Stricken language would be deleted from and underlined language would be added to present law.
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State of Arkansas 1
95th General Assembly A Bill 2
Regular Session, 2025 HOUSE BILL 1353 3
4
By: Representatives Eubanks, Achor, F. Allen, Dalby, Eaton, Eaves, Evans, K. Ferguson, Gramlich, 5
Henley, Holcomb, Hollowell, Ladyman, Maddox, Magie, McGrew, Milligan, Nazarenko, Perry, J. 6
Richardson, Richmond, Steimel, Vaught, Warren, Wing, Wooten 7
By: Senators D. Wallace, J. Boyd, Caldwell, J. English, Irvin, M. Johnson, Rice, J. Scott 8
9
For An Act To Be Entitled 10
AN ACT TO REGULATE A VISION BENEFIT MANAGER; TO AMEND 11
THE VISION CARE PLAN ACT OF 2015; TO AMEND THE 12
HEALTHCARE CONTRACTING SIMPLIFICATION ACT; AND FOR 13
OTHER PURPOSES. 14
15
16
Subtitle 17
TO REGULATE A VISION BENEFIT MANAGER; TO 18
AMEND THE VISION CARE PLAN ACT OF 2015; 19
TO AMEND THE HEALTHCARE CONTRACTING 20
SIMPLIFICATION ACT. 21
22
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF ARKANSAS: 23
24
SECTION 1. Arkansas Code § 23 -85-132 is amended to read as follows: 25
23-85-132. Reduction of benefits due to other insurance contracts 26
prohibited. 27
(a) No A contract of individual accident and health insurance or 28
health coverage sold, delivered, or issued for delivery or offered for sale 29
in this state by an insurer, hospital and medical service corporation, or 30
health maintenance organization, directly or indirectly providing indemnity 31
services, healthcare services, or cash to an individual as a result of 32
hospitalization, medical or surgical treatment, or dental care, or vision 33
care shall not contain a provision reducing the benefit that would otherwise 34
be payable to the individual in the absence of other insurance or health 35
coverage if the reduction of benefits is due solely to the existence of one 36 HB1353
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(1) or more additional contracts providing benefits to that individual unless 1
the reduction complies with coordination of benefit rules adopted by the 2
Insurance Commissioner. 3
(b) No A contract of individual accident and health insurance sold, 4
delivered, or issued for delivery or offered for sale in this state providing 5
disability income coverage shall not contain any a provision for the denial 6
or reduction of benefits because of the existence of other insurance, except 7
as provided in § 23-85-122 or any coverages approved by the commissioner 8
pursuant thereto and except that the benefits may be reduced to offset 9
disability income benefits payable under the Social Security Act. 10
(c) The commissioner may issue rules to implement this section, 11
including, but not limited to, without limitation rules as to the amount of 12
reductions and the nature and timing of proofs of eligibility for Social 13
Security benefits. 14
15
SECTION 2. Arkansas Code § 23 -99-1002 is amended to read as follows: 16
23-99-1002. Definitions. 17
As used in this subchapter: 18
(1) "Covered materials" means materials for which reimbursement 19
from the insurer, vision benefit manager, vision care plan, or vision care 20
discount plan is provided to a vision care provider by an individual's vision 21
benefit plan or contract and that are reimbursable subject to a deductible, 22
copayment, coinsurance, or other contractual limitations; 23
(2) "Covered services" means services for which reimbursement 24
from the insurer, vision benefit manager, vision care plan, or vision care 25
discount plan is provided to a vision care provider by an individual's vision 26
benefit plan or contract and that are reimbursable subject to a deductible, 27
copayment, coinsurance, or other contractual limitations; 28
(3) "Enrollee" means an individual participating in a health 29
benefit plan, vision benefit plan, or vision benefit discount plan that is 30
purchased by an individual or provided to an individual by an insurer, 31
company, organization, group, employer, government assistance program, or 32
another entity that purchases or supplies coverage for a health benefit plan, 33
vision care benefit plan, or vision benefit discount plan; 34
(4) "Extrapolation" means a mathematical formula, process, or 35
technique used by a vision benefit manager or the vision benefit manager's 36 HB1353
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agent, in an audit of an optometrist to estimate audit results or findings 1
for a larger batch or group of claims not reviewed by the vision benefit 2
manager; 3
(5) "Insurer" means an insurance company, a health maintenance 4
organization, a hospital and medical service corporation, or a self -insured 5
health plan for employees of a governmental entity; 6
(4)(6) "Materials" means ophthalmic devices, including without 7
limitation: 8
(A) Lenses; 9
(B) Devices containing lenses; 10
(C) Contact lenses; 11
(D) Artificial intraocular lenses; 12
(D)(E) Ophthalmic frames; 13
(E)(F) Lens-mounting apparatus; 14
(F)(G) Prisms; 15
(G)(H) Spectacle or contact lens treatments and coatings; 16
and 17
(H)(I) Prosthetic devices to correct, relieve, or treat 18
defects or abnormal conditions of the human eye or its adnexa; 19
(J) Low-vision devices; and 20
(K) Vision therapy devices; 21
(5)(7) "Noncovered materials" means materials that are not 22
covered by an insurer, a vision benefit manager, a vision care plan, or a 23
vision care discount plan; 24
(6)(8) "Noncovered services" means services that are not covered 25
by an insurer, a vision benefit manager, a vision care plan, or a vision care 26
discount plan; 27
(7)(9) "Participating provider agreement" means an agreement 28
between a vision care provider and an insurer that obligates a vision care 29
provider to provide for compensation services and materials to an individual 30
who is insured by the insurer; 31
(8)(10) "Services" means benefits or services provided by a 32
vision care provider; 33
(9)(11) "Vision benefit manager" means an individual, company, 34
organization, group, or other entity, including without limitation an 35
insurer, third party administrator, and a subcontractor, that creates, 36 HB1353
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promotes, sells, provides, advertises, or administers an integrated or stand -1
alone vision benefit plan, vision benefit discount plan, or other insurance 2
policy or contract that provides vision benefits or discounts to an enrollee 3
pertaining to the provision of covered services or covered materials; 4
(12) "Vision benefit plan or contract" means a plan, contract, 5
or policy of insurance issued by an insurer that provides for vision care 6
benefits, materials, or services; 7
(10)(13) "Vision care discount plan" means a separate plan to 8
provide benefits or services under a rider to a health benefit plan or as a 9
stand-alone agreement that is authorized by a vision care provider to provide 10
discounts to individuals under the Primary Eye Care Provider Act, § 23 -99-301 11
et seq.; 12
(11)(14) "Vision care plan" means an entity that provides health 13
benefits and that creates, promotes, sells, provides, advertises, or 14
administers an integrated or stand -alone vision benefit plan or contract; and 15
(12)(15) "Vision care provider" means an individual licensed as 16
an optometrist under § 17 -90-301 et seq., or a licensed osteopathic or 17
medical physician licensed under § 17 -91-101 et seq. or § 17-95-401 et seq., 18
if the physician has also completed a residency in ophthalmology. 19
20
SECTION 3. Arkansas Code § 23 -99-1003 is amended to read as follows: 21
23-99-1003. Prohibited practices — Agreements. 22
(a) A participating provider agreement between an insurer, vision 23
benefit manager, vision care plan, or vision care discount plan and a vision 24
care provider shall not establish a fee that a vision care provider shall 25
charge for services or materials that are not covered by a vision benefit 26
plan or contract. 27
(b) A vision care provider shall not charge a fee for services or 28
materials that is more than the vision care provider's normal rate for the 29
services or materials if the services or materials are noncovered services or 30
noncovered materials. 31
(c)(1) An insurer, vision benefit manager, vision care plan, or vision 32
care discount plan shall not require a vision care provider to apply a 33
discount to an individual who is insured by the insurer with a participating 34
vision care provider for noncovered services or noncovered materials. 35
(2) An insurer, vision benefit manager, vision care plan, or 36 HB1353
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vision care discount plan shall not avoid the restriction under subdivision 1
(c)(1) of this section by providing minimal reimbursement for a service or 2
materials to apply a discount. 3
(d) A reimbursement paid by an insurer, vision benefit manager, vision 4
care plan, or vision care discount plan to a vision care provider for covered 5
services and covered materials shall not be: 6
(1) Nominal or de minimis; or 7
(2) Less than the current calendar year Medicare reimbursement 8
rate for the covered service or covered materials provided to the enrollee. 9
(e) A participating provider agreement between an insurer, vision 10
benefit manager, vision care plan, or vision care discount plan and a vision 11
care provider shall not require that a vision care provider participate with 12
or be credentialed by any specific vision care plan or vision care discount 13
plan as a condition to join an insurer's provider panel. 14
(e)(f) A participating provider agreement between an insurer, vision 15
benefit manager, vision care plan, or vision care discount plan and a vision 16
care provider shall not restrict or limit, directly or indirectly, the vision 17
care provider's choice of optical labs or choice of sources and suppliers of 18
services or materials provided by the vision care provider to an individual 19
who is insured by the insurer. 20
(g) An insurer, vision benefit manager, vision care plan, or vision 21
care discount plan shall identify participating vision care providers in a 22
neutral manner and shall not distinguish between participating vision care 23
providers based on the following characteristics: 24
(1) Discount or incentive offered by the vision care provider on 25
services and materials that are not covered by the insurer or vision benefit 26
manager, vision care plan, or vision care discount plan; 27
(2) The dollar amount, volume amount, or percent usage amount of 28
any material or good purchased by the vision care provider; or 29
(3) The brand, source, manufacturer, or supplier of a covered 30
service or covered product utilized by the vision care provider. 31
(h) An insurer, vision benefit manager, vision care plan, or vision 32
care discount plan shall not advertise that services and materials are 33
covered with additional copay or coinsurance if the health benefit plan, 34
vision benefit plan, or vision benefit discount plan does not reimburse the 35
participating vision care provider for the services or materials in order to 36 HB1353
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claim that services and materials are covered services and materials. 1
(i) An insurer, vision benefit manager, vision care plan, or vision 2
care discount plan shall not steer enrollees to, or limit the enrollees’ 3
choice of, vision care provider for services or materials that are not 4
covered services or not covered materials. 5
(j) An insurer, vision benefit manager, vision care plan, or vision 6
care discount plan shall not incentivize, recommend, encourage, persuade, or 7
attempt to persuade an enrollee to obtain covered services, noncovered 8
services, covered materials, or noncovered materials: 9
(1) At any particular participating vision care provider over 10
another participating vision care provider; 11
(2) At a retail establishment owned by, partially owned by, 12
contracted with, or otherwise affiliated with the insurer, vision benefit 13
manager, vision care plan, or vision care discount plan instead of a 14
different vision care provider; or 15
(3) At any internet or virtual provider or retailer owned by, 16
partially owned by, contracted with, or otherwise affiliated with the vision 17
plan instead of a different participating vision care provider. 18
(k) An insurer, vision benefit manager, vision care plan, or vision 19
care discount plan shall not reimburse a vision care provider a different 20
amount for covered services or covered materials because of the vision care 21
provider’s choice of: 22
(1) Optical laboratory; 23
(2) Source of supplier of: 24
(A) Contact lenses; 25
(B) Ophthalmic lenses; 26
(C) Ophthalmic glasses frames; or 27
(D) Covered services, covered materials, noncovered 28
services, or noncovered materials; 29
(3) Equipment used for patient care; 30
(4) Retail optical affiliation; 31
(5) Vision support organization; 32
(6) Group purchasing organization; 33
(7) Doctor alliance; 34
(8) Professional trade association membership; 35
(9) Electronic health record software, electronic medical record 36 HB1353
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software, or practice management software; or 1
(10) Third-party claim filing service, billing service, or 2
electronic data interchange clearinghouse company. 3
(f)(l) The terms, discounts, and reimbursement rates in a 4
participating contract between an insurer, vision benefit manager, vision 5
care plan, or vision care discount plan with a vision care provider shall not 6
be modified during the term of a participating contract absent written 7
authorization from the vision care provider. 8
(m) A participating provider agreement between an insurer, vision 9
benefit manager, vision care plan, or vision care discount plan and a vision 10
care provider shall not require a vision care provider to accept a 11
reimbursement payment in the form of a virtual credit card or any other 12
payment method wherein a processing fee, administrative fee, percentage 13
amount, or dollar amount is assessed to the vision care provider to receive a 14
reimbursement payment. 15
(n)(1) An insurer, vision benefit manager, vision care plan, or vision 16
care discount plan shall not use extrapolation to complete an audit of a 17
participating vision care provider. 18
(2) An additional payment due to a participating vision care 19
provider or a refund due to the insurer or vision benefit manager shall not 20
be based on an extrapolation, but shall be based on the actual overpayment or 21
underpayment, as determined after an investigation by the insurer, vision 22
benefit manager, vision care plan, or vision care discount plan, and 23
participating vision care provider has been afforded, and has exhausted, all 24
opportunities to appeal the insurer, vision benefit manager, vision care 25
plan, or vision care discount plan’s findings, as stated in the provider 26
manual or policy document, or applicable law. 27
(o)(1) A participating provider agreement between an insurer, vision 28
benefit manager, vision care plan, or vision care discount plan and a vision 29
care provider shall not prohibit a vision care provider from accepting a cash 30
payment option from the enrollee if the cash payment option is less costly to 31
the enrollee than the total out -of-pocket cost of the service or material. 32
(2) A vision care provider shall not be subject to an audit for 33
offering a cash price option for services and materials. 34
(p) An insurer, vision benefit manager, vision care plan, or vision 35
care discount plan shall not withhold or recoup a contracted amount for a 36 HB1353
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covered service or covered material provided to an enrollee if the enrollee 1
is verified to be eligible by the vision care provider through customary 2
verification methods of the insurer, vision benefit manager, vision care 3
plan, or vision care discount plan to receive the covered service or covered 4
material on the date of service. 5
(g)(q) An optician licensed under the Ophthalmic Dispensing Act, § 17 -6
89-101 et seq., is subject to: 7
(1) Subsections (c) and (e)(f) of this section; and 8
(2) Subsection (b) of this section in regard to materials. 9
10
SECTION 4. Arkansas Code § 23 -99-1202(5), concerning the definition of 11
"health benefit plan" under the Healthcare Contracting Simplification Act, is 12
amended to read as follows: 13
(5)(A) "Health benefit plan" means a plan, policy, contract, 14
certificate, agreement, or other evidence of coverage for healthcare services 15
offered or issued by a healthcare insurer in this state. 16
(B) "Health benefit plan" includes: 17
(i) A nonfederal governmental plan as defined in 29 18
U.S.C. § 1002(32), as it existed on January 1, 2023; and January 1, 2025; 19
(ii) A contract for providing benefits for dental 20
care pursuant to: 21
(a) A healthcare insurance policy or 22
certificate; 23
(b) A dental-only plan; 24
(c) A health maintenance organization provider 25
contract; or 26
(d) A managed healthcare plan ; and 27
(iii) A contract for providing benefits for vision 28
care under a healthcare insurance policy or certificate, a vision -only plan, 29
a health maintenance organization provider contract, or a managed healthcare 30
plan. 31
(C) "Health benefit plan” does not include: 32
(i) A disability income plan; 33
(ii) A credit insurance plan; 34
(iii) Insurance coverage issued as a supplement to 35
liability insurance; 36 HB1353
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(iv) A medical payment under automobile or homeowners 1
insurance plans; 2
(v) 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
(vi) A plan that provides only indemnity for 6
hospital confinement; 7
(vii) An accident-only plan; 8
(viii) A specified disease plan; or 9
(ix) A long-term care only plan; or 10
(x) A vision-only plan; 11
12
SECTION 5. Arkansas Code § 23 -99-1202(7), concerning the definition of 13
"healthcare insurer" under the Healthcare Contracting Simplification Act, is 14
amended to read as follows: 15
(7)(A) "Healthcare insurer" means an entity that is subject to 16
state insurance regulation and provides health insurance in this state. 17
(B) "Healthcare insurer" includes: 18
(i) An insurance company; 19
(ii) A health maintenance organization; 20
(iii) A hospital and medical service corporation; 21
(iv) A risk-based provider organization; 22
(v) A sponsor of a nonfederal self -funded 23
governmental plan; and 24
(vi) A dental-only plan; and 25
(vii) A vision-only plan; 26
27
SECTION 6. DO NOT CODIFY. Effective date. This act shall apply to an 28
insurer, vision benefit manager, vision care plan, and vision discount plan 29
upon the earlier of: 30
(1) The period of renewal of an enrollee's current health 31
benefit plan or issue of a new health benefit plan to an enrollee; 32
(2) The initiation of a new contract with a vision care provider 33
or a modification of an existing contract with a vision care provider; or 34
(3) January 1, 2026. 35
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