Arkansas 2023 Regular Session

Arkansas Senate Bill SB142 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	Stricken language would be deleted from and underlined language would be added to present law.
2	2	ANS129 01/26/2023 11:27:49 AM ANS129
3	3
4	4	State of Arkansas 1
5	5	94th General Assembly A Bill 2
6	6	Regular Session, 2023 SENATE BILL 142 3
7	7	4
8	8	By: Senator Irvin 5
9	9	By: Representative D. Ferguson 6
10	10	7
11	11	For An Act To Be Entitled 8
12	12	AN ACT TO AMEND THE HEALTHCARE CONTRACTI NG 9
13	13	SIMPLIFICATION ACT; TO REGULATE NETWORK LEASING UNDER 10
14	14	THE HEALTHCARE CONTR ACTING SIMPLIFICATIO N ACT; AND 11
15	15	FOR OTHER PURPOSES. 12
16	16	13
17	17	14
18	18	Subtitle 15
19	19	TO AMEND THE HEALTHCARE CONTRACTING 16
20	20	SIMPLIFICATION ACT; AND TO REGULATE 17
21	21	NETWORK LEASING UNDER THE HEALTHCARE 18
22	22	CONTRACTING SIMPLIFICATION ACT. 19
23	23	20
24	24	21
25	25	BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF ARKANSAS: 22
26	26	23
27	27	SECTION 1. Arkansas Code § 23 -99-1202 is amended to read as follows: 24
28	28	23-99-1202. Definitions. 25
29	29	As used in this subchapter: 26
30	30	(1) “All-products clause” means a provision in a healthcare 27
31	31	contract that requires a healthcare provider, as a condition of participation 28
32	32	or continuation in a provider network or a health benefit plan, to: 29
33	33	(A) Serve in another provider network utilized by the 30
34	34	contracting entity or a healthcare insurer affiliated with the contracting 31
35	35	entity; or 32
36	36	(B) Provide healthcare services under another health 33
37	37	benefit plan or product offered by a contracting entity or a healthcare 34
38	38	insurer affiliated with the contracting entity; 35
39	39	(2) “Contracting entity” means a healthcare insurer or a 36 SB142
40	40
41	41	2 01/26/2023 11:27:49 AM ANS129
42	42
43	43
44	44	subcontractor, affiliate, or other entity that contracts directly or 1
45	45	indirectly with a healthcare provider for the delivery of healthcare services 2
46	46	to enrollees; 3
47	47	(3) “Enrollee” means an individual who is entitled to receive 4
48	48	healthcare services under the terms of a health benefit plan; 5
49	49	(4)(A) “Health benefit plan” means a plan, policy, contract, 6
50	50	certificate, agreement, or other evidence of coverage for healthcare services 7
51	51	offered or issued by a healthcare insurer in this state. 8
52	52	(B) “Health benefit plan” includes: 9
53	53	(i) A nonfederal governmental plans plan as defined 10
54	54	in 29 U.S.C. § 1002(32), as it existed on January 1, 2019; and 11
55	55	(ii) A contract for providing benefits for dental 12
56	56	care whether or not the contract is pursuant to: 13
57	57	(a) A healthcare insurance policy or 14
58	58	certificate; 15
59	59	(b) A dental-only plan; 16
60	60	(c) A health maintenance organization provider 17
61	61	contract; or 18
62	62	(d) A managed healthcare plan. 19
63	63	(C) “Health benefit plan” does not include: 20
64	64	(i) A disability income plan; 21
65	65	(ii) A credit insurance plan; 22
66	66	(iii) Insurance coverage issued as a supplement to 23
67	67	liability insurance; 24
68	68	(iv) A medical payment under automobile or 25
69	69	homeowners insurance plans; 26
70	70	(v) A health benefit plan provided under Arkansas 27
71	71	Constitution, Article 5, § 32, the Workers' Compensation Law, § 11-9-101 et 28
72	72	seq., or the Public Employee Workers' Compensation Act, § 21-5-601 et seq.; 29
73	73	(vi) A plan that provides only indemnity for 30
74	74	hospital confinement; 31
75	75	(vii) An accident-only plan; 32
76	76	(viii) A specified disease plan; 33
77	77	(ix) A long-term care only plan; or 34
78	78	(x) A dental-only plan; or 35
79	79	(xi) A vision-only plan; 36 SB142
80	80
81	81	3 01/26/2023 11:27:49 AM ANS129
82	82
83	83
84	84	(5) “Healthcare contract” means a contract entered into, 1
85	85	materially amended, or renewed between a contracting entity and a healthcare 2
86	86	provider that specifies the rights and responsibilities of the contracting 3
87	87	entity and provides for the delivery of and payment for healthcare services 4
88	88	to enrollees; 5
89	89	(6)(A) “Healthcare insurer” means an entity that is subject to 6
90	90	state insurance regulation and provides health insurance in this state. 7
91	91	(B) “Healthcare insurer” includes: 8
92	92	(i) An insurance company; 9
93	93	(ii) A health maintenance organization; 10
94	94	(iii) A hospital and medical service corporation; 11
95	95	(iv) A risk-based provider organization; and 12
96	96	(v) A sponsor of a nonfederal self-funded 13
97	97	governmental plan; and 14
98	98	(vi) A dental-only plan; 15
99	99	(7) “Healthcare provider” means a person or entity that is 16
100	100	licensed, certified, or otherwise authorized by the laws of this state to 17
101	101	provide healthcare services; 18
102	102	(8)(A) “Healthcare services” means services or goods provided 19
103	103	for the purpose of or incidental to the purpose of preventing, diagnosing, 20
104	104	treating, alleviating, relieving, curing, or healing human illness, disease, 21
105	105	condition, disability, or injury. 22
106	106	(B) "Healthcare services" includes services for the 23
107	107	diagnosis, prevention, treatment, or cure of a dental condition, illness, 24
108	108	injury, or disease; 25
109	109	(9) “Material amendment” means a change in a healthcare contract 26
110	110	that results in: 27
111	111	(A) A decrease in fees, payments, or reimbursement to a 28
112	112	participating healthcare provider; 29
113	113	(B) A change in the payment methodology for determining 30
114	114	fees, payments, or reimbursement to a participating healthcare provider; 31
115	115	(C) A new or revised coding guideline; 32
116	116	(D) A new or revised payment rule; or 33
117	117	(E) A change of procedures that may reasonably be expected 34
118	118	to significantly increase a healthcare provider's administrative expenses; 35
119	119	(10) “Most favored nation clause” means a provision in a 36 SB142
120	120
121	121	4 01/26/2023 11:27:49 AM ANS129
122	122
123	123
124	124	healthcare contract that: 1
125	125	(A) Prohibits or grants a contracting entity an option to 2
126	126	prohibit a participating healthcare provider from contracting with another 3
127	127	contracting entity to provide healthcare services at a lower price than the 4
128	128	payment specified in the healthcare contract; 5
129	129	(B) Requires or grants a contracting entity an option to 6
130	130	require a participating healthcare provider to accept a lower payment in the 7
131	131	event the participating healthcare provider agrees to provide healthcare 8
132	132	services to another contracting entity at a lower price; 9
133	133	(C) Requires or grants a contracting entity an option to 10
134	134	require termination or renegotiation of an existing healthcare contract if a 11
135	135	participating healthcare provider agrees to provide healthcare services to 12
136	136	another contracting entity at a lower price; or 13
137	137	(D) Requires a participating healthcare provider to 14
138	138	disclose the participating healthcare provider's contractual reimbursement 15
139	139	rates with other contracting entities; 16
140	140	(11) “Participating healthcare provider” means a healthcare 17
141	141	provider that has a healthcare contract with a contracting entity to provide 18
142	142	healthcare services to enrollees with the expectation of receiving payment 19
143	143	from the contracting entity or a healthcare insurer affiliated with the 20
144	144	contracting entity; and 21
145	145	(12) “Provider network” means a group of healthcare providers 22
146	146	that are contracted to provide healthcare services to enrollees at contracted 23
147	147	rates; and 24
148	148	(13) "Third party" means an individual or entity that enters 25
149	149	into a contract with a contracting entity or with another third party to gain 26
150	150	access to the services or contractual discounts of a healthcare contract 27
151	151	through leasing the network. 28
152	152	29
153	153	SECTION 2. Arkansas Code § 23 -99-1203 is amended to read as follows: 30
154	154	23-99-1203. All-products clause — Prohibition — Network leasing. 31
155	155	(a) Except as provided in subsections (b) and (d) of this section, a 32
156	156	contracting entity shall not: 33
157	157	(1) Offer to a healthcare provider a healthcare contract that 34
158	158	includes an all-products clause; 35
159	159	(2) Enter into a healthcare contract with a healthcare provider 36 SB142
160	160
161	161	5 01/26/2023 11:27:49 AM ANS129
162	162
163	163
164	164	that includes an all-products clause; or 1
165	165	(3) Amend or renew an existing healthcare contract previously 2
166	166	entered into with a healthcare provider so that the healthcare contract as 3
167	167	amended or renewed adds or continues to include an all-products clause. 4
168	168	(b)(1) This section does not prohibit a contracting entity from: 5
169	169	(A) Offering a healthcare provider a contract that covers 6
170	170	multiple health benefit plans that have the same reimbursement rates and 7
171	171	other financial terms for the healthcare provider; 8
172	172	(B) Adding a new health benefit plan to an existing 9
173	173	healthcare contract with a healthcare provider under the same reimbursement 10
174	174	rates and other financial terms applicable under the original healthcare 11
175	175	contract; or 12
176	176	(C) Requiring a healthcare provider to accept multiple 13
177	177	health benefit plans that do not differ in reimbursement rates or other 14
178	178	financial terms for the healthcare provider. 15
179	179	(2) A healthcare contract may include health benefit plans or 16
180	180	coverage options for enrollees within a health benefit plan with different 17
181	181	cost-sharing structures, including different deductibles or copayments, as 18
182	182	long as the reimbursement rates and other financial terms between the 19
183	183	contracting entity and the healthcare provider remain the same for each plan 20
184	184	or coverage option included in the healthcare contract. 21
185	185	(3) This section does not authorize a healthcare provider to: 22
186	186	(A) Opt out of providing services to an enrollee of a 23
187	187	particular health benefit plan after the healthcare provider has entered into 24
188	188	a valid contract under this section to provide the services; or 25
189	189	(B) Refuse to disclose the provider networks or health 26
190	190	benefit plans in which the healthcare provider participates. 27
191	191	(c)(1) A violation of this section is: 28
192	192	(A) An unfair trade practice under § 23-66-206; and 29
193	193	(B) Subject to the Trade Practices Act, § 23-66-201 et 30
194	194	seq. 31
195	195	(2) If a healthcare contract contains a provision that violates 32
196	196	this section, the healthcare contract is void. 33
197	197	(d) A contracting entity may require a healthcare provider to 34
198	198	participate in the State and Public School Life and Health Insurance Program 35
199	199	as a condition of contracting or continuing to contract with the healthcare 36 SB142
200	200
201	201	6 01/26/2023 11:27:49 AM ANS129
202	202
203	203
204	204	provider for healthcare services under another health benefit plan, if: 1
205	205	(1) The other health benefit plan is an individual health plan 2
206	206	not sold on the health insurance marketplace, as defined in § 23-64-602; and 3
207	207	(2) The rates offered to the healthcare provider for healthcare 4
208	208	services to program enrollees are no lower than the rates paid to the 5
209	209	healthcare provider under the other health benefit plan. 6
210	210	(e)(1) A healthcare contract, renewal, or amendment offered by a 7
211	211	healthcare insurer pertaining to granting access to a provider network for a 8
212	212	third party that otherwise complies with the requirements of this section 9
213	213	shall allow a healthcare provider to: 10
214	214	(A) Choose not to participate in any contract provisions 11
215	215	that provide third-party access to the contract; or 12
216	216	(B) Enter into a healthcare contract directly with the 13
217	217	healthcare insurer. 14
218	218	(2) A healthcare insurer shall not cancel or otherwise terminate 15
219	219	or deny a contractual relationship with a healthcare provider because the 16
220	220	healthcare provider exercises its rights as provided in subdivision (e)(1) of 17
221	221	this section. 18
222	222	(3) This subsection applies only to a dentist licensed under the 19
223	223	Arkansas Dental Practice Act, § 17-82-101 et seq. 20
224	224	21
225	225	22
226	226	23
227	227	24
228	228	25
229	229	26
230	230	27
231	231	28
232	232	29
233	233	30
234	234	31
235	235	32
236	236	33
237	237	34
238	238	35
239	239	36