Arkansas 2023 Regular Session

Arkansas House Bill HB1312 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1	1		Stricken language would be deleted from and underlined language would be added to present law.
2		-	Act 578 of the Regular Session
3	2		ANS181 04-04-2023 10:45:26 ANS181
4	3
5	4		State of Arkansas As Engrossed: H3/30/23 H4/4/23 1
6	5		94th General Assembly A Bill 2
7	6		Regular Session, 2023 HOUSE BILL 1312 3
8	7		4
9	8		By: Representatives Perry, Painter 5
10	9		By: Senator J. Boyd 6
11	10		7
12	11		For An Act To Be Entitled 8
13	12		AN ACT TO ESTABLISH THE TRANSPORTATION B ENEFIT 9
14	13		MANAGER ACT; TO REGU LATE CONTRACTS OF CE RTAIN 10
15	14		AMBULANCE PROVIDERS; TO REGULATE CLAIMS A ND PRIOR 11
16	15		AUTHORIZATION PROCED URES FOR CERTAIN AMB ULANCE 12
17	16		SERVICES; AND FOR OT HER PURPOSES. 13
18	17		14
19	18		15
20	19		Subtitle 16
21	20		TO ESTABLISH THE TRANSPORTATION BENEFIT 17
22	21		MANAGER ACT; TO REGULATE CONTRACTS OF 18
23	22		CERTAIN AMBULANCE PROVIDERS; AND TO 19
24	23		REGULATE CLAIMS AND PRIOR AUTHORIZATION 20
25	24		PROCEDURES FOR CERTAIN AMBULANCE 21
26	25		SERVICES. 22
27	26		23
28	27		24
29	28		BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF ARKANSAS: 25
30	29		26
31	30		SECTION 1. Arkansas Code Title 23, Chapter 99, is amended to add an 27
32	31		additional subchapter to read as follows: 28
33	32		Subchapter 16 — Transportation Benefit Manager Act 29
34	33		30
35	34		23-99-1601. Title. 31
36	35		This subchapter shall be known and may be cited as the "Transportation 32
37	36		Benefit Manager Act". 33
38	37		34
39	38		23-99-1602. Definitions. 35
40	39		As used in this subchapter: 36 As Engrossed: H3/30/23 H4/4/23 HB1312
41	40
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45	44		(1) "Air ambulance" means an aircraft, fixed or rotary wing, 1
46	45		utilized for on-scene responses or transports licensed by the Department of 2
47	46		Health; 3
48	47		(2) "Air ambulance services" means those services authorized and 4
49	48		licensed by the department to provide care and air transportation by air 5
50	49		ambulance of subscribers; 6
51	50		(3)(A) "Ambulance" means a vehicle used for transporting any 7
52	51		person by stretcher or gurney upon the streets or highways of Arkansas, 8
53	52		excluding vehicles intended solely for personal use by immediate family 9
54	53		members. 10
55	54		(B) "Ambulance" does not include nonemergency 11
56	55		transportation vehicles that may accommodate an individual in an upright 12
57	56		position or Fowler's position while in a wheelchair without the aid of 13
58	57		emergency medical services personnel; 14
59	58		(4) "Ambulance provider" means an entity that provides 15
60	59		transportation and emergency medical services to a patient; 16
61	60		(5) "Ambulance services" means services authorized and licensed 17
62	61		by the department to provide care and transportation of patients upon the 18
63	62		streets and highways of Arkansas; 19
64	63		(6) "Contracting entity" means: 20
65	64		(A) A healthcare insurer or a subcontractor, affiliate, or 21
66	65		other entity that contracts directly or indirectly with an ambulance provider 22
67	66		for the delivery of ambulance services to subscribers; or 23
68	67		(B) A transportation benefit manager or a subcontractor, 24
69	68		affiliate, or other entity that contracts directly or indirectly with an 25
70	69		ambulance provider for the delivery of ambulance services to subscribers; 26
71	70		(7) "Emergency medical services" means: 27
72	71		(A) The transportation and medical care provided to the 28
73	72		ill or injured before arrival at a medical facility by licensed emergency 29
74	73		medical services personnel or other healthcare provider; 30
75	74		(B) Continuation of the initial emergency care within a 31
76	75		medical facility subject to the approval of the medical staff and governing 32
77	76		board of that medical facility; and 33
78	77		(C) Integrated medical care in emergency and nonurgent 34
79	78		settings with the oversight of a physician; 35
80	79		(8)(A) "Emergency medical services personnel" means individuals 36 As Engrossed: H3/30/23 H4/4/23 HB1312
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84	83
85	84		licensed by the department at any level established by the rules adopted by 1
86	85		the State Board of Health under the Emergency Medical Services Act, § 20-13-2
87	86		201 et seq., and authorized to perform the services stated in the rules. 3
88	87		(B) "Emergency medical services personnel" includes 4
89	88		without limitation: 5
90	89		(i) Emergency medical technicians; 6
91	90		(ii) Advanced emergency medical technicians; 7
92	91		(iii) Paramedics; 8
93	92		(iv) Emergency medical services instructors; and 9
94	93		(v) Emergency medical services instructor trainers; 10
95	94		(9)(A) "Health benefit plan" means a plan, policy, contract, 11
96	95		certificate, agreement, or other evidence of coverage for healthcare services 12
97	96		offered, issued, renewed, or extended in this state by a healthcare insurer, 13
98	97		including emergency medical services. 14
99	98		(B) "Health benefit plan" includes nonfederal governmental 15
100	99		plans as defined in 29 U.S.C. § 1002(32), as it existed on January 1, 2023. 16
101	100		(C) "Health benefit plan" does not include: 17
102	101		(i) A disability income plan; 18
103	102		(ii) A credit insurance plan; 19
104	103		(iii) Insurance coverage issued as a supplement to 20
105	104		liability insurance; 21
106	105		(iv) A medical payment under automobile or 22
107	106		homeowners insurance plans; 23
108	107		(v) A health benefit plan provided under Arkansas 24
109	108		Constitution, Article 5, § 32, the Workers' Compensation Law, § 11-9-101 et 25
110	109		seq., or the Public Employee Workers' Compensation Act, § 21-5-601 et seq.; 26
111	110		(vi) A plan that provides only indemnity for 27
112	111		hospital confinement; 28
113	112		(vii) An accident-only plan; 29
114	113		(viii) A specified disease plan; 30
115	114		(ix) A long-term-care-only plan; 31
116	115		(x) A dental-only plan; 32
117	116		(xi) A vision-only plan; 33
118	117		(xii) Medicaid; or 34
119	118		(xiii) Any state or local governmental employee 35
120	119		plan; 36 As Engrossed: H3/30/23 H4/4/23 HB1312
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125	124		(10)(A) "Healthcare insurer" means an entity that is subject to 1
126	125		state insurance regulation and provides coverage for health benefits in this 2
127	126		state. 3
128	127		(B) "Healthcare insurer" includes: 4
129	128		(i) An insurance company; 5
130	129		(ii) A health maintenance organization; 6
131	130		(iii) A hospital and medical service corporation; 7
132	131		(iv) A risk-based provider organization; and 8
133	132		(v) A sponsor of a nonfederal self-funded 9
134	133		governmental plan. 10
135	134		(C) "Healthcare insurer" does not include: 11
136	135		(i) Medicaid; or 12
137	136		(ii) Any entity that administers any state or local 13
138	137		governmental employee plan; 14
139	138		(11) "Medicaid" means the state and federal medical assistance 15
140	139		program established by Title XIX of the Social Security Act, 42 U.S.C. § 1396 16
141	140		et seq.; 17
142	141		(12) "Medical facility" means a hospital, medical clinic, 18
143	142		physician's office, nursing home, or other healthcare facility; 19
144	143		(13)(A) "Prior authorization" means the process by which a 20
145	144		transportation benefit manager determines the medical necessity of otherwise 21
146	145		covered ambulance services before ambulance services are rendered, including 22
147	146		without limitation preadmission review, pretreatment review, utilization 23
148	147		review, case management, and fail first protocol. 24
149	148		(B) "Prior authorization" may include the requirement that 25
150	149		a subscriber, healthcare provider, or ambulance provider notify the health 26
151	150		insurer or transportation benefit manager of the subscriber's intent to 27
152	151		receive ambulance services before ambulance services are provided; 28
153	152		(14)(A) "Subscriber" means an individual eligible to receive 29
154	153		coverage of ambulance services by a healthcare insurer under a health benefit 30
155	154		plan. 31
156	155		(B) "Subscriber" includes a subscriber's legally 32
157	156		authorized representative; and 33
158	157		(15)(A) "Transportation benefit manager" means an individual or 34
159	158		entity that assumes responsibility for all administrative tasks associated 35
160	159		with the ambulance services offered by a healthcare insurer, including 36 As Engrossed: H3/30/23 H4/4/23 HB1312
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165	164		without limitation utilization management, determination of appropriate mode 1
166	165		of transport, direction of missions, and invoice processing, and performs 2
167	166		prior authorization for at least one (1) of the following: 3
168	167		(i) A healthcare insurer; 4
169	168		(ii) A preferred provider organization or health 5
170	169		maintenance organization; or 6
171	170		(iii) Any other individual or entity that provides, 7
172	171		offers to provide, or administers hospital, outpatient, medical, or other 8
173	172		health benefits to a person treated by a healthcare provider in this state 9
174	173		under a policy, health benefit plan, or contract. 10
175	174		(B) A healthcare insurer is a transportation benefit 11
176	175		manager if the healthcare insurer performs prior authorization. 12
177	176		(C) "Transportation benefit manager" does not include an 13
178	177		insurer of automobile, homeowners, or casualty and commercial liability 14
179	178		insurance or the insurer's employees, agents, or contractors. 15
180	179		16
181	180		23-99-1603. Contracts. 17
182	181		(a) An ambulance provider may contract directly or indirectly with a 18
183	182		contracting entity as a network provider of ambulance services. 19
184	183		(b) An ambulance provider shall not be required to participate as an 20
185	184		in-network provider of a transportation benefit manager. 21
186	185		22
187	186		22-99-1604. Prior authorization. 23
188	187		(a) A contracting entity shall not require prior authorization for: 24
189	188		(1) Ground or air prehospital transportation; or 25
190	189		(2) Ground or air emergent or urgent ambulance transportation 26
191	190		from one (1) hospital or medical facility to another hospital or medical 27
192	191		facility in order to obtain medically needed diagnostic or medical 28
193	192		therapeutic services. 29
194	193		(b) A contracting entity may require a prior authorization for non-30
195	194		urgent and nonemergent ground or air ambulance services by an air ambulance. 31
196	195		(c) A decision on a request for prior authorization by a 32
197	196		transportation benefit manager shall include a determination as to whether or 33
198	197		not the individual is covered by a health benefit plan and eligible to 34
199	198		receive the requested ambulance services under the health benefit plan as a 35
200	199		subscriber. 36 As Engrossed: H3/30/23 H4/4/23 HB1312
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205	204		(d) A transportation benefit manager shall not rescind, limit, 1
206	205		condition, or restrict a prior authorization based upon medical necessity. 2
207	206		(e) A transportation benefit manager shall provide ambulance providers 3
208	207		with a direct contact number, that is answered twenty-four (24) hours a day, 4
209	208		seven (7) days a week, in which to obtain prior authorization for ambulance 5
210	209		services. 6
211	210		(f)(1) Determination of prior authorization for ambulance services 7
212	211		between medical facilities shall be provided or declined within twenty (20) 8
213	212		minutes of the ambulance provider's or medical facility's placing a request 9
214	213		for determination. 10
215	214		(2) If not denied within twenty (20) minutes, the ambulance 11
216	215		services shall be deemed automatically approved. 12
217	216		(g) If a medical facility is required to obtain a prior authorization 13
218	217		on behalf of the ambulance provider, the transportation benefit manager shall 14
219	218		advise the ambulance provider of the requirement before ambulance transport. 15
220	219		16
221	220		23-99-1605. Claims. 17
222	221		(a) A contracting entity shall pay a claim for ambulance services for 18
223	222		which prior authorization was received regardless of the terminology used by 19
224	223		the transportation benefit manager or health benefit plan within thirty (30) 20
225	224		days of receipt of the claim from an ambulance provider, unless: 21
226	225		(1) Authorized ambulance services were never performed; or 22
227	226		(2) There is specific information available for review by the 23
228	227		appropriate state or federal agency that the subscriber or ambulance provider 24
229	228		has engaged in material misrepresentation, fraud, or abuse regarding the 25
230	229		claim for the authorized ambulance services. 26
231	230		(b)(1) A healthcare insurer or transportation benefit manager shall 27
232	231		pay two hundred fifty percent (250%) of the Medicare Ambulance Fee Schedule, 28
233	232		Rural Rate for a claim for ambulance services to an ambulance provider. 29
234	233		(2) An ambulance provider shall accept the payment under 30
235	234		subdivision (b)(1) of this section as payment in full for services provided 31
236	235		to the subscriber. 32
237	236		(3) An ambulance provider shall not balance bill or otherwise 33
238	237		demand a payment from the subscriber othe r than a deductible, copayment, or 34
239	238		coinsurance required under the subscriber's health benefit plan. 35
240	239		(c) Ambulance services authorized or guaranteed for payment under this 36 As Engrossed: H3/30/23 H4/4/23 HB1312
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245	244		section for which the prior authorization is not rescinded or reversed under 1
246	245		subsection (a) of this section are not subject to audit recoupment. 2
247	246		(d) A claim submitted by an ambulance provider shall include any 3
248	247		information as required by the Insurance Commissioner. 4
249	248		5
250	249		23-99-1606. Enforcement — Rules. 6
251	250		(a) A contracting entity is subject to the Trade Practices Act, § 23 -7
252	251		66-201 et seq. 8
253	252		(b) The expenses of implementing this subchapter shall not be used as 9
254	253		justification to increase premiums or decrease payments to any ambulance 10
255	254		provider or medical facility. 11
256	255		(c) The Insurance Commi ssioner may promulgate rules necessary to 12
257	256		implement and enforce this subchapter. 13
258	257		14
259	258		/s/Perry 15
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262		-	~~APPROVED: 4/11/23~~ 18
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