Stricken language would be deleted from and underlined language would be added to present law.
*ANS081* 01/29/2025 10:02:29 AM ANS081
State of Arkansas 1
95th General Assembly A Bill 2
Regular Session, 2025 HOUSE BILL 1295 3
4
By: Representative L. Johnson 5
By: Senator Irvin 6
7
For An Act To Be Entitled 8
AN ACT TO CREATE THE HEALTHCARE COST -SHARING 9
COLLECTIONS ACT; AND FOR OTHER PURPOSES. 10
11
12
Subtitle 13
TO CREATE THE HEALTHCARE COST -SHARING 14
COLLECTIONS ACT. 15
16
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF ARKANSAS: 17
18
SECTION 1. Arkansas Code Title 23, Chapter 99, is amended to add an 19
additional subchapter to read as follows: 20
21
Subchapter 19 — Healthcare Cost-Sharing Collections Act 22
23
23-99-1901. Title. 24
This subchapter shall be known and may be cited as the "Healthcare 25
Cost-Sharing Collections Act". 26
27
23-99-1902. Definitions. 28
As used in this subchapter: 29
(1)(A) "Contracting entity" means a healthcare insurer, or a 30
subcontractor, affiliate, or other entity that contracts directly or 31
indirectly with a healthcare provider for the delivery of healthcare services 32
to enrollees. 33
(B) "Contracting entity" includes without limitation: 34
(i) An insurance company; 35
(ii) A health maintenance organization; 36 HB1295
2 01/29/2025 10:02:29 AM ANS081
(iii) A hospital and medical service corporation; 1
(iv) A preferred provider organization; 2
(v) A risk-based provider organization; 3
(vi) A third-party administrator; 4
(vii) A nonprofit agricultural membership 5
organization; and 6
(viii) A prescription benefit management company; 7
(2)(A) "Cost sharing" means the amount of the costs that are 8
covered by a health benefit plan for which an enrollee is financially 9
responsible. 10
(B) "Cost sharing" includes without limitation a 11
deductible payment, a coinsurance amount, a copayment, or other similar 12
charges. 13
(C) "Cost sharing" does not include a premium, balance 14
billing amount for out -of-network healthcare providers, or the cost of 15
noncovered services; 16
(3) "Enrollee" means an individual who is entitled to receive 17
healthcare services under the terms of a health benefit plan; 18
(4) "Entity of the state" means an agency, board, bureau, 19
commission, committee, council, department, division, institution of higher 20
education, office, public school, quasi -public organization, or other 21
political subdivision of the state; 22
(5)(A) "Health benefit plan" means an individual, blanket, or 23
group plan, policy, or contract for healthcare services issued, renewed, or 24
extended in this state by a healthcare insurer. 25
(B) "Health benefit plan" includes a nonfederal 26
governmental plan as defined in 29 U.S.C. § 1002(32), as it existed on 27
January 1, 2025. 28
(C) "Health benefit plan" does not include: 29
(i) A plan that provides only dental benefits; 30
(ii) A plan that provides only eye and vision 31
benefits; 32
(iii) A disability income plan; 33
(iv) A credit insurance plan; 34
(v) Insurance coverage issued as a supplement to 35
liability insurance; 36 HB1295
3 01/29/2025 10:02:29 AM ANS081
(vi) Medical payments under an automobile or 1
homeowners’ insurance plan; 2
(vii) A health benefit plan provided under Arkansas 3
Constitution, Article 5, § 32, the Workers' Compensation Law, § 11 -9-101 et 4
seq., or the Public Employee Workers’ Compensation Act, § 21 -5-601 et seq.; 5
(viii) A plan that provides only indemnity for 6
hospital confinement; 7
(ix) An accident-only plan; 8
(x) A specified disease plan; 9
(xi) A policy, contract, certificate, or agreement 10
offered or issued by a healthcare insurer to provide, deliver, arrange for, 11
pay for, or reimburse any of the costs of healthcare services, including 12
pharmacy benefits, to an entity of the state; 13
(xii) A long-term care insurance plan; or 14
(xiii) A healthcare provider self -insured plan; 15
(6) "Healthcare contract" means a contract entered into, 16
materially amended, or renewed between a contracting entity and a healthcare 17
provider for the delivery of healthcare services to an enrollee; 18
(7)(A) "Healthcare insurer" means an entity that is authorized 19
by this state to offer or provide health benefit plans, policies, subscriber 20
contracts, or any other contracts of a similar nature that indemnify or 21
compensate a healthcare provider for the provision of healthcare services. 22
(B) "Healthcare insurer" includes: 23
(i) An insurance company; 24
(ii) A hospital and medical service corporation; 25
(iii) A health maintenance organization; 26
(iv) A risk-based provider organization; 27
(v) A nonprofit agricultural membership 28
organization; 29
(vi) Any sponsor of a nonfederal self -funded 30
governmental plan in this state; and 31
(vii) A third-party administrator or other entity 32
providing claims administration services for a health benefit plan; 33
(8) "Healthcare provider" means a person or entity that is 34
licensed, certified, or otherwise authorized by the laws of this state to 35
administer healthcare services; 36 HB1295
4 01/29/2025 10:02:29 AM ANS081
(9) "Healthcare services" means services or goods provided for 1
the purpose of or incidental to the purpose of preventing, diagnosing, 2
treating, alleviating, relieving, curing, or healing human illness, disease, 3
condition, disability, or injury; 4
(10) "Medical loss ratio" means the measure used in healthcare 5
insurance to assess the percentage of premium dollars spent on medical claims 6
and quality improvements versus administrative costs; 7
(11) "Net premium income" means the dollar amount of direct 8
business plus reinsurance assumed minus reinsurance ceded; and 9
(12) "Premium" means the dollar amount charged for the insurance 10
coverage of an enrollee. 11
12
23-99-1903. Collection authority of healthcare insurers. 13
(a) A healthcare insurer shall: 14
(1) Pay a healthcare provider the full amount due for healthcare 15
services under the terms of a health benefit plan, including any cost 16
sharing; 17
(2) Have the sole responsibility for collecting cost sharing 18
from an enrollee; and 19
(3) Upon request of the enrollee, collect cost sharing 20
throughout the plan year in increments defined by the healthcare insurer. 21
(b) A healthcare insurer shall not: 22
(1) Withhold an amount for cost sharing from the payment to a 23
healthcare provider; 24
(2) Require a healthcare provider to offer additional discounts 25
to an enrollee outside the terms of the healthcare contract between the 26
healthcare insurer and the healthcare provider; 27
(3) Deny or delay payment to a healthcare provider for the 28
healthcare insurer’s failure to collect the enrollee’s cost sharing; or 29
(4) Require a person or entity to collect the enrollee’s cost 30
sharing on behalf of the healthcare insurer. 31
(c) Any value of a copay assistance coupon or similar assistance 32
program shall be applied to the enrollee’s annual cost -sharing requirement 33
and may be paid directly to the healthcare insurer on the enrollee’s behalf. 34
(d) A healthcare insurer shall not cancel the health benefit plan of 35
an enrollee for failure to collect cost sharing. 36 HB1295
5 01/29/2025 10:02:29 AM ANS081
(e) An expense incurred by a healthcare insurer to implement or comply 1
with this subchapter shall not be used as justification to increase premiums 2
or decrease payments to a healthcare provider. 3
4
23-99-1904. Transparency and reporting. 5
(a)(1)(A) Annually on or before March 1, a healthcare insurer shall 6
file with the Insurance Commissioner a full and true statement of the 7
healthcare insurer's financial condition, transactions, and affairs as of the 8
December 31 preceding. 9
(B)(i) The commissioner may grant an extension of time to 10
file the statement required under subdivision (a)(1)(A) of this section for 11
good cause shown. 12
(ii) The commissioner may grant an extension of time 13
for good cause under subdivision (a)(1)(B)(i) of this section only if a 14
written application for an extension of time is received at least five (5) 15
business days before the filing due date. 16
(2) The statement required under subdivision (a)(1)(A) of this 17
section shall be prepared according to the companion National Association of 18
Insurance Commissioners’ Annual and Quarterly Statement Instructions, as 19
adopted by rule by the commissioner, and follow those accounting principles 20
and procedures prescribed by the companion National Association of Insurance 21
Commissioners’ Accounting Practices and Procedures Manual, as adopted by rule 22
by the commissioner. 23
(3) The statement required under subdivision (a)(1)(A) of this 24
section shall include the healthcare insurer's: 25
(A) Total assets; 26
(B) Total liabilities; 27
(C) Total reserves; 28
(D)(i) Net premium income for each line of business of the 29
healthcare insurer. 30
(ii) Each line of business of the healthcare insurer 31
shall include: 32
(a) Comprehensive hospital plans and 33
comprehensive medical plans; 34
(b) Medicare supplement plans; 35
(c) Dental-only plans; 36 HB1295
6 01/29/2025 10:02:29 AM ANS081
(d) Vision-only plans; 1
(e) The Federal Employees Health Benefits 2
Program; 3
(f) Medicare; 4
(g) Medicare Advantage Plans; 5
(h) The Arkansas Medicaid Program; 6
(i) Plans offered under the Medicaid Provider -7
Led Organized Care Act, § 20 -77-2701 et seq., or any successor program; 8
(j) Qualified health plans offered under the 9
Arkansas Health and Opportunity for Me Program or any successor program; 10
(k) Other Medicaid plans; and 11
(l) Other health benefit plans; 12
(E)(i) Total claims paid for each line of business of the 13
healthcare insurer. 14
(ii) Each line of business of the healthcare insurer 15
shall include: 16
(a) Comprehensive hospital plans and 17
comprehensive medical plans; 18
(b) Medicare supplement plans; 19
(c) Dental-only plans; 20
(d) Vision-only plans; 21
(e) The Federal Employees Health Benefits 22
Program; 23
(f) Medicare; 24
(g) Medicare Advantage Plans; 25
(h) The Arkansas Medicaid Program; 26
(i) Plans offered under the Medicaid Provider-27
Led Organized Care Act, § 20 -77-2701 et seq., or any successor program; 28
(j) Qualified health plans offered under the 29
Arkansas Health and Opportunity for Me Program or any successor program; 30
(k) Other Medicaid plans; and 31
(l) Other health benefit plans; 32
(F)(i) Total claims denied for each line of business of 33
the healthcare insurer. 34
(ii) Each line of business of the healthcare insurer 35
shall include: 36 HB1295
7 01/29/2025 10:02:29 AM ANS081
(a) Comprehensive hospital plans and 1
comprehensive medical plans; 2
(b) Medicare supplement plans; 3
(c) Dental-only plans; 4
(d) Vision-only plans; 5
(e) The Federal Employees Health Benefits 6
Program; 7
(f) Medicare; 8
(g) Medicare Advantage Plans; 9
(h) The Arkansas Medicaid Program; 10
(i) Plans offered under the Medicaid Provider -11
Led Organized Care Act, § 20 -77-2701 et seq., or any successor program; 12
(j) Qualified health plans offered under the 13
Arkansas Health and Opportunity for Me Program or any successor program; 14
(k) Other Medicaid plans; and 15
(l) Other health benefit plans; and 16
(G) Low, high, and average premium price data for each 17
line of service of the healthcare insurer. 18
(b) A healthcare insurer shall file an executive summary of the 19
statement required under subdivision (a)(1)(A) of this section with the: 20
(1) House Committee on Insurance and Commerce; and 21
(2) Senate Committee on Insurance and Commerce. 22
(c)(1) Annually, between thirty (30) and sixty (60) days before the 23
initial date of open enrollment for Medicare, a healthcare insurer shall send 24
a report to each enrollee. 25
(2) The report required under subdivision (c)(1) of this section 26
shall include: 27
(A) The dollar amount of premiums collected from the 28
enrollee and paid to the healthcare insurer from the previous period of 29
January 1 through December 31; 30
(B) The dollar amount of premiums paid to the healthcare 31
insurer by a person or entity, including without limitation an employer, 32
other than the enrollee on behalf of the enrollee from the previous period of 33
January 1 through December 31; 34
(C) The dollar amount of cost sharing collected, itemized 35
by deductibles, coinsurance, and copayments, or similar charges from the 36 HB1295
8 01/29/2025 10:02:29 AM ANS081
enrollee from the previous period of January 1 through December 31; 1
(D) The dollar amount of the unpaid cost -sharing balance 2
owed to the healthcare insurer from the previous period of January 1 through 3
December 31; 4
(E) The payment made to each in -network healthcare 5
provider on behalf of the enrollee from the previous period of January 1 6
through December 31; 7
(F) The payment made to each out -of-network healthcare 8
provider on behalf of the enrollee from the previous period of January 1 9
through December 31; 10
(G) A list of claims denied to a healthcare provider who 11
provided healthcare services to the enrollee from the previous period of 12
January 1 through December 31; 13
(H) The low, average, and high premium rates comparable to 14
the enrollee’s health benefit plan; 15
(I) A list of any underwriting, auditing, actuarial, 16
financial analysis, treasury, and investment expenses; 17
(J) A list of any marketing and sales expenses, including 18
without limitation advertising, member relations, member enrollment, and all 19
expenses associated with producers, brokers, and benefit consultants; 20
(K) A list of any claims operations expenses, including 21
without limitation those expenses for adjudication, appeals, settlements, and 22
expenses associated with paying claims; 23
(L) A list of any medical administration expenses, 24
including without limitation disease management, utilization review, and 25
medical management; 26
(M) A list of any network operations expenses, including 27
without limitation those expenses for contracting, hospital and physician 28
relations, and medical policy procedures; 29
(N) A list of any charitable expenses, including without 30
limitation to contributions to tax -exempt foundations and community benefits; 31
(O) The amount of state insurance premium taxes; 32
(P) The amount paid for board, bureau, and association 33
fees; 34
(Q) The fees related to depreciation; and 35
(R) A list of miscellaneous expenses described in detail 36 HB1295
9 01/29/2025 10:02:29 AM ANS081
by expense, including any expense not included in subdivisions (c)(2)(I) —(Q) 1
of this section. 2
3
23-99-1905. Prohibition on pricing increases. 4
(a) Except as provided in subsection (b) of this section, a healthcare 5
insurer shall not increase cost sharing, premiums, or other fees, including 6
per member per month payments, on an enrollee, employer, or any other entity 7
paying cost sharing, premiums, or other fees, including per member per month 8
payments, on behalf of an enrollee for healthcare insurance coverage. 9
(b) A healthcare insurer may increase cost sharing, premiums, or other 10
fees, including per member per month payments, on an enrollee, employer, or 11
any other entity paying cost sharing, premiums, or other fees, including per 12
member per month payments, on behalf of an enrollee for healthcare insurance 13
coverage if: 14
(1) The healthcare insurer’s excess of capital over its 15
mandatory control level RBC as defined in § 23 -63-1302(12)(C) is less than 16
six hundred fifty percent (650%); and 17
(2)(A) The healthcare insurer’s medical loss ratio is ninety 18
percent (90%) or greater on clinical services and quality improvement. 19
(B) The calculation of medical claims and quality 20
improvements for a healthcare insurer's medical loss ratio under subdivision 21
(b)(2)(A) of this section shall exclude: 22
(i) Any performance -based compensation, bonus, or 23
other financial incentive paid directly or indirectly to a contracting entity 24
employee, affiliate, contractor, or other entity or individual; 25
(ii) Any expense under § 23 -99-1904(c)(2)(I)—(R); 26
(iii) Any expense associated with carrying enrollee 27
medical debt; and 28
(iv) Cost sharing. 29
30
23-99-1906. Violation of Trade Practices Act — Enforcement. 31
(a) A violation of this subchapter is a deceptive act, as defined by 32
the Trade Practices Act, § 23 -66-201 et seq., and § 4 -88-101 et seq. 33
(b) All remedies, penalties, and authority granted to the Insurance 34
Commissioner under the Trade Practices Act, § 23 -66-201 et seq., shall be 35
available to the commissioner for the enforcement of this subchapter. 36 HB1295
10 01/29/2025 10:02:29 AM ANS081
(c) The State Insurance Department shall enforce this subchapter. 1
2
23-99-1907. Private right of action. 3
An enrollee may file suit against a healthcare insurer in a court of 4
competent jurisdiction and is entitled to collect: 5
(1) Double the amount of any overcharge of premiums and cost 6
sharing; 7
(2) The enrollee’s costs related to the suit; and 8
(3) Reasonable attorney’s fees. 9
10
23-99-1908. Rules. 11
The Insurance Commissioner may promulgate rules to implement this 12
subchapter. 13
14
23-99-1909. Severability. 15
The provisions of this section shall be severable, and if any phrase, 16
clause, sentence, or provision is deemed unenforceable, the remaining 17
provisions of the section shall be enforceable. 18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36