Title 23 — Public Utilities and Regulated Industries
95 chapters · 4,024 sections in this title.
Ark. Code Ann. § 23-97-313 Certificates
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(1) A certificate issued for delivery in this state under a group long-term care insurance policy shall include:(1) A description of the principal benefits and coverage provided in the policy;(2) A statement of the principal exclusions, reductions, and limitations contained in th…
Ark. Code Ann. § 23-97-314 Delivery of policy and summary — Disclosures
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(a) If an application for a long-term care insurance contract or certificate is approved, the issuer shall deliver the contract or certificate of insurance to the applicant no later than thirty (30) days after the date of approval. (b) (1) At the time of the delivery of the polic…
Ark. Code Ann. § 23-97-315 Acceleration of death benefit
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(a) Any time a long-term care benefit funded through a life insurance vehicle by the acceleration of the death benefit is in benefit payment status, a monthly report shall be provided to the policyholder. (b) The report shall include:(1) Any long-term care benefits paid out durin…
Ark. Code Ann. § 23-97-316 Denial of claims
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(1) If a claim under a long-term care insurance contract is denied, within sixty (60) days of the date of a written request by the policyholder or certificate holder or a representative of the policyholder or certificate holder, the issuer shall:(1) Provide a written explanation …
Ark. Code Ann. § 23-97-317 Offer of long-term care or nursing home insurance
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Any policy or rider advertised, marketed, or offered as long-term care or nursing home insurance shall comply with the provisions of this subchapter.
Ark. Code Ann. § 23-97-318 Incontestability period
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(a) An insurer may rescind a long-term care insurance policy or certificate or deny an otherwise valid long-term care insurance claim if:(1) The long-term care insurance policy or certificate has been in force for less than six (6) months and the insurer relied upon a material mi…
Ark. Code Ann. § 23-97-319 Nonforfeiture benefits
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(a) (1) Except as provided in subsection (b) of this section, a long-term care insurance policy may not be delivered or issued for delivery in this state unless the policyholder or certificate holder has been offered the option of purchasing a policy or certificate containing a n…
Ark. Code Ann. § 23-97-320 Authority to promulgate rules
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(1) The Insurance Commissioner shall issue rules for long-term care insurance to:(1) Promote premium adequacy;(2) Protect the policyholder in the event of substantial rate increases; and(3) Establish minimum standards for:(A) Marketing practices;(B) Agent compensation;(C) Agent t…
Ark. Code Ann. § 23-97-321 Penalties
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(1) In addition to any other penalties provided by the laws of this state, any insurer or agent found to have violated any requirement of this state relating to the regulation of long-term care insurance or the marketing of long-term care insurance is subject to the greater of:(1…
Ark. Code Ann. § 23-98-101 Legislative findings
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(1) The General Assembly finds that the cost of health insurance coverage is not affordable for many small businesses, their employees, self-employed persons, and other individuals, and that as a result hundreds of thousands of Arkansas citizens do not have any health insurance c…
Ark. Code Ann. § 23-98-102 Definitions
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(1) As used in this chapter:(1) “Children's preventive healthcare services” means physician-delivered or physician-supervised services for eligible dependents from birth through age six (6), with periodic physical examinations including medical history, physical examination, deve…
Ark. Code Ann. § 23-98-103 Notices and hearings before adopting rules
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The Insurance Commissioner shall provide notice and conduct hearings in accordance with the Arkansas Administrative Procedure Act, § 25-15-201 et seq., before adopting any rules of general applicability to minimum basic benefit policies to be issued pursuant to this chapter.
Ark. Code Ann. § 23-98-104 Formation of trusts of qualified individuals
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Solely for purposes of obtaining minimum basic benefit policies pursuant to the authority granted by this chapter, trusts may be formed composed of qualified individuals, qualified families, or qualified groups. Each trust may serve as a master policyholder. Members of qualified …
Ark. Code Ann. § 23-98-105 Issuance of minimum basic benefit policies permitted — Applicability
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Insurers are authorized to issue minimum basic benefit policies pursuant to and in compliance with the provisions of this chapter to qualified individuals, qualified families, qualified trusts, and qualified groups. This chapter shall apply only to those minimum basic benefit pol…
Ark. Code Ann. § 23-98-106 Minimum basic benefits
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(a) Minimum basic benefit policies offered under the authority of this chapter shall provide basic levels of primary, preventive, and hospital care, including, but not limited to, the following:(1) Fifteen (15) days of inpatient hospitalization coverage per policy year;(2) (A) As…
Ark. Code Ann. § 23-98-107 Disclosure requirements for minimum basic benefit policies
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(a) Before any insurer issues a minimum basic benefit policy, it shall obtain from the prospective insured a signed, written statement in a form approved by the Insurance Commissioner in which the prospective insured:(1) Certifies as to eligibility for coverage under the minimum …
Ark. Code Ann. § 23-98-108 Notice of minimum basic benefit policies — Payroll deduction
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(a) Those employers in the State of Arkansas that do not provide a portion of the cost of health insurance for their employees shall provide notice to their employees of the existence of the minimum basic benefit policy authorized by this chapter. The notice shall be in a form pr…
Ark. Code Ann. § 23-98-109 Managed care and cost control provisions
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(a) The insurer may include any or all of the following managed care provisions to control the cost of a minimum basic benefit policy issued pursuant to this chapter:(1) An exclusion for services that are not medically necessary;(2) A procedure for preauthorization by telephone, …
Ark. Code Ann. § 23-98-110 Approval of forms and rates
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(a) All minimum basic benefit policy forms, including applications, enrollment forms, policies, certificates, evidences of coverage, riders, amendments, endorsements, disclosure forms, and marketing communications used in connection with the sale or advertisement of a minimum bas…
Ark. Code Ann. § 23-98-111 Record-keeping and reporting requirement for insurers
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Each insurer issuing a minimum basic benefit policy in this state shall maintain separate and distinct records of enrollment, claim costs, premium income, utilization, and such other information as may be required by the Insurance Commissioner. Each insurer providing a minimum ba…
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…