Title 23 — Public Utilities and Regulated Industries

95 chapters · 4,024 sections in this title.

4,024 sectionsFiltered byTitle 23

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.
Ark. Code Ann. § 23-99-1304 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. § 23-99-1305 Rules
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The Insurance Commissioner shall promulgate rules necessary to ensure compliance with this subchapter.
Ark. Code Ann. § 23-99-1401 Title
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This subchapter shall be known and may be cited as the “Temporary Hospital Facility Act”.
Ark. Code Ann. § 23-99-1402 Legislative findings and intent
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(a) The General Assembly finds that:(1) The Centers for Medicare & Medicaid Services' Hospitals Without Walls program allows participating ambulatory surgery centers to convert to licensed hospitals during the period of the coronavirus 2019 (COVID-19) public health emergency;(2) …
Ark. Code Ann. § 23-99-1403 Definitions
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(1) 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 enrollees;(2) “Healthcare contract” means …
Ark. Code Ann. § 23-99-1404 Healthcare contract — Good-faith cooperation
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(a) A healthcare insurer shall cooperate in good faith with a temporary hospital facility in timely executing a healthcare contract. (b) A healthcare insurer shall cooperate in good faith as required in subsection (a) of this section by timely offering a temporary hospital facili…
Ark. Code Ann. § 23-99-1405 Converting back to ambulatory surgery center
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(a) If a temporary hospital facility converts back to an ambulatory surgery center, a healthcare insurer shall not delay in providing a contract for an ambulatory surgery center based on the healthcare insurer's standard and reasonable terms and conditions. (b) The effective date…
Ark. Code Ann. § 23-99-1406 Applicability
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This subchapter shall apply to any future public health emergencies if the Centers for Medicare & Medicaid Services and the Department of Health have implemented similar programs as described in § 23-99-1402(a)(2).
Ark. Code Ann. § 23-99-1407 Penalty
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A violation of this subchapter is a violation of § 23-99-804 and the Healthcare Contracting Simplification Act, § 23-99-1201 et seq.
Ark. Code Ann. § 23-99-1501 Title
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This subchapter shall be known and may be cited as the “Billing in the Best Interest of Patients Act”.
Ark. Code Ann. § 23-99-1502 Definitions
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(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) (A) “Health benefit plan” means an individual, blanket, or group plan, policy, or contract for healthcare services issued,…
Ark. Code Ann. § 23-99-1503 Determination of best interest for enrollee — Billing decision
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(a) A healthcare provider that provides healthcare services and prescribes prescription medication to an enrollee may make a determination that it is in the best interest of the enrollee to bill the enrollee's:(1) Healthcare payor; or(2) Pharmacy benefits carrier. (1) Healthcare …
Ark. Code Ann. § 23-99-1504 Rules
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The Insurance Commissioner shall develop and promulgate rules for the implementation and administration of this subchapter.
Ark. Code Ann. § 23-99-1601 Title
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This subchapter shall be known and may be cited as the “Electronic Access of Medical Records by Healthcare Payor Act”.
Ark. Code Ann. § 23-99-1602 Definitions
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(1) As used in this subchapter:(1) “Authorized designee” means an entity that is:(A) Designated by a healthcare payor to operate on its behalf; and(B) Authorized to access an enrollee's protected health information under the Health Insurance Portability and Accountability Act of …
Ark. Code Ann. § 23-99-1603 Electronic access to medical records sufficient
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(a) A healthcare provider that provides healthcare services to an enrollee may grant electronic access to the healthcare provider's medical records system to a healthcare payor or the healthcare payor's authorized designee:(1) To evaluate potential health care to be provided to a…
Ark. Code Ann. § 23-99-1701 Title
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This subchapter shall be known and may be cited as the “Transportation Benefit Manager Act”.
Ark. Code Ann. § 23-99-1702 Definitions
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(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…
Ark. Code Ann. § 23-99-1703 Contracts
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(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.
Ark. Code Ann. § 23-99-1704 Prior authorization
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(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…
Ark. Code Ann. § 23-99-1705 Claims
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(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,…
Ark. Code Ann. § 23-99-1706 Enforcement — Rules
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(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…
Ark. Code Ann. § 23-99-1801 Definitions
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(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…
Ark. Code Ann. § 23-99-1802 Minimum allowable reimbursement for ground ambulance services
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(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…
Ark. Code Ann. § 23-99-1901 Definitions
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(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…
Ark. Code Ann. § 23-99-1902 Mental health crisis — Prior authorization or precertification for healthcare service prohibited
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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.
Ark. Code Ann. § 23-99-1903 Rules
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(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…
Ark. Code Ann. § 23-99-2001 Title
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This subchapter shall be known and may be cited as the “Arkansas Medical Audit Bill of Rights Act”.
Ark. Code Ann. § 23-99-2002 Definitions
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(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…
Ark. Code Ann. § 23-99-2003 Arkansas Medical Audit Bill of Rights
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(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…