Stricken language would be deleted from and underlined language would be added to present law.
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State of Arkansas 1
95th General Assembly A Bill 2
Regular Session, 2025 HOUSE BILL 1700 3
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By: Representative Achor 5
By: Senator J. Boyd 6
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For An Act To Be Entitled 8
AN ACT TO AMEND THE PRIOR AUTHORIZATION TRANSPARENCY 9
ACT; TO EXCLUDE THE NAME OF A REVIEWING PHYSICIAN 10
FROM DISCLOSURE IN AN ADVERSE DETERMINATION NOTICE 11
UNDER THE PRIOR AUTHORIZATION TRANSPARENCY ACT; AND 12
FOR OTHER PURPOSES. 13
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Subtitle 16
TO AMEND THE PRIOR AUTHORIZATION 17
TRANSPARENCY ACT; AND TO EXCLUDE THE 18
NAME OF A REVIEWING PHYSICIAN FROM 19
DISCLOSURE IN AN ADVERSE DETERMINATION 20
NOTICE UNDER THE PRIOR AUTHORIZATION 21
TRANSPARENCY ACT. 22
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BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF ARKANSAS: 24
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SECTION 1. Arkansas Code § 23-99-1111(c)(3)(A), concerning the 26
information required from a utilization review entity in an adverse 27
determination notice under the Prior Authorization Transparency Act, is 28
amended to read as follows: 29
(3)(A)(i) Subject to this subdivision (c)(3), when an adverse 30
determination is issued by a utilization review entity that questions the 31
medical necessity, the appropriateness, or the experimental or 32
investigational nature of a healthcare service, the utilization review entity 33
shall provide in the notice of adverse determination the name and telephone 34
number of a physician who possesses a current and unrestricted license in 35
this state with whom the requesting healthcare provider may have a reasonable 36 HB1700
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opportunity to discuss the patient's treatment plan and the clinical basis 1
for the intervention. 2
(ii) A physician contacted by a requesting 3
healthcare provider under subdivision (c)(3)(A)(i) of this section shall 4
disclose his or her name and license information to the requesting healthcare 5
provider. 6
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SECTION 2. Arkansas Code § 23 -99-1115(b), concerning the information 8
required in the written and verbal notice of an adverse determination under 9
the Prior Authorization Transparency Act, is amended to read as follows: 10
(b) The written or verbal notice required to a healthcare provider 11
under this section shall include: 12
(1) The following information: 13
(A) The name, title, and telephone number of the physician 14
responsible for making the adverse determination and, in the event that the 15
physician responsible for making the adverse determination is not available, 16
a telephone number where a peer -to-peer contact with another physician 17
regarding the adverse determination can be made; 18
(B) The reviewing physician's specialty or practice area, 19
including board certification status or board eligibility; and 20
(C) A list of states in which the reviewing physician is 21
licensed and the license number issued to the reviewing physician by each 22
state; 23
(D) For a verbal notice, the name and license number of 24
the reviewing physician; and 25
(E) For a written notice, a telephone number that the 26
requesting healthcare provider may call to obtain the name and license number 27
of the reviewing physician; 28
(2) The written clinical criteria, if any, and any internal 29
rule, guideline, or protocol on which the utilization review entity relied 30
when making the adverse determination and how those provisions apply to the 31
subscriber's specific medical circumstance; 32
(3) Information for the subscriber and the subscriber's 33
healthcare provider that describes the procedure through which the subscriber 34
or healthcare provider may request a copy of any report developed by 35
personnel performing the review that led to the adverse determination; and 36 HB1700
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(4)(A) Information that explains to the subscriber and the 1
subscriber's healthcare provider the right to appeal the adverse 2
determination. 3
(B) The information required under subdivision (b)(4)(A) 4
of this section shall include: 5
(i) Instructions concerning how to perfect an appeal 6
and how the subscriber and the subscriber's healthcare provider may ensure 7
that written materials supporting the appeal will be considered in the appeal 8
process; and 9
(ii)(a) Addresses and telephone numbers to be used 10
by healthcare providers and subscribers to make complaints to the Arkansas 11
State Medical Board, the State Board of Health, and the State Insurance 12
Department. 13
(b) Subdivision (b)(4)(B)(ii)(a) of this 14
section does not apply to self -insured plans for employees of governmental 15
entities. 16
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SECTION 3. Arkansas Code § 23 -99-1115, concerning the notice 18
requirements and process for appealing adverse determinations under the Prior 19
Authorization Transparency Act, is amended to add additional subsections to 20
read as follows: 21
(e)(1) Upon a request from a subscriber, a utilization review entity 22
shall provide: 23
(A)(i) An explanation in clear and ordinary terms of the 24
basis for the adverse determination. 25
(ii) An explanation under subdivision (e)(1)(A)(i) 26
of this section shall include without limitation: 27
(a) A listing of clinical criteria, if 28
applicable, and any internal rule, guideline, or protocol upon which a 29
utilization review entity relied when making an adverse determination; and 30
(b) The reason why the provisions listed in 31
subdivision (e)(1)(A)(ii)(a) of this section apply to the subscriber's 32
specific medical circumstance; 33
(B) A description of the procedure through which the 34
subscriber may request a copy of a report developed by personnel performing 35
the utilization review that led to the adverse determination; 36 HB1700
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(C) Information that explains to the subscriber the right 1
to appeal the adverse determination, including instructions concerning how to 2
perfect an appeal and how the subscriber may ensure that written materials 3
supporting the appeal will be considered in the appeals process; and 4
(D) An address and telephone number to be used by a 5
subscriber to make a complaint to the Arkansas State Medical Board, the State 6
Board of Health, and the State Insurance Department. 7
(2) A utilization review entity shall treat a subscriber’s 8
request for any information related to a prior authorization, including a 9
general inquiry, as a request under subdivision (e)(1) of this section. 10
(f) A utilization review entity shall not disclose the name or license 11
number of a reviewing physician in a written notice to a healthcare provider 12
or subscriber under this section. 13
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