Arkansas 2025 Regular Session

Arkansas House Bill HB1321 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1	1		Stricken language would be deleted from and underlined language would be added to present law.
2		-	Act 513 of the Regular Session
3	2		ANS167 01/30/2025 11:01:38 AM ANS167
4	3		State of Arkansas 1
5	4		95th General Assembly A Bill 2
6	5		Regular Session, 2025 HOUSE BILL 1321 3
7	6		4
8	7		By: Representative Wooldridge 5
9	8		By: Senator D. Wallace 6
10	9		7
11	10		For An Act To Be Entitled 8
12	11		AN ACT TO REGULATE STEP THERAPY AND FAIL FIRST 9
13	12		PROTOCOLS CONCERNING CERTAIN PRESCRIBED VENTILATORS; 10
14	13		AND FOR OTHER PURPOSES. 11
15	14		12
16	15		13
17	16		Subtitle 14
18	17		TO REGULATE STEP THERAPY AND FAIL FIRST 15
19	18		PROTOCOLS CONCERNING CERTAIN PRESCRIBED 16
20	19		VENTILATORS. 17
21	20		18
22	21		BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF ARKANSAS: 19
23	22		20
24	23		SECTION 1. Arkansas Code Title 23, Chapter 79, is amended to add an 21
25	24		additional subchapter to read as follows: 22
26	25		23
27	26		Subchapter 29 — Coverage for Noninvasive Ventilators 24
28	27		25
29	28		23-79-2901. Definitions. 26
30	29		As used in this subchapter: 27
31	30		(1) "Enrollee" means an individual entitled to coverage of 28
32	31		healthcare services from a healthcare insurer; 29
33	32		(2)(A) "Health benefit plan" means: 30
34	33		(i) An individual, blanket, or group plan, policy, 31
35	34		or contract for healthcare services issued, renewed, or extended in this 32
36	35		state by a healthcare insurer, health maintenance organization, hospital 33
37	36		medical service corporation, or self -insured governmental or church plan in 34
38	37		this state; and 35
39	38		(ii) Any health benefit program receiving state or 36 HB1321
40	39
41	40		2 01/30/2025 11:01:38 AM ANS167
42	41		federal appropriations from the State of Arkansas, including the Arkansas 1
43	42		Medicaid Program and the Arkansas Health and Opportunity for Me Program 2
44	43		established by the Arkansas Health and Opportunity for Me Act of 2021, § 23 -3
45	44		61-1001 et seq. 4
46	45		(B) "Health benefit plan" includes: 5
47	46		(i) Indemnity and managed care plans; and 6
48	47		(ii) Plans providing health benefits to state and 7
49	48		public school employees under § 21 -5-401 et seq. 8
50	49		(C) "Health benefit plan" does not include: 9
51	50		(i) A plan that provides only dental benefits or eye 10
52	51		and vision care benefits; 11
53	52		(ii) A disability income plan; 12
54	53		(iii) A credit insurance plan; 13
55	54		(iv) Insurance coverage issued as a supplement to 14
56	55		liability insurance; 15
57	56		(v) Medical payments under an automobile or 16
58	57		homeowners insurance plan; 17
59	58		(vi) A health benefit plan provided under Arkansas 18
60	59		Constitution, Article 5, § 32, the Workers' Compensation Law, § 11 -9-101 et 19
61	60		seq., or the Public Employee Workers' Compensation Act, § 21 -5-601 et seq.; 20
62	61		(vii) A plan that provides only indemnity for 21
63	62		hospital confinement; 22
64	63		(viii) An accident-only plan; 23
65	64		(ix) A specified disease plan other than a cancer 24
66	65		insurance plan or cancer supplemental policy; or 25
67	66		(x) A long-term-care-only plan; 26
68	67		(3)(A) "Healthcare insurer" means an insurance company, hospital 27
69	68		and medical service corporation, health maintenance organization, or a 28
70	69		nonprofit agricultural membership organization as defined in § 23 -60-104 that 29
71	70		issues or delivers health benefit plans in this state. 30
72	71		(B) "Healthcare insurer" does not include an entity that 31
73	72		provides only dental benefits or eye and vision care benefits; 32
74	73		(4) "Healthcare professional" means a person who is licensed, 33
75	74		certified, or otherwise authorized by the laws of this state to administer 34
76	75		health care in the ordinary course of the practice of his or her profession; 35
77	76		and 36 HB1321
78	77
79	78		3 01/30/2025 11:01:38 AM ANS167
80	79		(5) "Healthcare service" means an item or service provided to an 1
81	80		individual for the purposes of alleviating, curing, healing, or preventing 2
82	81		human illness, injury, or physical disability. 3
83	82		4
84	83		23-79-2902. Step therapy or fail first protocols prohibited. 5
85	84		(a) A healthcare insurer shall not require step therapy protocols or 6
86	85		fail first protocols of a lesser device or healthcare service for a 7
87	86		prescription or order of a healthcare professional for a noninvasive 8
88	87		ventilator if: 9
89	88		(1) The noninvasive ventilator requires frequent or substantial 10
90	89		servicing as classified by the Centers for Medicare & Medicaid Services and 11
91	90		determined by a healthcare professional; 12
92	91		(2) There is clinical evidence or enrollee history that suggests 13
93	92		the alternative treatments required under the step therapy protocol or fail 14
94	93		first protocol will: 15
95	94		(A) Be less effective for an enrollee; or 16
96	95		(B) Cause an adverse reaction to the enrollee; or 17
97	96		(3) The noninvasive ventilator is deemed medically necessary by 18
98	97		the United States Food and Drug Administration. 19
99	98		(b) The Secretary of the Department of Human Services shall require 20
100	99		Medicaid managed care organizations to reimburse for a noninvasive ventilator 21
101	100		at no less than one hundred percent (100%) of the fee schedule of the 22
102	101		Arkansas Medicaid Program for a ventilator. 23
103	102		24
104	103		23-79-2903. Rules. 25
105	104		(a) The Insurance Commissioner may develop and promulgate rules for 26
106	105		the implementation and administration of this subchapter. 27
107	106		(b) The Secretary of the Department of Human Services may develop and 28
108	107		promulgate rules for the implementation and administration of this subchapter 29
109	108		that may apply to the Arkansas Medicaid Program or the Arkansas Health and 30
110	109		Opportunity for Me Program under the Arkansas Health and Opportunity for Me 31
111	110		Act of 2021, § 23-61-1001 et seq. 32
112	111		(c) The State Board of Finance may develop and promulgate rules for 33
113	112		the administration of this subchapter for the plans providing health benefits 34
114	113		to state and public school employees under § 21 -5-401 et seq. 35
115		-	~~APPROVED: 4/10/25~~ 36
	114	+	36