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Arkansas Senate Bill SR8

Arkansas 2022 Regular Session

Arkansas Senate Bill SR8 Compare Versions

Only one version of the bill is available at this time.
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44 State of Arkansas 1
55 93rd General Assembly 2
66 Fiscal Session, 2022 SR 8 3
77 4
88 By: Senators Rice, Hickey, Irvin, Beckham, L. Chesterfield, J. Dismang, Elliott, J. English, Flippo, 5
99 Gilmore, Hill, K. Ingram, G. Leding, B. Sample 6
1010 7
1111 SENATE RESOLUTION 8
1212 TO AUTHORIZE THE INT RODUCTION OF A NONAP PROPRIATION 9
1313 BILL TO ESTABLISH CO VERAGE FOR THE DIAGN OSIS AND 10
1414 TREATMENT OF MORBID OBESITY UNDER THE STATE AND 11
1515 PUBLIC SCHOOL LIFE A ND HEALTH INSURANCE PROGRAM. 12
1616 13
1717 14
1818 Subtitle 15
1919 TO AUTHORIZE THE INTRODUCTION OF A 16
2020 NONAPPROPRIATION BILL TO ESTABLISH 17
2121 COVERAGE FOR THE DIAGNOSIS AND TREATMENT 18
2222 OF MORBID OBESITY UNDER THE STATE AND 19
2323 PUBLIC SCHOOL LIFE AND HEALTH INSUR ANCE 20
2424 PROGRAM. 21
2525 22
2626 23
2727 BE IT RESOLVED BY THE SENATE OF THE NINETY -THIRD GENERAL ASSEMBLY OF THE 24
2828 STATE OF ARKANSAS: 25
2929 26
3030 THAT Senator Rice or Senator Irvin is authorized to introduce a bill 27
3131 which as introduced will read substantially as follows: 28
3232 29
3333 "Title 30
3434 AN ACT TO ESTABLISH COVERAGE FOR THE DIAGNOSIS AND TREATMENT OF MORBID 31
3535 OBESITY UNDER THE STATE AND PUBLIC SCHOOL LIFE AND HEALTH INSURANCE PROGRAM; 32
3636 TO DECLARE AN EMERGENCY; AND FOR OTHER PURPOSES. 33
3737 34
3838 Subtitle 35
3939 TO ESTABLISH COVERAGE FOR THE DIAGNOSIS AND TRE ATMENT OF MORBID OBESITY UNDER 36 SR8
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4444 THE STATE AND PUBLIC SCHOOL LIFE AND HEALTH INSURANCE PROGRAM; AND TO DECLARE 1
4545 AN EMERGENCY. 2
4646 3
4747 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF ARKANSAS: 4
4848 5
4949 SECTION 1. Arkansas Code Title 21, Chapter 5, Subchapter 4, i s amended 6
5050 to add an additional section to read as follows: 7
5151 21-5-419. Coverage for diagnosis and treatment of morbid obesity —8
5252 Legislative findings and intent — Definitions — Rules. 9
5353 (a) The General Assembly finds that: 10
5454 (1) Morbid obesity causes many m edical problems and costly 11
5555 health complications, such as diabetes, hypertension, heart disease, and 12
5656 stroke; 13
5757 (2) The cost of managing the complications of morbid obesity, 14
5858 largely due to inadequate treatment, far outweighs the cost of expeditious 15
5959 and effective medical treatment; 16
6060 (3) The recommended guidelines developed by the National 17
6161 Institutes of Health, the American Society for Metabolic and Bariatric 18
6262 Surgery, the American Obesity Association, and Shape Up America and embraced 19
6363 by the American Medical Association and the American College of Surgeons are 20
6464 that patients who are morbidly obese receive responsible and affordable 21
6565 medical treatment for their obesity; 22
6666 (4) The rate of bariatric surgery use has increased in the past 23
6767 decade to more than one hu ndred seventy thousand (170,000) surgical 24
6868 procedures per year in the United States; 25
6969 (5) Payers can rely on bariatric surgery paying for itself 26
7070 through decreased comorbidities within two (2) to four (4) years; 27
7171 (6) In 2019, the majority of members who had bariatric surgery 28
7272 under the State and Public School Life and Health Insurance Program had a 29
7373 total per-member per-month cost reduction of thirty -seven percent (37%), 30
7474 primarily due to a reduction of forty -five percent (45%) in medical per -31
7575 member per-month costs; 32
7676 (7) There is a clinical and financial benefit to reducing the 33
7777 burden of chronic disease through coverage; and 34
7878 (8) The diagnosis and treatment of morbid obesity should be a 35
7979 clinical decision made by a physician based on evidence -based guidelines. 36 SR8
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8484 (b) It is the intent of the General Assembly to provide coverage for 1
8585 the diagnosis and treatment of morbid obesity. 2
8686 (c) As used in this section: 3
8787 (1) "Body mass index" means body weight in kilograms divided by 4
8888 height in meters squared; and 5
8989 (2) "Morbid obesity": 6
9090 (A) Means a weight that is at least two (2) times the 7
9191 ideal weight for frame, age, height, and sex of an individual as determined 8
9292 by an examining physician; and 9
9393 (B) May be measured as a body mass index: 10
9494 (i) Equal to or grea ter than thirty-five kilograms 11
9595 per meter squared (35 kg/m2) with comorbidity or coexisting medical 12
9696 conditions such as hypertension, cardiopulmonary conditions, sleep apnea, or 13
9797 diabetes; or 14
9898 (ii) Greater than forty kilograms per meter squared 15
9999 (40 kg/m2). 16
100100 (d)(1) Each state and public school employee's health benefit plan 17
101101 under the program that is offered, issued, or renewed on or after January 1, 18
102102 2023, shall offer coverage for the diagnosis and treatment of morbid obesity. 19
103103 (2) The coverage for the di agnosis and treatment of morbid 20
104104 obesity offered under subdivision (d)(1) of this section shall include 21
105105 without limitation coverage for bariatric surgery, including: 22
106106 (A) Gastric bypass surgery; 23
107107 (B) Adjustable gastric banding surgery; 24
108108 (C) Sleeve gastrectomy surgery; and 25
109109 (D) Duodenal switch biliopancreatic diversion. 26
110110 (3)(A) Priority on coverage for the diagnosis and treatment of 27
111111 morbid obesity offered under subdivision (d)(1) of this section shall be for 28
112112 participants who have at least one (1 ) diagnosis that bariatric surgery has 29
113113 been recognized by medical science to reduce healthcare costs. 30
114114 (B) The diagnosis described in subdivision (d)(3)(A) of 31
115115 this section shall include without limitation: 32
116116 (i) Cardiovascular disease; 33
117117 (ii) Coronary artery disease; 34
118118 (iii) Diabetes mellitus; 35
119119 (iv) Evidence of fatty liver disease, including 36 SR8
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124124 without limitation nonalcoholic fatty liver disease or nonalcoholic 1
125125 steatohepatitis; 2
126126 (v) Gastroesophageal reflux disease refractory to 3
127127 medical therapy; 4
128128 (vi) Hyperlipidemia; 5
129129 (vii) Lower extremity lymphatic or venous 6
130130 obstruction; 7
131131 (viii) Mechanical arthropathy in a weight -bearing 8
132132 joint or symptomatic degenerative joint disease in a weight -bearing joint; 9
133133 (ix) Obstructive sleep apne a; 10
134134 (x)(a) Poorly controlled hypertension. 11
135135 (b) As used in subdivision (d)(3)(B)(x)(a) of 12
136136 this section, "poorly controlled hypertension" means a systolic blood 13
137137 pressure of at least one hundred forty millimeters of mercury (140 mmHg) or a 14
138138 diastolic blood pressure of ninety millimeters of mercury (90 mmHg) or 15
139139 greater, despite medical management; or 16
140140 (xi) Pulmonary hypertension. 17
141141 (C)(i) Any additional clinical recommendations for adding 18
142142 or removing diagnoses under subdivision (d)(3)(B) of this section as being 19
143143 recognized by medical science to reduce healthcare costs and that are 20
144144 determined by the Director of the Employee Benefits Division in consultation 21
145145 with the University of Arkansas for Medical Sciences and consistent with 22
146146 guidelines or recommendations issued by the American Society for Metabolic 23
147147 and Bariatric Surgery shall result in the diagnoses' being added or removed. 24
148148 (ii) Additional guidelines or recommendations that 25
149149 may be considered under subdivision (d)(3)(C)(i) of this section include 26
150150 without limitation those issued by: 27
151151 (a) The American Diabetes Association; 28
152152 (b) The American Association of Clinical 29
153153 Endocrinology; and 30
154154 (c) The American Gastroenterological 31
155155 Association. 32
156156 (e) The coverage for morbid obesity diagnos is and treatment offered 33
157157 under this section does not diminish or limit benefits otherwise allowable 34
158158 under the Arkansas State Employees Health Benefit Plan and the Arkansas 35
159159 Public School Employees Health Benefit Plan. 36 SR8
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164164 (f) To ensure the financial soundness and overall well-being of the 1
165165 program, the State Board of Finance, subject to approval of the Legislative 2
166166 Council, may: 3
167167 (1) Discontinue or suspend a plan option offered under 4
168168 subsection (d) of this section; 5
169169 (2) Promulgate a rule to establish an annu al expenditure limit 6
170170 on a plan option offered under subsection (d) of this section; or 7
171171 (3) Promulgate rules to implement this section. 8
172172 9
173173 SECTION 2. EMERGENCY CLAUSE. It is found and determined by the 10
174174 General Assembly of the State of Arkansas that the State and Public School 11
175175 Life and Health Insurance Program is inadequate to provide sustainable 12
176176 affordable health benefits for public school employees and state employees; 13
177177 that an urgent need exists to address the state's funding and administration 14
178178 of benefits for public school employees and state employees in order for the 15
179179 program to remain viable and to avoid severe financial hardship to plan 16
180180 participants; and that this act is immediately necessary to provide 17
181181 affordable health benefit options in a timely m anner to the state's public 18
182182 school employees participating in the program and state employees 19
183183 participating in the program. Therefore, an emergency is declared to exist, 20
184184 and this act being immediately necessary for the preservation of the public 21
185185 peace, health, and safety shall become effective on: 22
186186 (1) The date of its approval by the Governor; 23
187187 (2) If the bill is neither approved nor vetoed by the Governor, 24
188188 the expiration of the period of time during which the Governor may veto the 25
189189 bill; or 26
190190 (3) If the bill is vetoed by the Governor and the veto is 27
191191 overridden, the date the last house overrides the veto. " 28
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