Arkansas 2023 Regular Session

Arkansas Senate Bill SB278 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.
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4	4	State of Arkansas 1
5	5	94th General Assembly A Bill 2
6	6	Regular Session, 2023 SENATE BILL 278 3
7	7	4
8	8	By: Senator B. King 5
9	9	By: Representative Miller 6
10	10	7
11	11	For An Act To Be Entitled 8
12	12	AN ACT TO TERMINATE THE ARKANSAS HEALTH AND 9
13	13	OPPORTUNITY FOR ME P ROGRAM; TO TRANSFER ALL 10
14	14	BENEFICIARIES IN THE ARKANSAS HOME AND OP PORTUNITY 11
15	15	FOR ME PROGRAM TO TH E TRADITIONAL ARKANS AS MEDICAID 12
16	16	PROGRAM; TO REPEAL T HE ARKANSAS HEALTH A ND 13
17	17	OPPORTUNITY FOR ME A CT OF 2021; AND FOR OTH ER 14
18	18	PURPOSES. 15
19	19	16
20	20	17
21	21	Subtitle 18
22	22	TO TERMINATE THE ARKANSAS HEALTH AND 19
23	23	OPPORTUNITY FOR ME PROGRAM; AND TO 20
24	24	TRANSFER ALL BENEFICIARIES IN THE 21
25	25	ARKANSAS HOME AND OPPORTUNITY FOR ME 22
26	26	PROGRAM TO THE TRADITIONAL ARKANSAS 23
27	27	MEDICAID PROGRAM. 24
28	28	25
29	29	26
30	30	BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF ARKANSAS: 27
31	31	28
32	32	SECTION 1. DO NOT CODIFY. Legislative intent. 29
33	33	It is the intent of the General Assembly to: 30
34	34	(1) Repeal the Arkansas Health and Opportunity for Me Program; 31
35	35	(2) Amend various sections of t he Arkansas Code to end 32
36	36	Arkansas's participation in the Arkansas Health and Opportunity for Me 33
37	37	Program; and 34
38	38	(3) Instruct the Governor to submit a waiver to: 35
39	39	(A) Transfer all individuals enrolled and participating in 36 SB278
40	40
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42	42
43	43
44	44	the Arkansas Health and Opportuni ty for Me Program to the traditional 1
45	45	Medicaid program on and after July 1, 2023; and 2
46	46	(B) Terminate the Arkansas Health and Opportunity for Me 3
47	47	Program on December 31, 2024. 4
48	48	5
49	49	SECTION 2. DO NOT CODIFY. Arkansas Health and Opportunity for Me 6
50	50	Program. 7
51	51	(a) The Department of Human Services shall: 8
52	52	(1) Notify all persons enrolled in the Arkansas Health and 9
53	53	Opportunity for Me Program as of the effective date of this act that the 10
54	54	Arkansas Health and Opportunity for Me Program ends on December 31, 2024; 11
55	55	(2) Inform a new enrollee in the Arkansas Health and Opportunity 12
56	56	for Me Program after the effective date of this act that the Arkansas Health 13
57	57	and Opportunity for Me Program ends on December 31, 2024; and 14
58	58	(3) Transfer all persons enrolled in the Arkansas Health and 15
59	59	Opportunity for Me Program or any person who enrolled in the Arkansas Health 16
60	60	and Opportunity for Me Program after July 1, 2023, to coverage under the 17
61	61	traditional Medicaid program on July 1, 2023. 18
62	62	(b) The department may prohibit new enrollees in the Arkansas Health 19
63	63	and Opportunity for Me Program to begin the transition period before the 20
64	64	termination date of December 31, 2024. 21
65	65	(c) On the effective date of this act, the department shall submit any 22
66	66	Medicaid state plan amendments and federal waive rs necessary to eliminate the 23
67	67	eligibility in the Arkansas Health and Opportunity for Me Program after 24
68	68	December 31, 2024. 25
69	69	(d) This section does not prohibit the payment of expenses incurred 26
70	70	before December 31, 2024, by persons participating in the Arkansa s Health and 27
71	71	Opportunity for Me Program. 28
72	72	29
73	73	SECTION 3. Arkansas Code § 19 -5-984(b)(2)(D), concerning the Division 30
74	74	of Workforce Services Special Fund, is repealed. 31
75	75	(D) The Arkansas Health and Opportunity for Me Act of 32
76	76	2021, § 23-61-1001 et seq., or its successor; and 33
77	77	34
78	78	SECTION 4. Arkansas Code § 19 -5-1146 is repealed. 35
79	79	19-5-1146. Arkansas Health and Opportunity for Me Program Trust Fund. 36 SB278
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84	84	(a) There is created on the books of the Treasurer of State, the 1
85	85	Auditor of State, and the Chief Fiscal Officer of the State a trust fund to 2
86	86	be known as the “Arkansas Health and Opportunity for Me Program Trust Fund”. 3
87	87	(b) The fund shall consist of: 4
88	88	(1) Moneys saved and accrued under the Arkansas Health and 5
89	89	Opportunity for Me Act of 2021, § 23 -61-1001 et seq., including without 6
90	90	limitation: 7
91	91	(A) Increases in premium tax collections; and 8
92	92	(B) Other spending reductions resulting from the Arkansas 9
93	93	Health and Opportunity for Me Act of 2021, § 23 -61-1001 et seq.; and 10
94	94	(2) Other revenues and funds authorized by la w. 11
95	95	(c) The Department of Human Services shall use the fund to pay for 12
96	96	future obligations under the Arkansas Health and Opportunity for Me Program 13
97	97	created by the Arkansas Health and Opportunity for Me Act of 2021, § 23 -61-14
98	98	1001 et seq. 15
99	99	16
100	100	SECTION 5. Arkansas Code § 23-61-803(h), concerning the Arkansas 17
101	101	Health Insurance Marketplace, is amended to read as follows: 18
102	102	(h) The State Insurance Department and any eligible entity under 19
103	103	subdivision (e)(2) of this section shall provide claims and other plan and 20
104	104	enrollment data to the Department of Human Services upon request to : 21
105	105	(1) Facilitate facilitate compliance with reporting requirements 22
106	106	under state and federal law ; and 23
107	107	(2) Assess the performance of the Arkansas Health and 24
108	108	Opportunity for Me Program established by the Arkansas Health and Opportunity 25
109	109	for Me Act of 2021, § 23 -61-1001 et seq., including without limitation the 26
110	110	program's quality, cost, and consumer access . 27
111	111	28
112	112	SECTION 6. Arkansas Code Title 23, Chapter 16, Subchapter 10, is 29
113	113	repealed. 30
114	114	31
115	115	Subchapter 10 — Arkansas Health and Opportunity for Me Act of 2021 32
116	116	33
117	117	23-61-1001. Title. 34
118	118	This subchapter shall be known and may be cited as the “Arkansas Health 35
119	119	and Opportunity for Me Act of 2021”. 36 SB278
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123	123
124	124	1
125	125	23-61-1002. Legislative intent. 2
126	126	Notwithstanding any genera l or specific laws to the contrary, it is the 3
127	127	intent of the General Assembly for the Arkansas Health and Opportunity for Me 4
128	128	Program to be a fiscally sustainable, cost -effective, and opportunity -driven 5
129	129	program that: 6
130	130	(1) Achieves comprehensive and innovat ive healthcare reform that 7
131	131	reduces the rate of growth in state and federal obligations for providing 8
132	132	healthcare coverage to low -income adults in Arkansas; 9
133	133	(2) Reduces the maternal and infant mortality rates in the state 10
134	134	through initiatives that promote healthy outcomes for eligible women with 11
135	135	high-risk pregnancies; 12
136	136	(3) Promotes the health, welfare, and stability of mothers and 13
137	137	their infants after birth through hospital -based community bridge 14
138	138	organizations; 15
139	139	(4) Encourages personal responsibility for individuals to 16
140	140	demonstrate that they value healthcare coverage and understand their roles 17
141	141	and obligations in maintaining private insurance coverage; 18
142	142	(5) Increases opportunities for full -time work and attainment of 19
143	143	economic independence, especially for certain young adults, to reduce long -20
144	144	term poverty that is associated with additional risk for disease and 21
145	145	premature death; 22
146	146	(6) Addresses health -related social needs of Arkansans in rural 23
147	147	counties through hospital -based community bridge organizations and reduces 24
148	148	the additional risk for disease and premature death associated with living in 25
149	149	a rural county; 26
150	150	(7) Strengthens the financial stability of the critical access 27
151	151	hospitals and other small, rural hospitals; and 28
152	152	(8) Fills gaps in the continuum of c are for individuals in need 29
153	153	of services for serious mental illness and substance use disorders. 30
154	154	31
155	155	23-61-1003. Definitions. 32
156	156	As used in this subchapter: 33
157	157	(1) “Acute care hospital” means a hospital that: 34
158	158	(A) Is licensed by the Department of Health und er § 20-9-35
159	159	201 et seq., as a general hospital or a surgery and general medical care 36 SB278
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163	163
164	164	hospital; and 1
165	165	(B) Is enrolled as a provider with the Arkansas Medicaid 2
166	166	Program; 3
167	167	(2) “Birthing hospital” means a hospital in this state or in a 4
168	168	border state that: 5
169	169	(A) Is licensed as a general hospital; 6
170	170	(B) Provides obstetrics services; and 7
171	171	(C) Is enrolled as a provider with the Arkansas Medicaid 8
172	172	Program; 9
173	173	(3) “Community bridge organization” means an organization that 10
174	174	is authorized by the Department of Huma n Services to participate in the 11
175	175	economic independence initiative or the health improvement initiative to: 12
176	176	(A) Screen and refer Arkansans to resources available in 13
177	177	their communities to address health -related social needs; and 14
178	178	(B) Assist eligible in dividuals identified as target 15
179	179	populations most at risk of disease and premature death and who need a higher 16
180	180	level of intervention to improve their health outcomes and succeed in meeting 17
181	181	their long-term goals to achieve independence, including economic 18
182	182	independence; 19
183	183	(4) “Cost sharing” means the portion of the cost of a covered 20
184	184	medical service that is required to be paid by or on behalf of an eligible 21
185	185	individual; 22
186	186	(5) “Critical access hospital” means an acute care hospital that 23
187	187	is: 24
188	188	(A) Designated by the Centers for Medicare & Medicaid 25
189	189	Services as a critical access hospital; and 26
190	190	(B) Is enrolled as a provider in the Arkansas Medicaid 27
191	191	Program; 28
192	192	(6) “Economic independence initiative” means an initiative 29
193	193	developed by the Department of Human Services that is designed to promote 30
194	194	economic stability by encouraging participation of program participants to 31
195	195	engage in full-time, full-year work, and to demonstrate the value of 32
196	196	enrollment in an individual qualified health insurance plan through 33
197	197	incentives and disincentives; 34
198	198	(7) “Eligible individual” means an individual who is in the 35
199	199	eligibility category created by section 1902(a)(10)(A)(i)(VIII) of the Social 36 SB278
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203	203
204	204	Security Act, 42 U.S.C. § 1396a; 1
205	205	(8) “Employer health insurance coverage” means a health 2
206	206	insurance benefit plan offered by an employer or, as authorized by this 3
207	207	subchapter, an employer self -funded insurance plan governed by the Employee 4
208	208	Retirement Income Security Act of 1974, Pub. L. No. 93 -406, as amended; 5
209	209	(9) “Health improvement initiative” means an initiative 6
210	210	developed by an individual qualified health insurance plan or the Department 7
211	211	of Human Services that is designed to encourage the participation of eligible 8
212	212	individuals in health assessments and wellness programs, including fitness 9
213	213	programs and smoking or tobacco cessation programs; 10
214	214	(10) “Health insurance benefit plan” means a policy, contract, 11
215	215	certificate, or agreement offered or issued by a health insurer to provide, 12
216	216	deliver, arrange for, pay for, or reimburse any of the costs of healthcar e 13
217	217	services, but not including excepted benefits as defined under 42 U.S.C. § 14
218	218	300gg-91(c), as it existed on January 1, 2021; 15
219	219	(11) “Health insurance marketplace” means the applicable 16
220	220	entities that were designed to help individuals, families, and businesse s in 17
221	221	Arkansas shop for and select health insurance benefit plans in a way that 18
222	222	permits comparison of available plans based upon price, benefits, services, 19
223	223	and quality, and refers to either: 20
224	224	(A) The Arkansas Health Insurance Marketplace created 21
225	225	under the Arkansas Health Insurance Marketplace Act, § 23 -61-801 et seq., or 22
226	226	a successor entity; or 23
227	227	(B) The federal health insurance marketplace or federal 24
228	228	health benefit exchange created under the Patient Protection and Affordable 25
229	229	Care Act, Pub. L. No. 111 -148; 26
230	230	(12) “Health insurer” means an insurer authorized by the State 27
231	231	Insurance Department to provide health insurance or a health insurance 28
232	232	benefit plan in the State of Arkansas, including without limitation: 29
233	233	(A) An insurance company; 30
234	234	(B) A medical services plan; 31
235	235	(C) A hospital plan; 32
236	236	(D) A hospital medical service corporation; 33
237	237	(E) A health maintenance organization; 34
238	238	(F) A fraternal benefits society; 35
239	239	(G) Any other entity providing health insurance or a 36 SB278
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243	243
244	244	health insurance benefit plan subject to state insurance regulation; or 1
245	245	(H) A risk-based provider organization licensed by the 2
246	246	Insurance Commissioner under § 20 -77-2704; 3
247	247	(13) “Healthcare coverage” means coverage provided under this 4
248	248	subchapter through either an individual qualif ied health insurance plan, a 5
249	249	risk-based provider organization, employer health insurance coverage, or the 6
250	250	fee-for-service Arkansas Medicaid Program; 7
251	251	(14) “Individual qualified health insurance plan” means an 8
252	252	individual health insurance benefit plan offe red by a health insurer that 9
253	253	participates in the health insurance marketplace to provide coverage in 10
254	254	Arkansas that covers only essential health benefits as defined by Arkansas 11
255	255	rule and 45 C.F.R. § 156.110 and any federal insurance regulations, as they 12
256	256	existed on January 1, 2021; 13
257	257	(15) “Member” means a program participant who is enrolled in an 14
258	258	individual qualified health insurance plan; 15
259	259	(16) “Premium” means a monthly fee that is required to be paid 16
260	260	by or on behalf of an eligible individual to maintain s ome or all health 17
261	261	insurance benefits; 18
262	262	(17) “Program participant” means an eligible individual who: 19
263	263	(A) Is at least nineteen (19) years of age and no more 20
264	264	than sixty-four (64) years of age with an income that meets the income 21
265	265	eligibility standards es tablished by rule of the Department of Human 22
266	266	Services; 23
267	267	(B) Is authenticated to be a United States citizen or 24
268	268	documented qualified alien according to the Personal Responsibility and Work 25
269	269	Opportunity Reconciliation Act of 1996, Pub. L. No. 104 -193; 26
270	270	(C) Is not eligible for Medicare or advanced premium tax 27
271	271	credits through the health insurance marketplace; and 28
272	272	(D) Is not determined by the Department of Human Services 29
273	273	to be medically frail or eligible for services through a risk -based provider 30
274	274	organization; 31
275	275	(18) “Risk-based provider organization” means the same as 32
276	276	defined in § 20-77-2703; and 33
277	277	(19) “Small rural hospital” means a critical access hospital or 34
278	278	a general hospital that: 35
279	279	(A) Is located in a rural area; 36 SB278
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283	283
284	284	(B) Has fifty (50) o r fewer staffed beds; and 1
285	285	(C) Is enrolled as a provider in the Arkansas Medicaid 2
286	286	Program. 3
287	287	4
288	288	23-61-1004. Administration. 5
289	289	(a)(1) The Department of Human Services, in coordination with the 6
290	290	State Insurance Department and other state agencies, as necessa ry, shall: 7
291	291	(A) Provide healthcare coverage under this subchapter to 8
292	292	eligible individuals; 9
293	293	(B) Create and administer the Arkansas Health and 10
294	294	Opportunity for Me Program by: 11
295	295	(i) Applying for any federal waivers, Medicaid state 12
296	296	plan amendments, or other authority necessary to implement the Arkansas 13
297	297	Health and Opportunity for Me Program in a manner consistent with this 14
298	298	subchapter; and 15
299	299	(ii) Administering the Arkansas Health and 16
300	300	Opportunity for Me Program as approved by the Centers for Medicare & Medicaid 17
301	301	Services; 18
302	302	(C)(i) Administer the economic independence initiative 19
303	303	designed to reduce the short -term effects of the work penalty and the long -20
304	304	term effects of poverty on health outcomes among program participants through 21
305	305	incentives and disincentives. 22
306	306	(ii) The Department of Human Services shall align 23
307	307	the economic independence initiative with other state -administered work-24
308	308	related programs to the extent practicable; 25
309	309	(D) Screen, refer, and assist eligible individuals through 26
310	310	community bridge organizations under agreements with the Department of Human 27
311	311	Services; 28
312	312	(E) Offer incentives to promote personal responsibility, 29
313	313	individual health, and economic independence through individual qualified 30
314	314	health insurance plans and community brid ge organizations; and 31
315	315	(F) Seek a waiver to reduce the period of retroactive 32
316	316	eligibility for an eligible individual under this subchapter to thirty (30) 33
317	317	days before the date of the application. 34
318	318	(2) The Governor shall request the assistance and involv ement of 35
319	319	other state agencies that he or she deems necessary for the implementation of 36 SB278
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323	323
324	324	the Arkansas Health and Opportunity for Me Program. 1
325	325	(b) Healthcare coverage under this subchapter shall be provided 2
326	326	through enrollment in: 3
327	327	(1) An individual qualifi ed health insurance plan through a 4
328	328	health insurer; 5
329	329	(2) A risk-based provider organization; 6
330	330	(3) An employer-sponsored health insurance coverage; or 7
331	331	(4) The fee-for-service Arkansas Medicaid Program. 8
332	332	(c) Annually, the Department of Human Services shall develop 9
333	333	purchasing guidelines that: 10
334	334	(1) Describe which individual qualified health insurance plans 11
335	335	are suitable for purchase in the next demonstration year, including without 12
336	336	limitation: 13
337	337	(A) The level of the plan; 14
338	338	(B) The amounts of allowa ble premiums; 15
339	339	(C) Cost sharing; 16
340	340	(D) Auto-assignment methodology; and 17
341	341	(E) The total per-member-per-month enrollment range; and 18
342	342	(2) Ensure that: 19
343	343	(A) Payments to an individual qualified health insurance 20
344	344	plan do not exceed budget neutrality limitations in each demonstration year; 21
345	345	(B) The total payments to all of the individual qualified 22
346	346	health insurance plans offered by the health insurers for eligible 23
347	347	individuals combined do not exceed budget targets for the Arkansas Health and 24
348	348	Opportunity for Me Program in each demonstration year that the Department of 25
349	349	Human Services may achieve by: 26
350	350	(i) Setting in advance an enrollment range to 27
351	351	represent the minimum and a maximum total monthly number of enrollees into 28
352	352	all individual qualified health insurance plans no later than April 30 of 29
353	353	each demonstration year in order for the individual qualified health 30
354	354	insurance plans to file rates for the following demonstration year; 31
355	355	(ii) Temporarily suspending auto -assignment into the 32
356	356	individual qualified health insurance plans at any time in a demonstration 33
357	357	year if necessary, to remain within the enrollment range and budget targets 34
358	358	for the demonstration year; and 35
359	359	(iii) Developing a methodology for random auto -36 SB278
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363	363
364	364	assignment of program participants into the individual qualified health 1
365	365	insurance plans after a suspension period has ended; 2
366	366	(C) Individual qualified health insurance plans meet and 3
367	367	report quality and performance measurement targets set by the Department of 4
368	368	Human Services; and 5
369	369	(D) At least two (2) health insurers offer individual 6
370	370	qualified health insurance plans in each county in the state. 7
371	371	(d)(1) The Department of Human Services, the State Insurance 8
372	372	Department, and each of the individual qualified health insurance plans shall 9
373	373	enter into a memorandum of understanding that shall specify the duties and 10
374	374	obligations of each party in the operation of the Arkansas Health and 11
375	375	Opportunity for Me Program, including provisions necessary to effectuate the 12
376	376	purchasing guidelines and reporting requir ements, at least thirty (30) 13
377	377	calendar days before the annual open enrollment period. 14
378	378	(2) If a memorandum of understanding is not fully executed with 15
379	379	a health insurer by January 1 of each new demonstration year, the Department 16
380	380	of Human Services shall sus pend auto-assignment of new members to the health 17
381	381	insurers until the first day of the month after the new memorandum of 18
382	382	understanding is fully executed. 19
383	383	(3) The memorandum of understanding shall include financial 20
384	384	sanctions determined appropriate by the Department of Human Services that may 21
385	385	be applied if the Department of Human Services determines that an individual 22
386	386	qualified health insurance plan has not met the quality and performance 23
387	387	measurement targets or any other condition of the memorandum of 24
388	388	understanding. 25
389	389	(4)(A) If the Department of Human Services determines that the 26
390	390	individual qualified health insurance plans have not met the quality and 27
391	391	health performance targets for two (2) years, the Department of Human 28
392	392	Services shall develop additional reforms to achieve the quality and health 29
393	393	performance targets. 30
394	394	(B) If legislative action is required to implement the 31
395	395	additional reforms described in subdivision (d)(4)(A) of this section, the 32
396	396	Department of Human Services may take the action to the Leg islative Council 33
397	397	or the Executive Subcommittee of the Legislative Council for immediate 34
398	398	action. 35
399	399	(e) The Department of Human Services shall: 36 SB278
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403	403
404	404	(1) Adopt premiums and cost -sharing levels for individuals 1
405	405	enrolled in the Arkansas Health and Opportunity for Me Program, not to exceed 2
406	406	aggregate limits under 42 C.F.R. § 447.56; 3
407	407	(2)(A) Establish and maintain a process for premium payments, 4
408	408	advanced cost-sharing reduction payments, and reconciliation payments to 5
409	409	health insurers. 6
410	410	(B) The process described in subdivision (e)(2)(A) of this 7
411	411	section shall attribute any unpaid member liabilities as solely the financial 8
412	412	obligation of the individual member. 9
413	413	(C) The Department of Human Services shall not include any 10
414	414	unpaid individual member obligation in any paym ent or financial 11
415	415	reconciliation with health insurers or in a future premium rate; and 12
416	416	(3)(A) Calculate a total per -member-per-month amount for each 13
417	417	individual qualified health insurance plan based on all payments made by the 14
418	418	Department of Human Services on behalf of an individual enrolled in the 15
419	419	individual qualified health insurance plan. 16
420	420	(B)(i) The amount described in subdivision (e)(3)(A) of 17
421	421	this section shall include premium payments, advanced cost -sharing reduction 18
422	422	payments for services provided to covered individuals during the 19
423	423	demonstration year, and any other payments accruing to the budget neutrality 20
424	424	target for plan-enrolled individuals made during the demonstration year and 21
425	425	the member months for each demonstration year. 22
426	426	(ii) The total per-member-per-month upper limit is 23
427	427	the budget neutrality per -member-per-month limit established in the approved 24
428	428	demonstration for each demonstration year. 25
429	429	(C) If the Department of Human Services calculates that 26
430	430	the total per-member-per-month limit for an individual qualified health 27
431	431	insurance plan for that demonstration year exceeds the budget neutrality per -28
432	432	member-per-month limit for that demonstration year, the Department of Human 29
433	433	Services shall not make any additional reconciliation payments to the hea lth 30
434	434	insurer for that individual qualified health insurance plan. 31
435	435	(D) If the Department of Human Services determines that 32
436	436	the budget neutrality limit has been exceeded, the Department of Human 33
437	437	Services shall recover the excess funds from the health insu rer for that 34
438	438	individual qualified health insurance plan. 35
439	439	(f)(1) If the federal medical assistance percentages for the Arkansas 36 SB278
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443	443
444	444	Health and Opportunity for Me Program are reduced to below ninety percent 1
445	445	(90%), the Department of Human Services shall present to the Centers for 2
446	446	Medicare & Medicaid Services a plan within thirty (30) days of the reduction 3
447	447	to terminate the Arkansas Health and Opportunity for Me Program and 4
448	448	transition eligible individuals out of the Arkansas Health and Opportunity 5
449	449	for Me Program within one hundred twenty (120) days of the reduction. 6
450	450	(2) An eligible individual shall maintain coverage during the 7
451	451	process to implement the plan to terminate the Arkansas Health and 8
452	452	Opportunity for Me Program and the transition of eligible individuals out of 9
453	453	the Arkansas Health and Opportunity for Me Program. 10
454	454	(g)(1) A health insurer that is providing an individual qualified 11
455	455	health insurance plan or employer health insurance coverage for an eligible 12
456	456	individual shall submit claims and enrollment data to the Department of Human 13
457	457	Services to facilitate reporting required under this subchapter or other 14
458	458	state or federally required reporting or evaluation activities. 15
459	459	(2) A health insurer may utilize existing mechanisms with 16
460	460	supplemental enrollment informati on to fulfill requirements under this 17
461	461	subchapter, including without limitation the state's all -payer claims 18
462	462	database established under the Arkansas Healthcare Transparency Initiative 19
463	463	Act of 2015, § 23-61-901 et seq., for claims and enrollment data submissi on. 20
464	464	(h)(1) The Governor shall request a block grant under relevant federal 21
465	465	law and regulations for the funding of the Arkansas Medicaid Program as soon 22
466	466	as practical if the federal law or regulations change to allow the approval 23
467	467	of a block grant for this purpose. 24
468	468	(2) The Governor shall request a waiver under relevant federal 25
469	469	law and regulations for a work requirement as a condition of maintaining 26
470	470	coverage in the Arkansas Medicaid Program as soon as practical if the federal 27
471	471	law or regulations change to allow the approval of a waiver for this purpose. 28
472	472	29
473	473	23-61-1005. Requirements for eligible individuals. 30
474	474	(a) An eligible individual is responsible for all applicable cost -31
475	475	sharing and premium payment requirements as determined by the Department of 32
476	476	Human Services. 33
477	477	(b) An eligible individual may participate in a health improvement 34
478	478	initiative, as developed and implemented by either the eligible individual's 35
479	479	individual qualified health insurance plan or the department. 36 SB278
480	480
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482	482
483	483
484	484	(c)(1)(A) An eligible individual who is determined by the department 1
485	485	to meet the eligibility criteria for a risk -based provider organization due 2
486	486	to serious mental illness or substance use disorder shall be enrolled in a 3
487	487	risk-based provider organization under criteria established by the 4
488	488	department. 5
489	489	(B) An eligible individual who is enrolled in a risk -based 6
490	490	provider organization is exempt from the requirements of subsections (a) and 7
491	491	(b) of this section. 8
492	492	(2)(A) An eligible individual who is determined by the 9
493	493	department to be medically frail shall receive healthcare coverage through 10
494	494	the fee-for-service Arkansas Medicaid Program. 11
495	495	(B) An eligible individual who is enrolled in the fee -for-12
496	496	service Arkansas Medicaid Program is exempt from the requirements of 13
497	497	subsection (a) of this section. 14
498	498	(d) An eligible individual shall receive notice that: 15
499	499	(1) The Arkansas Health and Opportunity for Me Program is not a 16
500	500	perpetual federal or state right or a guaranteed entitlement; 17
501	501	(2) The Arkansas Health and Opportunity for Me Program is 18
502	502	subject to cancellation upon appropriate notice; 19
503	503	(3) Enrollment in an individual qualified health insurance plan 20
504	504	is not a right; and 21
505	505	(4) If the individual chooses not to participate or fails to 22
506	506	meet participation goals in the economic independence initiative, the 23
507	507	individual may lose incentives provided through enrollment in an individual 24
508	508	qualified health insurance plan or be unenrolled from the individual 25
509	509	qualified health insurance plan after notification by the department. 26
510	510	27
511	511	23-61-1006. Requirements for program p articipants. 28
512	512	(a) The economic independence initiative applies to all program 29
513	513	participants in accordance with the implementation schedule of the Department 30
514	514	of Human Services. 31
515	515	(b) Incentives established by the department for participation in the 32
516	516	economic independence initiative and the health improvement initiative may 33
517	517	include, without limitation, the waiver of premium payments and cost -sharing 34
518	518	requirements as determined by the department for participation in one (1) or 35
519	519	more initiatives. 36 SB278
520	520
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522	522
523	523
524	524	(c) Failure by a program participant to meet the cost -sharing and 1
525	525	premium payment requirement under § 23 -61-1005(a) may result in the accrual 2
526	526	of a personal debt to the health insurer or provider. 3
527	527	(d)(1)(A) Failure by the program participant to meet the initiative 4
528	528	participation requirements of subsection (b) of this section may result in: 5
529	529	(i) Being unenrolled from the individual qualified 6
530	530	health insurance plan; or 7
531	531	(ii) The loss of incentives, as defined by the 8
532	532	department. 9
533	533	(B) However, an individual who is u nenrolled shall not 10
534	534	lose Medicaid healthcare coverage based solely on disenrollment from the 11
535	535	individual qualified health insurance plan. 12
536	536	(2) The department shall develop and notify program participants 13
537	537	of the criteria for restoring eligibility for incen tive benefits that were 14
538	538	removed as a result of the program participants' failure to meet the 15
539	539	initiative participation requirements of subsection (b) of this section. 16
540	540	(3)(A) A program participant who also meets the criteria of a 17
541	541	community bridge organiza tion target population may qualify for additional 18
542	542	incentives by successfully completing the economic independence initiative 19
543	543	provided through a community bridge organization. 20
544	544	(B) If successfully completing the initiative results in 21
545	545	an increase in the p rogram participant's income that exceeds the program's 22
546	546	financial eligibility limits, a program participant may receive, for a 23
547	547	specified period of time, financial assistance to pay: 24
548	548	(i) The individual's share of employer -sponsored 25
549	549	health insurance cove rage not to exceed a limit determined by the department; 26
550	550	or 27
551	551	(ii) A share of the individual's cost -sharing 28
552	552	obligation, as determined by the department, if the individual enrolls in a 29
553	553	health insurance benefit plan offered through the Arkansas Health Ins urance 30
554	554	Marketplace. 31
555	555	32
556	556	23-61-1007. Insurance standards for individual qualified health 33
557	557	insurance plans. 34
558	558	(a) Insurance coverage for a member enrolled in an individual 35
559	559	qualified health insurance plan shall be obtained, at a minimum, through 36 SB278
560	560
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562	562
563	563
564	564	silver-level metallic plans as provided in 42 U.S.C. § 18022(d) and § 18071, 1
565	565	as they existed on January 1, 2021, that restrict out -of-pocket costs to 2
566	566	amounts that do not exceed applicable out -of-pocket cost limitations. 3
567	567	(b) As provided under § 23 -61-1004(e)(2), health insurers shall track 4
568	568	the applicable premium payments and cost sharing collected from members to 5
569	569	ensure that the total amount of an individual's payments for premiums and 6
570	570	cost sharing does not exceed the aggregate cap imposed by 42 C.F.R. § 447.56. 7
571	571	(c) All health benefit plans purchased by the Department of Human 8
572	572	Services shall: 9
573	573	(1) Conform to the requirements of this section and applicable 10
574	574	insurance rules; 11
575	575	(2) Be certified by the State Insurance Department; 12
576	576	(3)(A) Maintain a medical -loss ratio of at least eighty percent 13
577	577	(80%) for an individual qualified health insurance plan as required under 45 14
578	578	C.F.R. § 158.210(c), as it existed on January 1, 2021, or rebate the 15
579	579	difference to the Department of Human Services for members. 16
580	580	(B) However, the De partment of Human Services may approve 17
581	581	up to one percent (1%) of revenues as community investments and as benefit 18
582	582	expenses in calculating the medical -loss ratio of a plan in accordance with 19
583	583	45 C.F.R. § 158.150; 20
584	584	(4) Develop: 21
585	585	(A) An annual quality ass essment and performance 22
586	586	improvement strategic plan to be approved by the Department of Human Services 23
587	587	that aligns with federal quality improvement initiatives and quality and 24
588	588	reporting requirements of the Department of Human Services; and 25
589	589	(B) Targeted initiatives based on requirements established 26
590	590	by the Department of Human Services in consultation with the Department of 27
591	591	Health; and 28
592	592	(5) Make reports to the Department of Human Services and the 29
593	593	Department of Health regarding quality and performance metr ics in a manner 30
594	594	and frequency established by a memorandum of understanding. 31
595	595	(d) A health insurer offering individual qualified health insurance 32
596	596	plans for members shall participate in the Arkansas Patient -Centered Medical 33
597	597	Home Program, including: 34
598	598	(1) Attributing enrollees in individual qualified health 35
599	599	insurance plans, including members, to a primary care physician; 36 SB278
600	600
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602	602
603	603
604	604	(2) Providing financial support to patient -centered medical 1
605	605	homes to meet practice transformation milestones; and 2
606	606	(3) Supplying clinical performance data to patient -centered 3
607	607	medical homes, including data to enable patient -centered medical homes to 4
608	608	assess the relative cost and quality of healthcare providers to whom patient -5
609	609	centered medical homes refer patients. 6
610	610	(e)(1) Each individual qualified health insurance plan shall provide 7
611	611	for a health improvement initiative, subject to the review and approval of 8
612	612	the Department of Human Services, to provide incentives to its enrolled 9
613	613	members to participate in one (1) or more health improvement i nitiatives as 10
614	614	defined in § 23-61-1003(9). 11
615	615	(2)(A) The Department of Human Services shall work with health 12
616	616	insurers offering individual qualified health insurance plans to ensure the 13
617	617	economic independence initiative offered by the health insurer includes a 14
618	618	robust outreach and communications effort which targets specific health, 15
619	619	education, training, employment, and other opportunities appropriate for its 16
620	620	enrolled members. 17
621	621	(B) The outreach and communications effort shall recognize 18
622	622	that enrolled members r eceive information from multiple channels, including 19
623	623	without limitation: 20
624	624	(i) Community service organizations; 21
625	625	(ii) Local community outreach partners; 22
626	626	(iii) Email; 23
627	627	(iv) Radio; 24
628	628	(v) Religious organizations; 25
629	629	(vi) Social media; 26
630	630	(vii) Television; 27
631	631	(viii) Text message; and 28
632	632	(ix) Traditional methods such as newspaper or mail. 29
633	633	(f) On or before January 1, 2022, the State Insurance Department and 30
634	634	the Department of Human Services may implement through certification 31
635	635	requirements or rule, or both, the applicable provisions of this section. 32
636	636	33
637	637	23-61-1009. Sunset. 34
638	638	This subchapter shall expire on December 31, 2026. 35
639	639	36 SB278
640	640
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642	642
643	643
644	644	23-61-1010. Community bridge organizations. 1
645	645	(a) The Department of Human Services shall develop requirements and 2
646	646	qualifications for community bridge organizations to provide assistance to 3
647	647	one (1) or more of the following target populations: 4
648	648	(1) Individuals who become pregnant with a high -risk pregnancy 5
649	649	and the child, throughout the pregnancy and up to twenty -four (24) months 6
650	650	after birth; 7
651	651	(2) Individuals in rural areas of the state in need of treatment 8
652	652	for serious mental illness or substance use disorder; 9
653	653	(3) Individuals who are young adults most at risk of poor health 10
654	654	due to long-term poverty and who meet cr iteria established by the Department 11
655	655	of Human Services, including without limitation the following: 12
656	656	(A) An individual between nineteen (19) and twenty -four 13
657	657	(24) years of age who has been previously placed under the supervision of 14
658	658	the: 15
659	659	(i) Division of Youth Services; or 16
660	660	(ii) Department of Corrections; 17
661	661	(B) An individual between nineteen (19) and twenty -seven 18
662	662	(27) years of age who has been previously placed under the supervision of the 19
663	663	Division of Children and Family Services; or 20
664	664	(C) An individual between nineteen (19) and thirty (30) 21
665	665	years of age who is a veteran; and 22
666	666	(4) Any other target populations identified by the Department of 23
667	667	Human Services. 24
668	668	(b)(1) Each community bridge organization shall be administered by a 25
669	669	hospital under conditions established by the Department of Human Services. 26
670	670	(2) A hospital is eligible to serve eligible individuals under 27
671	671	subdivision (a)(1) of this section if the hospital: 28
672	672	(A) Is a birthing hospital; 29
673	673	(B) Provides or contracts with a qualified e ntity for the 30
674	674	provision of a federally recognized evidence -based home visitation model to a 31
675	675	woman during pregnancy and to the woman and child for a period of up to 32
676	676	twenty-four (24) months after birth; and 33
677	677	(C) Meets any additional criteria established b y the 34
678	678	Department of Human Services. 35
679	679	(3)(A) A hospital is eligible to serve eligible individuals 36 SB278
680	680
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682	682
683	683
684	684	under subdivision (a)(2) of this section if the hospital: 1
685	685	(i) Is a small rural hospital; 2
686	686	(ii) Screens all Arkansans who seek services at the 3
687	687	hospital for health-related social needs; 4
688	688	(iii) Refers Arkansans identified as having health -5
689	689	related social needs for social services available in the community; 6
690	690	(iv) Employs local qualified staff to assist 7
691	691	eligible individuals in need of treatment for serious mental illness or 8
692	692	substance use disorder in accessing medical treatment from healthcare 9
693	693	professionals and supports to meet health -related social needs; 10
694	694	(v) Enrolls with the Arkansas Medicaid Program as an 11
695	695	acute crisis unit provider; and 12
696	696	(vi) Meets any additional criteria established by 13
697	697	the Department of Human Services. 14
698	698	(B) The hospital may use funding available through the 15
699	699	Department of Human Services to improve the hospital's ability to deliver 16
700	700	care through coordination with other he althcare professionals and with the 17
701	701	local emergency response system that may include training of personnel and 18
702	702	improvements in equipment to support the delivery of medical services through 19
703	703	telemedicine. 20
704	704	(4) A hospital is eligible to serve eligible indiv iduals under 21
705	705	subdivision (a)(3) of this section if the hospital: 22
706	706	(A) Is an acute care hospital; 23
707	707	(B) Administers or contracts for the administration of 24
708	708	programs using proven models, as defined by the Department of Human Services, 25
709	709	to provide employment, training, education, or other social supports; and 26
710	710	(C) Meets any additional criteria established by the 27
711	711	Department of Human Services. 28
712	712	(c) An individual is not required or entitled to enroll in a community 29
713	713	bridge organization as a condition of Med icaid eligibility. 30
714	714	(d) A hospital is not: 31
715	715	(1) Required to apply to become a community bridge organization; 32
716	716	or 33
717	717	(2) Entitled to be selected as a community bridge organization. 34
718	718	35
719	719	23-61-1011. Health and Economic Outcomes Accountability Oversight 36 SB278
720	720
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722	722
723	723
724	724	Advisory Panel. 1
725	725	(a) There is created the Health and Economic Outcomes Accountability 2
726	726	Oversight Advisory Panel. 3
727	727	(b) The advisory panel shall be composed of the following members: 4
728	728	(1) The following members of the General Assembly: 5
729	729	(A) The Chair of the Senate Committee on Public Health, 6
730	730	Welfare, and Labor; 7
731	731	(B) The Chair of the House Committee on Public Health, 8
732	732	Welfare, and Labor; 9
733	733	(C) The Chair of the Senate Committee on Education; 10
734	734	(D) The Chair of the House Committee on Education; 11
735	735	(E) The Chair of the Senate Committee on Insurance and 12
736	736	Commerce; 13
737	737	(F) The Chair of the House Committee on Insurance and 14
738	738	Commerce; 15
739	739	(G) An at-large member of the Senate appointed by the 16
740	740	President Pro Tempore of the Senate; 17
741	741	(H) An at-large member of the House of Representatives 18
742	742	appointed by the Speaker of the House of Representatives; 19
743	743	(I) An at-large member of the Senate appointed by the 20
744	744	minority leader of the Senate; and 21
745	745	(J) An at-large member of the House of Representatives 22
746	746	appointed by the minority leader of the House of Representatives; 23
747	747	(2) The Secretary of the Department of Human Services; 24
748	748	(3) The Arkansas Surgeon General; 25
749	749	(4) The Insurance Commissioner; 26
750	750	(5) The heads of the following executive branch agencies or 27
751	751	their designees: 28
752	752	(A) Department of Health; 29
753	753	(B) Department of Education; 30
754	754	(C) Department of Corrections; 31
755	755	(D) Department of Commerce; and 32
756	756	(E) Department of Finance and Administration; 33
757	757	(6) The Executive Director of the Arkansas Minority Health 34
758	758	Commission; and 35
759	759	(7)(A) Three (3) community members who represent health, 36 SB278
760	760
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762	762
763	763
764	764	business, or education, who reflect the broad racial and geographic diversity 1
765	765	in the state, and who have demonstrated a commitment to improving the health 2
766	766	and welfare of Arkansans, appoin ted as follows: 3
767	767	(i) One (1) member shall be appointed by and serve 4
768	768	at the will of the Governor; 5
769	769	(ii) One (1) member shall be appointed by and serve 6
770	770	at the will of the President Pro Tempore of the Senate; and 7
771	771	(iii) One (1) member shall be appointed by and serve 8
772	772	at the will of the Speaker of the House of Representatives. 9
773	773	(B) Members serving under subdivision (b)(7)(A) of this 10
774	774	section may receive mileage reimbursement. 11
775	775	(c)(1) The Secretary of the Department of Human Services and one (1) 12
776	776	legislative member shall serve as the cochairs of the Health and Economic 13
777	777	Outcomes Accountability Oversight Advisory Panel and shall convene meetings 14
778	778	quarterly of the advisory panel. 15
779	779	(2) The legislative member who serves as the cochair shall be 16
780	780	selected by majority vote of all legislative members serving on the advisory 17
781	781	panel. 18
782	782	(d)(1) The advisory panel shall review, make nonbinding 19
783	783	recommendations, and provide advice concerning the proposed quality 20
784	784	performance targets presented by the Department of Hu man Services for each 21
785	785	participating individual qualified health insurance plan. 22
786	786	(2) The advisory panel shall deliver all nonbinding 23
787	787	recommendations to the Secretary of the Department of Human Services. 24
788	788	(3)(A) The Secretary of the Department of Human Services, in 25
789	789	consultation with the State Medicaid Director, shall determine all quality 26
790	790	performance targets for each participating individual qualified health 27
791	791	insurance plan. 28
792	792	(B) The Secretary of the Department of Human Services may 29
793	793	consider the nonbinding recommendations of the advisory panel when 30
794	794	determining quality performance targets for each participating individual 31
795	795	qualified health insurance plan. 32
796	796	(e) The advisory panel shall review: 33
797	797	(1) The annual quality assessment and performance improveme nt 34
798	798	strategic plan for each participating individual qualified health insurance 35
799	799	plan; 36 SB278
800	800
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802	802
803	803
804	804	(2) Financial performance of the Arkansas Health and Opportunity 1
805	805	for Me Program against the budget neutrality targets in each demonstration 2
806	806	year; 3
807	807	(3) Quarterly repor ts prepared by the Department of Human 4
808	808	Services, in consultation with the Department of Commerce, on progress 5
809	809	towards meeting economic independence outcomes and health improvement 6
810	810	outcomes, including without limitation: 7
811	811	(A) Community bridge organizatio n outcomes; 8
812	812	(B) Individual qualified health insurance plan health 9
813	813	improvement outcomes; 10
814	814	(C) Economic independence initiative outcomes; and 11
815	815	(D) Any sanctions or penalties assessed on participating 12
816	816	individual qualified health insurance plans; 13
817	817	(4) Quarterly reports prepared by the Department of Human 14
818	818	Services on the Arkansas Health and Opportunity for Me Program, including 15
819	819	without limitation: 16
820	820	(A) Eligibility and enrollment; 17
821	821	(B) Utilization; 18
822	822	(C) Premium and cost -sharing reduction cost s; and 19
823	823	(D) Health insurer participation and competition; and 20
824	824	(5) Any other topics as requested by the Secretary of the 21
825	825	Department of Human Services. 22
826	826	(f)(1) The advisory panel may furnish advice, gather information, make 23
827	827	recommendations, and publis h reports. 24
828	828	(2) However, the advisory panel shall not administer any portion 25
829	829	of the Arkansas Health and Opportunity for Me Program or set policy. 26
830	830	(g) The Department of Human Services shall provide administrative 27
831	831	support necessary for the advisory panel to perform its duties. 28
832	832	(h) The Department of Human Services shall produce and submit a 29
833	833	quarterly report incorporating the advisory panel's findings to the President 30
834	834	Pro Tempore of the Senate, the Speaker of the House of Representatives, and 31
835	835	the public on the progress in health and economic improvement resulting from 32
836	836	the Arkansas Health and Opportunity for Me Program, including without 33
837	837	limitation: 34
838	838	(1) Eligibility and enrollment; 35
839	839	(2) Participation in and the impact of the economic independence 36 SB278
840	840
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842	842
843	843
844	844	initiative and the health improvement initiative of the eligible individuals, 1
845	845	health insurers, and community bridge organizations; 2
846	846	(3) Utilization of medical services; 3
847	847	(4) Premium and cost -sharing reduction costs; and 4
848	848	(5) Health insurer participation and completion. 5
849	849	6
850	850	23-61-1012. Rules. 7
851	851	The Department of Human Services shall adopt rules necessary to 8
852	852	implement this subchapter. 9
853	853	10
854	854	SECTION 8. Arkansas Code § 26 -57-604(a)(1)(B)(ii), concerning the 11
855	855	allowance of a credit to be applied against the insurance premium tax, is 12
856	856	amended to read as follows: 13
857	857	(ii) However, the credit shall not be applied as an 14
858	858	offset against the premium tax on collections resulting from an eligible 15
859	859	individual insured under the Arkansas Health and Opportunity for Me Act of 16
860	860	2021, § 23-61-1001 et seq., the Arkansas Health Insurance Marketplace Act, § 17
861	861	23-61-801 et seq., or individual qualified health insurance plans, including 18
862	862	without limitation stand -alone dental plans, issued through the health 19
863	863	insurance marketplace as defined by § 23-61-1003. 20
864	864	21
865	865	SECTION 9. Arkansas Code § 26 -57-610(b)(2), concerning the disposition 22
866	866	of the insurance premium tax, is amended to read as follows: 23
867	867	(2) The taxes based on premiums collected under the Arkansas 24
868	868	Health and Opportunity for Me Act of 2021, § 23-61-1001 et seq., the Arkansas 25
869	869	Health Insurance Marketplace Act, § 23 -61-801 et seq., or individual 26
870	870	qualified health insurance plans, including without limitation stand -alone 27
871	871	dental plans, issued through the health insurance marketplace as defined by § 28
872	872	23-61-1003 shall be: 29
873	873	(A) At at the time of deposit, separately certified by the 30
874	874	commissioner to the Treasurer of State for classification and distribution 31
875	875	under this section; and 32
876	876	(B) Transferred to the Arkansas Health and Opportunity for 33
877	877	Me Program Trust Fund and used as required by the Arkansas Health and 34
878	878	Opportunity for Me Program Trust Fund; 35
879	879	36