Stricken language would be deleted from and underlined language would be added to present law.
*JMB252* 2/15/2023 10:56:06 AM JMB252
State of Arkansas 1
94th General Assembly A Bill 2
Regular Session, 2023 SENATE BILL 278 3
4
By: Senator B. King 5
By: Representative Miller 6
7
For An Act To Be Entitled 8
AN ACT TO TERMINATE THE ARKANSAS HEALTH AND 9
OPPORTUNITY FOR ME P ROGRAM; TO TRANSFER ALL 10
BENEFICIARIES IN THE ARKANSAS HOME AND OP PORTUNITY 11
FOR ME PROGRAM TO TH E TRADITIONAL ARKANS AS MEDICAID 12
PROGRAM; TO REPEAL T HE ARKANSAS HEALTH A ND 13
OPPORTUNITY FOR ME A CT OF 2021; AND FOR OTH ER 14
PURPOSES. 15
16
17
Subtitle 18
TO TERMINATE THE ARKANSAS HEALTH AND 19
OPPORTUNITY FOR ME PROGRAM; AND TO 20
TRANSFER ALL BENEFICIARIES IN THE 21
ARKANSAS HOME AND OPPORTUNITY FOR ME 22
PROGRAM TO THE TRADITIONAL ARKANSAS 23
MEDICAID PROGRAM. 24
25
26
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF ARKANSAS: 27
28
SECTION 1. DO NOT CODIFY. Legislative intent. 29
It is the intent of the General Assembly to: 30
(1) Repeal the Arkansas Health and Opportunity for Me Program; 31
(2) Amend various sections of t he Arkansas Code to end 32
Arkansas's participation in the Arkansas Health and Opportunity for Me 33
Program; and 34
(3) Instruct the Governor to submit a waiver to: 35
(A) Transfer all individuals enrolled and participating in 36 SB278
2 2/15/2023 10:56:06 AM JMB252
the Arkansas Health and Opportuni ty for Me Program to the traditional 1
Medicaid program on and after July 1, 2023; and 2
(B) Terminate the Arkansas Health and Opportunity for Me 3
Program on December 31, 2024. 4
5
SECTION 2. DO NOT CODIFY. Arkansas Health and Opportunity for Me 6
Program. 7
(a) The Department of Human Services shall: 8
(1) Notify all persons enrolled in the Arkansas Health and 9
Opportunity for Me Program as of the effective date of this act that the 10
Arkansas Health and Opportunity for Me Program ends on December 31, 2024; 11
(2) Inform a new enrollee in the Arkansas Health and Opportunity 12
for Me Program after the effective date of this act that the Arkansas Health 13
and Opportunity for Me Program ends on December 31, 2024; and 14
(3) Transfer all persons enrolled in the Arkansas Health and 15
Opportunity for Me Program or any person who enrolled in the Arkansas Health 16
and Opportunity for Me Program after July 1, 2023, to coverage under the 17
traditional Medicaid program on July 1, 2023. 18
(b) The department may prohibit new enrollees in the Arkansas Health 19
and Opportunity for Me Program to begin the transition period before the 20
termination date of December 31, 2024. 21
(c) On the effective date of this act, the department shall submit any 22
Medicaid state plan amendments and federal waive rs necessary to eliminate the 23
eligibility in the Arkansas Health and Opportunity for Me Program after 24
December 31, 2024. 25
(d) This section does not prohibit the payment of expenses incurred 26
before December 31, 2024, by persons participating in the Arkansa s Health and 27
Opportunity for Me Program. 28
29
SECTION 3. Arkansas Code § 19 -5-984(b)(2)(D), concerning the Division 30
of Workforce Services Special Fund, is repealed. 31
(D) The Arkansas Health and Opportunity for Me Act of 32
2021, § 23-61-1001 et seq., or its successor; and 33
34
SECTION 4. Arkansas Code § 19 -5-1146 is repealed. 35
19-5-1146. Arkansas Health and Opportunity for Me Program Trust Fund. 36 SB278
3 2/15/2023 10:56:06 AM JMB252
(a) There is created on the books of the Treasurer of State, the 1
Auditor of State, and the Chief Fiscal Officer of the State a trust fund to 2
be known as the “Arkansas Health and Opportunity for Me Program Trust Fund”. 3
(b) The fund shall consist of: 4
(1) Moneys saved and accrued under the Arkansas Health and 5
Opportunity for Me Act of 2021, § 23 -61-1001 et seq., including without 6
limitation: 7
(A) Increases in premium tax collections; and 8
(B) Other spending reductions resulting from the Arkansas 9
Health and Opportunity for Me Act of 2021, § 23 -61-1001 et seq.; and 10
(2) Other revenues and funds authorized by la w. 11
(c) The Department of Human Services shall use the fund to pay for 12
future obligations under the Arkansas Health and Opportunity for Me Program 13
created by the Arkansas Health and Opportunity for Me Act of 2021, § 23 -61-14
1001 et seq. 15
16
SECTION 5. Arkansas Code § 23-61-803(h), concerning the Arkansas 17
Health Insurance Marketplace, is amended to read as follows: 18
(h) The State Insurance Department and any eligible entity under 19
subdivision (e)(2) of this section shall provide claims and other plan and 20
enrollment data to the Department of Human Services upon request to : 21
(1) Facilitate facilitate compliance with reporting requirements 22
under state and federal law ; and 23
(2) Assess the performance of the Arkansas Health and 24
Opportunity for Me Program established by the Arkansas Health and Opportunity 25
for Me Act of 2021, § 23 -61-1001 et seq., including without limitation the 26
program's quality, cost, and consumer access . 27
28
SECTION 6. Arkansas Code Title 23, Chapter 16, Subchapter 10, is 29
repealed. 30
31
Subchapter 10 — Arkansas Health and Opportunity for Me Act of 2021 32
33
23-61-1001. Title. 34
This subchapter shall be known and may be cited as the “Arkansas Health 35
and Opportunity for Me Act of 2021”. 36 SB278
4 2/15/2023 10:56:06 AM JMB252
1
23-61-1002. Legislative intent. 2
Notwithstanding any genera l or specific laws to the contrary, it is the 3
intent of the General Assembly for the Arkansas Health and Opportunity for Me 4
Program to be a fiscally sustainable, cost -effective, and opportunity -driven 5
program that: 6
(1) Achieves comprehensive and innovat ive healthcare reform that 7
reduces the rate of growth in state and federal obligations for providing 8
healthcare coverage to low -income adults in Arkansas; 9
(2) Reduces the maternal and infant mortality rates in the state 10
through initiatives that promote healthy outcomes for eligible women with 11
high-risk pregnancies; 12
(3) Promotes the health, welfare, and stability of mothers and 13
their infants after birth through hospital -based community bridge 14
organizations; 15
(4) Encourages personal responsibility for individuals to 16
demonstrate that they value healthcare coverage and understand their roles 17
and obligations in maintaining private insurance coverage; 18
(5) Increases opportunities for full -time work and attainment of 19
economic independence, especially for certain young adults, to reduce long -20
term poverty that is associated with additional risk for disease and 21
premature death; 22
(6) Addresses health -related social needs of Arkansans in rural 23
counties through hospital -based community bridge organizations and reduces 24
the additional risk for disease and premature death associated with living in 25
a rural county; 26
(7) Strengthens the financial stability of the critical access 27
hospitals and other small, rural hospitals; and 28
(8) Fills gaps in the continuum of c are for individuals in need 29
of services for serious mental illness and substance use disorders. 30
31
23-61-1003. Definitions. 32
As used in this subchapter: 33
(1) “Acute care hospital” means a hospital that: 34
(A) Is licensed by the Department of Health und er § 20-9-35
201 et seq., as a general hospital or a surgery and general medical care 36 SB278
5 2/15/2023 10:56:06 AM JMB252
hospital; and 1
(B) Is enrolled as a provider with the Arkansas Medicaid 2
Program; 3
(2) “Birthing hospital” means a hospital in this state or in a 4
border state that: 5
(A) Is licensed as a general hospital; 6
(B) Provides obstetrics services; and 7
(C) Is enrolled as a provider with the Arkansas Medicaid 8
Program; 9
(3) “Community bridge organization” means an organization that 10
is authorized by the Department of Huma n Services to participate in the 11
economic independence initiative or the health improvement initiative to: 12
(A) Screen and refer Arkansans to resources available in 13
their communities to address health -related social needs; and 14
(B) Assist eligible in dividuals identified as target 15
populations most at risk of disease and premature death and who need a higher 16
level of intervention to improve their health outcomes and succeed in meeting 17
their long-term goals to achieve independence, including economic 18
independence; 19
(4) “Cost sharing” means the portion of the cost of a covered 20
medical service that is required to be paid by or on behalf of an eligible 21
individual; 22
(5) “Critical access hospital” means an acute care hospital that 23
is: 24
(A) Designated by the Centers for Medicare & Medicaid 25
Services as a critical access hospital; and 26
(B) Is enrolled as a provider in the Arkansas Medicaid 27
Program; 28
(6) “Economic independence initiative” means an initiative 29
developed by the Department of Human Services that is designed to promote 30
economic stability by encouraging participation of program participants to 31
engage in full-time, full-year work, and to demonstrate the value of 32
enrollment in an individual qualified health insurance plan through 33
incentives and disincentives; 34
(7) “Eligible individual” means an individual who is in the 35
eligibility category created by section 1902(a)(10)(A)(i)(VIII) of the Social 36 SB278
6 2/15/2023 10:56:06 AM JMB252
Security Act, 42 U.S.C. § 1396a; 1
(8) “Employer health insurance coverage” means a health 2
insurance benefit plan offered by an employer or, as authorized by this 3
subchapter, an employer self -funded insurance plan governed by the Employee 4
Retirement Income Security Act of 1974, Pub. L. No. 93 -406, as amended; 5
(9) “Health improvement initiative” means an initiative 6
developed by an individual qualified health insurance plan or the Department 7
of Human Services that is designed to encourage the participation of eligible 8
individuals in health assessments and wellness programs, including fitness 9
programs and smoking or tobacco cessation programs; 10
(10) “Health insurance benefit plan” means a policy, contract, 11
certificate, or agreement offered or issued by a health insurer to provide, 12
deliver, arrange for, pay for, or reimburse any of the costs of healthcar e 13
services, but not including excepted benefits as defined under 42 U.S.C. § 14
300gg-91(c), as it existed on January 1, 2021; 15
(11) “Health insurance marketplace” means the applicable 16
entities that were designed to help individuals, families, and businesse s in 17
Arkansas shop for and select health insurance benefit plans in a way that 18
permits comparison of available plans based upon price, benefits, services, 19
and quality, and refers to either: 20
(A) The Arkansas Health Insurance Marketplace created 21
under the Arkansas Health Insurance Marketplace Act, § 23 -61-801 et seq., or 22
a successor entity; or 23
(B) The federal health insurance marketplace or federal 24
health benefit exchange created under the Patient Protection and Affordable 25
Care Act, Pub. L. No. 111 -148; 26
(12) “Health insurer” means an insurer authorized by the State 27
Insurance Department to provide health insurance or a health insurance 28
benefit plan in the State of Arkansas, including without limitation: 29
(A) An insurance company; 30
(B) A medical services plan; 31
(C) A hospital plan; 32
(D) A hospital medical service corporation; 33
(E) A health maintenance organization; 34
(F) A fraternal benefits society; 35
(G) Any other entity providing health insurance or a 36 SB278
7 2/15/2023 10:56:06 AM JMB252
health insurance benefit plan subject to state insurance regulation; or 1
(H) A risk-based provider organization licensed by the 2
Insurance Commissioner under § 20 -77-2704; 3
(13) “Healthcare coverage” means coverage provided under this 4
subchapter through either an individual qualif ied health insurance plan, a 5
risk-based provider organization, employer health insurance coverage, or the 6
fee-for-service Arkansas Medicaid Program; 7
(14) “Individual qualified health insurance plan” means an 8
individual health insurance benefit plan offe red by a health insurer that 9
participates in the health insurance marketplace to provide coverage in 10
Arkansas that covers only essential health benefits as defined by Arkansas 11
rule and 45 C.F.R. § 156.110 and any federal insurance regulations, as they 12
existed on January 1, 2021; 13
(15) “Member” means a program participant who is enrolled in an 14
individual qualified health insurance plan; 15
(16) “Premium” means a monthly fee that is required to be paid 16
by or on behalf of an eligible individual to maintain s ome or all health 17
insurance benefits; 18
(17) “Program participant” means an eligible individual who: 19
(A) Is at least nineteen (19) years of age and no more 20
than sixty-four (64) years of age with an income that meets the income 21
eligibility standards es tablished by rule of the Department of Human 22
Services; 23
(B) Is authenticated to be a United States citizen or 24
documented qualified alien according to the Personal Responsibility and Work 25
Opportunity Reconciliation Act of 1996, Pub. L. No. 104 -193; 26
(C) Is not eligible for Medicare or advanced premium tax 27
credits through the health insurance marketplace; and 28
(D) Is not determined by the Department of Human Services 29
to be medically frail or eligible for services through a risk -based provider 30
organization; 31
(18) “Risk-based provider organization” means the same as 32
defined in § 20-77-2703; and 33
(19) “Small rural hospital” means a critical access hospital or 34
a general hospital that: 35
(A) Is located in a rural area; 36 SB278
8 2/15/2023 10:56:06 AM JMB252
(B) Has fifty (50) o r fewer staffed beds; and 1
(C) Is enrolled as a provider in the Arkansas Medicaid 2
Program. 3
4
23-61-1004. Administration. 5
(a)(1) The Department of Human Services, in coordination with the 6
State Insurance Department and other state agencies, as necessa ry, shall: 7
(A) Provide healthcare coverage under this subchapter to 8
eligible individuals; 9
(B) Create and administer the Arkansas Health and 10
Opportunity for Me Program by: 11
(i) Applying for any federal waivers, Medicaid state 12
plan amendments, or other authority necessary to implement the Arkansas 13
Health and Opportunity for Me Program in a manner consistent with this 14
subchapter; and 15
(ii) Administering the Arkansas Health and 16
Opportunity for Me Program as approved by the Centers for Medicare & Medicaid 17
Services; 18
(C)(i) Administer the economic independence initiative 19
designed to reduce the short -term effects of the work penalty and the long -20
term effects of poverty on health outcomes among program participants through 21
incentives and disincentives. 22
(ii) The Department of Human Services shall align 23
the economic independence initiative with other state -administered work-24
related programs to the extent practicable; 25
(D) Screen, refer, and assist eligible individuals through 26
community bridge organizations under agreements with the Department of Human 27
Services; 28
(E) Offer incentives to promote personal responsibility, 29
individual health, and economic independence through individual qualified 30
health insurance plans and community brid ge organizations; and 31
(F) Seek a waiver to reduce the period of retroactive 32
eligibility for an eligible individual under this subchapter to thirty (30) 33
days before the date of the application. 34
(2) The Governor shall request the assistance and involv ement of 35
other state agencies that he or she deems necessary for the implementation of 36 SB278
9 2/15/2023 10:56:06 AM JMB252
the Arkansas Health and Opportunity for Me Program. 1
(b) Healthcare coverage under this subchapter shall be provided 2
through enrollment in: 3
(1) An individual qualifi ed health insurance plan through a 4
health insurer; 5
(2) A risk-based provider organization; 6
(3) An employer-sponsored health insurance coverage; or 7
(4) The fee-for-service Arkansas Medicaid Program. 8
(c) Annually, the Department of Human Services shall develop 9
purchasing guidelines that: 10
(1) Describe which individual qualified health insurance plans 11
are suitable for purchase in the next demonstration year, including without 12
limitation: 13
(A) The level of the plan; 14
(B) The amounts of allowa ble premiums; 15
(C) Cost sharing; 16
(D) Auto-assignment methodology; and 17
(E) The total per-member-per-month enrollment range; and 18
(2) Ensure that: 19
(A) Payments to an individual qualified health insurance 20
plan do not exceed budget neutrality limitations in each demonstration year; 21
(B) The total payments to all of the individual qualified 22
health insurance plans offered by the health insurers for eligible 23
individuals combined do not exceed budget targets for the Arkansas Health and 24
Opportunity for Me Program in each demonstration year that the Department of 25
Human Services may achieve by: 26
(i) Setting in advance an enrollment range to 27
represent the minimum and a maximum total monthly number of enrollees into 28
all individual qualified health insurance plans no later than April 30 of 29
each demonstration year in order for the individual qualified health 30
insurance plans to file rates for the following demonstration year; 31
(ii) Temporarily suspending auto -assignment into the 32
individual qualified health insurance plans at any time in a demonstration 33
year if necessary, to remain within the enrollment range and budget targets 34
for the demonstration year; and 35
(iii) Developing a methodology for random auto -36 SB278
10 2/15/2023 10:56:06 AM JMB252
assignment of program participants into the individual qualified health 1
insurance plans after a suspension period has ended; 2
(C) Individual qualified health insurance plans meet and 3
report quality and performance measurement targets set by the Department of 4
Human Services; and 5
(D) At least two (2) health insurers offer individual 6
qualified health insurance plans in each county in the state. 7
(d)(1) The Department of Human Services, the State Insurance 8
Department, and each of the individual qualified health insurance plans shall 9
enter into a memorandum of understanding that shall specify the duties and 10
obligations of each party in the operation of the Arkansas Health and 11
Opportunity for Me Program, including provisions necessary to effectuate the 12
purchasing guidelines and reporting requir ements, at least thirty (30) 13
calendar days before the annual open enrollment period. 14
(2) If a memorandum of understanding is not fully executed with 15
a health insurer by January 1 of each new demonstration year, the Department 16
of Human Services shall sus pend auto-assignment of new members to the health 17
insurers until the first day of the month after the new memorandum of 18
understanding is fully executed. 19
(3) The memorandum of understanding shall include financial 20
sanctions determined appropriate by the Department of Human Services that may 21
be applied if the Department of Human Services determines that an individual 22
qualified health insurance plan has not met the quality and performance 23
measurement targets or any other condition of the memorandum of 24
understanding. 25
(4)(A) If the Department of Human Services determines that the 26
individual qualified health insurance plans have not met the quality and 27
health performance targets for two (2) years, the Department of Human 28
Services shall develop additional reforms to achieve the quality and health 29
performance targets. 30
(B) If legislative action is required to implement the 31
additional reforms described in subdivision (d)(4)(A) of this section, the 32
Department of Human Services may take the action to the Leg islative Council 33
or the Executive Subcommittee of the Legislative Council for immediate 34
action. 35
(e) The Department of Human Services shall: 36 SB278
11 2/15/2023 10:56:06 AM JMB252
(1) Adopt premiums and cost -sharing levels for individuals 1
enrolled in the Arkansas Health and Opportunity for Me Program, not to exceed 2
aggregate limits under 42 C.F.R. § 447.56; 3
(2)(A) Establish and maintain a process for premium payments, 4
advanced cost-sharing reduction payments, and reconciliation payments to 5
health insurers. 6
(B) The process described in subdivision (e)(2)(A) of this 7
section shall attribute any unpaid member liabilities as solely the financial 8
obligation of the individual member. 9
(C) The Department of Human Services shall not include any 10
unpaid individual member obligation in any paym ent or financial 11
reconciliation with health insurers or in a future premium rate; and 12
(3)(A) Calculate a total per -member-per-month amount for each 13
individual qualified health insurance plan based on all payments made by the 14
Department of Human Services on behalf of an individual enrolled in the 15
individual qualified health insurance plan. 16
(B)(i) The amount described in subdivision (e)(3)(A) of 17
this section shall include premium payments, advanced cost -sharing reduction 18
payments for services provided to covered individuals during the 19
demonstration year, and any other payments accruing to the budget neutrality 20
target for plan-enrolled individuals made during the demonstration year and 21
the member months for each demonstration year. 22
(ii) The total per-member-per-month upper limit is 23
the budget neutrality per -member-per-month limit established in the approved 24
demonstration for each demonstration year. 25
(C) If the Department of Human Services calculates that 26
the total per-member-per-month limit for an individual qualified health 27
insurance plan for that demonstration year exceeds the budget neutrality per -28
member-per-month limit for that demonstration year, the Department of Human 29
Services shall not make any additional reconciliation payments to the hea lth 30
insurer for that individual qualified health insurance plan. 31
(D) If the Department of Human Services determines that 32
the budget neutrality limit has been exceeded, the Department of Human 33
Services shall recover the excess funds from the health insu rer for that 34
individual qualified health insurance plan. 35
(f)(1) If the federal medical assistance percentages for the Arkansas 36 SB278
12 2/15/2023 10:56:06 AM JMB252
Health and Opportunity for Me Program are reduced to below ninety percent 1
(90%), the Department of Human Services shall present to the Centers for 2
Medicare & Medicaid Services a plan within thirty (30) days of the reduction 3
to terminate the Arkansas Health and Opportunity for Me Program and 4
transition eligible individuals out of the Arkansas Health and Opportunity 5
for Me Program within one hundred twenty (120) days of the reduction. 6
(2) An eligible individual shall maintain coverage during the 7
process to implement the plan to terminate the Arkansas Health and 8
Opportunity for Me Program and the transition of eligible individuals out of 9
the Arkansas Health and Opportunity for Me Program. 10
(g)(1) A health insurer that is providing an individual qualified 11
health insurance plan or employer health insurance coverage for an eligible 12
individual shall submit claims and enrollment data to the Department of Human 13
Services to facilitate reporting required under this subchapter or other 14
state or federally required reporting or evaluation activities. 15
(2) A health insurer may utilize existing mechanisms with 16
supplemental enrollment informati on to fulfill requirements under this 17
subchapter, including without limitation the state's all -payer claims 18
database established under the Arkansas Healthcare Transparency Initiative 19
Act of 2015, § 23-61-901 et seq., for claims and enrollment data submissi on. 20
(h)(1) The Governor shall request a block grant under relevant federal 21
law and regulations for the funding of the Arkansas Medicaid Program as soon 22
as practical if the federal law or regulations change to allow the approval 23
of a block grant for this purpose. 24
(2) The Governor shall request a waiver under relevant federal 25
law and regulations for a work requirement as a condition of maintaining 26
coverage in the Arkansas Medicaid Program as soon as practical if the federal 27
law or regulations change to allow the approval of a waiver for this purpose. 28
29
23-61-1005. Requirements for eligible individuals. 30
(a) An eligible individual is responsible for all applicable cost -31
sharing and premium payment requirements as determined by the Department of 32
Human Services. 33
(b) An eligible individual may participate in a health improvement 34
initiative, as developed and implemented by either the eligible individual's 35
individual qualified health insurance plan or the department. 36 SB278
13 2/15/2023 10:56:06 AM JMB252
(c)(1)(A) An eligible individual who is determined by the department 1
to meet the eligibility criteria for a risk -based provider organization due 2
to serious mental illness or substance use disorder shall be enrolled in a 3
risk-based provider organization under criteria established by the 4
department. 5
(B) An eligible individual who is enrolled in a risk -based 6
provider organization is exempt from the requirements of subsections (a) and 7
(b) of this section. 8
(2)(A) An eligible individual who is determined by the 9
department to be medically frail shall receive healthcare coverage through 10
the fee-for-service Arkansas Medicaid Program. 11
(B) An eligible individual who is enrolled in the fee -for-12
service Arkansas Medicaid Program is exempt from the requirements of 13
subsection (a) of this section. 14
(d) An eligible individual shall receive notice that: 15
(1) The Arkansas Health and Opportunity for Me Program is not a 16
perpetual federal or state right or a guaranteed entitlement; 17
(2) The Arkansas Health and Opportunity for Me Program is 18
subject to cancellation upon appropriate notice; 19
(3) Enrollment in an individual qualified health insurance plan 20
is not a right; and 21
(4) If the individual chooses not to participate or fails to 22
meet participation goals in the economic independence initiative, the 23
individual may lose incentives provided through enrollment in an individual 24
qualified health insurance plan or be unenrolled from the individual 25
qualified health insurance plan after notification by the department. 26
27
23-61-1006. Requirements for program p articipants. 28
(a) The economic independence initiative applies to all program 29
participants in accordance with the implementation schedule of the Department 30
of Human Services. 31
(b) Incentives established by the department for participation in the 32
economic independence initiative and the health improvement initiative may 33
include, without limitation, the waiver of premium payments and cost -sharing 34
requirements as determined by the department for participation in one (1) or 35
more initiatives. 36 SB278
14 2/15/2023 10:56:06 AM JMB252
(c) Failure by a program participant to meet the cost -sharing and 1
premium payment requirement under § 23 -61-1005(a) may result in the accrual 2
of a personal debt to the health insurer or provider. 3
(d)(1)(A) Failure by the program participant to meet the initiative 4
participation requirements of subsection (b) of this section may result in: 5
(i) Being unenrolled from the individual qualified 6
health insurance plan; or 7
(ii) The loss of incentives, as defined by the 8
department. 9
(B) However, an individual who is u nenrolled shall not 10
lose Medicaid healthcare coverage based solely on disenrollment from the 11
individual qualified health insurance plan. 12
(2) The department shall develop and notify program participants 13
of the criteria for restoring eligibility for incen tive benefits that were 14
removed as a result of the program participants' failure to meet the 15
initiative participation requirements of subsection (b) of this section. 16
(3)(A) A program participant who also meets the criteria of a 17
community bridge organiza tion target population may qualify for additional 18
incentives by successfully completing the economic independence initiative 19
provided through a community bridge organization. 20
(B) If successfully completing the initiative results in 21
an increase in the p rogram participant's income that exceeds the program's 22
financial eligibility limits, a program participant may receive, for a 23
specified period of time, financial assistance to pay: 24
(i) The individual's share of employer -sponsored 25
health insurance cove rage not to exceed a limit determined by the department; 26
or 27
(ii) A share of the individual's cost -sharing 28
obligation, as determined by the department, if the individual enrolls in a 29
health insurance benefit plan offered through the Arkansas Health Ins urance 30
Marketplace. 31
32
23-61-1007. Insurance standards for individual qualified health 33
insurance plans. 34
(a) Insurance coverage for a member enrolled in an individual 35
qualified health insurance plan shall be obtained, at a minimum, through 36 SB278
15 2/15/2023 10:56:06 AM JMB252
silver-level metallic plans as provided in 42 U.S.C. § 18022(d) and § 18071, 1
as they existed on January 1, 2021, that restrict out -of-pocket costs to 2
amounts that do not exceed applicable out -of-pocket cost limitations. 3
(b) As provided under § 23 -61-1004(e)(2), health insurers shall track 4
the applicable premium payments and cost sharing collected from members to 5
ensure that the total amount of an individual's payments for premiums and 6
cost sharing does not exceed the aggregate cap imposed by 42 C.F.R. § 447.56. 7
(c) All health benefit plans purchased by the Department of Human 8
Services shall: 9
(1) Conform to the requirements of this section and applicable 10
insurance rules; 11
(2) Be certified by the State Insurance Department; 12
(3)(A) Maintain a medical -loss ratio of at least eighty percent 13
(80%) for an individual qualified health insurance plan as required under 45 14
C.F.R. § 158.210(c), as it existed on January 1, 2021, or rebate the 15
difference to the Department of Human Services for members. 16
(B) However, the De partment of Human Services may approve 17
up to one percent (1%) of revenues as community investments and as benefit 18
expenses in calculating the medical -loss ratio of a plan in accordance with 19
45 C.F.R. § 158.150; 20
(4) Develop: 21
(A) An annual quality ass essment and performance 22
improvement strategic plan to be approved by the Department of Human Services 23
that aligns with federal quality improvement initiatives and quality and 24
reporting requirements of the Department of Human Services; and 25
(B) Targeted initiatives based on requirements established 26
by the Department of Human Services in consultation with the Department of 27
Health; and 28
(5) Make reports to the Department of Human Services and the 29
Department of Health regarding quality and performance metr ics in a manner 30
and frequency established by a memorandum of understanding. 31
(d) A health insurer offering individual qualified health insurance 32
plans for members shall participate in the Arkansas Patient -Centered Medical 33
Home Program, including: 34
(1) Attributing enrollees in individual qualified health 35
insurance plans, including members, to a primary care physician; 36 SB278
16 2/15/2023 10:56:06 AM JMB252
(2) Providing financial support to patient -centered medical 1
homes to meet practice transformation milestones; and 2
(3) Supplying clinical performance data to patient -centered 3
medical homes, including data to enable patient -centered medical homes to 4
assess the relative cost and quality of healthcare providers to whom patient -5
centered medical homes refer patients. 6
(e)(1) Each individual qualified health insurance plan shall provide 7
for a health improvement initiative, subject to the review and approval of 8
the Department of Human Services, to provide incentives to its enrolled 9
members to participate in one (1) or more health improvement i nitiatives as 10
defined in § 23-61-1003(9). 11
(2)(A) The Department of Human Services shall work with health 12
insurers offering individual qualified health insurance plans to ensure the 13
economic independence initiative offered by the health insurer includes a 14
robust outreach and communications effort which targets specific health, 15
education, training, employment, and other opportunities appropriate for its 16
enrolled members. 17
(B) The outreach and communications effort shall recognize 18
that enrolled members r eceive information from multiple channels, including 19
without limitation: 20
(i) Community service organizations; 21
(ii) Local community outreach partners; 22
(iii) Email; 23
(iv) Radio; 24
(v) Religious organizations; 25
(vi) Social media; 26
(vii) Television; 27
(viii) Text message; and 28
(ix) Traditional methods such as newspaper or mail. 29
(f) On or before January 1, 2022, the State Insurance Department and 30
the Department of Human Services may implement through certification 31
requirements or rule, or both, the applicable provisions of this section. 32
33
23-61-1009. Sunset. 34
This subchapter shall expire on December 31, 2026. 35
36 SB278
17 2/15/2023 10:56:06 AM JMB252
23-61-1010. Community bridge organizations. 1
(a) The Department of Human Services shall develop requirements and 2
qualifications for community bridge organizations to provide assistance to 3
one (1) or more of the following target populations: 4
(1) Individuals who become pregnant with a high -risk pregnancy 5
and the child, throughout the pregnancy and up to twenty -four (24) months 6
after birth; 7
(2) Individuals in rural areas of the state in need of treatment 8
for serious mental illness or substance use disorder; 9
(3) Individuals who are young adults most at risk of poor health 10
due to long-term poverty and who meet cr iteria established by the Department 11
of Human Services, including without limitation the following: 12
(A) An individual between nineteen (19) and twenty -four 13
(24) years of age who has been previously placed under the supervision of 14
the: 15
(i) Division of Youth Services; or 16
(ii) Department of Corrections; 17
(B) An individual between nineteen (19) and twenty -seven 18
(27) years of age who has been previously placed under the supervision of the 19
Division of Children and Family Services; or 20
(C) An individual between nineteen (19) and thirty (30) 21
years of age who is a veteran; and 22
(4) Any other target populations identified by the Department of 23
Human Services. 24
(b)(1) Each community bridge organization shall be administered by a 25
hospital under conditions established by the Department of Human Services. 26
(2) A hospital is eligible to serve eligible individuals under 27
subdivision (a)(1) of this section if the hospital: 28
(A) Is a birthing hospital; 29
(B) Provides or contracts with a qualified e ntity for the 30
provision of a federally recognized evidence -based home visitation model to a 31
woman during pregnancy and to the woman and child for a period of up to 32
twenty-four (24) months after birth; and 33
(C) Meets any additional criteria established b y the 34
Department of Human Services. 35
(3)(A) A hospital is eligible to serve eligible individuals 36 SB278
18 2/15/2023 10:56:06 AM JMB252
under subdivision (a)(2) of this section if the hospital: 1
(i) Is a small rural hospital; 2
(ii) Screens all Arkansans who seek services at the 3
hospital for health-related social needs; 4
(iii) Refers Arkansans identified as having health -5
related social needs for social services available in the community; 6
(iv) Employs local qualified staff to assist 7
eligible individuals in need of treatment for serious mental illness or 8
substance use disorder in accessing medical treatment from healthcare 9
professionals and supports to meet health -related social needs; 10
(v) Enrolls with the Arkansas Medicaid Program as an 11
acute crisis unit provider; and 12
(vi) Meets any additional criteria established by 13
the Department of Human Services. 14
(B) The hospital may use funding available through the 15
Department of Human Services to improve the hospital's ability to deliver 16
care through coordination with other he althcare professionals and with the 17
local emergency response system that may include training of personnel and 18
improvements in equipment to support the delivery of medical services through 19
telemedicine. 20
(4) A hospital is eligible to serve eligible indiv iduals under 21
subdivision (a)(3) of this section if the hospital: 22
(A) Is an acute care hospital; 23
(B) Administers or contracts for the administration of 24
programs using proven models, as defined by the Department of Human Services, 25
to provide employment, training, education, or other social supports; and 26
(C) Meets any additional criteria established by the 27
Department of Human Services. 28
(c) An individual is not required or entitled to enroll in a community 29
bridge organization as a condition of Med icaid eligibility. 30
(d) A hospital is not: 31
(1) Required to apply to become a community bridge organization; 32
or 33
(2) Entitled to be selected as a community bridge organization. 34
35
23-61-1011. Health and Economic Outcomes Accountability Oversight 36 SB278
19 2/15/2023 10:56:06 AM JMB252
Advisory Panel. 1
(a) There is created the Health and Economic Outcomes Accountability 2
Oversight Advisory Panel. 3
(b) The advisory panel shall be composed of the following members: 4
(1) The following members of the General Assembly: 5
(A) The Chair of the Senate Committee on Public Health, 6
Welfare, and Labor; 7
(B) The Chair of the House Committee on Public Health, 8
Welfare, and Labor; 9
(C) The Chair of the Senate Committee on Education; 10
(D) The Chair of the House Committee on Education; 11
(E) The Chair of the Senate Committee on Insurance and 12
Commerce; 13
(F) The Chair of the House Committee on Insurance and 14
Commerce; 15
(G) An at-large member of the Senate appointed by the 16
President Pro Tempore of the Senate; 17
(H) An at-large member of the House of Representatives 18
appointed by the Speaker of the House of Representatives; 19
(I) An at-large member of the Senate appointed by the 20
minority leader of the Senate; and 21
(J) An at-large member of the House of Representatives 22
appointed by the minority leader of the House of Representatives; 23
(2) The Secretary of the Department of Human Services; 24
(3) The Arkansas Surgeon General; 25
(4) The Insurance Commissioner; 26
(5) The heads of the following executive branch agencies or 27
their designees: 28
(A) Department of Health; 29
(B) Department of Education; 30
(C) Department of Corrections; 31
(D) Department of Commerce; and 32
(E) Department of Finance and Administration; 33
(6) The Executive Director of the Arkansas Minority Health 34
Commission; and 35
(7)(A) Three (3) community members who represent health, 36 SB278
20 2/15/2023 10:56:06 AM JMB252
business, or education, who reflect the broad racial and geographic diversity 1
in the state, and who have demonstrated a commitment to improving the health 2
and welfare of Arkansans, appoin ted as follows: 3
(i) One (1) member shall be appointed by and serve 4
at the will of the Governor; 5
(ii) One (1) member shall be appointed by and serve 6
at the will of the President Pro Tempore of the Senate; and 7
(iii) One (1) member shall be appointed by and serve 8
at the will of the Speaker of the House of Representatives. 9
(B) Members serving under subdivision (b)(7)(A) of this 10
section may receive mileage reimbursement. 11
(c)(1) The Secretary of the Department of Human Services and one (1) 12
legislative member shall serve as the cochairs of the Health and Economic 13
Outcomes Accountability Oversight Advisory Panel and shall convene meetings 14
quarterly of the advisory panel. 15
(2) The legislative member who serves as the cochair shall be 16
selected by majority vote of all legislative members serving on the advisory 17
panel. 18
(d)(1) The advisory panel shall review, make nonbinding 19
recommendations, and provide advice concerning the proposed quality 20
performance targets presented by the Department of Hu man Services for each 21
participating individual qualified health insurance plan. 22
(2) The advisory panel shall deliver all nonbinding 23
recommendations to the Secretary of the Department of Human Services. 24
(3)(A) The Secretary of the Department of Human Services, in 25
consultation with the State Medicaid Director, shall determine all quality 26
performance targets for each participating individual qualified health 27
insurance plan. 28
(B) The Secretary of the Department of Human Services may 29
consider the nonbinding recommendations of the advisory panel when 30
determining quality performance targets for each participating individual 31
qualified health insurance plan. 32
(e) The advisory panel shall review: 33
(1) The annual quality assessment and performance improveme nt 34
strategic plan for each participating individual qualified health insurance 35
plan; 36 SB278
21 2/15/2023 10:56:06 AM JMB252
(2) Financial performance of the Arkansas Health and Opportunity 1
for Me Program against the budget neutrality targets in each demonstration 2
year; 3
(3) Quarterly repor ts prepared by the Department of Human 4
Services, in consultation with the Department of Commerce, on progress 5
towards meeting economic independence outcomes and health improvement 6
outcomes, including without limitation: 7
(A) Community bridge organizatio n outcomes; 8
(B) Individual qualified health insurance plan health 9
improvement outcomes; 10
(C) Economic independence initiative outcomes; and 11
(D) Any sanctions or penalties assessed on participating 12
individual qualified health insurance plans; 13
(4) Quarterly reports prepared by the Department of Human 14
Services on the Arkansas Health and Opportunity for Me Program, including 15
without limitation: 16
(A) Eligibility and enrollment; 17
(B) Utilization; 18
(C) Premium and cost -sharing reduction cost s; and 19
(D) Health insurer participation and competition; and 20
(5) Any other topics as requested by the Secretary of the 21
Department of Human Services. 22
(f)(1) The advisory panel may furnish advice, gather information, make 23
recommendations, and publis h reports. 24
(2) However, the advisory panel shall not administer any portion 25
of the Arkansas Health and Opportunity for Me Program or set policy. 26
(g) The Department of Human Services shall provide administrative 27
support necessary for the advisory panel to perform its duties. 28
(h) The Department of Human Services shall produce and submit a 29
quarterly report incorporating the advisory panel's findings to the President 30
Pro Tempore of the Senate, the Speaker of the House of Representatives, and 31
the public on the progress in health and economic improvement resulting from 32
the Arkansas Health and Opportunity for Me Program, including without 33
limitation: 34
(1) Eligibility and enrollment; 35
(2) Participation in and the impact of the economic independence 36 SB278
22 2/15/2023 10:56:06 AM JMB252
initiative and the health improvement initiative of the eligible individuals, 1
health insurers, and community bridge organizations; 2
(3) Utilization of medical services; 3
(4) Premium and cost -sharing reduction costs; and 4
(5) Health insurer participation and completion. 5
6
23-61-1012. Rules. 7
The Department of Human Services shall adopt rules necessary to 8
implement this subchapter. 9
10
SECTION 8. Arkansas Code § 26 -57-604(a)(1)(B)(ii), concerning the 11
allowance of a credit to be applied against the insurance premium tax, is 12
amended to read as follows: 13
(ii) However, the credit shall not be applied as an 14
offset against the premium tax on collections resulting from an eligible 15
individual insured under the Arkansas Health and Opportunity for Me Act of 16
2021, § 23-61-1001 et seq., the Arkansas Health Insurance Marketplace Act, § 17
23-61-801 et seq., or individual qualified health insurance plans, including 18
without limitation stand -alone dental plans, issued through the health 19
insurance marketplace as defined by § 23-61-1003. 20
21
SECTION 9. Arkansas Code § 26 -57-610(b)(2), concerning the disposition 22
of the insurance premium tax, is amended to read as follows: 23
(2) The taxes based on premiums collected under the Arkansas 24
Health and Opportunity for Me Act of 2021, § 23-61-1001 et seq., the Arkansas 25
Health Insurance Marketplace Act, § 23 -61-801 et seq., or individual 26
qualified health insurance plans, including without limitation stand -alone 27
dental plans, issued through the health insurance marketplace as defined by § 28
23-61-1003 shall be: 29
(A) At at the time of deposit, separately certified by the 30
commissioner to the Treasurer of State for classification and distribution 31
under this section; and 32
(B) Transferred to the Arkansas Health and Opportunity for 33
Me Program Trust Fund and used as required by the Arkansas Health and 34
Opportunity for Me Program Trust Fund; 35
36