1 | 1 | | Stricken language would be deleted from and underlined language would be added to present law. |
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2 | 2 | | *ANS166* 01/25/2023 04:57:57 PM ANS166 |
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3 | 3 | | |
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4 | 4 | | State of Arkansas 1 |
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5 | 5 | | 94th General Assembly A Bill 2 |
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6 | 6 | | Regular Session, 2023 SENATE BILL 137 3 |
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7 | 7 | | 4 |
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8 | 8 | | By: Senator Irvin 5 |
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9 | 9 | | By: Representative L. Johnson 6 |
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10 | 10 | | 7 |
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11 | 11 | | For An Act To Be Entitled 8 |
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12 | 12 | | AN ACT TO MANDATE CO VERAGE FOR NECESSARY 9 |
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13 | 13 | | MAXILLOFACIAL SERVIC ES; AND FOR OTHER PU RPOSES. 10 |
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14 | 14 | | 11 |
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15 | 15 | | 12 |
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16 | 16 | | Subtitle 13 |
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17 | 17 | | TO MANDATE COVERAGE FOR NECESSARY 14 |
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18 | 18 | | MAXILLOFACIAL SERVICES. 15 |
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19 | 19 | | 16 |
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20 | 20 | | 17 |
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21 | 21 | | BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF ARKANSAS: 18 |
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22 | 22 | | 19 |
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23 | 23 | | SECTION 1. Arkansas Code Title 23, Chapter 99, Subchapter 4, is 20 |
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24 | 24 | | amended to add an additional section to read as follows: 21 |
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25 | 25 | | 23-99-422. Coverage for necessary maxillofacial services — 22 |
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26 | 26 | | Definitions. 23 |
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27 | 27 | | (a) As used in this section: 24 |
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28 | 28 | | (1)(A) “Health benefit pla n” means an individual, blanket, or 25 |
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29 | 29 | | group plan, policy, or contract for healthcare services offered, issued, 26 |
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30 | 30 | | renewed, or extended in this state by a healthcare insurer, health 27 |
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31 | 31 | | maintenance organization, hospital medical service corporation, or self -28 |
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32 | 32 | | insured governmental or church plan in this state. 29 |
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33 | 33 | | (B) “Health benefit plan” includes: 30 |
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34 | 34 | | (i) Indemnity and managed care plans; and 31 |
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35 | 35 | | (ii) Plans providing health benefits to state and 32 |
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36 | 36 | | public school employees under § 21 -5-401 et seq. 33 |
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37 | 37 | | (C) “Health benefit plan” does not include: 34 |
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38 | 38 | | (i) A plan that provides only dental benefits or eye 35 |
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39 | 39 | | and vision care benefits; 36 SB137 |
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41 | 41 | | 2 01/25/2023 04:57:57 PM ANS166 |
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44 | 44 | | (ii) A disability income plan; 1 |
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45 | 45 | | (iii) A credit insurance plan; 2 |
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46 | 46 | | (iv) Insurance coverage issued as a supplement to 3 |
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47 | 47 | | liability insurance; 4 |
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48 | 48 | | (v) Medical payments under an automobile or 5 |
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49 | 49 | | homeowners insurance plan; 6 |
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50 | 50 | | (vi) A health benefit plan provided under Arkansas 7 |
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51 | 51 | | Constitution, Article 5, § 32, the Workers' Compensation Law, § 11 -9-101 et 8 |
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52 | 52 | | seq., or the Public Employee Workers' Compensa tion Act, § 21-5-601 et seq.; 9 |
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53 | 53 | | (vii) A plan that provides only indemnity for 10 |
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54 | 54 | | hospital confinement; 11 |
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55 | 55 | | (viii) An accident-only plan; 12 |
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56 | 56 | | (ix) A specified disease plan; or 13 |
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57 | 57 | | (x) A program established by the Arkansas Health and 14 |
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58 | 58 | | Opportunity for Me Ac t of 2021, § 23-61-1001 et seq.; 15 |
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59 | 59 | | (2)(A) "Healthcare insurer" means any insurance company, 16 |
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60 | 60 | | hospital and medical service corporation, or health maintenance organization 17 |
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61 | 61 | | that issues or delivers health benefit plans in this state and is subject to 18 |
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62 | 62 | | any of the following laws: 19 |
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63 | 63 | | (i) The insurance laws of this state; 20 |
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64 | 64 | | (ii) Section 23-75-101 et seq., pertaining to 21 |
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65 | 65 | | hospital and medical service corporations; or 22 |
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66 | 66 | | (iii) Section 23-76-101 et seq., pertaining to 23 |
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67 | 67 | | health maintenance organizations. 24 |
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68 | 68 | | (B) "Healthcare insurer" does not include an entity that 25 |
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69 | 69 | | provides only dental benefits or eye and vision care benefits; 26 |
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70 | 70 | | (3) "Healthcare professional" means a person who is licensed, 27 |
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71 | 71 | | certified, or otherwise authorized by the laws of this state to administer 28 |
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72 | 72 | | health care in the ordinary course of the practice of his or her profession; 29 |
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73 | 73 | | (4) "Healthcare services" means services and products provided 30 |
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74 | 74 | | by a healthcare professional within the scope of the healthcare 31 |
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75 | 75 | | professional's license; and 32 |
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76 | 76 | | (5)(A) "Necessary maxillofacial services" means healthcare 33 |
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77 | 77 | | services that are used to: 34 |
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78 | 78 | | (i) Restore and manage the head and facial 35 |
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79 | 79 | | structures of an individual that are defective because of disease, trauma, or 36 SB137 |
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82 | 82 | | |
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83 | 83 | | |
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84 | 84 | | birth or developmental deformities and cannot be replaced wit h living tissue; 1 |
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85 | 85 | | or 2 |
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86 | 86 | | (ii) Repair or stabilize living tissue that is 3 |
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87 | 87 | | defective because of disease, trauma, or birth or developmental deformities. 4 |
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88 | 88 | | (B) "Necessary maxillofacial services" includes only 5 |
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89 | 89 | | healthcare services used for the purpose of: 6 |
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90 | 90 | | (i) Controlling or eliminating infection; 7 |
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91 | 91 | | (ii) Controlling or eliminating pain; or 8 |
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92 | 92 | | (iii) Restoring facial configuration or functions 9 |
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93 | 93 | | including without limitation speech, swallowing, or chewing. 10 |
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94 | 94 | | (C) "Necessary maxillofacial services" does not include 11 |
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95 | 95 | | cosmetic procedures if provided to improve on the normal range of conditions. 12 |
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96 | 96 | | (b) A health benefit plan that is offered, issued, renewed, or 13 |
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97 | 97 | | extended in this state shall provide coverage for necessary maxillofacial 14 |
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98 | 98 | | services. 15 |
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99 | 99 | | (c) An exclusion fo r coverage for dental care or orthodontic services 16 |
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100 | 100 | | in a health benefit plan does not apply to necessary maxillofacial services. 17 |
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101 | 101 | | 18 |
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102 | 102 | | SECTION 2. DO NOT CODIFY. EFFECTIVE DATE. This act is effective on 19 |
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103 | 103 | | and after September 1, 2023. 20 |
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