AR
Arkansas House Bill HB1700

Arkansas 2025 Regular Session

Arkansas House Bill HB1700 Compare Versions

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11 Stricken language would be deleted from and underlined language would be added to present law.
2-Act 638 of the Regular Session
3-*ANS111* 04-02-2025 11:44:39 ANS111
4-
5-State of Arkansas As Engrossed: S4/2/25 1
2+*ANS111* 03/06/2025 8:46:16 AM ANS111
3+State of Arkansas 1
64 95th General Assembly A Bill 2
75 Regular Session, 2025 HOUSE BILL 1700 3
86 4
97 By: Representative Achor 5
108 By: Senator J. Boyd 6
119 7
1210 For An Act To Be Entitled 8
1311 AN ACT TO AMEND THE PRIOR AUTHORIZATION TRANSPARENCY 9
14-ACT; TO CLARIFY THE PROCESS OF AN ADVERSE 10
15-DETERMINATION NOTICE UNDER THE PRIOR AUTHORIZATION 11
16-TRANSPARENCY ACT; AND FOR OTHER PURPOSES. 12
17- 13
12+ACT; TO EXCLUDE THE NAME OF A REVIEWING PHYSICIAN 10
13+FROM DISCLOSURE IN AN ADVERSE DETERMINATION NOTICE 11
14+UNDER THE PRIOR AUTHORIZATION TRANSPARENCY ACT; AND 12
15+FOR OTHER PURPOSES. 13
1816 14
19-Subtitle 15
20-TO AMEND THE PRIOR AUTHORIZATION 16
21-TRANSPARENCY ACT; AND TO CLARIFY THE 17
22-PROCESS OF AN ADVERSE DETERMINATION 18
23-NOTICE UNDER THE PRIOR AUTHORIZATION 19
24-TRANSPARENCY ACT. 20
25- 21
26-BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF ARKANSAS: 22
17+ 15
18+Subtitle 16
19+TO AMEND THE PRIOR AUTHORIZATION 17
20+TRANSPARENCY ACT; AND TO EXCLUDE THE 18
21+NAME OF A REVIEWING PHYSICIAN FROM 19
22+DISCLOSURE IN AN ADVERSE DETERMINATION 20
23+NOTICE UNDER THE PRIOR AUTHORIZATION 21
24+TRANSPARENCY ACT. 22
2725 23
28- SECTION 1. Arkansas Code § 23 -99-1111(c)(3)(A), concerning the 24
29-information required from a utilization review entity in an adverse 25
30-determination notice under the Prior Authorization Transparency Act, is 26
31-amended to read as follows: 27
32- (3)(A)(i) Subject to this subdivision (c)(3), when an adverse 28
33-determination is issued by a utilization review entity that questions the 29
34-medical necessity, the appropriateness, or the experimental or 30
35-investigational nature of a healthcare service, the utilization review entity 31
36-shall provide in the notice of adverse determination the name and telephone 32
37-number of a physician who possesses a current and unrestricted license in 33
38-this state with whom the requesting healthcare provider may have a reasonable 34
39-opportunity to discuss the patient's treatment plan and the clinical basis 35
40-for the intervention. 36 As Engrossed: S4/2/25 HB1700
26+BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF ARKANSAS: 24
27+ 25
28+ SECTION 1. Arkansas Code § 23-99-1111(c)(3)(A), concerning the 26
29+information required from a utilization review entity in an adverse 27
30+determination notice under the Prior Authorization Transparency Act, is 28
31+amended to read as follows: 29
32+ (3)(A)(i) Subject to this subdivision (c)(3), when an adverse 30
33+determination is issued by a utilization review entity that questions the 31
34+medical necessity, the appropriateness, or the experimental or 32
35+investigational nature of a healthcare service, the utilization review entity 33
36+shall provide in the notice of adverse determination the name and telephone 34
37+number of a physician who possesses a current and unrestricted license in 35
38+this state with whom the requesting healthcare provider may have a reasonable 36 HB1700
4139
42- 2 04-02-2025 11:44:39 ANS111
40+ 2 03/06/2025 8:46:16 AM ANS111
41+opportunity to discuss the patient's treatment plan and the clinical basis 1
42+for the intervention. 2
43+ (ii) A physician contacted by a requesting 3
44+healthcare provider under subdivision (c)(3)(A)(i) of this section shall 4
45+disclose his or her name and license information to the requesting healthcare 5
46+provider. 6
47+ 7
48+ SECTION 2. Arkansas Code § 23 -99-1115(b), concerning the information 8
49+required in the written and verbal notice of an adverse determination under 9
50+the Prior Authorization Transparency Act, is amended to read as follows: 10
51+ (b) The written or verbal notice required to a healthcare provider 11
52+under this section shall include: 12
53+ (1) The following information: 13
54+ (A) The name, title, and telephone number of the physician 14
55+responsible for making the adverse determination and, in the event that the 15
56+physician responsible for making the adverse determination is not available, 16
57+a telephone number where a peer -to-peer contact with another physician 17
58+regarding the adverse determination can be made; 18
59+ (B) The reviewing physician's specialty or practice area, 19
60+including board certification status or board eligibility; and 20
61+ (C) A list of states in which the reviewing physician is 21
62+licensed and the license number issued to the reviewing physician by each 22
63+state; 23
64+ (D) For a verbal notice, the name and license number of 24
65+the reviewing physician; and 25
66+ (E) For a written notice, a telephone number that the 26
67+requesting healthcare provider may call to obtain the name and license number 27
68+of the reviewing physician; 28
69+ (2) The written clinical criteria, if any, and any internal 29
70+rule, guideline, or protocol on which the utilization review entity relied 30
71+when making the adverse determination and how those provisions apply to the 31
72+subscriber's specific medical circumstance; 32
73+ (3) Information for the subscriber and the subscriber's 33
74+healthcare provider that describes the procedure through which the subscriber 34
75+or healthcare provider may request a copy of any report developed by 35
76+personnel performing the review that led to the adverse determination; and 36 HB1700
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79+ (4)(A) Information that explains to the subscriber and the 1
80+subscriber's healthcare provider the right to appeal the adverse 2
81+determination. 3
82+ (B) The information required under subdivision (b)(4)(A) 4
83+of this section shall include: 5
84+ (i) Instructions concerning how to perfect an appeal 6
85+and how the subscriber and the subscriber's healthcare provider may ensure 7
86+that written materials supporting the appeal will be considered in the appeal 8
87+process; and 9
88+ (ii)(a) Addresses and telephone numbers to be used 10
89+by healthcare providers and subscribers to make complaints to the Arkansas 11
90+State Medical Board, the State Board of Health, and the State Insurance 12
91+Department. 13
92+ (b) Subdivision (b)(4)(B)(ii)(a) of this 14
93+section does not apply to self -insured plans for employees of governmental 15
94+entities. 16
95+ 17
96+ SECTION 3. Arkansas Code § 23 -99-1115, concerning the notice 18
97+requirements and process for appealing adverse determinations under the Prior 19
98+Authorization Transparency Act, is amended to add additional subsections to 20
99+read as follows: 21
100+ (e)(1) Upon a request from a subscriber, a utilization review entity 22
101+shall provide: 23
102+ (A)(i) An explanation in clear and ordinary terms of the 24
103+basis for the adverse determination. 25
104+ (ii) An explanation under subdivision (e)(1)(A)(i) 26
105+of this section shall include without limitation: 27
106+ (a) A listing of clinical criteria, if 28
107+applicable, and any internal rule, guideline, or protocol upon which a 29
108+utilization review entity relied when making an adverse determination; and 30
109+ (b) The reason why the provisions listed in 31
110+subdivision (e)(1)(A)(ii)(a) of this section apply to the subscriber's 32
111+specific medical circumstance; 33
112+ (B) A description of the procedure through which the 34
113+subscriber may request a copy of a report developed by personnel performing 35
114+the utilization review that led to the adverse determination; 36 HB1700
44115
45- 1
46- (ii) A physician contacted by a 2
47-requesting healthcare provider under subdivision (c)(3)(A)(i) of this section 3
48-shall disclose his or her name and license information to the requesting 4
49-healthcare provider. 5
50- (iii) If a healthcare provider submits an audio 6
51-recording demonstrating a violation of subdivision (c)(3)(A) of this section 7
52-to the State Insurance Department: 8
53- (a) The requested prior authorization is 9
54-deemed approved; and 10
55- (b) The department shall direct the 11
56-utilization review entity to immediately issue the requested prior 12
57-authorization to the healthcare provider. 13
116+ 4 03/06/2025 8:46:16 AM ANS111
117+ (C) Information that explains to the subscriber the right 1
118+to appeal the adverse determination, including instructions concerning how to 2
119+perfect an appeal and how the subscriber may ensure that written materials 3
120+supporting the appeal will be considered in the appeals process; and 4
121+ (D) An address and telephone number to be used by a 5
122+subscriber to make a complaint to the Arkansas State Medical Board, the State 6
123+Board of Health, and the State Insurance Department. 7
124+ (2) A utilization review entity shall treat a subscriber’s 8
125+request for any information related to a prior authorization, including a 9
126+general inquiry, as a request under subdivision (e)(1) of this section. 10
127+ (f) A utilization review entity shall not disclose the name or license 11
128+number of a reviewing physician in a written notice to a healthcare provider 12
129+or subscriber under this section. 13
58130 14
59- SECTION 2. Arkansas Code § 23 -99-1115(b), concerning the information 15
60-required in the written and verbal notice of an adverse determination under 16
61-the Prior Authorization Transparency Act, is amended to read as follows: 17
62- (b) The written or verbal notice required to a healthcare provider 18
63-under this section shall include: 19
64- (1) The following information: 20
65- (A) The name, title, and telephone number of the physician 21
66-responsible for making the adverse determination and, in the event that the 22
67-physician responsible for making the adverse determination is not available, 23
68-a telephone number where a peer -to-peer contact with another physician 24
69-regarding the adverse determination can be made; 25
70- (B) The reviewing physician's specialty or practice area, 26
71-including board certification status or board eligibility; and 27
72- (C) A list of states in which the reviewing physician is 28
73-licensed and the license number issued to the reviewing physician by each 29
74-state; 30
75- (D) For a verbal notice, the name and license number of 31
76-the reviewing physician; and 32
77- (E) For a written notice, a telephone number that the 33
78-requesting healthcare provider may call to obtain the name and license number 34
79-of the reviewing physician; 35
80- (2) The written clinical criteria, if any, and any internal 36 As Engrossed: S4/2/25 HB1700
81-
82- 3 04-02-2025 11:44:39 ANS111
83-
84-
85-rule, guideline, or protocol on which the utilization review entity relied 1
86-when making the adverse determination and how those provisions apply to the 2
87-subscriber's specific medical circumstance; 3
88- (3) Information for the subscriber and the subscriber's 4
89-healthcare provider that describes the procedure through which the subscriber 5
90-or healthcare provider may request a copy of any report developed by 6
91-personnel performing the review that led to the adverse determination; and 7
92- (4)(A) Information that explains to the subscriber and the 8
93-subscriber's healthcare provider the right to appeal the adverse 9
94-determination. 10
95- (B) The information required under subdivision (b)(4)(A) 11
96-of this section shall include: 12
97- (i) Instructions concerning how to perfect an appeal 13
98-and how the subscriber and the subscriber's healthcare provider may ensure 14
99-that written materials supporting the appeal will be considered in the appeal 15
100-process; and 16
101- (ii)(a) Addresses and telephone numbers to be used 17
102-by healthcare providers and subscribers to make complaints to the Arkansas 18
103-State Medical Board, the State Board of Health, and the State Insurance 19
104-Department. 20
105- (b) Subdivision (b)(4)(B)(ii)(a) of this 21
106-section does not apply to self -insured plans for employees of governmental 22
107-entities. 23
108- 24
109- SECTION 3. Arkansas Code § 23 -99-1115, concerning the notice 25
110-requirements and process for appealing adverse determinations under the Prior 26
111-Authorization Transparency Act, is amended to add additional subsections to 27
112-read as follows: 28
113- (e)(1) Upon an adverse determination by a utilization review entity, 29
114-the utilization review entity shall provide a written notice to the 30
115-subscriber, which shall include without limitation: 31
116- (A)(i) An explanation in clear and ordinary terms of the 32
117-basis for the adverse determination. 33
118- (ii) An explanation under subdivision (e)(1)(A)(i) 34
119-of this section shall include without limitation: 35
120- (a) A listing of clinical criteria, if 36 As Engrossed: S4/2/25 HB1700
121-
122- 4 04-02-2025 11:44:39 ANS111
123-
124-
125-applicable, and any internal rule, guideline, or protocol upon which a 1
126-utilization review entity relied when making an adverse determination; and 2
127- (b) The reason why the provisions listed in 3
128-subdivision (e)(1)(A)(ii)(a) of this section apply to the subscriber's 4
129-specific medical circumstance; 5
130- (B) A description of the procedure through which the 6
131-subscriber may request a copy of a report developed by personnel performing 7
132-the utilization review that led to the adverse determination; 8
133- (C) Information that explains to the subscriber the right 9
134-to appeal the adverse determination, including instructions concerning how to 10
135-perfect an appeal and how the subscriber may ensure that written materials 11
136-supporting the appeal will be considered in the appeals process; and 12
137- (D) An address and telephone number to be used by a 13
138-subscriber to make a complaint to the Arkansas State Medical Board, the State 14
139-Board of Health, and the State Insurance Department. 15
140- (2) A utilization review entity shall treat a subscriber’s 16
141-request for any information related to a prior authorization, including a 17
142-general inquiry, as a request under subdivision (e)(1) of this section. 18
131+ 15
132+ 16
133+ 17
134+ 18
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146138 22
147-APPROVED: 4/16/25 23
139+ 23
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