AR
Arkansas Senate Bill SB122

Arkansas 2023 Regular Session

Arkansas Senate Bill SB122 Compare Versions

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11 Stricken language would be deleted from and underlined language would be added to present law.
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2+*ANS114* 01-30-2023 10:40:54 ANS114
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4-State of Arkansas As Engrossed: S1/30/23 S2/15/23 1
4+State of Arkansas As Engrossed: S1/30/23 1
55 94th General Assembly A Bill 2
66 Regular Session, 2023 SENATE BILL 122 3
77 4
88 By: Senator B. King 5
99 6
1010 For An Act To Be Entitled 7
1111 AN ACT TO CREATE THE HEALTHCARE COST-SHARING 8
1212 COLLECTIONS ACT; AND FOR OTHER PURPOSES. 9
1313 10
1414 11
1515 Subtitle 12
1616 TO CREATE THE HEALTHCARE COST -SHARING 13
1717 COLLECTIONS ACT. 14
1818 15
1919 16
2020 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF ARKANSAS: 17
2121 18
2222 SECTION 1. Arkansas Code Title 23, Chapter 99, is amended to add an 19
2323 additional subchapter to read as follows: 20
2424 21
2525 Subchapter 16 — Healthcare Cost-Sharing Collections Act 22
2626 23
2727 23-99-1601. Title. 24
2828 This subchapter shall be known and may be cited as the "Healthcare 25
2929 Cost-Sharing Collections Act". 26
3030 27
3131 23-99-1602. Definitions. 28
3232 As used in this subchapter: 29
3333 (1)(A) "Cost sharing" means t he share of costs covered by a 30
3434 health benefit plan for which an enrollee is financial responsible. 31
3535 (B) "Cost sharing" includes deductibles, co insurance, 32
3636 copayments, or similar charges. 33
3737 (C) "Cost sharing" does not include premiums, balance 34
3838 billing amounts for nonnetwork providers, or the cost of noncovered 35
39-healthcare services; 36 As Engrossed: S1/30/23 S2/15/23 SB122
39+healthcare services; 36 As Engrossed: S1/30/23 SB122
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4343
4444 (2)(A) "Contracting entity" means a healthcare insurer, 1
4545 subcontractor, affiliate, or other entity that contracts directly or 2
4646 indirectly with a healthcare provider for the delivery of healthcare services 3
4747 to an enrollee. 4
4848 (B) "Contracting entity" includes without limitation: 5
4949 (i) An insurance company; 6
5050 (ii) A health maintenance organization; 7
5151 (iii) A hospital and medical service corporation; 8
5252 (iv) A preferred provider organization; 9
53- (v) A risk-based provider organization; and 10
54- (vi) Third-party administrator; 11
55- (3) "Enrollee" means an i ndividual who is entitled to receive 12
56-healthcare services under the terms of a health benefit plan; 13
57- (4) "Entity of the state" means any agency, board, bureau, 14
58-commission, committee, council, department, division, institution of higher 15
59-education, office, public school, quasi -public organization, or other 16
60-political subdivision of the state; 17
61- (5)(A) "Health benefit plan" means an individual, blanket, or 18
62-group plan, policy, or contract for healthcare services issued, renewed, or 19
63-extended in this state by a healthcare insurer. 20
64- (B) "Health benefit plan" includes a nonfederal 21
65-governmental plan as defined in 29 U.S.C. § 1002(32), as it existed on 22
66-January 1, 2023. 23
67- (C) "Health benefit plan" does not include: 24
68- (i) A plan that provides only dental benefi ts or eye 25
69-and vision care benefits; 26
70- (ii) A disability income plan; 27
71- (iii) A credit insurance plan; 28
72- (iv) Insurance coverage issued as a supplement to 29
73-liability insurance; 30
74- (v) Medical payments under an automobile or 31
75-homeowners insurance pl an; 32
76- (vi) A health benefit plan provided under Arkansas 33
77-Constitution, Article 5, § 32, the Workers’ Compensation Law, § 11 -9-101 et 34
78-seq., or the Public Employee Workers’ Compensation Act, § 21 -5-601 et seq.; 35
79- (vii) A plan that provides only indemn ity for 36 As Engrossed: S1/30/23 S2/15/23 SB122
53+ (v) A risk-based provider organization; 10
54+ (vi) Third-party administrator; and 11
55+ (vii) A prescription ben efit management company; 12
56+ (3) "Enrollee" means an individual who is entitled to receive 13
57+healthcare services under the terms of a health benefit plan; 14
58+ (4) "Entity of the state" means any agency, board, bureau, 15
59+commission, committee, council, department, division, institution of higher 16
60+education, office, public school, quasi -public organization, or other 17
61+political subdivision of the state; 18
62+ (5)(A) "Health benefit plan" means an individual, blanket, or 19
63+group plan, policy, or contract for healt hcare services issued, renewed, or 20
64+extended in this state by a healthcare insurer. 21
65+ (B) "Health benefit plan" includes a nonfederal 22
66+governmental plan as defined in 29 U.S.C. § 1002(32), as it existed on 23
67+January 1, 2023. 24
68+ (C) "Health benefit plan" doe s not include: 25
69+ (i) A plan that provides only dental benefits or eye 26
70+and vision care benefits; 27
71+ (ii) A disability income plan; 28
72+ (iii) A credit insurance plan; 29
73+ (iv) Insurance coverage issued as a supplement to 30
74+liability insurance; 31
75+ (v) Medical payments under an automobile or 32
76+homeowners insurance plan; 33
77+ (vi) A health benefit plan provided under Arkansas 34
78+Constitution, Article 5, § 32, the Workers’ Compensation Law, § 11 -9-101 et 35
79+seq., or the Public Employee Workers’ Compensation Act, § 21-5-601 et seq.; 36 As Engrossed: S1/30/23 SB122
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84-hospital confinement; 1
85- (viii) An accident-only plan; 2
86- (ix) A specified disease plan; 3
87- (x) A policy, contract, certificate, or agreement 4
88-offered or issued by a healthcare insurer to provide, deliver, arrange for, 5
89-pay for, or reimburse a ny of the costs of healthcare services, including 6
90-pharmacy benefits, to an entity of the state; 7
91- (xi) A long-term care insurance plan; or 8
92- (xii) A healthcare provider self -insured plan; 9
93- (6) "Healthcare contract" means a contract entered into, 10
94-materially amended, or renewed between a contracting entity and a healthcare 11
95-provider for the delivery of healthcare services to an enrollee; 12
96- (7)(A) "Healthcare insurer" means an entity that is subject to 13
97-state insurance regulation and provides health i nsurance in this state. 14
98- (B) "Healthcare insurer" includes: 15
99- (i) An insurance company; 16
100- (ii) A health maintenance organization; 17
101- (iii) A hospital and medical service corporation; 18
102- (iv) A risk-based provider organization; and 19
103- (v) Any sponsor of a nonfederal self -funded 20
104-governmental plan in this state; 21
105- (8) "Healthcare provider" means a person or entity that is 22
106-licensed, certified, or otherwise authorized by the laws of this state to 23
107-administer healthcare services; and 24
108- (9) "Healthcare services" means services or goods provided for 25
109-preventing, diagnosing, treating, alleviating, relieving, curing, or healing 26
110-human illness, disease, condition, disability, or injury. 27
111- 28
112- 23-99-1603. Collection by healthcare insurer — Authority. 29
113- (a) A healthcare insurer shall: 30
114- (1) Pay a healthcare provider the full amount due for healthcare 31
115-services under the terms of a health benefit plan, including any cost 32
116-sharing; 33
117- (2) Have the sole responsibility for collecting cost sharing 34
118-from an enrollee; and 35
119- (3) Upon request of the enrollee, collect cost -sharing 36 As Engrossed: S1/30/23 S2/15/23 SB122
84+ (vii) A plan that provides only indemnity for 1
85+hospital confinement; 2
86+ (viii) An accident-only plan; 3
87+ (ix) A specified disease plan; 4
88+ (x) A policy, contract, certificate, or agreement 5
89+offered or issued by a healthcare in surer to provide, deliver, arrange for, 6
90+pay for, or reimburse any of the costs of healthcare services, including 7
91+pharmacy benefits, to an entity of the state; 8
92+ (xi) A long-term care insurance plan; or 9
93+ (xii) A healthcare provider self -insured plan; 10
94+ (6) "Healthcare contract" means a contract entered into, 11
95+materially amended, or renewed between a contracting entity and a healthcare 12
96+provider for the delivery of healthcare services to an enrollee; 13
97+ (7)(A) "Healthcare insurer" means an entity that i s subject to 14
98+state insurance regulation and provides health insurance in this state. 15
99+ (B) "Healthcare insurer" includes: 16
100+ (i) An insurance company; 17
101+ (ii) A health maintenance organization; 18
102+ (iii) A hospital and medical service corporation; 19
103+ (iv) A risk-based provider organization; and 20
104+ (v) Any sponsor of a nonfederal self -funded 21
105+governmental plan in this state; 22
106+ (8) "Healthcare provider" means a person or entity that is 23
107+licensed, certified, or otherwise authorized by the laws of this state to 24
108+administer healthcare services; and 25
109+ (9) "Healthcare services" means services or goods provided for 26
110+preventing, diagnosing, treating, alleviating, relieving, curing, or healing 27
111+human illness, disease, condition, disability, or injury. 28
112+ 29
113+ 23-99-1603. Collection by healthcare insurer — Authority. 30
114+ (a) A healthcare insurer shall: 31
115+ (1) Pay a healthcare provider the full amount due for healthcare 32
116+services under the terms of a health benefit plan, including any cost 33
117+sharing; 34
118+ (2) Have the sole responsibility for collecting cost sharing 35
119+from an enrollee; and 36 As Engrossed: S1/30/23 SB122
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122122
123123
124-throughout the plan year in increments defined by the healthcare insurer. 1
125- (b) A healthcare insurer shall not: 2
126- (1) Withhold any amount for cost sharing from the payment to a 3
127-healthcare provider; or 4
128- (2) Require a healthcare provider to offer additional discounts 5
129-to enrollees outside the terms of the healthcare contract between the 6
130-healthcare insurer and the healthcare provider. 7
131- (c) Any value of a copay assistance coupon or similar assista nce 8
132-program shall be applied to an enrollee’s annual cost -sharing requirement and 9
133-may be paid directly to the healthcare insurer on the enrollee’s behalf. 10
134- (d) A healthcare insurer shall not cancel the health benefit plan of 11
135-an enrollee for failure to col lect cost sharing. 12
136- (e) Any expenses of implementing this subchapter by a healthcare 13
137-insurer shall not be used as justification to increase premiums or decrease 14
138-payments to a healthcare provider. 15
139- 16
140- 23-99-1604. Violation of Trade Practices Act — Enforcement. 17
141- (a) A violation of this subchapter is a deceptive act, as defined by 18
142-the Trade Practices Act, § 23-66-201 et seq. 19
143- (b) All remedies, penalties, and authority granted to the Insurance 20
144-Commissioner under the Trade Practices Act, § 23-66-201 et seq., shall be 21
145-available to the commissioner for the enforcement of this subchapter. 22
146- 23
147- 23-99-1605. Rules. 24
148- The Insurance Commissioner may promulgate rules necessary to implement 25
149-and administer this subchapter. 26
150- 27
151-/s/B. King 28
152- 29
124+ (3) Upon request of the enrollee, collect cost -sharing 1
125+throughout the plan year in increments defined by the healthcare insurer. 2
126+ (b) A healthcare insurer shall not: 3
127+ (1) Withhold any amount for cost sharing from the payment to a 4
128+healthcare provider; or 5
129+ (2) Require a healthcare provider to offer additional discounts 6
130+to enrollees outside the terms of the healthcare contract between the 7
131+healthcare insurer and the healthcare provide r. 8
132+ (c) Any value of a copay assistance coupon or similar assistance 9
133+program shall be applied to an enrollee’s annual cost -sharing requirement and 10
134+may be paid directly to the healthcare insurer on the enrollee’s behalf. 11
135+ (d) A healthcare insurer shall no t cancel the health benefit plan of 12
136+an enrollee for failure to collect cost sharing. 13
137+ (e) Any expenses of implementing this subchapter by a healthcare 14
138+insurer shall not be used as justification to increase premiums or decrease 15
139+payments to a healthcare pro vider. 16
140+ 17
141+ 23-99-1604. Violation of Trade Practices Act — Enforcement. 18
142+ (a) A violation of this subchapter is a deceptive act, as defined by 19
143+the Trade Practices Act, § 23-66-201 et seq. 20
144+ (b) All remedies, penalties, and authority granted to the Insurance 21
145+Commissioner under the Trade Practices Act, § 23-66-201 et seq., shall be 22
146+available to the commissioner for the enforcement of this subchapter. 23
147+ 24
148+ 23-99-1605. Rules. 25
149+ The Insurance Commis sioner may promulgate rules necessary to implement 26
150+and administer this subchapter. 27
151+ 28
152+/s/B. King 29
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154154 31
155155 32
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