by managed care features that include decisions regarding coverage and appropriateness of health care, there is a vital need to protect patients in this environment.

(1) As used in this subchapter:(1) “Acute condition” means a medical condition, illness, or disease having a short and relatively severe course;(2) “Commissioner” means the Insurance Commissioner;(3) “Covered person” means a person on whose behalf the healthcare insurer issuing o…

(a) (1) Except as provided in subsection (b) of this section, a healthcare insurer may not restrict benefits for any hospital stay in connection with childbirth for the mother or newborn child to less than forty-eight (48) hours following a normal vaginal delivery or to less than…