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Arkansas House Bill HB1930

Arkansas 2025 Regular Session

Arkansas House Bill HB1930 Compare Versions

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11 Stricken language would be deleted from and underlined language would be added to present law.
22 *ANS282* 03/31/2025 2:06:37 PM ANS282
33 State of Arkansas 1
44 95th General Assembly A Bill 2
55 Regular Session, 2025 HOUSE BILL 1930 3
66 4
77 By: Representatives Wardlaw, Pilkington, Achor, Barker, Beaty Jr., Dalby, Duffield, Eubanks, Evans, 5
88 Jean, L. Johnson, Maddox, Milligan, Pearce, Perry, Richmond, M. Shepherd, Steimel, Warren 6
99 By: Senator J. Boyd 7
1010 8
1111 For An Act To Be Entitled 9
1212 AN ACT TO MANDATE MINIMUM REIMBURSEMENT LEVELS FOR 10
1313 HEALTHCARE SERVICES; AND FOR OTHER PURPOSES. 11
1414 12
1515 13
1616 Subtitle 14
1717 TO MANDATE MINIMUM REIMBURSEMENT LEVELS 15
1818 FOR HEALTHCARE SERVICES. 16
1919 17
2020 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF ARKANSAS: 18
2121 19
2222 SECTION 1. DO NOT CODIFY. Legislative findings and intent. 20
2323 (a) The General Assembly finds that: 21
2424 (1) Arkansas’s healthcare providers are at a significant 22
2525 disadvantage as a result of national reimbursement methodologies; 23
2626 (2) Arkansas's healthcare providers receive some of the lowest 24
2727 government and commercial reimbursement rates in the country; 25
2828 (3) The cumulative impact of receiving some of the lowest 26
2929 reimbursement rates in the country has resulted in scarce resources for 27
3030 Arkansas’s healthcare systems; 28
3131 (4) The disparities in payment: 29
3232 (A) Greatly affect the financial stability of healthcare 30
3333 providers; and 31
3434 (B) Make it harder for Arkansas to: 32
3535 (i) Attract and retain qualified healthcare 33
3636 professionals; and 34
3737 (ii) Maintain adequate facilities and equipment; 35
3838 (5)(A) On December 10, 2024, the Rand Corporation published its 36 HB1930
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4141 fifth study that analyzed states’ average reimbursement rates relative to 1
4242 Medicare prices. 2
4343 (B) This study found that Arkansas had the lowest 3
4444 reimbursement rates in the nation with an overall relative rate below one 4
4545 hundred seventy percent (170%) of Medicare prices while the national average 5
4646 is two hundred fifty -four percent (254%) of Medicare prices; and 6
4747 (6) The adjoining states to Arkansas all receive significantly 7
4848 higher reimbursement rates than Arkansas, which further exacerbates the 8
4949 healthcare disparities in Arkansas. 9
5050 (b) It is the intent of the General Assembly to ensure that Arkansas 10
5151 has an adequate healthcare system to provide healthcare for all Arkansans and 11
5252 that Arkansas healthcare systems can recruit and retain a workforce and 12
5353 maintain adequate infrastructure to treat the needs of Arkansans. 13
5454 14
5555 SECTION 2. Arkansas Code Title 23, Chapter 99, is amended to add an 15
5656 additional subchapter to read as follows: 16
5757 17
5858 Subchapter 19 — Minimum Reimbursement Rates for Healthcare Services 18
5959 19
6060 23-99-1901. Definitions. 20
6161 As used in this subchapter: 21
6262 (1) "Adjoining states" means Louisiana, Mississippi, Missouri, 22
6363 Oklahoma, Tennessee, and Texas; 23
6464 (2) "Ambulatory surgery center" means an entity certified by the 24
6565 Department of Health as an ambulatory surgery center that operates for the 25
6666 purpose of providing surgical services to patients; 26
6767 (3)(A) "Equivalent Medicare reimbursement" means the amount, 27
6868 based on prevailing reimbursement rates and methodologies, that a healthcare 28
6969 provider or health system is entitled to for healthcare services. 29
7070 (B)(i) "Equivalent Medicare reimbursement" includes 30
7171 services that are not covered by Medicare or are set locally by Medicare 31
7272 contractors. 32
7373 (ii) Services under this subdivision (3) will be 33
7474 priced at the healthcare provider's overall prevailing Medicare reimbursement 34
7575 collection-to-charge ratio; 35
7676 (4)(A) "Health benefit plan" means an individual, blanket, or 36 HB1930
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7979 group plan, policy, or contract for healthcare services issued, renewed, or 1
8080 extended in this state by a healthcare insurer. 2
8181 (B) "Health benefit plan" includes any group plan, policy, 3
8282 or contract for healthcare services issued outside this state that provides 4
8383 benefits to residents of this state; 5
8484 (C) "Health benefit plan" does not include: 6
8585 (i) A plan that provides only dental benefits; 7
8686 (ii) A plan that provides only eye and vision 8
8787 benefits; 9
8888 (iii) A disability income plan; 10
8989 (iv) A credit insurance plan; 11
9090 (v) Insurance coverage issued as a supplement to 12
9191 liability insurance; 13
9292 (vi) Medical payments under an automobile or 14
9393 homeowners’ insurance plan; 15
9494 (vii) A health benefit plan provided under Arkansas 16
9595 Constitution, Article 5, § 32, the Workers’ Compensation Law, § 11 -9-101 et 17
9696 seq., or the Public Employee Workers’ Compensation Act, § 21 -5-601 et seq.; 18
9797 (viii) A plan that provides only indemnity for 19
9898 hospital confinement; 20
9999 (ix) An accident-only plan; 21
100100 (x) A specified disease plan; 22
101101 (xi) A policy, contract, certificate, or agreement 23
102102 offered or issued by a healthcare insurer to provide, deliver, arrange for, 24
103103 pay for, or reimburse any of the costs of healthcare services, including 25
104104 pharmacy benefits, to an entity of the state under § 21 -5-401 et seq; 26
105105 (xii) A qualified health plan that is a health 27
106106 benefit plan under the Patient Protection and Affordable Care Act, Pub. L. 28
107107 No. 111-148, and purchased on the Arkansas Health Insurance Marketplace 29
108108 created under the Arkansas Health Insurance Marketplace Act, § 23 -61-801 et. 30
109109 seq., for an individual up to four hundred percent (400%) of the federal 31
110110 poverty level; 32
111111 (xiii) A health benefit plan provided by a trust 33
112112 established under § 14 -54-104 to provide benefits, including accident and 34
113113 health benefits, death benefits, dental benefits, and disability income 35
114114 benefits; or 36 HB1930
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117117 (ix) A long-term care insurance plan 1
118118 2
119119 (5) "Health system" means an organization that owns or operates 3
120120 more than one (1) hospital; 4
121121 (6)(A) "Healthcare insurer" means an entity that is authorized 5
122122 by this state to offer or provide health benefit plans, policies, subscriber 6
123123 contracts, or any other contracts of a similar nature that indemnify or 7
124124 compensate a healthcare provider for the provision of healthcare services. 8
125125 (B) "Healthcare insurer" includes without limitation: 9
126126 (i) An insurance company; 10
127127 (ii) A health maintenance organization; 11
128128 (iii) A hospital and medical service corporation; 12
129129 and 13
130130 (iv) An entity that provides or administers a self -14
131131 funded health benefit plan. 15
132132 (C) "Healthcare insurer" does not include: 16
133133 (i) The Arkansas Medicaid Program; 17
134134 (ii) The Arkansas Health and Opportunity for Me 18
135135 Program under the Arkansas Health and Opportunity for Me Act of 2021, § 23 -19
136136 61-1001 et seq., or any successor program; 20
137137 (iii) A provider-led Arkansas shared savings entity; 21
138138 or 22
139139 (iv) An entity that offers a plan providing health 23
140140 benefits to state and public school employees under § 21 -5-401 et seq.; 24
141141 (7) "Healthcare provider" means: 25
142142 (A) A hospital; 26
143143 (B) A health system; 27
144144 (C) A physician; 28
145145 (D)(i) A physician extender. 29
146146 (ii) A physician extender includes without 30
147147 limitation: 31
148148 (a) A physician assistant who is licensed in 32
149149 this state; 33
150150 (b) A nurse practitioner who is licensed in 34
151151 this state; 35
152152 (c) An advanced practice nurse who is licensed 36 HB1930
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155155 in this state; and 1
156156 (d) A certified midwife who is licensed in 2
157157 this state; 3
158158 (E) A licensed ambulatory surgery center; and 4
159159 (F) An outpatient facility that performs healthcare 5
160160 services, including without limitation primary care clinics, urgent care 6
161161 centers, specialty clinics, dialysis centers, and imaging centers; 7
162162 (8) "Healthcare service" means a service or good that is 8
163163 provided for the purpose of or incidental to the purpose of preventing, 9
164164 diagnosing, treating, alleviating curing, or healing human illness, disease, 10
165165 condition, disability, or injury; 11
166166 (9) “Hospital” means a healthcare facility licensed as a 12
167167 hospital by the Division of Health Facilities Services under § 20 -9-213; 13
168168 (10) "Minimum reimbursement level" means the minimum ratio of 14
169169 reimbursement to equivalent Medicare reimbursement that a healthcare provider 15
170170 or health system is entitled to by a healthcare insurer for healthcare 16
171171 services; 17
172172 (11) "Physician" means a person authorized or licensed to 18
173173 practice medicine under the Arkansas Medical Practices Act, § 17 -95-201 et 19
174174 seq., § 17-95-301 et seq., and § 17 -95-401 et seq.; and 20
175175 (12) "Reimbursement rate" means the amount that a healthcare 21
176176 provider is entitled to receive for healthcare services. 22
177177 23
178178 23-99-1902. Minimum reimbursement level. 24
179179 (a)(1) A health benefit plan shall reimburse a healthcare provider 25
180180 that provides a healthcare service the minimum reimbursement level for the 26
181181 healthcare service as determined by the Insurance Commissioner. 27
182182 (2) The commissioner is not required to establish a minimum 28
183183 reimbursement level for each healthcare service. 29
184184 (3) The minimum reimbursement level shall be established at the 30
185185 healthcare provider's contract level based on the healthcare provider's 31
186186 specific compliment of services. 32
187187 (b) The minimum reimbursement level under subdivision (a)(1) of this 33
188188 section shall be phased in according to the schedule below: 34
189189 (1) On or after January 1, 2026, eighty -five percent (85%); 35
190190 (2) On or after January 1, 2027, ninety -five percent (95%); and 36 HB1930
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193193 (3) On or after January 1, 2028, one hundred percent (100%). 1
194194 (c)(1) The commissioner shall determine the minimum reimbursement 2
195195 level for a healthcare service by calculating the weighted average ratio of 3
196196 commercial prices as a percentage of Medicare reimbursement for the 4
197197 healthcare service in adjoining states as derived from the RAND Corporation's 5
198198 Prices Paid to Hospitals by Private Plans findings as adopted by rule of the 6
199199 commissioner. 7
200200 (2) If the RAND Corporation's Prices Paid to Hospitals by 8
201201 Private Plans findings are discontinued, delayed, or deemed unsuitable by the 9
202202 commissioner, the commissioner shall compute an adjusted ratio of commercial 10
203203 prices as a percentage of Medicare by applying a factor of the annual change 11
204204 in the Consumer Price Index: Medical Care, commonly known as the "medical 12
205205 care index", published by the United States Bureau of Labor Statistics and 13
206206 adopted by rule of the commissioner to the weighted average increase of 14
207207 Medicare reimbursement for a healthcare provider to the most recently 15
208208 published minimum reimbursement level. 16
209209 (d) Beginning September 1, 2025, the commissioner shall publish 17
210210 annually on the State Insurance Department's website the minimum 18
211211 reimbursement level as determined under subsection (c) of this section. 19
212212 20
213213 23-99-1903. Disclosures. 21
214214 (a)(1) A healthcare insurer shall document compliance with this 22
215215 subchapter for each healthcare provider. 23
216216 (2) A healthcare insurer shall include documentation of 24
217217 compliance required in subdivision (a)(1) of this section for each health 25
218218 benefit plan offered by the healthcare insurer to a healthcare provider. 26
219219 (b)(1) A healthcare insurer shall disclose to each contracted 27
220220 healthcare provider summary documentation, including the supporting detailed 28
221221 calculations and assumptions. 29
222222 (2) The summary documentation under subdivision (b)(1) of this 30
223223 section shall be made available to: 31
224224 (A) The contracted healthcare provider before the 32
225225 execution or renewal of a contract and within fifteen (15) days of a formal 33
226226 request; and 34
227227 (B) The Insurance Commissioner within fifteen (15) days of 35
228228 a formal request. 36 HB1930
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231231 1
232232 23-99-1904. Enforcement. 2
233233 (a) A dispute under this subchapter shall be filed with the Insurance 3
234234 Commissioner. 4
235235 (b)(1) After notice and opportunity for a hearing, if a healthcare 5
236236 insurer or a health benefit plan is found to have violated this subchapter, 6
237237 the commissioner may revoke or suspend the authority of the healthcare 7
238238 insurer or health benefit plan to do business in this state. 8
239239 (2) The commissioner shall rule on a dispute within sixty (60) 9
240240 days. 10
241241 (c) A healthcare insurer or health benefit plan that has violated this 11
242242 subchapter shall be required to repay the healthcare provider all amounts in 12
243243 violation of this subchapter plus eight percent (8%) interest and five 13
244244 percent (5%) in administrative fees, inclusive of amounts otherwise due from 14
245245 the patient. 15
246246 16
247247 23-99-1905. Rules. 17
248248 The Insurance Commissioner may promulgate rules to implement and 18
249249 enforce this subchapter. 19
250250 20
251251 SECTION 3. DO NOT CODIFY. Severability. 21
252252 The provisions of this act are severable, and the invalidity of any 22
253253 provision of this act shall not affect other provisions of this act that can 23
254254 be given effect without the invalid provision. 24
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