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