Arkansas 2025 Regular Session

Arkansas House Bill HB1420 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	Stricken language would be deleted from and underlined language would be added to present law.
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3	3	State of Arkansas 1
4	4	95th General Assembly A Bill 2
5	5	Regular Session, 2025 HOUSE BILL 1420 3
6	6	4
7	7	By: Representative Steimel 5
8	8	By: Senator J. Boyd 6
9	9	7
10	10	For An Act To Be Entitled 8
11	11	AN ACT TO ENACT THE STATE INSURANCE DEPARTMENT'S 9
12	12	GENERAL OMNIBUS AMENDMENT OF ARKANSAS INSURANCE CODE; 10
13	13	TO AMEND THE ARKANSAS WORKERS' COMPENSATION INSURANCE 11
14	14	PLAN; TO AMEND THE LAW CONCERNING RECIPROCAL 12
15	15	INSURERS; TO CLARIFY AN ATTORNEY'S BOND REQUIREMENT; 13
16	16	TO AMEND THE LAW CONCERNING BENEFITS FOR ALCOHOL AND 14
17	17	DRUG DEPENDENCY TREATMENT; TO AMEND THE LAW 15
18	18	CONCERNING SERVICE OF PROCESS IN SUITS INVOLVING 16
19	19	INSURERS; TO REPEAL THE COMPREHENSIVE HEALTH 17
20	20	INSURANCE POOL ACT; TO REPEAL THE MINIMUM BENEFITS 18
21	21	FOR MENTAL ILLNESS IN GROUP ACCIDENT AND HEALTH 19
22	22	INSURANCE POLICIES OR SUBSCRIBER'S CONTRACTS; TO 20
23	23	AMEND THE ARKANSAS MENTAL HEALTH PARITY ACT OF 2009; 21
24	24	AND FOR OTHER PURPOSES. 22
25	25	23
26	26	24
27	27	Subtitle 25
28	28	TO ENACT THE STATE INSURANCE 26
29	29	DEPARTMENT'S GENERAL OMNIBUS AMENDMENT 27
30	30	OF ARKANSAS INSURANCE CODE. 28
31	31	29
32	32	BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF ARKANSAS: 30
33	33	31
34	34	SECTION 1. Arkansas Code § 23 -67-304(e), concerning the ability of the 32
35	35	Insurance Commissioner to delegate responsibility under the Arkansas Workers' 33
36	36	Compensation Insurance Plan, is amended to read as follows: 34
37	37	(e)(1)(A) At his or her discretion, the The Insurance Commissioner is 35
38	38	authorized to may delegate all or any part of the commissioner's 36 HB1420
39	39
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41	41	responsibility to establish and operate the plan. 1
42	42	(B) However, any such plan, or plan of operation, and any 2
43	43	amendments thereto must receive the prior approval of the commissioner. 3
44	44	(2) Any person or entity to whom the establishment, 4
45	45	implementation, or operation of the plan is delegated pursuant to this 5
46	46	subsection shall file with and obtain the approval of the commissioner as to 6
47	47	all policy forms, rates, or supplementary rate information necessary to 7
48	48	effectuate the plan. 8
49	49	(3)(A) In delegating all or part of the commissioner's 9
50	50	responsibility, the commissioner shall not approve any plan or filing that 10
51	51	abrogates or restricts his or her authority to select the plan administrator 11
52	52	or servicing carriers. 12
53	53	(B) The commissioner shall competitively select the 13
54	54	organization or organizations to whom the responsibility of plan 14
55	55	administrator shall be delegated. 15
56	56	(C) If the administration of the plan is delegated, the 16
57	57	plan administrator or administrators shall have an office in Arkansas be 17
58	58	adequately staffed, outfitted, and maintained to provide the plan services 18
59	59	delegated. 19
60	60	(D) The commissioner shall specify duties and functions of 20
61	61	plan administrators and may structure and delegate administrative functions 21
62	62	separately such as, but not limited to, rates, forms, and statistics for the 22
63	63	best operation of the plan. 23
64	64	(4) Under the provisions of this subsection, the commissioner 24
65	65	shall vigorously promote competition for the designation of the plan 25
66	66	administrator and servicing carrier for the most effective operation of the 26
67	67	plan. 27
68	68	(5)(A) The office plan administrator and personnel in Arkansas 28
69	69	is established are placed in their positions to improve services provided by 29
70	70	the plan, to promote and secure courteous and timely service, and to assure 30
71	71	that the minimum standards as provided under subdivision (f)(2) of this 31
72	72	section are met. 32
73	73	(B) The office plan administrator and personnel in 33
74	74	Arkansas shall also assist employers or agents with questions, problems, or 34
75	75	complaints pertaining to the servicing carriers and secure and expedite 35
76	76	prompt and fair treatment to employers for servicing carrier errors and 36 HB1420
77	77
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79	79	service failures. 1
80	80	(6)(A) The Arkansas office manager shall have the authority to 2
81	81	intervene with servicing carriers to secure an adequate level of service and 3
82	82	prevent servicing carriers from imposing unreasonable demands or actions. 4
83	83	(B) The office manager shall keep a record of all employer 5
84	84	or agent problems and complaints by a servicing carrier, including a 6
85	85	description of the problem. This record shall be provided to the commissioner 7
86	86	within sixty (60) days of each calendar year or upon the request of the 8
87	87	commissioner. 9
88	88	(C) The manager shall promptly notify the commissioner of 10
89	89	any problems upon a request by an employer. 11
90	90	12
91	91	SECTION 2. Arkansas Code § 23 -70-110(a)(1), concerning the attorney's 13
92	92	bond required of a domestic reciprocal insurer, is amended to read as 14
93	93	follows: 15
94	94	(a)(1)(A) Concurrently with the filing of the declaration provided for 16
95	95	in § 23-70-106, the attorney of a domestic or foreign reciprocal insurer 17
96	96	shall file with the Insurance Commissioner a bond in favor of this state for 18
97	97	the benefit of all persons damaged as a result of breach by the attorney of 19
98	98	the conditions of his or her bond as set forth stated in subdivision (a)(2) 20
99	99	of this section. 21
100	100	(B) The bond under subdivision (a)(1)(A) of this section 22
101	101	shall be: 23
102	102	(i) executed Executed by the attorney and by an 24
103	103	authorized corporate surety ; and 25
104	104	(ii) shall be subject Subject to the commissioner's 26
105	105	approval. 27
106	106	28
107	107	SECTION 3. Arkansas Code § 23 -79-139 is repealed. 29
108	108	23-79-139. Benefits for alcohol or drug dependency treatment — 30
109	109	Definition. 31
110	110	(a)(1) Every insurer, hospital and medical service corporation, and 32
111	111	health maintenance organization transacting accident and health insurance in 33
112	112	this state shall offer and make available under all group policies, 34
113	113	contracts, and plans providing hospital and medical coverage on an expense 35
114	114	incurred, service, or prepaid basis benefits for the necessary care and 36 HB1420
115	115
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117	117	treatment of alcohol and other drug dependency that are not less favorable 1
118	118	than for physical illness generally, subject to the same durational limits, 2
119	119	dollar limits, deductibles, and coinsurance factors, except as provided in 3
120	120	this section. 4
121	121	(2)(A) The offer for these benefits shall be subject to the 5
122	122	right of the policy or contract holder to reject the coverage or select any 6
123	123	alternative level of benefits. 7
124	124	(B) The rejection by the policy or contract holder shall 8
125	125	be in writing. 9
126	126	(b) Any benefits provided under alcohol or drug dependency coverage 10
127	127	shall be determined as necessary care and treatment in an alcohol or drug 11
128	128	dependency treatment facility or care and treatment in a hospital. 12
129	129	(c) Treatment may include detoxification, administration of a 13
130	130	therapeutic regimen for the treatment of alcohol or drug dependent or 14
131	131	substance abusing persons, and related services. 15
132	132	(d) The facility or unit may be: 16
133	133	(1) A unit within a general hospital or an attached or 17
134	134	freestanding unit of a general hospital; 18
135	135	(2) A unit within a psychiatric hospital or an attached or 19
136	136	freestanding unit of a psychiatric hospital; or 20
137	137	(3) A freestanding facility specializing in treatment of persons 21
138	138	who are substance abusers or are alcohol or drug dependent, and may be 22
139	139	identified as “chemical dependency, substance abuse, alcoholism, or drug 23
140	140	abuse facilities”, “social setting detoxification facilities”, and “medical 24
141	141	detoxification facilities”, or by other names if the purpose is to provide 25
142	142	treatment of alcohol or drug dependent or substance abusing persons, but 26
143	143	shall not include halfway houses or recovery farms. 27
144	144	(e) Every policy or contract of insurance that provides benefits for 28
145	145	alcohol or drug dependency treatment and that provides total annual benefits 29
146	146	for all illnesses in excess of six thousand dollars ($6,000) is subject to 30
147	147	the following conditions: 31
148	148	(1) The policy or contract shall provide, for each twenty -four-32
149	149	month period, a minimum benefit of six thousand dollars ($6,000) for the 33
150	150	necessary care and treatment of alcohol or drug dependency; 34
151	151	(2) No more than one -half (½) of the policy's or contract's 35
152	152	maximum benefits for alcohol or drug dependency for a twenty -four-month 36 HB1420
153	153
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155	155	period shall be paid for the necessary care and treatment of alcohol or drug 1
156	156	dependency in any thirty -consecutive-day period; and 2
157	157	(3) The policy or contract shall provide a minimum benefit of 3
158	158	twelve thousand dollars ($12,000) for the necessary care and treatment of 4
159	159	alcohol or drug dependency for the life of the recipient of benefits. 5
160	160	(f) For the purposes of this section, the term “alcohol or drug 6
161	161	dependency treatment facility” means a public or private facility or unit in 7
162	162	a facility that provides treatment twenty -four (24) hours a day for alcohol 8
163	163	or drug dependency or substance abuse, that provides a program for the 9
164	164	treatment of alcohol or other drug dependency under a written treatment plan 10
165	165	approved and monitored by a physician, and that is also properly licensed or 11
166	166	accredited to provide those services by the Division of Aging, Adult, and 12
167	167	Behavioral Health Services of the Department of Human Services. 13
168	168	(g) Nothing in this section shall prohibit any certificate or contract 14
169	169	from requiring the most cost -effective treatment setting to be utilized by 15
170	170	the person undergoing necessary care and treatment for alcohol or drug 16
171	171	dependency. 17
172	172	(h) As used in this section, “alcohol or drug dependency” means the 18
173	173	pathological use or abuse of alcohol or other drugs in a manner or to a 19
174	174	degree that produces an impairment in personal, social, or occupational 20
175	175	functioning and that may, but need not, include a pattern of tolerance and 21
176	176	withdrawal. 22
177	177	(i) This section shall apply to group policies or contracts delivered 23
178	178	or issued for delivery or renewed in this state after November 17, 1987, but 24
179	179	shall not apply to blanket short -term travel accident only, limited or 25
180	180	specified disease, conversion policies or contracts, nor to policies or 26
181	181	contracts referred to as Medicare supplement policies, designed for issuance 27
182	182	to persons eligible for coverage under Title XVIII of the Social Security 28
183	183	Act. 29
184	184	30
185	185	SECTION 4. Arkansas Code § 23 -79-205(a), concerning service of process 31
186	186	against an insurer, is amended to read as follows: 32
187	187	(a) In any suit brought in this state against an insurer, process may 33
188	188	be served upon the insurer as follows: 34
189	189	(1) As to domestic insurers, service of process may be had only 35
190	190	in the manner as provided by § 16-58-124 the Arkansas Rules of Civil 36 HB1420
191	191
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193	193	Procedure; 1
194	194	(2) As to licensed foreign or alien insurers, service on and 2
195	195	after January 1, 2003, may be made as provided in § 23 -63-301 et seq.; and 3
196	196	(3) As to suits against unauthorized insurers, service of 4
197	197	process shall be made as provided in §§ 23 -65-101 — 23-65-104, § 23-65-201 et 5
198	198	seq., and §§ 23-65-301 — 23-65-318 for unauthorized insurers and surplus 6
199	199	lines. 7
200	200	8
201	201	SECTION 5. Arkansas Code Title 23, Chapter 79, Subchapter 5, is 9
202	202	repealed. 10
203	203	Subchapter 5 — Comprehensive Health Insurance Pool Act 11
204	204	12
205	205	23-79-501. Purpose. 13
206	206	(a)(1) Acts 1995, No. 1339, established the Arkansas Comprehensive 14
207	207	Health Insurance Pool as a state program that was intended to provide an 15
208	208	alternate market for health insurance for certain uninsurable Arkansas 16
209	209	residents, and further this subchapter is intended to provide for the 17
210	210	successor entity that will provide the acceptable alternative mechanism as 18
211	211	described in the Health Insurance Portability and Accountability Act of 1996 19
212	212	for providing portable and accessible individual health insurance coverage 20
213	213	for federally eligible individuals as defined in this subchapter. 21
214	214	(2) This subchapter further is intended to provide a health 22
215	215	insurance coverage option for persons eligible for a federal income tax 23
216	216	credit under section 35 of the Internal Revenue Code, as created by the Trade 24
217	217	Adjustment Assistance Reform Act of 2002 or as subsequently amended. 25
218	218	(b) The General Assembly declares that it intends for this program to 26
219	219	provide portable and accessible individual health insurance coverage for 27
220	220	every individual who qualifies for coverage in accordance with § 23 -79-509(b) 28
221	221	as a federally eligible individual or as a qualified trade adjustment 29
222	222	assistance eligible person but does not intend for every eligible person who 30
223	223	qualifies for pool coverage in accordance with § 23 -79-509 to be guaranteed a 31
224	224	right to be issued a policy under this pool as a matter of entitlement. 32
225	225	33
226	226	23-79-502. Short title. 34
227	227	This subchapter may be cited as the “Comprehensive Health Insurance 35
228	228	Pool Act”, and is amendatory to the Arkansas Insurance Code and the 36 HB1420
229	229
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231	231	provisions of the Arkansas Insurance Code which are not in conflict with this 1
232	232	subchapter are applicable to this subchapter. 2
233	233	3
234	234	23-79-503. Definitions. 4
235	235	As used in this subchapter: 5
236	236	(1) “Agent” means any person who is licensed to sell health 6
237	237	insurance in this state; 7
238	238	(2) “Board” means the Board of Directors of the Arkansas 8
239	239	Comprehensive Health Insurance Pool; 9
240	240	(3) “Church plan” has the same meaning given that term in the 10
241	241	Health Insurance Portability and Accountability Act of 1996; 11
242	242	(4) “Commissioner” means the Insurance Commissioner; 12
243	243	(5) “Continuation coverage” means continuation of coverage under 13
244	244	a group health plan or other health insurance coverage for former employees 14
245	245	or dependents of former employees that would otherwise have terminated under 15
246	246	the terms of that coverage pursuant to any continuation provisions under 16
247	247	federal or state law, including the Consolidated Omnibus Budget 17
248	248	Reconciliation Act of 1985 (COBRA), as amended, § 23 -86-114 of the Arkansas 18
249	249	Insurance Code, or any other similar requirement in another state; 19
250	250	(6) “Covered person” means a person who is and continues to 20
251	251	remain eligible for pool coverage and is covered under one (1) of the plans 21
252	252	offered by the pool; 22
253	253	(7)(A) “Creditable coverage” means, with respect to a federally 23
254	254	eligible individual or a qualified trade adjustment assistance eligible 24
255	255	person, coverage of the individual under any of the following: 25
256	256	(i) A group health plan; 26
257	257	(ii) Health insurance coverage, including group 27
258	258	health insurance coverage; 28
259	259	(iii) Medicare; 29
260	260	(iv) Medical assistance; 30
261	261	(v) 10 U.S.C. § 1071 et seq.; 31
262	262	(vi) A medical care program of the Indian Health 32
263	263	Service or of a tribal organization; 33
264	264	(vii) A state health benefits risk pool; 34
265	265	(viii) A health plan offered under 5 U.S.C. § 8901 et 35
266	266	seq.; 36 HB1420
267	267
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269	269	(ix) A public health plan, as defined in regulations 1
270	270	consistent with section 104 of the Health Insurance Portability and 2
271	271	Accountability Act of 1996 that may be promulgated by the Secretary of the 3
272	272	United States Department of Health and Human Services; and 4
273	273	(x) A health benefit plan under section 5(e) of the 5
274	274	Peace Corps Act, 22 U.S.C. § 2504(e). 6
275	275	(B) “Creditable coverage” does not include: 7
276	276	(i) Coverage consisting solely of coverage of 8
277	277	excepted benefits as defined in section 2791(C) of Title XXVII of the Public 9
278	278	Health Service Act, 42 U.S.C. § 300gg -91; or 10
279	279	(ii)(a) Any period of coverage under 11
280	280	subdivisions (7)(A)(i) -(x) of this section that occurred before a break of 12
281	281	more than sixty-three (63) days during all of which the individual was not 13
282	282	covered under subdivisions (7)(A)(i) -(x) of this section. 14
283	283	(b) Any period that an individual is in a 15
284	284	waiting period for any coverage under a group health plan or for group health 16
285	285	insurance coverage or is in an affiliation period under the terms of health 17
286	286	insurance coverage offered by a health maintenance organization shall not be 18
287	287	taken into account in determining if there has been a break of more than 19
288	288	sixty-three (63) days in any creditable coverage; 20
289	289	(8) “Department” means the State Insurance Department; 21
290	290	(9) “Excess or stop -loss coverage” means an arrangement whereby 22
291	291	an insurer insures against the risk that any one (1) claim will exceed a 23
292	292	specific dollar amount or that the entire loss of a self -insurance plan will 24
293	293	exceed a specific amount; 25
294	294	(10) “Federally eligible individual” means an individual resident 26
295	295	of Arkansas: 27
296	296	(A) For whom: 28
297	297	(i) As of the date on which the individual seeks 29
298	298	pool coverage under § 23 -79-509, the aggregate of the periods of creditable 30
299	299	coverage is eighteen (18) or more months; and 31
300	300	(ii) The most recent prior creditable coverage was 32
301	301	under group health insurance coverage offered by an insurer, a group health 33
302	302	plan, a governmental plan, a church plan, or health insurance coverage 34
303	303	offered in connection with any such plans; 35
304	304	(B) Who is not eligible for coverage under: 36 HB1420
305	305
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307	307	(i) A group health plan; 1
308	308	(ii) Part A or Part B of Medicare; or 2
309	309	(iii) Medical assistance and does not have other 3
310	310	health insurance coverage; 4
311	311	(C) With respect to whom the most recent coverage within 5
312	312	the coverage period described in subdivision (10)(A)(i) of this section was 6
313	313	not terminated based upon a factor related to nonpayment of premiums or 7
314	314	fraud; 8
315	315	(D) If the individual has been offered the option of 9
316	316	continuation coverage under a Consolidated Omnibus Budget Reconciliation Act 10
317	317	of 1985 (COBRA) continuation provision or under a similar state program, who 11
318	318	elected such coverage; and 12
319	319	(E) Who, if the individual elected the continuation 13
320	320	coverage, has exhausted the continuation coverage under such a provision or 14
321	321	program; 15
322	322	(11) “Governmental plan” has the same meaning given that term in 16
323	323	the federal Health Insurance Portability and Accountability Act of 1996; 17
324	324	(12) “Group health plan” has the same meaning given that term in 18
325	325	the federal Health Insurance Portability and Accountability Act of 1996; 19
326	326	(13)(A) “Health insurance” means any hospital and medical 20
327	327	expense-incurred policy, certificate, or contract provided by an insurer, 21
328	328	hospital or medical service corporation, health maintenance organization, or 22
329	329	any other healthcare plan or arrangement that pays for or furnishes medical 23
330	330	or healthcare services whether by insurance or otherwise and includes any 24
331	331	excess or stop-loss coverage. 25
332	332	(B) “Health insurance” does not include long -term care, 26
333	333	disability income, short -term, accident, dental -only, vision-only, fixed 27
334	334	indemnity, limited-benefit or credit insurance, coverage issued as a 28
335	335	supplement to liability insurance, insurance arising out of workers' 29
336	336	compensation or similar law, automobile medical -payment insurance, or 30
337	337	insurance under which benefits are payable with or without regard to fault 31
338	338	and that is statutorily required to be contained in any liability insurance 32
339	339	policy or equivalent self -insurance; 33
340	340	(14) “Health maintenance organization” shall have the same 34
341	341	meaning as defined in § 23 -76-102; 35
342	342	(15) “Hospital” shall have the same meaning as defined in § 20 -9-36 HB1420
343	343
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345	345	201; 1
346	346	(16) “Individual health insurance coverage” means health 2
347	347	insurance coverage offered to individuals in the individual market but does 3
348	348	not include short-term, limited-duration insurance; 4
349	349	(17)(A) “Insurer” means any entity that provides health 5
350	350	insurance, including excess or stop -loss health insurance, in the State of 6
351	351	Arkansas. 7
352	352	(B) For the purposes of this subchapter, “insurer” 8
353	353	includes an insurance company, medical services plans, hospital plans, 9
354	354	hospital medical service corporations, health maintenance organizations, 10
355	355	fraternal benefits society, or any other entity providing a plan of health 11
356	356	insurance or health benefits subject to state insurance regulation; 12
357	357	(18) “Medical assistance” means the state medical assistance 13
358	358	program provided under Title XIX of the Social Security Act or under any 14
359	359	similar program of healthcare benefits in a state other than Arkansas; 15
360	360	(19)(A)(i) “Medically necessary” means that a service, 16
361	361	drug, supply, or article is necessary and appropriate for the diagnosis or 17
362	362	treatment of an illness or injury in accord with generally accepted standards 18
363	363	of medical practice at the time the service, drug, or supply is provided. 19
364	364	(ii) When specifically applied to a confinement, 20
365	365	“medically necessary” further means that the diagnosis or treatment of the 21
366	366	covered person's medical symptoms or condition cannot be safely provided to 22
367	367	that person as an outpatient. 23
368	368	(B) A service, drug, supply, or article shall not be 24
369	369	medically necessary if it: 25
370	370	(i) Is investigational, experimental, or for 26
371	371	research purposes; 27
372	372	(ii) Is provided solely for the convenience of the 28
373	373	patient, the patient's family, physician, hospital, or any other provider; 29
374	374	(iii) Exceeds in scope, duration, or intensity that 30
375	375	level of care that is needed to provide safe, adequate, and appropriate 31
376	376	diagnosis or treatment; 32
377	377	(iv) Could have been omitted without adversely 33
378	378	affecting the covered person's condition or the quality of medical care; or 34
379	379	(v) Involves the use of a medical device, drug, or 35
380	380	substance not formally approved by the United States Food and Drug 36 HB1420
381	381
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383	383	Administration; 1
384	384	(20) “Medicare” means coverage under Part A and Part B of Title 2
385	385	XVIII of the Social Security Act, 42 U.S.C. § 1395 et seq.; 3
386	386	(21) “Physician” means a person licensed to practice medicine as 4
387	387	duly licensed by the State of Arkansas; 5
388	388	(22) “Plan” means the comprehensive health insurance plan as 6
389	389	adopted by the board or by rule; 7
390	390	(23) “Plan administrator” means the insurer designated under § 8
391	391	23-79-508 to carry out the provisions of the plan of operation; 9
392	392	(24) “Plan of operation” means the plan of operation of the pool, 10
393	393	including articles, bylaws, and operating rules adopted by the board pursuant 11
394	394	to this subchapter; 12
395	395	(25) “Provider” means any hospital, skilled nursing facility, 13
396	396	hospice, home health agency, physician, pharmacist, or any other person or 14
397	397	entity licensed in Arkansas to furnish medical care, articles, and supplies; 15
398	398	(26) “Qualified high -risk pool” has the same meaning given that 16
399	399	term in the Health Insurance Portability and Accountability Act of 1996; 17
400	400	(27) “Qualified trade adjustment assistance eligible person” 18
401	401	means a person who is a trade adjustment assistance eligible person as 19
402	402	defined by this section and for whom, on the date an application for the 20
403	403	individual is received by the pool under § 23 -79-509, has an aggregate of at 21
404	404	least three (3) months of creditable coverage without a break in coverage of 22
405	405	sixty-three (63) days or more; 23
406	406	(28) “Resident eligible person” means a person who: 24
407	407	(A) Has been legally domiciled in the State of Arkansas 25
408	408	for a period of at least: 26
409	409	(i) Ninety (90) days and continues to be domiciled 27
410	410	in Arkansas; or 28
411	411	(ii) Thirty (30) days, continues to be domiciled in 29
412	412	Arkansas, and was covered under a qualified high -risk pool in another state 30
413	413	up until sixty-three (63) days or less prior to the date that the pool 31
414	414	receives his or her application for coverage; and 32
415	415	(B) Is not eligible for coverage under: 33
416	416	(i) A group health plan; 34
417	417	(ii) Part A or Part B of Medicare; or 35
418	418	(iii) Medical assistance as defined in this section 36 HB1420
419	419
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421	421	and does not have other health insurance coverage as defined in this section; 1
422	422	and 2
423	423	(29) “Trade adjustment assistance eligible person” means a person 3
424	424	who is legally domiciled in the State of Arkansas on the date of application 4
425	425	to the pool and is eligible for the tax credit for health insurance coverage 5
426	426	premiums under section 35 of the Internal Revenue Code of 1986. 6
427	427	7
428	428	23-79-504. Arkansas Comprehensive Health Insurance Pool. 8
429	429	(a) There is created a nonprofit legal entity to be known as the 9
430	430	“Arkansas Comprehensive Health Insurance Pool” as the successor entity to the 10
431	431	nonprofit legal entity established by Acts 1995, No. 1339. 11
432	432	(b)(1) The pool shall operate subject to the supervision and control 12
433	433	of the Board of Directors of the Arkansas Comprehensive Health Insurance 13
434	434	Pool. The pool is created as a political subdivision, instrumentality, and 14
435	435	body politic of the State of Arkansas, and, as such, is not a state agency. 15
436	436	(2) Except to the extent defined in this subchapter, the pool 16
437	437	will be exempt from: 17
438	438	(A) All state, county, and local taxes; 18
439	439	(B) The Arkansas Procurement Law, § 19 -11-201 et seq.; 19
440	440	(C) The Freedom of Information Act of 1967, § 25 -19-101 et 20
441	441	seq.; and 21
442	442	(D) The Arkansas Administrative Procedure Act, § 25 -15-201 22
443	443	et seq. 23
444	444	(3) The board shall consist of the following seven (7) members 24
445	445	to be appointed by the Insurance Commissioner: 25
446	446	(A) Two (2) current or former representatives of insurance 26
447	447	companies licensed to do business in the State of Arkansas; 27
448	448	(B) Two (2) current or former representatives of health 28
449	449	maintenance organizations licensed to do business in the State of Arkansas; 29
450	450	(C) One (1) member of a health -related profession licensed 30
451	451	in the State of Arkansas; 31
452	452	(D) One (1) member from the general public who is not 32
453	453	associated with the medical profession, a hospital, or an insurer; and 33
454	454	(E) One (1) member to represent a group considered to be 34
455	455	uninsurable. 35
456	456	(4) In making appointments to the board, the commissioner shall 36 HB1420
457	457
458	458	13 02/03/2025 4:09:03 PM ANS140
459	459	strive to ensure that at least one (1) person serving on the board is at 1
460	460	least sixty (60) years of age. 2
461	461	(5) All terms shall be for three (3) years. 3
462	462	(6) The board shall elect one (1) of its members as chair. 4
463	463	(7) Any vacancy in the board occurring for any reason other than 5
464	464	the expiration of a term shall be filled for the unexpired term in the same 6
465	465	manner as the original appointment. 7
466	466	(8) Members of the board may be reimbursed from moneys of the 8
467	467	pool for actual and necessary expenses incurred by them in the performance of 9
468	468	their official duties as members of the board but shall not otherwise be 10
469	469	compensated for their services. 11
470	470	(c) All insurers, as a condition of doing business in the State of 12
471	471	Arkansas, shall participate in the pool by paying the assessments, submitting 13
472	472	the reports, and providing the information required by the board or the 14
473	473	commissioner to implement the provisions of this subchapter. 15
474	474	(d)(1) Neither the board nor its employees shall be liable for any 16
475	475	obligations of the pool. 17
476	476	(2) No board member or employee of the board shall be liable, 18
477	477	and no cause of action of any nature may arise against them, for any act or 19
478	478	omission related to the performance of their powers and duties under this 20
479	479	subchapter. 21
480	480	(3) The board may provide in its bylaws or rules for 22
481	481	indemnification of, and legal representation for, the board members and 23
482	482	employees. 24
483	483	25
484	484	23-79-505. Plan of operation. 26
485	485	(a)(1) The Board of Directors of the Arkansas Comprehensive Health 27
486	486	Insurance Pool shall adopt a plan of operation pursuant to this subchapter 28
487	487	and shall submit to the Insurance Commissioner for approval the plan of 29
488	488	operation including the Arkansas Comprehensive Health Insurance Pool's 30
489	489	articles, bylaws and operating rules, and any amendments thereto necessary or 31
490	490	suitable to assure the fair, reasonable, and equitable administration of the 32
491	491	pool. The plan of operation shall become effective upon approval in writing 33
492	492	by the commissioner. 34
493	493	(2) If the board fails to submit a suitable plan of operation 35
494	494	within one hundred eighty (180) days after the appointment of the board of 36 HB1420
495	495
496	496	14 02/03/2025 4:09:03 PM ANS140
497	497	directors, or at any time thereafter fails to submit suitable amendments to 1
498	498	the plan of operation, the commissioner shall adopt and promulgate such rules 2
499	499	as are necessary or advisable to effectuate the provisions of this section. 3
500	500	The rules shall continue in force until modified by the commissioner or 4
501	501	superseded by a plan of operation submitted by the board and approved by the 5
502	502	commissioner. 6
503	503	(b) The plan of operation shall: 7
504	504	(1) Establish procedures for operation of the pool; 8
505	505	(2) Establish procedures for selecting a plan administrator in 9
506	506	accordance with § 23-79-508; 10
507	507	(3) Create a fund, under management of the board, to pay 11
508	508	administrative claims and other expenses of the pool; 12
509	509	(4) Establish procedures for the handling, accounting, and 13
510	510	auditing of assets, moneys, and claims of the pool and the plan 14
511	511	administrator; 15
512	512	(5) Develop and implement a program to publicize the existence 16
513	513	of the plan, the eligibility requirements, and the procedures for enrollment 17
514	514	and to maintain public awareness of the plan; 18
515	515	(6)(A) Establish procedures under which applicants and 19
516	516	participants may have grievances reviewed by a grievance committee appointed 20
517	517	by the board. The grievances shall be reported to the board after completion 21
518	518	of the review. 22
519	519	(B) The board shall retain all written complaints 23
520	520	regarding the plan for at least three (3) years; and 24
521	521	(7) Provide for other matters as may be necessary and proper for 25
522	522	the execution of the board's powers, duties, and obligations under this 26
523	523	subchapter. 27
524	524	28
525	525	23-79-506. Powers. 29
526	526	(a)(1) The Arkansas Comprehensive Health Insurance Pool shall have the 30
527	527	general powers and authority granted under the laws of the State of Arkansas 31
528	528	to health insurers and, in addition thereto, the specific authority to: 32
529	529	(A) Enter into contracts as are necessary or proper to 33
530	530	carry out the provisions and purposes of this subchapter; 34
531	531	(B) Sue or be sued, including taking any legal actions 35
532	532	necessary or proper; 36 HB1420
533	533
534	534	15 02/03/2025 4:09:03 PM ANS140
535	535	(C) Take such legal action as necessary, including without 1
536	536	limitation: 2
537	537	(i) Avoiding the payment of improper claims against 3
538	538	the pool or the coverage provided by or through the pool; 4
539	539	(ii) Recovering any amounts erroneously or improperly 5
540	540	paid by the pool; 6
541	541	(iii) Recovering any amounts paid by the pool as a 7
542	542	result of mistake of fact or law; 8
543	543	(iv) Recovering other amounts due the pool; or 9
544	544	(v) Coordinating legal action with the Insurance 10
545	545	Commissioner to enforce the provisions of this subchapter; 11
546	546	(D)(i) Establish and modify from time to time as 12
547	547	appropriate, rates, rate schedules, rate adjustments, expense allowances, 13
548	548	agent referral fees, claim reserve formulas, deductibles, copayments, 14
549	549	coinsurance, and any other actuarial function appropriate to the operation of 15
550	550	the pool. 16
551	551	(ii) Rates and rate schedules may be adjusted for 17
552	552	appropriate factors such as age, sex, and geographical variation in claim 18
553	553	costs and shall take into consideration appropriate factors in accordance 19
554	554	with established actuarial and underwriting practices; 20
555	555	(E) Issue policies of insurance in accordance with the 21
556	556	requirements of this subchapter. All policy forms shall be subject to the 22
557	557	approval of the commissioner; 23
558	558	(F) Authorize the plan administrator to prepare and 24
559	559	distribute certificate of eligibility forms and enrollment instruction forms 25
560	560	to agents and to the general public; 26
561	561	(G) Provide and employ cost-containment measures and 27
562	562	requirements, including without limitation preadmission screening, second 28
563	563	surgical opinion, concurrent utilization review, and individual case 29
564	564	management for the purposes of making the plan more cost effective; 30
565	565	(H) Design, utilize, contract, or otherwise arrange the 31
566	566	delivery of cost-effective healthcare services, including establishing or 32
567	567	contracting directly or through the plan administrator with preferred 33
568	568	provider organizations, health maintenance organizations, physician hospital 34
569	569	organizations, or other limited network provider arrangements; 35
570	570	(I) Borrow money to effect the purposes of the pool. Any 36 HB1420
571	571
572	572	16 02/03/2025 4:09:03 PM ANS140
573	573	notes or other evidence of indebtedness of the pool not in default shall be 1
574	574	legal investments for insurers and may be carried as admitted assets; 2
575	575	(J) Pledge, assign, and grant a security interest in any 3
576	576	of the assessments authorized by this subchapter or other assets of the pool 4
577	577	in order to secure any notes or other evidences of indebtedness of the pool; 5
578	578	(K) Provide reinsurance of risks incurred by the pool; 6
579	579	(L) Provide additional types of plans to provide optional 7
580	580	coverages, including Medicare supplement health insurance and health savings 8
581	581	accounts that comply with applicable federal law as in effect January 1, 9
582	582	2005; 10
583	583	(M) Enter into reciprocal agreements with other comparable 11
584	584	state plans in order to provide coverage for persons who move between states 12
585	585	and are covered by such other states' plans; and 13
586	586	(N) Establish lifetime maximum benefits under § 23 -79-14
587	587	510(a)(2)(W) for any person covered by a plan. 15
588	588	(2) In addition to the other powers granted by the Arkansas 16
589	589	Insurance Code, the commissioner may impose, after notice and hearing in 17
590	590	accordance with the provisions of the Arkansas Insurance Code, a monetary 18
591	591	penalty upon any insurer or suspend or revoke the certificate of authority to 19
592	592	transact insurance in the State of Arkansas of any insurer that fails to pay 20
593	593	an assessment or otherwise file any report or furnish information required to 21
594	594	be filed with the Board of Directors of the Arkansas Comprehensive Health 22
595	595	Insurance Pool pursuant to the board's direction that the board believes is 23
596	596	necessary in order for the board to perform its duties under this subchapter. 24
597	597	(b) All outstanding contracts executed by the Board of Directors of 25
598	598	the State Comprehensive Health Insurance Pool created by Acts 1995, No. 1339, 26
599	599	shall be deemed continuing obligations of the board created by this 27
600	600	subchapter. 28
601	601	(c) As provided for in § 23 -79-502, any health insurance benefit not 29
602	602	provided for in this subchapter shall be deemed to be in conflict with and 30
603	603	therefore inapplicable to the provisions of this subchapter. 31
604	604	32
605	605	23-79-507. Funding of pool. 33
606	606	(a) Premiums. 34
607	607	(1) (A) The Arkansas Comprehensive Health Insurance Pool shall 35
608	608	establish premium rates for plan coverage as provided in subdivision (a)(2) 36 HB1420
609	609
610	610	17 02/03/2025 4:09:03 PM ANS140
611	611	of this section. 1
612	612	(B) Separate schedules of premium rates based on age, sex, 2
613	613	and geographical location may apply for individual risks. 3
614	614	(C) Premium rates and schedules shall be submitted to the 4
615	615	Insurance Commissioner for approval prior to use. 5
616	616	(2)(A)(i) With the assistance of the commissioner, the pool 6
617	617	shall determine a standard risk rate by considering the premium rates charged 7
618	618	by other insurers offering health insurance coverage to individuals in 8
619	619	Arkansas. 9
620	620	(ii) The standard risk rate shall be established 10
621	621	using reasonable actuarial techniques and shall reflect anticipated 11
622	622	experience and expenses for the coverage. 12
623	623	(B)(i) Rates for plan coverage shall not exceed one 13
624	624	hundred fifty percent (150%) of rates established as applicable for 14
625	625	individual standard risks in Arkansas. 15
626	626	(ii) Subject to the limits provided in this 16
627	627	subdivision (a)(2), subsequent rates shall be established to help provide for 17
628	628	the expected costs of claims, including recovery of prior losses, expenses of 18
629	629	operation, investment income of claim reserves, and any other cost factors 19
630	630	subject to the limitations described in this section. 20
631	631	(b) Sources of Additional Revenue. 21
632	632	(1) In addition to the powers enumerated in § 23-79-506, the 22
633	633	pool shall have the authority to: 23
634	634	(A) Assess insurers in accordance with the provisions of 24
635	635	this section; and 25
636	636	(B)(i) Make advance interim assessments as may be 26
637	637	reasonable and necessary for the pool's organizational and interim operating 27
638	638	expenses. 28
639	639	(ii) Any such interim assessments may be credited as 29
640	640	offsets against any regular assessments due following the close of the fiscal 30
641	641	year. 31
642	642	(2)(A) Following the close of each fiscal year, the plan 32
643	643	administrator shall determine the net premiums, that is, premiums less 33
644	644	administrative expense allowances, the pool expenses of administration and 34
645	645	operation, and the incurred losses for the year, taking into account 35
646	646	investment income and other appropriate gains and losses. 36 HB1420
647	647
648	648	18 02/03/2025 4:09:03 PM ANS140
649	649	(B) The deficit incurred by the pool not otherwise 1
650	650	recouped under either subdivision (b)(9) of this section or subsection (e) of 2
651	651	this section [repealed], or both, shall be recouped by assessments 3
652	652	apportioned among insurers by the Board of Directors of the Arkansas 4
653	653	Comprehensive Health Insurance Pool. 5
654	654	(3) Each insurer's assessment shall be determined by multiplying 6
655	655	the total assessment of all insurers as determined in subdivision (b)(2) of 7
656	656	this section by a fraction, the numerator of which equals that insurer's 8
657	657	premium and subscriber contract charges for health insurance written in the 9
658	658	state during the preceding calendar year and the denominator of which equals 10
659	659	the total of all health insurance premiums by all insurers. 11
660	660	(4)(A) If assessments or other funds received under either 12
661	661	subdivision (b)(9) of this section or subsection (e) of this section 13
662	662	[repealed], or both, or any combination of the assessments and funds exceed 14
663	663	the pool's actual losses and administrative expenses, the excess shall be 15
664	664	held at interest and used by the board to offset future losses or to reduce 16
665	665	future assessments. 17
666	666	(B) As used in this subsection, “future losses” includes 18
667	667	reserves for incurred but not reported claims. 19
668	668	(5) Each insurer's assessment shall be determined annually by 20
669	669	the board based on annual statements and other reports deemed necessary by 21
670	670	the board and filed by the insurer with the board or the commissioner. 22
671	671	(6)(A)(i) An insurer may petition the commissioner for an 23
672	672	abatement or deferment of all or part of an assessment imposed by the board. 24
673	673	(ii) The commissioner may abate or defer, in whole or 25
674	674	in part, the assessment if, in the opinion of the commissioner, payment of 26
675	675	the assessment would endanger the ability of the insurer to fulfill its 27
676	676	contractual obligations. 28
677	677	(B)(i) In the event an assessment against an insurer is 29
678	678	abated or deferred, in whole or in part, the amount by which the assessment 30
679	679	is abated or deferred shall be assessed against the other insurers in a 31
680	680	manner consistent with the basis for assessments set forth in this 32
681	681	subsection. 33
682	682	(ii) The insurer receiving the abatement or deferment 34
683	683	shall remain liable to the plan for the deficiency for four (4) years. 35
684	684	(7) For all assessments issued by the board, beginning January 36 HB1420
685	685
686	686	19 02/03/2025 4:09:03 PM ANS140
687	687	1, 1998, only those individuals, corporations, associations, or other 1
688	688	entities defined as an insurer in § 23 -79-503 shall be subject to assessment. 2
689	689	(8) In the event the board fails to act within a reasonable 3
690	690	period of time to recoup by assessment any deficit incurred by the pool, the 4
691	691	commissioner shall have all the powers and duties of the board under this 5
692	692	chapter with respect to assessing insurers. 6
693	693	(9) The General Assembly further intends that the pool be 7
694	694	eligible for, and for the pool, its board, or other officers of state 8
695	695	government, as appropriate, to take steps necessary to obtain federal grant 9
696	696	funds to offset losses of the pool, including any funds made available under 10
697	697	the Trade Adjustment Assistance Reform Act of 2002. 11
698	698	(c) Assessment Offsets. 12
699	699	(1) Any assessment may be offset in an amount equal to the 13
700	700	amount of the assessment paid to the pool against the premium tax payable by 14
701	701	that insurer for the year in which the assessment is levied or for the four 15
702	702	(4) years subsequent to that year. 16
703	703	(2) No offset shall be allowed for any penalty assessed under 17
704	704	subdivision (d)(1) of this section. 18
705	705	(d)(1) All assessments and fees shall be due and payable upon receipt 19
706	706	and shall be delinquent if not paid within thirty (30) days of the receipt of 20
707	707	the notice by the insurer. 21
708	708	(2) Failure to timely pay the assessment will automatically 22
709	709	subject the insurer to a ten percent (10%) penalty, which will be due and 23
710	710	payable within the next thirty -day period. 24
711	711	(3) The board and the commissioner shall have the authority to 25
712	712	enforce the collection of the assessment and penalty in accordance with the 26
713	713	provisions of this subchapter and the Arkansas Insurance Code. 27
714	714	(4) The board may waive the penalty authorized by this 28
715	715	subsection if it determines that compelling circumstances exist that justify 29
716	716	such a waiver. 30
717	717	31
718	718	23-79-508. Plan administrator. 32
719	719	(a) The Board of Directors of the Arkansas Comprehensive Health 33
720	720	Insurance Pool shall select an insurer through a competitive bidding process 34
721	721	to administer the plan. However, the administering insurer designated by the 35
722	722	board created by Acts 1995, No. 1339, shall serve as the plan administrator 36 HB1420
723	723
724	724	20 02/03/2025 4:09:03 PM ANS140
725	725	under this subchapter until the expiration of the current contract of the 1
726	726	administering insurer. The board shall evaluate bids submitted under this 2
727	727	section based upon criteria established by the board which shall include, but 3
728	728	not be limited to, the following: 4
729	729	(1) The plan administrator's proven ability to handle large 5
730	730	group accident and health benefit plans; 6
731	731	(2) The efficiency and timeliness of the plan administrator's 7
732	732	claim processing procedures; 8
733	733	(3) An estimate of total charges for administering the plan; 9
734	734	(4) The plan administrator's ability to apply effective cost 10
735	735	containment programs and procedures and to administer the plan in a cost 11
736	736	efficient manner; and 12
737	737	(5) The financial condition and stability of the plan 13
738	738	administrator. 14
739	739	(b)(1) The plan administrator shall serve for a period of three (3) 15
740	740	years subject to removal for cause and subject to the terms, conditions, and 16
741	741	limitations of the contract between the board and the plan administrator. 17
742	742	(2) The board shall advertise for and accept bids to serve as 18
743	743	the plan administrator for the succeeding three -year periods. 19
744	744	(c) The plan administrator shall perform functions related to the plan 20
745	745	as may be assigned to it, including: 21
746	746	(1) Determination of eligibility; 22
747	747	(2) Payment and processing of claims; 23
748	748	(3) Establishment of a premium billing procedure for collection 24
749	749	of premiums. Billings shall be made on a periodic basis as determined by the 25
750	750	board; and 26
751	751	(4) Other necessary functions to assure timely payment of 27
752	752	benefits to covered persons under the plan, including: 28
753	753	(A) Making available information relating to the proper 29
754	754	manner of submitting a claim for benefits under the plan and distributing 30
755	755	forms upon which submissions shall be made; and 31
756	756	(B) Evaluating the eligibility of each claim for payment 32
757	757	under the plan. 33
758	758	(d)(1) The plan administrator shall submit regular reports to the 34
759	759	board regarding the operation of the plan. 35
760	760	(2) Frequency, content, and form of the report shall be 36 HB1420
761	761
762	762	21 02/03/2025 4:09:03 PM ANS140
763	763	determined by the board. 1
764	764	(e)(1) The plan administrator shall pay claim expenses from the 2
765	765	premium payments received from or on behalf of plan participants and 3
766	766	allocated by the board for claim expenses. 4
767	767	(2) If the plan administrator's payments for claims expenses 5
768	768	exceed the portion of premiums allocated by the board for payment of claims 6
769	769	expenses, the board shall provide additional funds to the plan administrator 7
770	770	for payment of claims expenses. 8
771	771	(f) The plan administrator shall be governed by the requirements of 9
772	772	this subchapter and shall be compensated as provided in the contract between 10
773	773	the board and the plan administrator. 11
774	774	12
775	775	23-79-509. Plan eligibility. 13
776	776	(a) General Eligibility Requirements. The following requirements 14
777	777	apply to a resident eligible person or a trade adjustment assistance eligible 15
778	778	person in order for the person to be eligible for plan coverage: 16
779	779	(1) Except as provided in subdivision (a)(2) of this section or 17
780	780	subsection (b) of this section, any individual person who meets the 18
781	781	definition of resident eligible person as defined by § 23 -79-503 or a trade 19
782	782	adjustment assistance eligible person as defined by § 23 -79-503 and is either 20
783	783	a citizen of the United States or an alien lawfully admitted for permanent 21
784	784	residence who continues to be a resident of this state shall be eligible for 22
785	785	plan coverage if evidence is provided of: 23
786	786	(A) A notice of rejection or refusal by an insurer to 24
787	787	issue substantially similar individual health insurance coverage by reason of 25
788	788	the existence or history of a medical condition or upon such other evidence 26
789	789	that the Board of Directors of the Arkansas Comprehensive Health Insurance 27
790	790	Pool deems sufficient in order to verify that the applicant is unable to 28
791	791	obtain the coverage from an insurer due to the existence or history of a 29
792	792	medical condition; 30
793	793	(B)(i) A refusal by an insurer to issue individual health 31
794	794	insurance coverage except at a rate that the board determines is 32
795	795	substantially in excess of the applicable plan rate. 33
796	796	(ii) A rejection or refusal by a group health plan or 34
797	797	insurer offering only stop -loss or excess-of-loss insurance or contracts, 35
798	798	agreements, or other arrangements for reinsurance coverage with respect to 36 HB1420
799	799
800	800	22 02/03/2025 4:09:03 PM ANS140
801	801	the applicant shall not be sufficient evidence under this subsection; 1
802	802	(C)(i) Until September 30, 2011, a refusal by an insurer 2
803	803	to issue individual health insurance coverage to a child under nineteen (19) 3
804	804	years of age. 4
805	805	(ii) After September 30, 2011, the eligibility of a 5
806	806	child under nineteen (19) years of age for individual health insurance 6
807	807	coverage shall be determined by the board; or 7
808	808	(D) Evidence that the applicant was covered under a 8
809	809	qualified high-risk pool of another state, provided that the coverage 9
810	810	terminated no more than sixty -three (63) days prior to the date the pool 10
811	811	receives the applicant's application for coverage and the other state's 11
812	812	qualified high-risk pool did not terminate the person's coverage for fraud; 12
813	813	(2) A person shall not be eligible for coverage under the plan 13
814	814	if: 14
815	815	(A) The person has or obtains health insurance coverage 15
816	816	substantially similar to or more comprehensive than a plan policy or would be 16
817	817	eligible to have coverage if the person elected to obtain it except that: 17
818	818	(i) A person may maintain other coverage for the 18
819	819	period of time the person is satisfying any waiting period for a preexisting 19
820	820	condition under a plan policy; and 20
821	821	(ii) A person may maintain plan coverage for the 21
822	822	period of time the person is satisfying a waiting period for a preexisting 22
823	823	condition under another health insurance policy intended to replace the plan 23
824	824	policy; 24
825	825	(B) The person is determined to be eligible for healthcare 25
826	826	benefits under Title XIX of the Social Security Act; 26
827	827	(C) The person has previously terminated plan coverage 27
828	828	unless twelve (12) months have elapsed since termination of coverage; 28
829	829	(D) The person fails to pay the required premium under the 29
830	830	covered person's terms of enrollment and participation, in which event the 30
831	831	liability of the plan shall be limited to benefits incurred under the plan 31
832	832	for the same period for which premiums had been paid and the covered person 32
833	833	remained eligible for plan coverage; 33
834	834	(E) The plan has paid on behalf of the covered person the 34
835	835	maximum lifetime benefit established by the board in accordance with § 23 -79-35
836	836	510(a)(2)(W); 36 HB1420
837	837
838	838	23 02/03/2025 4:09:03 PM ANS140
839	839	(F) The person is a resident of a public institution; 1
840	840	(G) All or part of the person's premium is paid for or 2
841	841	reimbursed: 3
842	842	(i) By one (1) of the following in connection with a 4
843	843	group health plan: 5
844	844	(a) The person’s current employer; 6
845	845	(b) If the person is retired, by the person's 7
846	846	former employer; or 8
847	847	(c) If the person is a dependent of an 9
848	848	employee or retiree, by the current or former employer of the employee or 10
849	849	retiree; or 11
850	850	(ii) Under any government-sponsored program or by any 12
851	851	government agency, foundation, healthcare facility, or healthcare provider 13
852	852	except for premiums paid on behalf of: 14
853	853	(a) A trade adjustment assistance eligible 15
854	854	person or a qualified trade adjustment assistance eligible person in 16
855	855	accordance with section 35 of the Internal Revenue Code; or 17
856	856	(b) An otherwise qualifying full -time employee 18
857	857	or dependent of a qualifying full -time employee of a government agency, 19
858	858	foundation, healthcare facility, or healthcare provider; or 20
859	859	(H) The person commits a fraudulent insurance act as 21
860	860	defined in § 23-66-501(4) against the Arkansas Comprehensive Health Insurance 22
861	861	Pool; 23
862	862	(3) The board or the plan administrator shall require 24
863	863	verification of residency and may require any additional information, 25
864	864	documentation, or statements under oath whenever necessary to determine plan 26
865	865	eligibility or residency; 27
866	866	(4) Coverage shall cease: 28
867	867	(A) On the date a person is no longer a resident of the 29
868	868	State of Arkansas; 30
869	869	(B) On the date a person requests coverage to end; 31
870	870	(C) On the death of the covered person; 32
871	871	(D) On the date state law requires cancellation of the 33
872	872	policy; or 34
873	873	(E) At the plan's option, thirty (30) days after the plan 35
874	874	makes any written inquiry concerning a person's eligibility or place of 36 HB1420
875	875
876	876	24 02/03/2025 4:09:03 PM ANS140
877	877	residence to which the person does not reply; and 1
878	878	(5) Except under the conditions set forth in subdivision (a)(4) 2
879	879	of this section, the coverage of any person who ceases to meet the 3
880	880	eligibility requirements of this section terminates at the end of the month 4
881	881	that the person ceases to meet the eligibility requirements of this section. 5
882	882	(b) Persons Eligible for Guaranteed Issuance of Coverage. The 6
883	883	following requirements apply to a federally eligible individual or a 7
884	884	qualified trade adjustment assistance eligible person in order for such an 8
885	885	individual to be eligible for plan coverage: 9
886	886	(1) Notwithstanding the requirements of subsection (a) of this 10
887	887	section, any federally eligible individual or a qualified trade adjustment 11
888	888	assistance eligible person for whom a plan application and such enclosures 12
889	889	and supporting documentation as the board may require is received by the 13
890	890	board within sixty-three (63) days after the termination of prior creditable 14
891	891	coverage for reasons other than nonpayment of premium or fraud that covered 15
892	892	the applicant shall qualify to enroll in the plan under the portability 16
893	893	provisions of this subsection; 17
894	894	(2) Any individual seeking plan coverage under this subsection 18
895	895	must submit with his or her application evidence, including acceptable 19
896	896	written certification of previous creditable coverage, that will establish to 20
897	897	the board's satisfaction that he or she meets all of the requirements to be a 21
898	898	federally eligible individual or a qualified trade adjustment assistance 22
899	899	eligible person and is currently and permanently residing in the State of 23
900	900	Arkansas as of the date his or her application was received by the board; 24
901	901	(3) A period of creditable coverage shall not be counted, with 25
902	902	respect to qualifying an applicant for plan coverage as an individual under 26
903	903	this subsection, if after such a period and before the application for plan 27
904	904	coverage was received by the board, there was at least a sixty -three-day 28
905	905	period during all of which the individual was not covered under any 29
906	906	creditable coverage; 30
907	907	(4) Any individual who the board determines qualifies for plan 31
908	908	coverage under this subsection shall be offered his or her choice of 32
909	909	enrolling in one (1) of the alternative portability plans that the board is 33
910	910	authorized under this subsection to establish for those individuals; 34
911	911	(5)(A)(i) The board shall offer a choice of healthcare coverages 35
912	912	consistent with major medical coverage under the alternative plans authorized 36 HB1420
913	913
914	914	25 02/03/2025 4:09:03 PM ANS140
915	915	by this subsection to every individual qualifying for coverage under this 1
916	916	subsection. 2
917	917	(ii) The coverages to be offered under the plans, the 3
918	918	schedule of benefits, deductibles, copayments, coinsurance, exclusions, and 4
919	919	other limitations shall be approved by the board. 5
920	920	(B) One (1) optional form of coverage shall be comparable 6
921	921	to comprehensive health insurance coverage offered in the individual market 7
922	922	in the State of Arkansas or a standard option of coverage available under the 8
923	923	individual health insurance laws of the State of Arkansas. The standard plan 9
924	924	that is authorized by § 23 -79-510 may be used for this purpose. 10
925	925	(C) The board also may offer a preferred provider option 11
926	926	and such other options as the board determines may be appropriate for 12
927	927	individuals who qualify for plan coverage pursuant to this subsection; 13
928	928	(6) Notwithstanding the requirements of § 23 -79-510(f), any plan 14
929	929	coverage that is issued to individuals who qualify for plan coverage pursuant 15
930	930	to the portability provisions of this subsection shall not be subject to any 16
931	931	preexisting conditions exclusion, waiting period, or other similar limitation 17
932	932	on coverage; 18
933	933	(7) Individuals who qualify and enroll in the plan pursuant to 19
934	934	this subsection shall be required to pay such premium rates as the board 20
935	935	shall establish and approve in accordance with the requirements of § 23-79-21
936	936	507(a); 22
937	937	(8) The total premium, without regard to any subsidy of premium, 23
938	938	for individuals who qualify and enroll in the plan pursuant to this 24
939	939	subsection shall not be greater than a similarly situated individual 25
940	940	qualifying for pool coverage under subsection (a) of this section; and 26
941	941	(9) A federally eligible individual who qualifies and enrolls in 27
942	942	the plan pursuant to this subsection must continue to satisfy all of the 28
943	943	other eligibility requirements of this subchapter to the extent not 29
944	944	inconsistent with the Health Insurance Portability and Accountability Act of 30
945	945	1996 in order to maintain continued eligibility for coverage under the plan. 31
946	946	(c) Any person who was issued a policy pursuant to the provisions of 32
947	947	Acts 1995, No. 1339, shall be deemed continuously covered consistent with the 33
948	948	terms of this subchapter and reissued a new policy in accordance with the 34
949	949	provisions of this subchapter. 35
950	950	36 HB1420
951	951
952	952	26 02/03/2025 4:09:03 PM ANS140
953	953	23-79-510. Outline of benefits. 1
954	954	(a)(1) Subject to the contractual policy form language adopted by the 2
955	955	Board of Directors of the Arkansas Comprehensive Health Insurance Pool, 3
956	956	expenses for the following services, supplies, drugs, or articles when 4
957	957	prescribed by a physician and determined by the plan to be medically 5
958	958	necessary shall be covered, subject to provisions of subsection (b) of this 6
959	959	section: 7
960	960	(A) Hospital services; 8
961	961	(B) Professional services for the diagnosis or treatment 9
962	962	of injuries, illnesses, or conditions, other than mental or dental, that are 10
963	963	rendered by a physician or by other licensed professionals at his or her 11
964	964	direction; 12
965	965	(C) Drugs requiring a physician's prescription; 13
966	966	(D) Skilled nursing services of a licensed skilled nursing 14
967	967	facility for not more than one hundred twenty (120) days during a policy 15
968	968	year; 16
969	969	(E) Services of a home health agency up to a maximum of 17
970	970	two hundred seventy (270) services per year; 18
971	971	(F) Use of radium or other radioactive materials; 19
972	972	(G) Oxygen; 20
973	973	(H) Prostheses other than dental; 21
974	974	(I) Rental of durable medical equipment, other than 22
975	975	eyeglasses and hearing aids, for which there is no personal use in the 23
976	976	absence of the conditions for which such equipment is prescribed; 24
977	977	(J) Diagnostic X rays and laboratory tests; 25
978	978	(K) Oral surgery for excision of partially or completely 26
979	979	unerupted, impacted teeth or the gums and tissues of the mouth when not 27
980	980	performed in connection with the extraction or repair of teeth; 28
981	981	(L) Services of a physical therapist; 29
982	982	(M) Emergency and other medically necessary transportation 30
983	983	provided by a licensed ambulance service to the nearest facility qualified to 31
984	984	treat a covered condition; 32
985	985	(N) Services for diagnosis and treatment of mental and 33
986	986	nervous disorders or chemical and drug dependency, provided that a covered 34
987	987	person shall be required to make a fifty percent (50%) copayment and that the 35
988	988	plan's payment shall not exceed four thousand dollars ($4,000) annually; and 36 HB1420
989	989
990	990	27 02/03/2025 4:09:03 PM ANS140
991	991	(O) Such additional benefits deemed appropriate by the 1
992	992	board in accordance with the provisions of subsection (b) of this section. 2
993	993	(2) Exclusions. Unless the contractual policy form language 3
994	994	adopted by the board provides otherwise, the following services, supplies, 4
995	995	drugs, or articles whether or not prescribed by a physician, shall not be 5
996	996	covered: 6
997	997	(A) Any charge for treatment for cosmetic purposes other 7
998	998	than surgery for the repair or treatment of an injury or a congenital bodily 8
999	999	defect to restore normal bodily functions; 9
1000	1000	(B) Care that is primarily for custodial or domiciliary 10
1001	1001	purposes; 11
1002	1002	(C) Any charge for confinement in a private room to the 12
1003	1003	extent it is in excess of the institution's charge for its most common 13
1004	1004	semiprivate room unless a private room is medically necessary; 14
1005	1005	(D) That part of any charge for services rendered or 15
1006	1006	articles prescribed by a physician, dentist, or other healthcare personnel 16
1007	1007	that exceeds the prevailing charge in the locality or for any charge not 17
1008	1008	medically necessary; 18
1009	1009	(E) Any charge for services or articles the provision of 19
1010	1010	which is not within the scope of authorized practice of the institution or 20
1011	1011	individual providing the services or articles; 21
1012	1012	(F) Any expense incurred prior to the effective date of 22
1013	1013	coverage by the plan for the person on whose behalf the expense is incurred; 23
1014	1014	(G) Dental care except as provided in subdivision 24
1015	1015	(a)(1)(K) of this section; 25
1016	1016	(H) Eyeglasses and hearing aids; 26
1017	1017	(I) Illness or injury due to acts of war; 27
1018	1018	(J) Services of blood donors and any fee for failure to 28
1019	1019	replace the first three (3) pints of blood provided to a covered person each 29
1020	1020	policy year; 30
1021	1021	(K) Personal supplies or services provided by a hospital 31
1022	1022	or nursing home or any other nonmedical or nonprescribed supply or service; 32
1023	1023	(L) Any expense or charge for services, articles, drugs, 33
1024	1024	or supplies that are not provided in accord with generally accepted standards 34
1025	1025	of current medical practice; 35
1026	1026	(M) Any expense for which a charge is not made in the 36 HB1420
1027	1027
1028	1028	28 02/03/2025 4:09:03 PM ANS140
1029	1029	absence of insurance or for which there is no legal obligation on the part of 1
1030	1030	the patient to pay; 2
1031	1031	(N) Any expense incurred for benefits provided under the 3
1032	1032	laws of the United States and the State of Arkansas, including Medicare and 4
1033	1033	Medicaid and other medical assistance, military service -connected disability 5
1034	1034	payments, medical services provided for members of the armed forces and their 6
1035	1035	dependents or employees of the United States Armed Forces, and medical 7
1036	1036	services financed on behalf of all citizens by the United States; 8
1037	1037	(O) Any expense or charge for in vitro fertilization, 9
1038	1038	artificial insemination, or any other artificial means used to cause 10
1039	1039	pregnancy; 11
1040	1040	(P) Any expense or charge for oral contraceptives used for 12
1041	1041	birth control or any other temporary birth control measures; 13
1042	1042	(Q) Any expense or charge for sterilization or 14
1043	1043	sterilization reversals; 15
1044	1044	(R) Any expense or charge for weight -loss programs, 16
1045	1045	exercise equipment, or treatment of obesity except when certified by a 17
1046	1046	physician as morbid obesity, i.e., at least two (2) times normal body weight; 18
1047	1047	(S) Any expense or charge for acupuncture treatment unless 19
1048	1048	used as an anesthetic agent for a covered surgery; 20
1049	1049	(T) Any expense or charge for organ or bone marrow 21
1050	1050	transplants other than those performed at a hospital with a board -approved 22
1051	1051	organ transplant program that has been designated by the board as a preferred 23
1052	1052	provider organization for that specific organ or bone marrow transplant; 24
1053	1053	(U) Any expense or charge for procedures, treatments, 25
1054	1054	equipment, or services that are provided in special settings for research 26
1055	1055	purposes or in a controlled environment, are being studied for safety, 27
1056	1056	efficiency, and effectiveness, and are awaiting endorsement by the 28
1057	1057	appropriate national medical specialty college for general use within the 29
1058	1058	medical community; 30
1059	1059	(V) Such additional exclusions deemed appropriate by the 31
1060	1060	board in accordance with the provisions of subsection (b) of this section; 32
1061	1061	and 33
1062	1062	(W)(i) Any benefits that exceed the maximum lifetime 34
1063	1063	benefit for plan coverage established by the board under § 23 -79-35
1064	1064	506(a)(1)(N). 36 HB1420
1065	1065
1066	1066	29 02/03/2025 4:09:03 PM ANS140
1067	1067	(ii) The maximum lifetime benefit shall not be less 1
1068	1068	than one million dollars ($1,000,000) and shall not exceed three million 2
1069	1069	dollars ($3,000,000). 3
1070	1070	(b) In establishing the plan coverage, the board shall take into 4
1071	1071	consideration the levels of health insurance provided in the state and 5
1072	1072	medical economic factors as may be deemed appropriate and promulgate 6
1073	1073	benefits, deductibles, copayments, coinsurance factors, exclusions, and 7
1074	1074	limitations determined to be generally reflective of and commensurate with 8
1075	1075	health insurance provided through a representative number of large employers 9
1076	1076	in the state. 10
1077	1077	(c) The board may adjust any deductibles, copayments, and coinsurance 11
1078	1078	factors annually according to the medical component of the Consumer Price 12
1079	1079	Index for All Urban Consumers. 13
1080	1080	(d) Nonduplication of Benefits. 14
1081	1081	(1)(A) The pool shall be payer of last resort of benefits 15
1082	1082	whenever any other benefit or source of third -party payment is available. 16
1083	1083	(B) Benefits otherwise payable under plan coverage shall 17
1084	1084	be reduced by all amounts paid or payable through any other health insurance 18
1085	1085	or any other source providing benefits because of a sickness or injury and by 19
1086	1086	all hospital and medical expense benefits paid or payable under any workers' 20
1087	1087	compensation coverage, automobile medical payment, or liability insurance 21
1088	1088	whether provided on the basis of fault or nonfault and by any hospital or 22
1089	1089	medical benefits paid or payable under or provided pursuant to any state or 23
1090	1090	federal law or program. 24
1091	1091	(2) The pool shall have a cause of action against a covered 25
1092	1092	person for the recovery of the amount of benefits paid that are not covered 26
1093	1093	by the pool. Benefits due from the pool may be reduced or refused as a set -27
1094	1094	off against any amount recoverable under this subdivision (d)(2). 28
1095	1095	(e) Right of Subrogation — Recoveries. 29
1096	1096	(1)(A) Whenever the pool has paid benefits because of sickness 30
1097	1097	or an injury to any covered person resulting from a third party's wrongful 31
1098	1098	act or negligence or for which an insurance company or self -insured entity is 32
1099	1099	liable in accordance with the provisions of any policy of insurance, and the 33
1100	1100	covered person has recovered or may recover damages from a third party that 34
1101	1101	is liable for damages, the pool shall have the right to recover the benefits 35
1102	1102	it paid from any amounts that the covered person has received or may receive 36 HB1420
1103	1103
1104	1104	30 02/03/2025 4:09:03 PM ANS140
1105	1105	regardless of the date of the sickness or injury or the date of any 1
1106	1106	settlement, judgment, or award resulting from the sickness or injury. 2
1107	1107	(B) The pool shall be subrogated to any right of recovery 3
1108	1108	the covered person may have under the terms of any private or public 4
1109	1109	healthcare coverage or liability coverage including coverage under a workers' 5
1110	1110	compensation act without the necessity of assignment of claim or other 6
1111	1111	authorization to secure the right of recovery. 7
1112	1112	(C) To enforce its subrogation right, the pool may: 8
1113	1113	(i) Intervene or join in an action or proceeding 9
1114	1114	brought by the covered person or his or her personal representative, 10
1115	1115	including his or her guardian, conservator, estate, dependents, or survivors, 11
1116	1116	against any third party or the third party's insurance carrier or self -12
1117	1117	insured entity that may be liable; or 13
1118	1118	(ii) Institute and prosecute legal proceedings 14
1119	1119	against any third party or the third party's insurance carrier or self -15
1120	1120	insured entity that may be liable for the sickness or injury in an 16
1121	1121	appropriate court either in the name of the pool or in the name of the 17
1122	1122	covered person or his or her personal representative including his or her 18
1123	1123	guardian, conservator, estate, dependents, or survivors. 19
1124	1124	(2)(A)(i) If any action or claim is brought by or on behalf of a 20
1125	1125	covered person against a third party or the third party's insurance carrier 21
1126	1126	or self-insured entity, the covered person or his or her personal 22
1127	1127	representative, including his or her guardian, conservator, estate, 23
1128	1128	dependents, or survivors, shall notify the pool by personal service or 24
1129	1129	registered mail of the action or claim and of the name of the court in which 25
1130	1130	the action or claim is brought, filing proof thereof in the action or claim. 26
1131	1131	(ii) The pool may, at any time thereafter, join in 27
1132	1132	the action or claim upon its motion so that all orders of court after hearing 28
1133	1133	and judgment shall be made for its protection. 29
1134	1134	(B) No release or settlement of a claim for damages and no 30
1135	1135	satisfaction of judgment in the action shall be valid without the written 31
1136	1136	consent of the pool to the extent of its interest in the settlement or 32
1137	1137	judgment and of the covered person or his or her personal representative. 33
1138	1138	(3)(A) In the event that the covered person or his or her 34
1139	1139	personal representative fails to institute a proceeding against any 35
1140	1140	appropriate third party before the fifth month before the action would be 36 HB1420
1141	1141
1142	1142	31 02/03/2025 4:09:03 PM ANS140
1143	1143	barred, the pool, in its own name or in the name of the covered person or 1
1144	1144	personal representative, may commence a proceeding against any appropriate 2
1145	1145	third party for the recovery of damages on account of any sickness, injury, 3
1146	1146	or death to the covered person. 4
1147	1147	(B) The covered person shall cooperate in doing what is 5
1148	1148	reasonably necessary to assist the pool in any recovery and shall not take 6
1149	1149	any action that would prejudice the pool's right to recovery. 7
1150	1150	(C) The pool shall pay to the covered person or his or her 8
1151	1151	personal representative all sums collected from any third party by judgment 9
1152	1152	or otherwise in excess of amounts paid in benefits under the pool and amounts 10
1153	1153	paid or to be paid as costs, attorney's fees, and reasonable expenses 11
1154	1154	incurred by the pool in making the collection or enforcing the judgment. 12
1155	1155	(4)(A)(i) In the event of judgment or award in either a suit or 13
1156	1156	claim against a third party, the court shall first order paid from any 14
1157	1157	judgment or award the reasonable litigation expenses incurred in preparation 15
1158	1158	and prosecution of the action or claim, together with reasonable attorney's 16
1159	1159	fees. 17
1160	1160	(ii) After payment of those expenses and attorney's 18
1161	1161	fees, the court shall apply out of the balance of the judgment or award an 19
1162	1162	amount sufficient to reimburse the pool the full amount of benefits paid on 20
1163	1163	behalf of the covered person under this subchapter, provided that the court 21
1164	1164	may reduce and apportion the pool's portion of the judgment proportionately 22
1165	1165	to the recovery of the covered person. 23
1166	1166	(B)(i) The burden of producing sufficient evidence to 24
1167	1167	support the exercise by the court of its discretion to reduce the amount of a 25
1168	1168	proven charge sought to be enforced against the recovery shall rest with the 26
1169	1169	party seeking the reduction. 27
1170	1170	(ii) The court may consider the nature and extent of 28
1171	1171	the injury, economic and noneconomic loss, settlement offers, comparative or 29
1172	1172	contributory negligence as it applies to the case at hand, hospital costs, 30
1173	1173	physician costs, and all other appropriate costs. 31
1174	1174	(C) The pool shall pay its pro rata share of the 32
1175	1175	attorney's fees based on the pool's recovery as it compares to the total 33
1176	1176	judgment. 34
1177	1177	(D) Any reimbursement rights of the pool shall take 35
1178	1178	priority over all other liens and charges existing under the laws of the 36 HB1420
1179	1179
1180	1180	32 02/03/2025 4:09:03 PM ANS140
1181	1181	State of Arkansas. 1
1182	1182	(5) The pool may compromise or settle and release any claim for 2
1183	1183	benefits provided under this subchapter or waive any claims for benefits, in 3
1184	1184	whole or in part, for the convenience of the pool or if the pool determines 4
1185	1185	that collection will result in undue hardship upon the covered person. 5
1186	1186	(f) Preexisting Conditions. 6
1187	1187	(1) Except for federally eligible individuals or qualified trade 7
1188	1188	adjustment assistance eligible persons qualifying for plan coverage under § 8
1189	1189	23-79-509(b) or resident eligible persons or trade adjustment assistance 9
1190	1190	eligible persons who qualify for and elect to purchase the waiver authorized 10
1191	1191	in subdivision (f)(2) of this section, plan coverage shall exclude charges or 11
1192	1192	expenses incurred during the first six (6) months following the effective 12
1193	1193	date of coverage as to any condition if: 13
1194	1194	(A) The condition has manifested itself within the six -14
1195	1195	month period immediately preceding the effective date of coverage in such a 15
1196	1196	manner as would cause an ordinary prudent person to seek diagnosis, care, or 16
1197	1197	treatment; or 17
1198	1198	(B) Medical advice, care, or treatment was recommended or 18
1199	1199	received within the six -month period immediately preceding the effective date 19
1200	1200	of the coverage. 20
1201	1201	(2) Waiver. The preexisting condition exclusions as set forth 21
1202	1202	in subdivision (f)(1) of this section will be waived to the extent to which 22
1203	1203	the resident eligible person or trade adjustment assistance eligible person: 23
1204	1204	(A) Has satisfied similar exclusions under any prior 24
1205	1205	individual health insurance coverage that was involuntarily terminated; and 25
1206	1206	(B)(i) Has applied for plan coverage not later than thirty 26
1207	1207	(30) days following the involuntary termination. 27
1208	1208	(ii) For each resident eligible person or trade 28
1209	1209	adjustment assistance eligible person who qualifies for and elects this 29
1210	1210	waiver, there shall be added on a prorated basis to each payment of premium a 30
1211	1211	surcharge of up to ten percent (10%) of the otherwise applicable annual 31
1212	1212	premium for as long as that individual's coverage under the plan remains in 32
1213	1213	effect or sixty (60) months, whichever is less. 33
1214	1214	(3)(A) Whenever benefits are due from the plan because of 34
1215	1215	sickness or an injury to a covered person resulting from a third party's 35
1216	1216	wrongful act or negligence and the covered person has recovered or may 36 HB1420
1217	1217
1218	1218	33 02/03/2025 4:09:03 PM ANS140
1219	1219	recover damages from a third party or its insurance carrier or self -insured 1
1220	1220	entity, the plan shall have the right to reduce benefits or to refuse to pay 2
1221	1221	benefits that otherwise may be payable in the amount of damages that the 3
1222	1222	covered person has recovered or may recover regardless of the date of the 4
1223	1223	sickness or injury or the date of any settlement, judgment, or award 5
1224	1224	resulting from that sickness or injury. 6
1225	1225	(B)(i) During the pendency of any action or claim that is 7
1226	1226	brought by or on behalf of a covered person against a third party or its 8
1227	1227	insurance carrier or self -insured entity, any benefits that would otherwise 9
1228	1228	be payable except for the provisions of this subsection shall be paid if 10
1229	1229	payment by or for the third party has not yet been made and the covered 11
1230	1230	person or, if capable, that person's legal representative agrees in writing 12
1231	1231	to pay back properly the benefits paid as a result of the sickness or injury 13
1232	1232	to the extent of any future payments made by or for the third party for the 14
1233	1233	sickness or injury. 15
1234	1234	(ii) This agreement is to apply whether or not 16
1235	1235	liability for the payments is established or admitted by the third party or 17
1236	1236	whether those payments are itemized. 18
1237	1237	(C) Any amounts due the plan to repay benefits may be 19
1238	1238	deducted from other benefits payable by the plan after payments by or for the 20
1239	1239	third party are made. 21
1240	1240	(4) Benefits due from the plan may be reduced or refused as an 22
1241	1241	offset against any amount otherwise recoverable under this section. 23
1242	1242	24
1243	1243	23-79-511. Confidentiality. 25
1244	1244	(a)(1) All steps necessary under state and federal law to protect 26
1245	1245	confidentiality of applicants and covered persons shall be undertaken by the 27
1246	1246	Board of Directors of the Arkansas Comprehensive Health Insurance Pool to 28
1247	1247	prevent the identification of individual records of covered persons under the 29
1248	1248	plan, rejected by the plan, or who may become ineligible for further 30
1249	1249	participation in the plan. 31
1250	1250	(2) Procedures shall be written by the board to assure the 32
1251	1251	confidentiality of records of persons covered under, rejected by, or who 33
1252	1252	became ineligible for further participation in the plan when gathering and 34
1253	1253	submitting data to the board or any other entity. 35
1254	1254	(b) Any information submitted to the board by hospitals or any other 36 HB1420
1255	1255
1256	1256	34 02/03/2025 4:09:03 PM ANS140
1257	1257	provider pursuant to this subchapter from which the identity of a particular 1
1258	1258	individual can be determined shall be privileged and confidential and shall 2
1259	1259	not be disclosed in any manner. The foregoing includes, but shall not be 3
1260	1260	limited to, disclosure, inspection, or copying under the Freedom of 4
1261	1261	Information Act of 1967, § 25 -19-101 et seq. 5
1262	1262	6
1263	1263	23-79-512. Collective action. 7
1264	1264	Neither the participation in the plan as insurers, the establishment of 8
1265	1265	rates, forms, or procedures nor any other joint or collective action required 9
1266	1266	by this subchapter shall be the basis of any legal action, criminal or civil 10
1267	1267	liability, or penalty against the plan or any insurer. 11
1268	1268	12
1269	1269	23-79-513. Unfair referral to plan — Prohibited practices by 13
1270	1270	employers. 14
1271	1271	(a) It shall constitute an unfair trade practice under the Trade 15
1272	1272	Practices Act, § 23-66-201 et seq., for an insurer, agent, broker, or third-16
1273	1273	party administrator to refer an individual to the Arkansas Comprehensive 17
1274	1274	Health Insurance Pool or arrange for an individual to apply to the pool for 18
1275	1275	the purpose of: 19
1276	1276	(1) Separating the individual from group health insurance 20
1277	1277	coverage provided by a group health plan; or 21
1278	1278	(2) Facilitating enrollment in the pool by any of the following 22
1279	1279	individuals associated with an employer, with the knowledge that the employer 23
1280	1280	intends to pay or is paying all or part of the premium payments owed by the 24
1281	1281	individual for pool coverage: 25
1282	1282	(A) An employee of the employer; 26
1283	1283	(B) A retired employee of the employer; or 27
1284	1284	(C) A dependent of an employee or retired employee of the 28
1285	1285	employer. 29
1286	1286	(b) Because pool coverage is not intended to cover participants who 30
1287	1287	are eligible for a group health plan, an individual described in subdivision 31
1288	1288	(a)(2) of this section is not eligible: 32
1289	1289	(1) For pool coverage if the employer associated with the 33
1290	1290	applicant intends to pay for all or part of the pool premium payments for the 34
1291	1291	individual; or 35
1292	1292	(2) To continue pool coverage if the employer associated with 36 HB1420
1293	1293
1294	1294	35 02/03/2025 4:09:03 PM ANS140
1295	1295	the individual directly or indirectly pays all or part of the pool premium 1
1296	1296	payments for the individual. 2
1297	1297	3
1298	1298	23-79-514. [Repealed.] 4
1299	1299	5
1300	1300	23-79-515. Orderly cessation of operations. 6
1301	1301	(a)(1) The Arkansas Comprehensive Health Insurance Pool shall cease 7
1302	1302	enrollment and coverage under the plan on and after January 1, 2014, as 8
1303	1303	required by federal law. 9
1304	1304	(2) After taking all reasonable steps, including those specified 10
1305	1305	in this section, to timely and efficiently assist in the transition of 11
1306	1306	individuals receiving plan coverage to the individual health insurance 12
1307	1307	market, the Board of Directors of the Arkansas Comprehensive Health Insurance 13
1308	1308	Pool shall cease operating the pool after paying health insurance claims for 14
1309	1309	plan coverage and meeting all other obligations of the board under this 15
1310	1310	section. 16
1311	1311	(b) The board may take all actions it deems necessary to: 17
1312	1312	(1) Cease enrollment for plan coverage effective December 1, 18
1313	1313	2013; 19
1314	1314	(2)(A) Terminate all existing plan coverage effective at the end 20
1315	1315	of the calendar day on December 31, 2013. 21
1316	1316	(B) The board shall provide at least ninety (90) days 22
1317	1317	notice to current policyholders of the termination; and 23
1318	1318	(3) Amend plan policies and provide adequate notice to 24
1319	1319	policyholders, agents, and providers that to be paid or reimbursed, a claim 25
1320	1320	for plan services is required to be filed by the earlier of one hundred 26
1321	1321	eighty (180) days after plan coverage ends or three hundred sixty -five (365) 27
1322	1322	days after the date of service giving rise to the claim. 28
1323	1323	(c) This section does not require the board to revise plan benefits to 29
1324	1324	comply with federal law or to maintain plan coverage for any individual after 30
1325	1325	December 31, 2013. 31
1326	1326	(d)(1) After all plan coverage terminates under this section, the 32
1327	1327	board shall take reasonable steps to wind up all significant operations of 33
1328	1328	the pool by December 31, 2014. 34
1329	1329	(2) Notwithstanding any other provision of this subchapter, to 35
1330	1330	facilitate an efficient cessation of operations: 36 HB1420
1331	1331
1332	1332	36 02/03/2025 4:09:03 PM ANS140
1333	1333	(A) The board may continue to use existing contractors 1
1334	1334	until cessation of operations without the need to issue competitive requests 2
1335	1335	for proposals; 3
1336	1336	(B) The board may continue to fund operations of this 4
1337	1337	subchapter under § 23 -79-507; 5
1338	1338	(C) The board shall remain in effect: 6
1339	1339	(i) As provided by § 23-79-504(b); and 7
1340	1340	(ii) Until a judgment, order, or decree in any 8
1341	1341	action, suit, or proceeding commenced against or by the pool is fully 9
1342	1342	executed; and 10
1343	1343	(D)(i) The term of each current board member shall be 11
1344	1344	extended until the date the pool concludes all business as provided under 12
1345	1345	this section and the Insurance Commissioner certifies the cessations of 13
1346	1346	operations under subsection (g) of this section. 14
1347	1347	(ii) The term of a board member expires when the 15
1348	1348	commissioner certifies the cessations of operations under subsection (g) of 16
1349	1349	this section. 17
1350	1350	(e) On or before June 30, 2013, the board shall amend the plan of 18
1351	1351	operation to reflect the actions necessary to implement this section. 19
1352	1352	(f) If the board has excess funds after the cessation of operations of 20
1353	1353	the pool, the funds shall be returned to the general revenue funds of the 21
1354	1354	state. 22
1355	1355	(g)(1) On or before March 1, 2016, or a later date if necessary to 23
1356	1356	complete the cessation of operations of the pool, the board shall file a 24
1357	1357	report with the General Assembly and commissioner that reflects completion of 25
1358	1358	the requirements of this section and includes an independent auditor's report 26
1359	1359	on the financial statements of the pool. 27
1360	1360	(2) If satisfied upon review of the report that the board has 28
1361	1361	complied with this section and accomplished the pool's cessation of 29
1362	1362	operations in a reasonable manner, the commissioner shall certify that the 30
1363	1363	business of the pool has concluded in accordance with this section and 31
1364	1364	publish the certification on the State Insurance Department website. 32
1365	1365	(h) Upon certification under subsection (g) of this section, the 33
1366	1366	operations of the pool are suspended indefinitely unless reactivated by the 34
1367	1367	General Assembly. 35
1368	1368	(i) The commissioner may address any matters regarding the pool 36 HB1420
1369	1369
1370	1370	37 02/03/2025 4:09:03 PM ANS140
1371	1371	arising after the certification under subsection (g) of this section, and the 1
1372	1372	Attorney General shall defend a legal action filed after the certification, 2
1373	1373	including seeking the dismissal of the action under § 23 -79-516 or for any 3
1374	1374	other purpose. 4
1375	1375	(j) Unless inconsistent with this section, the remainder of this 5
1376	1376	subchapter continues to apply to the pool and the board. 6
1377	1377	7
1378	1378	23-79-516. Statute of limitations and repose. 8
1379	1379	Because winding up the operations of the Arkansas Comprehensive Health 9
1380	1380	Insurance Pool requires the expeditious determination of its outstanding 10
1381	1381	liabilities, a cause of action against the pool or the Board of Directors of 11
1382	1382	the Arkansas Comprehensive Health Insurance Pool shall be commenced within 12
1383	1383	the earlier of one (1) year after the cause of action accrues or December 31, 13
1384	1384	2015. 14
1385	1385	15
1386	1386	23-79-517. Individuals moving to Arkansas and previously covered by 16
1387	1387	another qualified high -risk pool. 17
1388	1388	(a) Notwithstanding § 23 -79-510(f), if a resident eligible person is 18
1389	1389	eligible for plan coverage because the person previously was covered under a 19
1390	1390	qualified high-risk pool of another state, a preexisting condition exclusion 20
1391	1391	otherwise applicable to the resident eligible person: 21
1392	1392	(1) Shall be reduced by each month of coverage in which the 22
1393	1393	resident eligible person was subject to a preexisting condition exclusion in 23
1394	1394	the other state's qualified high -risk pool; or 24
1395	1395	(2) Does not apply if the resident eligible person was not 25
1396	1396	subject to a preexisting condition exclusion in the other state's qualified 26
1397	1397	high-risk pool. 27
1398	1398	(b) This section expires on the last day an individual may be enrolled 28
1399	1399	into plan coverage under this subchapter. 29
1400	1400	30
1401	1401	SECTION 6. Arkansas Code § 23 -86-113 is repealed. 31
1402	1402	23-86-113. Minimum benefits for mental illness in group accident and 32
1403	1403	health insurance policies or subscriber's contracts — Definition. 33
1404	1404	(a) Unless refused in writing, every group accident and health 34
1405	1405	insurance policy or group contract of hospital and medical service 35
1406	1406	corporations issued or renewed after July 1, 1983, providing hospitalization 36 HB1420
1407	1407
1408	1408	38 02/03/2025 4:09:03 PM ANS140
1409	1409	or medical benefits to Arkansas residents for conditions arising from mental 1
1410	1410	illness shall provide the following minimum benefits on and after July 1, 2
1411	1411	1983: 3
1412	1412	(1) In the case of benefits based upon confinement as an 4
1413	1413	inpatient in a hospital, psychiatric hospital, or outpatient psychiatric 5
1414	1414	center licensed by the Department of Health or a community mental health 6
1415	1415	center certified by the Division of Aging, Adult, and Behavioral Health 7
1416	1416	Services of the Department of Human Services, the benefits shall be as 8
1417	1417	defined in subsection (b) of this section; 9
1418	1418	(2)(A) In the case of benefits provided for partial 10
1419	1419	hospitalization in a hospital, psychiatric hospital, or outpatient 11
1420	1420	psychiatric center licensed by the department or a community mental health 12
1421	1421	center certified by the division as defined in subsection (b) of this 13
1422	1422	section. 14
1423	1423	(B) For the purpose of this section, “partial 15
1424	1424	hospitalization” means continuous treatment for at least four (4) hours, but 16
1425	1425	not more than sixteen (16) hours in any twenty -four-hour period; and 17
1426	1426	(3) In the case of outpatient benefits, the benefits shall cover 18
1427	1427	services furnished by: 19
1428	1428	(A) A hospital, a psychiatric hospital, or an outpatient 20
1429	1429	psychiatric center licensed by the department; 21
1430	1430	(B) A physician licensed under the Arkansas Medical 22
1431	1431	Practices Act, § 17-95-201 et seq., § 17-95-301 et seq., and § 17 -95-401 et 23
1432	1432	seq.; 24
1433	1433	(C) A psychologist licensed under § 17 -97-201 et seq.; or 25
1434	1434	(D) A community mental health center or other mental 26
1435	1435	health clinic certified by the division to furnish mental health services as 27
1436	1436	defined in subsection (b) of this section. 28
1437	1437	(b) The insurer or hospital and medical service corporation may 29
1438	1438	establish a copayment requirement for mental illness benefits paid for 30
1439	1439	inpatient, partial hospitalization, or outpatient care described in 31
1440	1440	subsection (a) of this section, which may or may not differ from the 32
1441	1441	copayment requirements for any other condition or illness, except that 33
1442	1442	copayment requirements for mental illness shall not exceed a twenty percent 34
1443	1443	(20%) copayment requirement. 35
1444	1444	(c)(1) For accident and health insurance sold to employers of fifty 36 HB1420
1445	1445
1446	1446	39 02/03/2025 4:09:03 PM ANS140
1447	1447	(50) or fewer employees, the insurer or hospital and medical service 1
1448	1448	corporation shall not impose limits on benefits under subsection (a) of this 2
1449	1449	section with regard to deductible amounts, lifetime maximum payments, 3
1450	1450	payments per outpatient visit, or payments per day of partial hospitalization 4
1451	1451	which differ from benefits for any other condition or illness, provided that 5
1452	1452	the insurer or hospital and medical service corporation may impose an annual 6
1453	1453	maximum benefit payable, which shall not be less than seven thousand five 7
1454	1454	hundred dollars ($7,500) per calendar year. 8
1455	1455	(2) For accident and health insurance sold to employers of 9
1456	1456	fifty-one (51) or more employees, the insurer or hospital and medical service 10
1457	1457	corporation shall not impose limits on benefits under subsection (a) of this 11
1458	1458	section with regard to deductible amounts, lifetime maximum payments, 12
1459	1459	payments per outpatient visit, or payments per day of partial hospitalization 13
1460	1460	which differ from benefits for any other condition or illness, provided that 14
1461	1461	the insurer or hospital and medical service corporation may impose an annual 15
1462	1462	maximum of eight (8) inpatient or partial hospitalization days together with 16
1463	1463	forty (40) outpatient visits. 17
1464	1464	(d) No person shall disclose mental health history, diagnosis, or 18
1465	1465	treatment services information received in an initial application for 19
1466	1466	coverage or subsequent claims for benefits to any person, group, 20
1467	1467	organization, or governmental agency without written consent of the insured, 21
1468	1468	except for purposes of: 22
1469	1469	(1) Obtaining professional review and judgments of quality and 23
1470	1470	appropriateness of treatment rendered; 24
1471	1471	(2) Litigation proceedings involving the insured and when 25
1472	1472	ordered by a court; 26
1473	1473	(3) Reinsurance, when required; 27
1474	1474	(4) Applying over-insurance provisions or for purposes of 28
1475	1475	claiming benefits for services on behalf of the insured; or 29
1476	1476	(5) Underwriting applications for insurance coverage. 30
1477	1477	(e) Nothing in this section shall be construed to prohibit an insurer, 31
1478	1478	a hospital and medical service corporation, a healthcare plan, a health 32
1479	1479	maintenance organization, or other person providing accident and health 33
1480	1480	insurance or medical benefits to Arkansas residents from issuing or 34
1481	1481	continuing to issue an accident and health insurance benefit plan, policy, or 35
1482	1482	contract that provides benefits greater than the minimum benefits required to 36 HB1420
1483	1483
1484	1484	40 02/03/2025 4:09:03 PM ANS140
1485	1485	be made available under this section or from issuing any plans, policies, or 1
1486	1486	contracts that provide benefits that are generally more favorable to the 2
1487	1487	insured than those required to be made available under this section. 3
1488	1488	(f) The requirements of this section with respect to a group or 4
1489	1489	blanket accident and health insurance benefit plan, policy, or subscriber 5
1490	1490	contract shall be satisfied, if the coverage specified is made available to 6
1491	1491	the master policyholder of the plan, policy, or contract. 7
1492	1492	(g)(1)(A) Every insurer or hospital and medical service corporation 8
1493	1493	that issues a group accident and health insurance policy, contract, or 9
1494	1494	agreement in this state that provides for mental health coverage shall offer 10
1495	1495	coverage for the payment of services rendered by licensed professional 11
1496	1496	counselors. 12
1497	1497	(B) The offer shall be made either at the time of 13
1498	1498	application for, or upon the first renewal of, the policy, contract, or 14
1499	1499	agreement after April 1, 1995. 15
1500	1500	(C) If the offer is accepted, the amount paid for services 16
1501	1501	provided by licensed professional counselors shall be subject to the same 17
1502	1502	limitations as set forth in the policy for mental health coverage. 18
1503	1503	(2) Nothing in this subsection shall be deemed to expand the 19
1504	1504	scope of the practice of licensed professional counselors currently licensed 20
1505	1505	by the Arkansas Board of Examiners in Counseling and possessing the 21
1506	1506	qualifications set forth in § 17 -27-301 et seq., or other applicable laws. 22
1507	1507	23
1508	1508	SECTION 7. Arkansas Code § 23 -99-502 is amended to read as follows: 24
1509	1509	23-99-502. Legislative findings and intent. 25
1510	1510	It is the intent of this state that if a health benefit plan provides 26
1511	1511	insurance coverage for a mental illness or substance abuse health and 27
1512	1512	substance use disorder, the treatment of the mental illness or substance 28
1513	1513	abuse disorder the benefits shall be as available as and at parity with that 29
1514	1514	for other medical illnesses other medical and surgical benefits . 30
1515	1515	31
1516	1516	SECTION 8. Arkansas Code § 23 -99-503 is amended to read as follows: 32
1517	1517	23-99-503. Definitions. 33
1518	1518	As used in this subchapter: 34
1519	1519	(1) "Carve-out arrangement" means an arrangement in which a 35
1520	1520	healthcare insurer contracts with a separate person or entity to arrange for 36 HB1420
1521	1521
1522	1522	41 02/03/2025 4:09:03 PM ANS140
1523	1523	the delivery of specific types of healthcare benefits under a health benefit 1
1524	1524	plan; 2
1525	1525	(2) “Commissioner” means the Insurance Commissioner; 3
1526	1526	(3)(2)(A) "Financial requirements" means copayments, 4
1527	1527	deductibles, out-of-network charges, out -of-pocket contributions or fees, 5
1528	1528	annual limits, lifetime aggregate limits imposed on individual patients, and 6
1529	1529	other patient cost-sharing amounts. 7
1530	1530	(B) "Financial requirements" does not include aggregate 8
1531	1531	lifetime or annual dollar limits ; 9
1532	1532	(4)(3) “Health benefit plan” means any individual, group, or 10
1533	1533	blanket plan, policy, or contract for healthcare services issued or delivered 11
1534	1534	in this state by healthcare insurers, including indemnity and managed care 12
1535	1535	plans and the plans providing health benefits to state and public school 13
1536	1536	employees pursuant to § 21 -5-401 et seq., but excluding plans providing 14
1537	1537	health care healthcare services pursuant to Arkansas Constitution, Article 5, 15
1538	1538	§ 32, the Workers' Compensation Law, § 11 -9-101 et seq., and the Public 16
1539	1539	Employee Workers' Compensation Act, § 21 -5-601 et seq.; 17
1540	1540	(5)(4) “Healthcare insurer” means any insurance company, 18
1541	1541	hospital and medical service corporation, or health maintenance organization 19
1542	1542	issuing or delivering health benefit plans in this state and subject to any 20
1543	1543	of the following laws: 21
1544	1544	(A) The Arkansas Insurance Code; 22
1545	1545	(B) Section 23-75-101 et seq., pertaining to hospital and 23
1546	1546	medical service corporations; 24
1547	1547	(C) Section 23-76-101 et seq., pertaining to health 25
1548	1548	maintenance organizations; and 26
1549	1549	(D) Any successor law of the foregoing; 27
1550	1550	(6)(A)(5)(A) “Mental illnesses” and “substance use disorders” 28
1551	1551	mean those illnesses and disorders that are covered by a health benefit plan 29
1552	1552	listed in the International Classification of Diseases manual and the 30
1553	1553	Diagnostic and Statistical Manual of Mental Disorders "Mental health 31
1554	1554	benefits" means benefits with respect to items or services for mental health 32
1555	1555	conditions, as defined under the terms of the health benefit plan or health 33
1556	1556	insurance coverage and according to applicable federal and state law . 34
1557	1557	(B) Unless specifically otherwise stated, “mental illness” 35
1558	1558	includes substance use disorders "Mental health benefits" that are defined by 36 HB1420
1559	1559
1560	1560	42 02/03/2025 4:09:03 PM ANS140
1561	1561	a health benefit plan or health insurance coverage as being or not being a 1
1562	1562	mental health condition shall be defined to be consistent with generally 2
1563	1563	recognized independent standards of current medical practice, including 3
1564	1564	conditions that are listed in the Diagnostic and Statistical Manual of Mental 4
1565	1565	Disorders, the International Classification of Diseases, or state guidelines ; 5
1566	1566	(7)(6) “Person” or “entity” means and includes, individually and 6
1567	1567	collectively, any individual, corporation, partnership, firm, trust, 7
1568	1568	association, voluntary organization, or any other form of business enterprise 8
1569	1569	or legal entity; and 9
1570	1570	(8)(7)(A) “Small employer” means any person or entity actively 10
1571	1571	engaged in business who, on at least fifty percent (50%) of its working days 11
1572	1572	during the preceding year, employed no more than fifty (50) eligible 12
1573	1573	employees "Substance abuse disorder benefits" means benefits with respect to 13
1574	1574	items or services for substance use disorders, as defined under the terms of 14
1575	1575	the health benefit plan or health insurance coverage and according to 15
1576	1576	applicable federal and state law . 16
1577	1577	(B) "Substance abuse disorder benefits" that are defined 17
1578	1578	by a health benefit plan or health insurance coverage as being or not being a 18
1579	1579	mental health condition shall be defined to be consistent with generally 19
1580	1580	recognized independent standards of current medical practice, including 20
1581	1581	conditions that are listed in the Diagnostic and Statistical Manual of Mental 21
1582	1582	Disorders, the International Classification of Diseases, or state guidelines. 22
1583	1583	23
1584	1584	SECTION 9. Arkansas Code § 23 -99-504 is amended to read as follows: 24
1585	1585	23-99-504. Exclusions. 25
1586	1586	This subchapter does not apply to: 26
1587	1587	(1) Dental insurance plans; 27
1588	1588	(2) Vision insurance plans; 28
1589	1589	(3) Specified-disease insurance plans; 29
1590	1590	(4) Accidental injury insurance plans; 30
1591	1591	(5) Long-term care plans; 31
1592	1592	(6) Disability income plans; and 32
1593	1593	(7) Individual health benefit plans if the healthcare insurers 33
1594	1594	offer individuals who satisfy the healthcare insurer's underwriting standards 34
1595	1595	the option of purchasing a plan that, other than being optional, meets all 35
1596	1596	the other requirements of this subchapter; 36 HB1420
1597	1597
1598	1598	43 02/03/2025 4:09:03 PM ANS140
1599	1599	(8) Health benefit plans for small employers if the healthcare 1
1600	1600	insurers offer purchasers the option of purchasing a plan that, other than 2
1601	1601	being optional, meets all the other requirements of this subchapter; and 3
1602	1602	(9) Medicare supplement plans, as subject to section 1882(g)(1) 4
1603	1603	of the Social Security Act. 5
1604	1604	6
1605	1605	SECTION 10. Arkansas Code § 23 -99-505 is amended to read as follows: 7
1606	1606	23-99-505. Increased cost exemption. 8
1607	1607	(a)(1) This subchapter does not apply to a health benefit plan during 9
1608	1608	the health benefit plan's following health benefit plan year if the 10
1609	1609	application of this subchapter to the health benefit plan in a health benefit 11
1610	1610	plan year resulted in an increase in the actual costs of coverage with 12
1611	1611	respect to medical and surgical benefits and mental illness health benefits 13
1612	1612	and substance abuse disorder benefits under the health benefit plan as 14
1613	1613	determined and certified under subsection (b) of this section by an amount 15
1614	1614	that exceeds: 16
1615	1615	(A) Two percent (2%) for the first health benefit plan 17
1616	1616	year in which this section is applied; or 18
1617	1617	(B) One percent (1%) for each subsequent health benefit 19
1618	1618	plan year. 20
1619	1619	(2) The exemption provided by subdivision (a)(1) of this section 21
1620	1620	applies to a health benefit plan for one (1) year. 22
1621	1621	(3) A healthcare insurer may elect to continue to apply mental 23
1622	1622	health parity under this subchapter to its health benefit plans regardless of 24
1623	1623	any increase in its total costs of coverage. 25
1624	1624	(b)(1) A determination under this section of increases to the actual 26
1625	1625	costs of coverage of a health benefit plan shall be made and certified by a 27
1626	1626	qualified and licensed actuary who is a member in good standing of the 28
1627	1627	American Academy of Actuaries. 29
1628	1628	(2) The determination shall be in a written report prepared by 30
1629	1629	the actuary. 31
1630	1630	(3) The report and all underlying documentation relied upon by 32
1631	1631	the actuary shall be maintained by the healthcare insurer for a period of six 33
1632	1632	(6) years following the notification required by subsection (d) of this 34
1633	1633	section. 35
1634	1634	(c) To obtain an exemption under this section, a healthcare insurer 36 HB1420
1635	1635
1636	1636	44 02/03/2025 4:09:03 PM ANS140
1637	1637	shall make the increased cost determination required by this section after 1
1638	1638	the health benefit plan has complied with this section for the first six (6) 2
1639	1639	months of the health benefit plan year. 3
1640	1640	(d)(1) A healthcare insurer that elects to claim an exemption for a 4
1641	1641	qualifying health benefit plan under this section based upon a certification 5
1642	1642	under subsection (b) of this section shall promptly notify the Insurance 6
1643	1643	Commissioner, the policyholder or contract holder, and the certificate 7
1644	1644	holders, subscribers, and enrollees covered by the health benefit plan of its 8
1645	1645	election. 9
1646	1646	(2)(A) The notification to the commissioner under subdivision 10
1647	1647	(d)(1) of this section shall include: 11
1648	1648	(A)(i) A description of the number of covered lives 12
1649	1649	under the health benefit plan at the time of the notification and, if 13
1650	1650	applicable, at the time of any prior election of the increased cost exemption 14
1651	1651	under this section; and 15
1652	1652	(B)(ii) For the current and previous health benefit 16
1653	1653	plan year: 17
1654	1654	(i)(a) A description of the actual total costs 18
1655	1655	of coverage for medical and surgical benefits and mental illness health and 19
1656	1656	substance use benefits under the health benefit plan; and 20
1657	1657	(ii)(b) The actual total costs of coverage 21
1658	1658	with respect to mental illness benefits under the health benefit plan. 22
1659	1659	(3)(A) A notification under this subsection is 23
1660	1660	confidential. 24
1661	1661	(B) The commissioner shall make available upon request, 25
1662	1662	but not more than annually, an anonymous itemization of notifications under 26
1663	1663	this section that includes a summary of the data received under this 27
1664	1664	subdivision (d)(2) of this section. 28
1665	1665	(3) The notification to the policyholder or contract holder and 29
1666	1666	certificate holders, subscribers, and enrollees shall comply with the 30
1667	1667	requirements of 45 C.F.R. § 146.136(g)(6)(i), as it existed on May 23, 2024. 31
1668	1668	(4) A notification provided under this subsection is 32
1669	1669	confidential. 33
1670	1670	(e) To determine compliance with this section, the commissioner may 34
1671	1671	audit the books and records of a healthcare insurer relating to an exemption, 35
1672	1672	including without limitation any actuarial reports prepared pursuant to 36 HB1420
1673	1673
1674	1674	45 02/03/2025 4:09:03 PM ANS140
1675	1675	subsection (b) of this section during the six -year period following the 1
1676	1676	notification required by subsection (d) of this section. 2
1677	1677	(f) The commissioner may promulgate rules to implement this section. 3
1678	1678	4
1679	1679	SECTION 11. Arkansas Code § 23 -99-506 is amended to read as follows: 5
1680	1680	23-99-506. Parity requirements. 6
1681	1681	(a) Except as provided in § 23 -99-504, if a health benefit plan that 7
1682	1682	provides benefits for the diagnosis and treatment of mental illnesses shall 8
1683	1683	provide the benefits under the same terms and conditions as provided for 9
1684	1684	covered benefits offered under the health benefit plan for the treatment of 10
1685	1685	other medical illnesses and conditions, including without limitation: 11
1686	1686	(1) The duration or frequency of coverage; 12
1687	1687	(2) The dollar amount of coverage; or 13
1688	1688	(3) Financial requirements insurance coverage for mental health 14
1689	1689	and substance use, the benefits shall be as available as and at parity with 15
1690	1690	other medical and surgical benefits . 16
1691	1691	(b) Except as provided under this section, a health carrier that 17
1692	1692	offers or issues individual or group health benefit plans that are delivered, 18
1693	1693	issued for delivery, continued, or renewed in this state and that provide 19
1694	1694	coverage for mental health and substance use shall comply with the 20
1695	1695	requirements of the Mental Health Parity and Addiction Equity Act of 2008, 42 21
1696	1696	U.S.C. Section 300gg -26, as it existed on January 1, 2025, and the federal 22
1697	1697	regulations promulgated thereunder. 23
1698	1698	(c) This subchapter does not: 24
1699	1699	(1) Require equal coverage between treatments for a mental 25
1700	1700	illness with mental health and substance use benefits and coverage for 26
1701	1701	preventive care benefits; 27
1702	1702	(2) Prohibit a healthcare insurer from: 28
1703	1703	(A) Negotiating separate reimbursement rates and service 29
1704	1704	delivery systems, including without limitation a carve -out arrangement; or 30
1705	1705	(B) Managing the provision of mental health benefits for 31
1706	1706	mental illnesses by common methods used for other medical conditions, 32
1707	1707	including without limitation preadmission screening, prior authorization of 33
1708	1708	services, or other mechanisms designed to limit coverage of services or 34
1709	1709	mental illnesses to mental illnesses that are deemed medically necessary; 35
1710	1710	(C) Limiting covered services to covered services 36 HB1420
1711	1711
1712	1712	46 02/03/2025 4:09:03 PM ANS140
1713	1713	authorized by the health benefit plan, if the limitations are made in 1
1714	1714	accordance with this subchapter and federal law; 2
1715	1715	(D) Using separate but equal cost -sharing features for 3
1716	1716	mental illnesses; or 4
1717	1717	(E) Using a single lifetime or annual dollar limit as 5
1718	1718	applicable to other medical illness; and 6
1719	1719	(3) Include a Medicare or Medicaid plan or contract or any 7
1720	1720	privatized risk or demonstration program for Medicare or Medicaid coverage. 8
1721	1721	9
1722	1722	SECTION 12. Arkansas Code § 23 -99-507 is amended to read as follows: 10
1723	1723	23-99-507. Medical necessity. 11
1724	1724	(a) The criteria for medical necessity determinations for mental 12
1725	1725	illness health benefits and substance abuse disorder benefits made under a 13
1726	1726	health benefit plan shall be made available by the healthcare insurer in 14
1727	1727	accordance with according to rules established by the Insurance Commissioner 15
1728	1728	to any current or potential covered individual or contracting provider upon 16
1729	1729	request. 17
1730	1730	(b) On request, the reason for a denial of reimbursement or payment 18
1731	1731	for services to diagnose or treat mental illness with respect to mental 19
1732	1732	health benefits or substance abuse disorder benefits under a health benefit 20
1733	1733	plan shall be made available by the healthcare insurer to a covered 21
1734	1734	individual in accordance with according to the rules of the commissioner. 22
1735	1735	23
1736	1736	SECTION 13. Arkansas Code § 23 -99-508 is repealed. 24
1737	1737	23-99-508. Permitted provisions. 25
1738	1738	(a) A healthcare insurer may at the healthcare insurer's option 26
1739	1739	provide coverage for a health service, such as intensive case management, 27
1740	1740	community residential treatment programs, or social rehabilitation programs, 28
1741	1741	that is used in the treatment of mental illnesses but is generally not used 29
1742	1742	for other injuries, illnesses, and conditions if the other requirements of 30
1743	1743	this subchapter are met. 31
1744	1744	(b) Healthcare insurers providing educational remediation may, but are 32
1745	1745	not required to, comply with the terms of this subchapter in regard to the 33
1746	1746	treatment or remediation. 34
1747	1747	(c) A healthcare insurer may provide coverage for a health service, 35
1748	1748	including without limitation physical rehabilitation or durable medical 36 HB1420
1749	1749
1750	1750	47 02/03/2025 4:09:03 PM ANS140
1751	1751	equipment, which generally is not used in the diagnosis or treatment of 1
1752	1752	serious mental illnesses but is used for other injuries, illnesses, and 2
1753	1753	conditions if the other requirements of this subchapter are met. 3
1754	1754	(d) A healthcare insurer may utilize common utilization management 4
1755	1755	protocols, including without limitation preadmission screening, prior 5
1756	1756	authorization of service, or other mechanisms designed to limit coverage of 6
1757	1757	service for mental illness to individuals whose diagnosis or treatment 7
1758	1758	coverage is considered medically necessary although the protocols are not 8
1759	1759	used in conjunction with other medical illnesses or conditions covered by the 9
1760	1760	health benefit plan. 10
1761	1761	11
1762	1762	SECTION 14. Arkansas Code § 23-99-512 is amended to read as follows: 12
1763	1763	23-99-512. Out-of-network providers. 13
1764	1764	In the case of a health benefit plan that provides both medical 14
1765	1765	benefits and mental illness health benefits and substance abuse disorder 15
1766	1766	benefits, if the health benefit plan provides coverage for medical benefits 16
1767	1767	provided by out-of-network providers, the health benefit plan shall provide 17
1768	1768	coverage for mental illness health benefits and substance abuse disorder 18
1769	1769	benefits provided by out -of-network providers pursuant to under this 19
1770	1770	subchapter. 20
1771	1771	21
1772	1772	22
1773	1773	23
1774	1774	24
1775	1775	25
1776	1776	26
1777	1777	27
1778	1778	28
1779	1779	29
1780	1780	30
1781	1781	31
1782	1782	32
1783	1783	33
1784	1784	34
1785	1785	35
1786	1786	36