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Arkansas House Bill HB1353

Arkansas 2025 Regular Session

Arkansas House Bill HB1353 Compare Versions

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11 Stricken language would be deleted from and underlined language would be added to present law.
2-Act 142 of the Regular Session
32 *ANS200* 01/31/2025 12:08:07 PM ANS200
43 State of Arkansas 1
54 95th General Assembly A Bill 2
65 Regular Session, 2025 HOUSE BILL 1353 3
76 4
87 By: Representatives Eubanks, Achor, F. Allen, Dalby, Eaton, Eaves, Evans, K. Ferguson, Gramlich, 5
98 Henley, Holcomb, Hollowell, Ladyman, Maddox, Magie, McGrew, Milligan, Nazarenko, Perry, J. 6
109 Richardson, Richmond, Steimel, Vaught, Warren, Wing, Wooten 7
1110 By: Senators D. Wallace, J. Boyd, Caldwell, J. English, Irvin, M. Johnson, Rice, J. Scott 8
1211 9
1312 For An Act To Be Entitled 10
1413 AN ACT TO REGULATE A VISION BENEFIT MANAGER; TO AMEND 11
1514 THE VISION CARE PLAN ACT OF 2015; TO AMEND THE 12
1615 HEALTHCARE CONTRACTING SIMPLIFICATION ACT; AND FOR 13
1716 OTHER PURPOSES. 14
1817 15
1918 16
2019 Subtitle 17
2120 TO REGULATE A VISION BENEFIT MANAGER; TO 18
2221 AMEND THE VISION CARE PLAN ACT OF 2015; 19
2322 TO AMEND THE HEALTHCARE CONTRACTING 20
2423 SIMPLIFICATION ACT. 21
2524 22
2625 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF ARKANSAS: 23
2726 24
2827 SECTION 1. Arkansas Code § 23 -85-132 is amended to read as follows: 25
2928 23-85-132. Reduction of benefits due to other insurance contracts 26
3029 prohibited. 27
3130 (a) No A contract of individual accident and health insurance or 28
3231 health coverage sold, delivered, or issued for delivery or offered for sale 29
3332 in this state by an insurer, hospital and medical service corporation, or 30
3433 health maintenance organization, directly or indirectly providing indemnity 31
3534 services, healthcare services, or cash to an individual as a result of 32
3635 hospitalization, medical or surgical treatment, or dental care, or vision 33
3736 care shall not contain a provision reducing the benefit that would otherwise 34
3837 be payable to the individual in the absence of other insurance or health 35
3938 coverage if the reduction of benefits is due solely to the existence of one 36 HB1353
4039
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4241 (1) or more additional contracts providing benefits to that individual unless 1
4342 the reduction complies with coordination of benefit rules adopted by the 2
4443 Insurance Commissioner. 3
4544 (b) No A contract of individual accident and health insurance sold, 4
4645 delivered, or issued for delivery or offered for sale in this state providing 5
4746 disability income coverage shall not contain any a provision for the denial 6
4847 or reduction of benefits because of the existence of other insurance, except 7
4948 as provided in § 23-85-122 or any coverages approved by the commissioner 8
5049 pursuant thereto and except that the benefits may be reduced to offset 9
5150 disability income benefits payable under the Social Security Act. 10
5251 (c) The commissioner may issue rules to implement this section, 11
5352 including, but not limited to, without limitation rules as to the amount of 12
5453 reductions and the nature and timing of proofs of eligibility for Social 13
5554 Security benefits. 14
5655 15
5756 SECTION 2. Arkansas Code § 23 -99-1002 is amended to read as follows: 16
5857 23-99-1002. Definitions. 17
5958 As used in this subchapter: 18
6059 (1) "Covered materials" means materials for which reimbursement 19
6160 from the insurer, vision benefit manager, vision care plan, or vision care 20
6261 discount plan is provided to a vision care provider by an individual's vision 21
6362 benefit plan or contract and that are reimbursable subject to a deductible, 22
6463 copayment, coinsurance, or other contractual limitations; 23
6564 (2) "Covered services" means services for which reimbursement 24
6665 from the insurer, vision benefit manager, vision care plan, or vision care 25
6766 discount plan is provided to a vision care provider by an individual's vision 26
6867 benefit plan or contract and that are reimbursable subject to a deductible, 27
6968 copayment, coinsurance, or other contractual limitations; 28
7069 (3) "Enrollee" means an individual participating in a health 29
7170 benefit plan, vision benefit plan, or vision benefit discount plan that is 30
7271 purchased by an individual or provided to an individual by an insurer, 31
7372 company, organization, group, employer, government assistance program, or 32
7473 another entity that purchases or supplies coverage for a health benefit plan, 33
7574 vision care benefit plan, or vision benefit discount plan; 34
7675 (4) "Extrapolation" means a mathematical formula, process, or 35
7776 technique used by a vision benefit manager or the vision benefit manager's 36 HB1353
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8079 agent, in an audit of an optometrist to estimate audit results or findings 1
8180 for a larger batch or group of claims not reviewed by the vision benefit 2
8281 manager; 3
8382 (5) "Insurer" means an insurance company, a health maintenance 4
8483 organization, a hospital and medical service corporation, or a self -insured 5
8584 health plan for employees of a governmental entity; 6
8685 (4)(6) "Materials" means ophthalmic devices, including without 7
8786 limitation: 8
8887 (A) Lenses; 9
8988 (B) Devices containing lenses; 10
9089 (C) Contact lenses; 11
9190 (D) Artificial intraocular lenses; 12
9291 (D)(E) Ophthalmic frames; 13
9392 (E)(F) Lens-mounting apparatus; 14
9493 (F)(G) Prisms; 15
9594 (G)(H) Spectacle or contact lens treatments and coatings; 16
9695 and 17
9796 (H)(I) Prosthetic devices to correct, relieve, or treat 18
9897 defects or abnormal conditions of the human eye or its adnexa; 19
9998 (J) Low-vision devices; and 20
10099 (K) Vision therapy devices; 21
101100 (5)(7) "Noncovered materials" means materials that are not 22
102101 covered by an insurer, a vision benefit manager, a vision care plan, or a 23
103102 vision care discount plan; 24
104103 (6)(8) "Noncovered services" means services that are not covered 25
105104 by an insurer, a vision benefit manager, a vision care plan, or a vision care 26
106105 discount plan; 27
107106 (7)(9) "Participating provider agreement" means an agreement 28
108107 between a vision care provider and an insurer that obligates a vision care 29
109108 provider to provide for compensation services and materials to an individual 30
110109 who is insured by the insurer; 31
111110 (8)(10) "Services" means benefits or services provided by a 32
112111 vision care provider; 33
113112 (9)(11) "Vision benefit manager" means an individual, company, 34
114113 organization, group, or other entity, including without limitation an 35
115114 insurer, third party administrator, and a subcontractor, that creates, 36 HB1353
116115
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118117 promotes, sells, provides, advertises, or administers an integrated or stand -1
119118 alone vision benefit plan, vision benefit discount plan, or other insurance 2
120119 policy or contract that provides vision benefits or discounts to an enrollee 3
121120 pertaining to the provision of covered services or covered materials; 4
122121 (12) "Vision benefit plan or contract" means a plan, contract, 5
123122 or policy of insurance issued by an insurer that provides for vision care 6
124123 benefits, materials, or services; 7
125124 (10)(13) "Vision care discount plan" means a separate plan to 8
126125 provide benefits or services under a rider to a health benefit plan or as a 9
127126 stand-alone agreement that is authorized by a vision care provider to provide 10
128127 discounts to individuals under the Primary Eye Care Provider Act, § 23 -99-301 11
129128 et seq.; 12
130129 (11)(14) "Vision care plan" means an entity that provides health 13
131130 benefits and that creates, promotes, sells, provides, advertises, or 14
132131 administers an integrated or stand -alone vision benefit plan or contract; and 15
133132 (12)(15) "Vision care provider" means an individual licensed as 16
134133 an optometrist under § 17 -90-301 et seq., or a licensed osteopathic or 17
135134 medical physician licensed under § 17 -91-101 et seq. or § 17-95-401 et seq., 18
136135 if the physician has also completed a residency in ophthalmology. 19
137136 20
138137 SECTION 3. Arkansas Code § 23 -99-1003 is amended to read as follows: 21
139138 23-99-1003. Prohibited practices — Agreements. 22
140139 (a) A participating provider agreement between an insurer, vision 23
141140 benefit manager, vision care plan, or vision care discount plan and a vision 24
142141 care provider shall not establish a fee that a vision care provider shall 25
143142 charge for services or materials that are not covered by a vision benefit 26
144143 plan or contract. 27
145144 (b) A vision care provider shall not charge a fee for services or 28
146145 materials that is more than the vision care provider's normal rate for the 29
147146 services or materials if the services or materials are noncovered services or 30
148147 noncovered materials. 31
149148 (c)(1) An insurer, vision benefit manager, vision care plan, or vision 32
150149 care discount plan shall not require a vision care provider to apply a 33
151150 discount to an individual who is insured by the insurer with a participating 34
152151 vision care provider for noncovered services or noncovered materials. 35
153152 (2) An insurer, vision benefit manager, vision care plan, or 36 HB1353
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156155 vision care discount plan shall not avoid the restriction under subdivision 1
157156 (c)(1) of this section by providing minimal reimbursement for a service or 2
158157 materials to apply a discount. 3
159158 (d) A reimbursement paid by an insurer, vision benefit manager, vision 4
160159 care plan, or vision care discount plan to a vision care provider for covered 5
161160 services and covered materials shall not be: 6
162161 (1) Nominal or de minimis; or 7
163162 (2) Less than the current calendar year Medicare reimbursement 8
164163 rate for the covered service or covered materials provided to the enrollee. 9
165164 (e) A participating provider agreement between an insurer, vision 10
166165 benefit manager, vision care plan, or vision care discount plan and a vision 11
167166 care provider shall not require that a vision care provider participate with 12
168167 or be credentialed by any specific vision care plan or vision care discount 13
169168 plan as a condition to join an insurer's provider panel. 14
170169 (e)(f) A participating provider agreement between an insurer, vision 15
171170 benefit manager, vision care plan, or vision care discount plan and a vision 16
172171 care provider shall not restrict or limit, directly or indirectly, the vision 17
173172 care provider's choice of optical labs or choice of sources and suppliers of 18
174173 services or materials provided by the vision care provider to an individual 19
175174 who is insured by the insurer. 20
176175 (g) An insurer, vision benefit manager, vision care plan, or vision 21
177176 care discount plan shall identify participating vision care providers in a 22
178177 neutral manner and shall not distinguish between participating vision care 23
179178 providers based on the following characteristics: 24
180179 (1) Discount or incentive offered by the vision care provider on 25
181180 services and materials that are not covered by the insurer or vision benefit 26
182181 manager, vision care plan, or vision care discount plan; 27
183182 (2) The dollar amount, volume amount, or percent usage amount of 28
184183 any material or good purchased by the vision care provider; or 29
185184 (3) The brand, source, manufacturer, or supplier of a covered 30
186185 service or covered product utilized by the vision care provider. 31
187186 (h) An insurer, vision benefit manager, vision care plan, or vision 32
188187 care discount plan shall not advertise that services and materials are 33
189188 covered with additional copay or coinsurance if the health benefit plan, 34
190189 vision benefit plan, or vision benefit discount plan does not reimburse the 35
191190 participating vision care provider for the services or materials in order to 36 HB1353
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194193 claim that services and materials are covered services and materials. 1
195194 (i) An insurer, vision benefit manager, vision care plan, or vision 2
196195 care discount plan shall not steer enrollees to, or limit the enrollees’ 3
197196 choice of, vision care provider for services or materials that are not 4
198197 covered services or not covered materials. 5
199198 (j) An insurer, vision benefit manager, vision care plan, or vision 6
200199 care discount plan shall not incentivize, recommend, encourage, persuade, or 7
201200 attempt to persuade an enrollee to obtain covered services, noncovered 8
202201 services, covered materials, or noncovered materials: 9
203202 (1) At any particular participating vision care provider over 10
204203 another participating vision care provider; 11
205204 (2) At a retail establishment owned by, partially owned by, 12
206205 contracted with, or otherwise affiliated with the insurer, vision benefit 13
207206 manager, vision care plan, or vision care discount plan instead of a 14
208207 different vision care provider; or 15
209208 (3) At any internet or virtual provider or retailer owned by, 16
210209 partially owned by, contracted with, or otherwise affiliated with the vision 17
211210 plan instead of a different participating vision care provider. 18
212211 (k) An insurer, vision benefit manager, vision care plan, or vision 19
213212 care discount plan shall not reimburse a vision care provider a different 20
214213 amount for covered services or covered materials because of the vision care 21
215214 provider’s choice of: 22
216215 (1) Optical laboratory; 23
217216 (2) Source of supplier of: 24
218217 (A) Contact lenses; 25
219218 (B) Ophthalmic lenses; 26
220219 (C) Ophthalmic glasses frames; or 27
221220 (D) Covered services, covered materials, noncovered 28
222221 services, or noncovered materials; 29
223222 (3) Equipment used for patient care; 30
224223 (4) Retail optical affiliation; 31
225224 (5) Vision support organization; 32
226225 (6) Group purchasing organization; 33
227226 (7) Doctor alliance; 34
228227 (8) Professional trade association membership; 35
229228 (9) Electronic health record software, electronic medical record 36 HB1353
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232231 software, or practice management software; or 1
233232 (10) Third-party claim filing service, billing service, or 2
234233 electronic data interchange clearinghouse company. 3
235234 (f)(l) The terms, discounts, and reimbursement rates in a 4
236235 participating contract between an insurer, vision benefit manager, vision 5
237236 care plan, or vision care discount plan with a vision care provider shall not 6
238237 be modified during the term of a participating contract absent written 7
239238 authorization from the vision care provider. 8
240239 (m) A participating provider agreement between an insurer, vision 9
241240 benefit manager, vision care plan, or vision care discount plan and a vision 10
242241 care provider shall not require a vision care provider to accept a 11
243242 reimbursement payment in the form of a virtual credit card or any other 12
244243 payment method wherein a processing fee, administrative fee, percentage 13
245244 amount, or dollar amount is assessed to the vision care provider to receive a 14
246245 reimbursement payment. 15
247246 (n)(1) An insurer, vision benefit manager, vision care plan, or vision 16
248247 care discount plan shall not use extrapolation to complete an audit of a 17
249248 participating vision care provider. 18
250249 (2) An additional payment due to a participating vision care 19
251250 provider or a refund due to the insurer or vision benefit manager shall not 20
252251 be based on an extrapolation, but shall be based on the actual overpayment or 21
253252 underpayment, as determined after an investigation by the insurer, vision 22
254253 benefit manager, vision care plan, or vision care discount plan, and 23
255254 participating vision care provider has been afforded, and has exhausted, all 24
256255 opportunities to appeal the insurer, vision benefit manager, vision care 25
257256 plan, or vision care discount plan’s findings, as stated in the provider 26
258257 manual or policy document, or applicable law. 27
259258 (o)(1) A participating provider agreement between an insurer, vision 28
260259 benefit manager, vision care plan, or vision care discount plan and a vision 29
261260 care provider shall not prohibit a vision care provider from accepting a cash 30
262261 payment option from the enrollee if the cash payment option is less costly to 31
263262 the enrollee than the total out -of-pocket cost of the service or material. 32
264263 (2) A vision care provider shall not be subject to an audit for 33
265264 offering a cash price option for services and materials. 34
266265 (p) An insurer, vision benefit manager, vision care plan, or vision 35
267266 care discount plan shall not withhold or recoup a contracted amount for a 36 HB1353
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270269 covered service or covered material provided to an enrollee if the enrollee 1
271270 is verified to be eligible by the vision care provider through customary 2
272271 verification methods of the insurer, vision benefit manager, vision care 3
273272 plan, or vision care discount plan to receive the covered service or covered 4
274273 material on the date of service. 5
275274 (g)(q) An optician licensed under the Ophthalmic Dispensing Act, § 17 -6
276275 89-101 et seq., is subject to: 7
277276 (1) Subsections (c) and (e)(f) of this section; and 8
278277 (2) Subsection (b) of this section in regard to materials. 9
279278 10
280279 SECTION 4. Arkansas Code § 23 -99-1202(5), concerning the definition of 11
281280 "health benefit plan" under the Healthcare Contracting Simplification Act, is 12
282281 amended to read as follows: 13
283282 (5)(A) "Health benefit plan" means a plan, policy, contract, 14
284283 certificate, agreement, or other evidence of coverage for healthcare services 15
285284 offered or issued by a healthcare insurer in this state. 16
286285 (B) "Health benefit plan" includes: 17
287286 (i) A nonfederal governmental plan as defined in 29 18
288287 U.S.C. § 1002(32), as it existed on January 1, 2023; and January 1, 2025; 19
289288 (ii) A contract for providing benefits for dental 20
290289 care pursuant to: 21
291290 (a) A healthcare insurance policy or 22
292291 certificate; 23
293292 (b) A dental-only plan; 24
294293 (c) A health maintenance organization provider 25
295294 contract; or 26
296295 (d) A managed healthcare plan ; and 27
297296 (iii) A contract for providing benefits for vision 28
298297 care under a healthcare insurance policy or certificate, a vision -only plan, 29
299298 a health maintenance organization provider contract, or a managed healthcare 30
300299 plan. 31
301300 (C) "Health benefit plan” does not include: 32
302301 (i) A disability income plan; 33
303302 (ii) A credit insurance plan; 34
304303 (iii) Insurance coverage issued as a supplement to 35
305304 liability insurance; 36 HB1353
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308307 (iv) A medical payment under automobile or homeowners 1
309308 insurance plans; 2
310309 (v) A health benefit plan provided under Arkansas 3
311310 Constitution, Article 5, § 32, the Workers' Compensation Law, § 11 -9-101 et 4
312311 seq., or the Public Employee Workers' Compensation Act, § 21 -5-601 et seq.; 5
313312 (vi) A plan that provides only indemnity for 6
314313 hospital confinement; 7
315314 (vii) An accident-only plan; 8
316315 (viii) A specified disease plan; or 9
317316 (ix) A long-term care only plan; or 10
318317 (x) A vision-only plan; 11
319318 12
320319 SECTION 5. Arkansas Code § 23 -99-1202(7), concerning the definition of 13
321320 "healthcare insurer" under the Healthcare Contracting Simplification Act, is 14
322321 amended to read as follows: 15
323322 (7)(A) "Healthcare insurer" means an entity that is subject to 16
324323 state insurance regulation and provides health insurance in this state. 17
325324 (B) "Healthcare insurer" includes: 18
326325 (i) An insurance company; 19
327326 (ii) A health maintenance organization; 20
328327 (iii) A hospital and medical service corporation; 21
329328 (iv) A risk-based provider organization; 22
330329 (v) A sponsor of a nonfederal self -funded 23
331330 governmental plan; and 24
332331 (vi) A dental-only plan; and 25
333332 (vii) A vision-only plan; 26
334333 27
335334 SECTION 6. DO NOT CODIFY. Effective date. This act shall apply to an 28
336335 insurer, vision benefit manager, vision care plan, and vision discount plan 29
337336 upon the earlier of: 30
338337 (1) The period of renewal of an enrollee's current health 31
339338 benefit plan or issue of a new health benefit plan to an enrollee; 32
340339 (2) The initiation of a new contract with a vision care provider 33
341-or a modification of an existing contract with a vision care provider; o r (3) 34
342-January 1, 2026. 35
343-APPROVED: 2/25/25 36
340+or a modification of an existing contract with a vision care provider; or 34
341+ (3) January 1, 2026. 35
342+ 36