Stricken language would be deleted from and underlined language would be added to present law.
Act 109 of the Fiscal Session
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State of Arkansas 1
93rd General Assembly A Bill 2
Fiscal Session, 2022 SENATE BILL 87 3
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By: Senators Rice, Hickey, Irvin, Beckham, L. Chesterfield, J. Dismang, Elliott, J. English, Flippo, 5
Gilmore, Hill, K. Ingram, B. Johnson, G. Leding, B. Sample, D. Sullivan 6
By: Representatives Dotson, Shepherd, Wardlaw, Beaty Jr., Beck, M. Berry, S. Berry, Bragg, Brown, C. 7
Cooper, Crawford, Dalby, M. Davis, Ennett, Eubanks, K. Ferguson, C. Fite, D. Garner, Godfrey, Hawks, 8
M. Hodges, Hollowell, Hudson, Jett, Love, Maddox, McCullough, S. Meeks, Nicks, Perry, Scott, S. 9
Smith, Speaks, Vaught, Warren, D. Whitaker, Wing, Wooten 10
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For An Act To Be Entitled 12
AN ACT TO ESTABLISH COVERAGE FOR THE DIA GNOSIS AND 13
TREATMENT OF MORBID OBESITY UNDER THE ST ATE AND 14
PUBLIC SCHOOL LIFE A ND HEALTH INSURANCE PROGRAM; TO 15
DECLARE AN EMERGENCY ; AND FOR OTHER PURP OSES. 16
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Subtitle 19
TO ESTABLISH COVERAGE FOR THE DIAGNOSIS 20
AND TREATMENT OF MORBID OBESITY UNDER THE 21
STATE AND PUBLIC SCHOOL LIFE AND HEALTH 22
INSURANCE PROGRAM; AND TO DECLARE AN 23
EMERGENCY. 24
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BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF ARKANSAS: 27
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SECTION 1. Arkansas Code Title 21, Chapter 5, Subchapter 4, is amended 29
to add an additional section to read as follows: 30
21-5-419. Coverage for diagnosis and treatment of morbid obesity —31
Legislative findings and intent — Definitions — Rules. 32
(a) The General Assembly finds that: 33
(1) Morbid obesity causes ma ny medical problems and costly 34
health complications, such as diabetes, hypertension, heart disease, and 35
stroke; 36 SB87
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(2) The cost of managing the complications of morbid obesity, 1
largely due to inadequate treatment, far outweighs the cost of expeditious 2
and effective medical treatment; 3
(3) The recommended guidelines developed by the National 4
Institutes of Health, the American Society for Metabolic and Bariatric 5
Surgery, the American Obesity Association, and Shape Up America and embraced 6
by the American Medical Association and the American College of Surgeons are 7
that patients who are morbidly obese receive responsible and affordable 8
medical treatment for their obesity; 9
(4) The rate of bariatric surgery use has increased in the past 10
decade to more than on e hundred seventy thousand (170,000) surgical 11
procedures per year in the United States; 12
(5) Payers can rely on bariatric surgery paying for itself 13
through decreased comorbidities within two (2) to four (4) years; 14
(6) In 2019, the majority of members who had bariatric surgery 15
under the State and Public School Life and Health Insurance Program had a 16
total per-member per-month cost reduction of thirty -seven percent (37%), 17
primarily due to a reduction of forty -five percent (45%) in medical per -18
member per-month costs; 19
(7) There is a clinical and financial benefit to reducing the 20
burden of chronic disease through coverage; and 21
(8) The diagnosis and treatment of morbid obesity should be a 22
clinical decision made by a physician based on evidence -based guidelines. 23
(b) It is the intent of the General Assembly to provide coverage for 24
the diagnosis and treatment of morbid obesity. 25
(c) As used in this section: 26
(1) "Body mass index" means body weight in kilograms divided by 27
height in meters squared; and 28
(2) "Morbid obesity": 29
(A) Means a weight that is at least two (2) times the 30
ideal weight for frame, age, height, and sex of an individual as determined 31
by an examining physician; and 32
(B) May be measured as a body mass index: 33
(i) Equal to or greater than thirty-five kilograms 34
per meter squared (35 kg/m2) with comorbidity or coexisting medical 35
conditions such as hypertension, cardiopulmonary conditions, sleep apnea, or 36 SB87
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diabetes; or 1
(ii) Greater than forty kilograms per meter squared 2
(40 kg/m2). 3
(d)(1) Each state and public school employee's health benefit plan 4
under the program that is offered, issued, or renewed on or after January 1, 5
2023, shall offer coverage for the diagnosis and treatment of morbid obesity. 6
(2) The coverage for th e diagnosis and treatment of morbid 7
obesity offered under subdivision (d)(1) of this section shall include 8
without limitation coverage for bariatric surgery, including: 9
(A) Gastric bypass surgery; 10
(B) Adjustable gastric banding surgery; 11
(C) Sleeve gastrectomy surgery; and 12
(D) Duodenal switch biliopancreatic diversion. 13
(3)(A) Priority on coverage for the diagnosis and treatment of 14
morbid obesity offered under subdivision (d)(1) of this section shall be for 15
participants who have at least one (1) diagnosis that bariatric surgery has 16
been recognized by medical science to reduce healthcare costs. 17
(B) The diagnosis described in subdivision (d)(3)(A) of 18
this section shall include without limitation: 19
(i) Cardiovascular disease; 20
(ii) Coronary artery disease; 21
(iii) Diabetes mellitus; 22
(iv) Evidence of fatty liver disease, including 23
without limitation nonalcoholic fatty liver disease or nonalcoholic 24
steatohepatitis; 25
(v) Gastroesophageal reflux disease refractory to 26
medical therapy; 27
(vi) Hyperlipidemia; 28
(vii) Lower extremity lymphatic or venous 29
obstruction; 30
(viii) Mechanical arthropathy in a weight -bearing 31
joint or symptomatic degenerative joint disease in a weight -bearing joint; 32
(ix) Obstructive sleep apnea; 33
(x)(a) Poorly controlled hypertension. 34
(b) As used in subdivision (d)(3)(B)(x)(a) of 35
this section, "poorly controlled hypertension" means a systolic blood 36 SB87
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pressure of at least one hundred forty millimeters of mercury (140 mmHg) or a 1
diastolic blood pressure of ninety millimeters of mercury (90 mmHg) or 2
greater, despite medical management; or 3
(xi) Pulmonary hypertension. 4
(C)(i) Any additional clinical recommendations for adding 5
or removing diagnoses under subdivision (d)(3)(B) o f this section as being 6
recognized by medical science to reduce healthcare costs and that are 7
determined by the Director of the Employee Benefits Division in consultation 8
with the University of Arkansas for Medical Sciences and consistent with 9
guidelines or recommendations issued by the American Society for Metabolic 10
and Bariatric Surgery shall result in the diagnoses' being added or removed. 11
(ii) Additional guidelines or recommendations that 12
may be considered under subdivision (d)(3)(C)(i) of this sec tion include 13
without limitation those issued by: 14
(a) The American Diabetes Association; 15
(b) The American Association of Clinical 16
Endocrinology; and 17
(c) The American Gastroenterological 18
Association. 19
(e) The coverage for morbid obesity di agnosis and treatment offered 20
under this section does not diminish or limit benefits otherwise allowable 21
under the Arkansas State Employees Health Benefit Plan and the Arkansas 22
Public School Employees Health Benefit Plan. 23
(f) To ensure the financial soun dness and overall well -being of the 24
program, the State Board of Finance, subject to approval of the Legislative 25
Council, may: 26
(1) Discontinue or suspend a plan option offered under 27
subsection (d) of this section; 28
(2) Promulgate a rule to establish an annual expenditure limit 29
on a plan option offered under subsection (d) of this section; or 30
(3) Promulgate rules to implement this section. 31
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SECTION 2. EMERGENCY CLAUSE. It is found and determined by the 33
General Assembly of the State of Arkansas that the State and Public School 34
Life and Health Insurance Program is inadequate to provide sustainable 35
affordable health benefits for public school employees an d state employees; 36 SB87
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that an urgent need exists to address the state's funding and administration 1
of benefits for public school employees and state employees in order for the 2
program to remain viable and to avoid severe financial hardship to plan 3
participants; and that this act is immediately necessary to provide 4
affordable health benefit options in a timely manner to the state's public 5
school employees participating in the program and state employees 6
participating in the program. Therefore, an emergency is declared to exist, 7
and this act being immediately necessary for the preservation of the public 8
peace, health, and safety shall become effective on: 9
(1) The date of its approval by the Governor; 10
(2) If the bill is neither approved nor vetoed by the Governor, 11
the expiration of the period of time during which the Governor may veto the 12
bill; or 13
(3) If the bill is vetoed by the Governor and the veto is 14
overridden, the date the last house overrides the veto. 15
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APPROVED: 3/1/22 18
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