Stricken language would be deleted from and underlined language would be added to present law.
*ANS181* 03-30-2023 10:44:33 ANS181
State of Arkansas As Engrossed: H3/30/23 1
94th General Assembly A Bill 2
Regular Session, 2023 HOUSE BILL 1312 3
4
By: Representatives Perry, Painter 5
By: Senator J. Boyd 6
7
For An Act To Be Entitled 8
AN ACT TO ESTABLISH THE TRANSPORTATION B ENEFIT 9
MANAGER ACT; TO REGU LATE CONTRACTS OF CE RTAIN 10
AMBULANCE SERVICE PR OVIDERS; TO REGULATE CLAIMS AND 11
PRIOR AUTHORIZATION PROCEDURES FOR CERTA IN AMBULANCE 12
SERVICES; AND FOR OT HER PURPOSES. 13
14
15
Subtitle 16
TO ESTABLISH THE TRANSPORTATION BENEFIT 17
MANAGER ACT; TO REGULATE CONTRACTS OF 18
CERTAIN AMBULANCE SERVICE PROVIDERS; AND 19
TO REGULATE CLAIMS AND PRIOR 20
AUTHORIZATION PROCEDURES FOR CERTAIN 21
AMBULANCE SERVICES. 22
23
24
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF ARKANSAS: 25
26
SECTION 1. Arkansas Code Title 23, Chapter 99, is amended to add an 27
additional subchapter to read as follows: 28
Subchapter 16 — Transportation Benefit Manager Act 29
30
23-99-1601. Title. 31
This subchapter shall be known and may be cited as the "T ransportation 32
Benefit Manager Act". 33
34
23-99-1602. Definitions. 35
As used in this subchapter: 36 As Engrossed: H3/30/23 HB1312
2 03-30-2023 10:44:33 ANS181
(1) "Air ambulance" means an aircraft, fixed or rotary wing, 1
utilized for on-scene responses or transports licensed by the Department of 2
Health; 3
(2) "Air ambulance services" means those services authorized and 4
licensed by the department to provide care and air transportation by air 5
ambulance of subscribers; 6
(3)(A) "Ambulance" means a vehicle used for transporting any 7
person by stretcher or gurney upon the streets or highways of Arkansas, 8
excluding vehicles intended solely for personal use by immediate family 9
members. 10
(B) "Ambulance" does not include nonemergency 11
transportation vehicles that may accommodate an individual in an upright 12
position or Fowler's position while in a wheelchair without the aid of 13
emergency medical services personnel; 14
(4) "Ambulance service provider" means an entity that provides 15
transportation and emergency medical services to a patient; 16
(5) "Ambulance services" means services authorized and licensed 17
by the department to provide care and transportation of patients upon the 18
streets and highways of Arkansas; 19
(6) "Contracting entity" means: 20
(A) A healthcare insurer or a subcontractor, affiliate, or 21
other entity that contracts directly or indirectly with an ambulance service 22
provider for the delivery of ambulance services to subscribers; or 23
(B) A transportation benefit manager or a subcontractor, 24
affiliate, or other entity that contracts directly or indirectly with an 25
ambulance service provider for the delivery of ambulance services to 26
subscribers; 27
(7) "Emergency medical services" means: 28
(A) The transportation and medical care provided to the 29
ill or injured before arrival at a medical facility by licensed emergency 30
medical services personnel or other healthcare provider; 31
(B) Continuation of the initial emergency care within a 32
medical facility subject to the approval of the medical staff and governing 33
board of that medical facility; and 34
(C) Integrated medical care in emergency and nonurgent 35
settings with the oversight of a physician; 36 As Engrossed: H3/30/23 HB1312
3 03-30-2023 10:44:33 ANS181
(8)(A) "Emergency medical services personnel" means individuals 1
licensed by the department at any level established by the rules adopted by 2
the State Board of Health under the Emergency Medical Services Act, § 20-13-3
201 et seq., and authorized to perform the services stated in the rules. 4
(B) "Emergency medical services personnel" includes 5
without limitation: 6
(i) Emergency medical technicians; 7
(ii) Advanced emergency medical technicians; 8
(iii) Paramedics; 9
(iv) Emergency medical services instructors; and 10
(v) Emergency medical services instructor trainers; 11
(9)(A) "Health benefit plan" means a plan, policy, contract, 12
certificate, agreement, or other evidence of coverage for healthcare services 13
offered, issued, renewed, or extended in this state by a healthcare insurer, 14
including emergency medical services. 15
(B) "Health benefit plan" includes nonfederal governmental 16
plans as defined in 29 U.S.C. § 1002(32), as it existed on January 1, 2023. 17
(C) "Health benefit plan" does not include: 18
(i) A disability income plan; 19
(ii) A credit insurance plan; 20
(iii) Insurance coverage issued as a supplement to 21
liability insurance; 22
(iv) A medical payment under automobile or 23
homeowners insurance plans; 24
(v) A health benefit plan provided under Arkansas 25
Constitution, Article 5, § 32, the Workers' Compensation Law, § 11-9-101 et 26
seq., or the Public Employee Workers' Compensation Act, § 21-5-601 et seq.; 27
(vi) A plan that provides only indemnity for 28
hospital confinement; 29
(vii) An accident-only plan; 30
(viii) A specified disease plan; 31
(ix) A long-term-care-only plan; 32
(x) A dental-only plan; 33
(xi) A vision-only plan; 34
(xii) Medicaid; or 35
(xiii) Any state or local governmental employee 36 As Engrossed: H3/30/23 HB1312
4 03-30-2023 10:44:33 ANS181
plan; 1
(10)(A) "Healthcare insurer" means an entity that is subject to 2
state insurance regulation and provides coverage for health benefits in this 3
state. 4
(B) "Healthcare insurer" includes: 5
(i) An insurance company; 6
(ii) A health maintenance organization; 7
(iii) A hospital and medical service corporation; 8
(iv) A risk-based provider organization; and 9
(v) A sponsor of a nonfederal self-funded 10
governmental plan. 11
(C) "Healthcare insurer" does not include: 12
(i) Medicaid; or 13
(ii) Any entity that administers any state or local 14
governmental employee plan; 15
(11) "Medicaid" means the state and federal medical assistance 16
program established by Title XIX of the Social Security Act, 42 U.S.C. § 1396 17
et seq.; 18
(12) "Medical facility" means a hospital, medical clinic, 19
physician's office, nursing home, or other healthcare facility; 20
(13)(A) "Prior authorization" means the process by which a 21
transportation benefit manager determines the medical necessity of otherwise 22
covered ambulance services before ambulance services are rendered, including 23
without limitation preadmission review, pretreatment review, utilization 24
review, case management, and fail first protocol. 25
(B) "Prior authorization" may include the requirement that 26
a subscriber, healthcare provider, or ambulance service provider notify the 27
health insurer or transportation benefit manager of the subscriber's intent 28
to receive ambulance services before ambulance services are provided; 29
(14)(A) "Subscriber" means an individual eligible to receive 30
coverage of ambulance services by a healthcare insurer under a health benefit 31
plan. 32
(B) "Subscriber" includes a subscriber's legally 33
authorized representative; and 34
(15)(A) "Transportation benefit manager" means an individual or 35
entity that assumes responsibility for all administrative tasks associated 36 As Engrossed: H3/30/23 HB1312
5 03-30-2023 10:44:33 ANS181
with the ambulance services offered by a healthcare insurer, including 1
without limitation utilization management, determination of appropriate mode 2
of transport, direction of missions, and invoice processing, and performs 3
prior authorization for at least one (1) of the following: 4
(i) A healthcare insurer; 5
(ii) A preferred provider organization or health 6
maintenance organization; or 7
(iii) Any other individual or entity that provides, 8
offers to provide, or administers hospital, outpatient, medical, or other 9
health benefits to a person treated by a healthcare provider in this state 10
under a policy, health benefit plan, or contract. 11
(B) A healthcare insurer is a transportation benefit 12
manager if the healthcare insurer performs prior authorization. 13
(C) "Transportation benefit manager" does not include an 14
insurer of automobile, homeowners, or casualty and commercial liability 15
insurance or the insurer's employees, agents, or contractors. 16
17
23-99-1603. Contracts. 18
(a) An ambulance service provider may contract directly or indirectly 19
with a contracting entity as a network provider of ambulance services. 20
(b) An ambulance service provider shall not be required to participate 21
as an in-network provider of a transportation benefit manager. 22
23
22-99-1604. Prior authorization. 24
(a) A contracting entity shall not require prior authorization for: 25
(1) Ground or air prehospital transportation; or 26
(2) Ground or air emergent or urgent ambulance transportation 27
from one (1) hospital or medical facility to another hospital or medical 28
facility in order to obtain medically needed diagnostic or medical 29
therapeutic services. 30
(b) A contracting entity may require a prior authorization for non-31
urgent and nonemergent ground or air ambulance services by an air ambulance. 32
(c) A decision on a request for prior authorization by a 33
transportation benefit manager shall include a determination as to whether or 34
not the individual is covered by a health benefit plan and eligible to 35
receive the requested ambulance services under the health benefit plan as a 36 As Engrossed: H3/30/23 HB1312
6 03-30-2023 10:44:33 ANS181
subscriber. 1
(d) A transportation benefit manager shall not rescind, limit, 2
condition, or restrict a prior authorization based upon medical necessity. 3
(e) A transportation benefit manager shall provide ambulance service 4
providers with a direct contact number, that is answered twenty-four (24) 5
hours a day, seven (7) days a week, in which to obtain prior authorization 6
for ambulance services. 7
(f)(1) Determination of prior authorization for ambulance services 8
between medical facilities shall be provided or declined within twenty (20) 9
minutes of the ambulance service provider's or medical facility's placing a 10
request for determination. 11
(2) If not denied within twenty (20) minutes, the ambulance 12
services shall be deemed automatically approved. 13
(g) If a medical facility is required to obtain a prior authorization 14
on behalf of the ambulance service provider, the transportation benefit 15
manager shall advise the ambulance service provider of the requirement before 16
ambulance transport. 17
18
23-99-1605. Claims. 19
(a) A contracting entity shall pay a claim for ambulance services for 20
which prior authorization was received regardless of the terminology used by 21
the transportation benefit manager or health benefit plan within thirty (30) 22
days of receipt of the claim from an ambulance service provider, unless: 23
(1) Authorized ambulance services were never performed; or 24
(2) There is specific information available for review by the 25
appropriate state or federal agency that the subscriber or ambulance service 26
provider has engaged in material misrepresentation, fraud, or abuse regarding 27
the claim for the authorized ambulance services. 28
(b) A healthcare insurer or transportation benefit manager shall pay a 29
claim for ambulance services to an a mbulance service provider: 30
(1) At the rates approved or contracted between an ambulance 31
service provider and a local government entity under § 14-266-105; or 32
(2) In the absence of rates under subdivision (b)(1) of this 33
section, the rates established by the Workers' Compensation Commission under 34
the commission's medical fee schedule for ambulance services. 35
(c) Ambulance services authorized or guaranteed for payment under this 36 As Engrossed: H3/30/23 HB1312
7 03-30-2023 10:44:33 ANS181
section for which the prior authorization is not rescinded or reversed unde r 1
subsection (a) of this section are not subject to audit recoupment. 2
3
23-99-1606. Enforcement — Rules. 4
(a) A contracting entity is subject to the Trade Practices Act, § 23 -5
66-201 et seq. 6
(b) The expenses of implementing this subchapter shall not be used as 7
justification to increase premiums or decrease payments to any ambulance 8
service provider or medical facility. 9
(c) The Insurance Commissioner may promulgate rules necessary to 10
implement and enforce this subchapter. 11
12
/s/Perry 13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36