Stricken language would be deleted from and underlined language would be added to present law.
Act 578 of the Regular Session
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State of Arkansas As Engrossed: H3/30/23 H4/4/23 1
94th General Assembly A Bill 2
Regular Session, 2023 HOUSE BILL 1312 3
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By: Representatives Perry, Painter 5
By: Senator J. Boyd 6
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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 PROVIDERS; TO REGULATE CLAIMS A ND PRIOR 11
AUTHORIZATION PROCED URES FOR CERTAIN AMB ULANCE 12
SERVICES; AND FOR OT HER PURPOSES. 13
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Subtitle 16
TO ESTABLISH THE TRANSPORTATION BENEFIT 17
MANAGER ACT; TO REGULATE CONTRACTS OF 18
CERTAIN AMBULANCE PROVIDERS; AND TO 19
REGULATE CLAIMS AND PRIOR AUTHORIZATION 20
PROCEDURES FOR CERTAIN AMBULANCE 21
SERVICES. 22
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BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF ARKANSAS: 25
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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
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23-99-1601. Title. 31
This subchapter shall be known and may be cited as the "Transportation 32
Benefit Manager Act". 33
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23-99-1602. Definitions. 35
As used in this subchapter: 36 As Engrossed: H3/30/23 H4/4/23 HB1312
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(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 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 provider 22
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 provider for the delivery of ambulance services to subscribers; 26
(7) "Emergency medical services" means: 27
(A) The transportation and medical care provided to the 28
ill or injured before arrival at a medical facility by licensed emergency 29
medical services personnel or other healthcare provider; 30
(B) Continuation of the initial emergency care within a 31
medical facility subject to the approval of the medical staff and governing 32
board of that medical facility; and 33
(C) Integrated medical care in emergency and nonurgent 34
settings with the oversight of a physician; 35
(8)(A) "Emergency medical services personnel" means individuals 36 As Engrossed: H3/30/23 H4/4/23 HB1312
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licensed by the department at any level established by the rules adopted by 1
the State Board of Health under the Emergency Medical Services Act, § 20-13-2
201 et seq., and authorized to perform the services stated in the rules. 3
(B) "Emergency medical services personnel" includes 4
without limitation: 5
(i) Emergency medical technicians; 6
(ii) Advanced emergency medical technicians; 7
(iii) Paramedics; 8
(iv) Emergency medical services instructors; and 9
(v) Emergency medical services instructor trainers; 10
(9)(A) "Health benefit plan" means a plan, policy, contract, 11
certificate, agreement, or other evidence of coverage for healthcare services 12
offered, issued, renewed, or extended in this state by a healthcare insurer, 13
including emergency medical services. 14
(B) "Health benefit plan" includes nonfederal governmental 15
plans as defined in 29 U.S.C. § 1002(32), as it existed on January 1, 2023. 16
(C) "Health benefit plan" does not include: 17
(i) A disability income plan; 18
(ii) A credit insurance plan; 19
(iii) Insurance coverage issued as a supplement to 20
liability insurance; 21
(iv) A medical payment under automobile or 22
homeowners insurance plans; 23
(v) A health benefit plan provided under Arkansas 24
Constitution, Article 5, § 32, the Workers' Compensation Law, § 11-9-101 et 25
seq., or the Public Employee Workers' Compensation Act, § 21-5-601 et seq.; 26
(vi) A plan that provides only indemnity for 27
hospital confinement; 28
(vii) An accident-only plan; 29
(viii) A specified disease plan; 30
(ix) A long-term-care-only plan; 31
(x) A dental-only plan; 32
(xi) A vision-only plan; 33
(xii) Medicaid; or 34
(xiii) Any state or local governmental employee 35
plan; 36 As Engrossed: H3/30/23 H4/4/23 HB1312
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(10)(A) "Healthcare insurer" means an entity that is subject to 1
state insurance regulation and provides coverage for health benefits in this 2
state. 3
(B) "Healthcare insurer" includes: 4
(i) An insurance company; 5
(ii) A health maintenance organization; 6
(iii) A hospital and medical service corporation; 7
(iv) A risk-based provider organization; and 8
(v) A sponsor of a nonfederal self-funded 9
governmental plan. 10
(C) "Healthcare insurer" does not include: 11
(i) Medicaid; or 12
(ii) Any entity that administers any state or local 13
governmental employee plan; 14
(11) "Medicaid" means the state and federal medical assistance 15
program established by Title XIX of the Social Security Act, 42 U.S.C. § 1396 16
et seq.; 17
(12) "Medical facility" means a hospital, medical clinic, 18
physician's office, nursing home, or other healthcare facility; 19
(13)(A) "Prior authorization" means the process by which a 20
transportation benefit manager determines the medical necessity of otherwise 21
covered ambulance services before ambulance services are rendered, including 22
without limitation preadmission review, pretreatment review, utilization 23
review, case management, and fail first protocol. 24
(B) "Prior authorization" may include the requirement that 25
a subscriber, healthcare provider, or ambulance provider notify the health 26
insurer or transportation benefit manager of the subscriber's intent to 27
receive ambulance services before ambulance services are provided; 28
(14)(A) "Subscriber" means an individual eligible to receive 29
coverage of ambulance services by a healthcare insurer under a health benefit 30
plan. 31
(B) "Subscriber" includes a subscriber's legally 32
authorized representative; and 33
(15)(A) "Transportation benefit manager" means an individual or 34
entity that assumes responsibility for all administrative tasks associated 35
with the ambulance services offered by a healthcare insurer, including 36 As Engrossed: H3/30/23 H4/4/23 HB1312
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without limitation utilization management, determination of appropriate mode 1
of transport, direction of missions, and invoice processing, and performs 2
prior authorization for at least one (1) of the following: 3
(i) A healthcare insurer; 4
(ii) A preferred provider organization or health 5
maintenance organization; or 6
(iii) Any other individual or entity that provides, 7
offers to provide, or administers hospital, outpatient, medical, or other 8
health benefits to a person treated by a healthcare provider in this state 9
under a policy, health benefit plan, or contract. 10
(B) A healthcare insurer is a transportation benefit 11
manager if the healthcare insurer performs prior authorization. 12
(C) "Transportation benefit manager" does not include an 13
insurer of automobile, homeowners, or casualty and commercial liability 14
insurance or the insurer's employees, agents, or contractors. 15
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23-99-1603. Contracts. 17
(a) An ambulance provider may contract directly or indirectly with a 18
contracting entity as a network provider of ambulance services. 19
(b) An ambulance provider shall not be required to participate as an 20
in-network provider of a transportation benefit manager. 21
22
22-99-1604. Prior authorization. 23
(a) A contracting entity shall not require prior authorization for: 24
(1) Ground or air prehospital transportation; or 25
(2) Ground or air emergent or urgent ambulance transportation 26
from one (1) hospital or medical facility to another hospital or medical 27
facility in order to obtain medically needed diagnostic or medical 28
therapeutic services. 29
(b) A contracting entity may require a prior authorization for non-30
urgent and nonemergent ground or air ambulance services by an air ambulance. 31
(c) A decision on a request for prior authorization by a 32
transportation benefit manager shall include a determination as to whether or 33
not the individual is covered by a health benefit plan and eligible to 34
receive the requested ambulance services under the health benefit plan as a 35
subscriber. 36 As Engrossed: H3/30/23 H4/4/23 HB1312
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(d) A transportation benefit manager shall not rescind, limit, 1
condition, or restrict a prior authorization based upon medical necessity. 2
(e) A transportation benefit manager shall provide ambulance providers 3
with a direct contact number, that is answered twenty-four (24) hours a day, 4
seven (7) days a week, in which to obtain prior authorization for ambulance 5
services. 6
(f)(1) Determination of prior authorization for ambulance services 7
between medical facilities shall be provided or declined within twenty (20) 8
minutes of the ambulance provider's or medical facility's placing a request 9
for determination. 10
(2) If not denied within twenty (20) minutes, the ambulance 11
services shall be deemed automatically approved. 12
(g) If a medical facility is required to obtain a prior authorization 13
on behalf of the ambulance provider, the transportation benefit manager shall 14
advise the ambulance provider of the requirement before ambulance transport. 15
16
23-99-1605. Claims. 17
(a) A contracting entity shall pay a claim for ambulance services for 18
which prior authorization was received regardless of the terminology used by 19
the transportation benefit manager or health benefit plan within thirty (30) 20
days of receipt of the claim from an ambulance provider, unless: 21
(1) Authorized ambulance services were never performed; or 22
(2) There is specific information available for review by the 23
appropriate state or federal agency that the subscriber or ambulance provider 24
has engaged in material misrepresentation, fraud, or abuse regarding the 25
claim for the authorized ambulance services. 26
(b)(1) A healthcare insurer or transportation benefit manager shall 27
pay two hundred fifty percent (250%) of the Medicare Ambulance Fee Schedule, 28
Rural Rate for a claim for ambulance services to an ambulance provider. 29
(2) An ambulance provider shall accept the payment under 30
subdivision (b)(1) of this section as payment in full for services provided 31
to the subscriber. 32
(3) An ambulance provider shall not balance bill or otherwise 33
demand a payment from the subscriber othe r than a deductible, copayment, or 34
coinsurance required under the subscriber's health benefit plan. 35
(c) Ambulance services authorized or guaranteed for payment under this 36 As Engrossed: H3/30/23 H4/4/23 HB1312
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section for which the prior authorization is not rescinded or reversed under 1
subsection (a) of this section are not subject to audit recoupment. 2
(d) A claim submitted by an ambulance provider shall include any 3
information as required by the Insurance Commissioner. 4
5
23-99-1606. Enforcement — Rules. 6
(a) A contracting entity is subject to the Trade Practices Act, § 23 -7
66-201 et seq. 8
(b) The expenses of implementing this subchapter shall not be used as 9
justification to increase premiums or decrease payments to any ambulance 10
provider or medical facility. 11
(c) The Insurance Commi ssioner may promulgate rules necessary to 12
implement and enforce this subchapter. 13
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/s/Perry 15
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APPROVED: 4/11/23 18
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