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 1930 3
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By: Representatives Wardlaw, Pilkington, Achor, Barker, Beaty Jr., Dalby, Duffield, Eubanks, Evans, 5
Jean, L. Johnson, Maddox, Milligan, Pearce, Perry, Richmond, M. Shepherd, Steimel, Warren 6
By: Senator J. Boyd 7
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For An Act To Be Entitled 9
AN ACT TO MANDATE MINIMUM REIMBURSEMENT LEVELS FOR 10
HEALTHCARE SERVICES; AND FOR OTHER PURPOSES. 11
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Subtitle 14
TO MANDATE MINIMUM REIMBURSEMENT LEVELS 15
FOR HEALTHCARE SERVICES. 16
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BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF ARKANSAS: 18
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SECTION 1. DO NOT CODIFY. Legislative findings and intent. 20
(a) The General Assembly finds that: 21
(1) Arkansas’s healthcare providers are at a significant 22
disadvantage as a result of national reimbursement methodologies; 23
(2) Arkansas's healthcare providers receive some of the lowest 24
government and commercial reimbursement rates in the country; 25
(3) The cumulative impact of receiving some of the lowest 26
reimbursement rates in the country has resulted in scarce resources for 27
Arkansas’s healthcare systems; 28
(4) The disparities in payment: 29
(A) Greatly affect the financial stability of healthcare 30
providers; and 31
(B) Make it harder for Arkansas to: 32
(i) Attract and retain qualified healthcare 33
professionals; and 34
(ii) Maintain adequate facilities and equipment; 35
(5)(A) On December 10, 2024, the Rand Corporation published its 36 HB1930
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fifth study that analyzed states’ average reimbursement rates relative to 1
Medicare prices. 2
(B) This study found that Arkansas had the lowest 3
reimbursement rates in the nation with an overall relative rate below one 4
hundred seventy percent (170%) of Medicare prices while the national average 5
is two hundred fifty -four percent (254%) of Medicare prices; and 6
(6) The adjoining states to Arkansas all receive significantly 7
higher reimbursement rates than Arkansas, which further exacerbates the 8
healthcare disparities in Arkansas. 9
(b) It is the intent of the General Assembly to ensure that Arkansas 10
has an adequate healthcare system to provide healthcare for all Arkansans and 11
that Arkansas healthcare systems can recruit and retain a workforce and 12
maintain adequate infrastructure to treat the needs of Arkansans. 13
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SECTION 2. Arkansas Code Title 23, Chapter 99, is amended to add an 15
additional subchapter to read as follows: 16
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Subchapter 19 — Minimum Reimbursement Rates for Healthcare Services 18
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23-99-1901. Definitions. 20
As used in this subchapter: 21
(1) "Adjoining states" means Louisiana, Mississippi, Missouri, 22
Oklahoma, Tennessee, and Texas; 23
(2) "Ambulatory surgery center" means an entity certified by the 24
Department of Health as an ambulatory surgery center that operates for the 25
purpose of providing surgical services to patients; 26
(3)(A) "Equivalent Medicare reimbursement" means the amount, 27
based on prevailing reimbursement rates and methodologies, that a healthcare 28
provider or health system is entitled to for healthcare services. 29
(B)(i) "Equivalent Medicare reimbursement" includes 30
services that are not covered by Medicare or are set locally by Medicare 31
contractors. 32
(ii) Services under this subdivision (3) will be 33
priced at the healthcare provider's overall prevailing Medicare reimbursement 34
collection-to-charge ratio; 35
(4)(A) "Health benefit plan" means an individual, blanket, or 36 HB1930
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group plan, policy, or contract for healthcare services issued, renewed, or 1
extended in this state by a healthcare insurer. 2
(B) "Health benefit plan" includes any group plan, policy, 3
or contract for healthcare services issued outside this state that provides 4
benefits to residents of this state; 5
(C) "Health benefit plan" does not include: 6
(i) A plan that provides only dental benefits; 7
(ii) A plan that provides only eye and vision 8
benefits; 9
(iii) A disability income plan; 10
(iv) A credit insurance plan; 11
(v) Insurance coverage issued as a supplement to 12
liability insurance; 13
(vi) Medical payments under an automobile or 14
homeowners’ insurance plan; 15
(vii) A health benefit plan provided under Arkansas 16
Constitution, Article 5, § 32, the Workers’ Compensation Law, § 11 -9-101 et 17
seq., or the Public Employee Workers’ Compensation Act, § 21 -5-601 et seq.; 18
(viii) A plan that provides only indemnity for 19
hospital confinement; 20
(ix) An accident-only plan; 21
(x) A specified disease plan; 22
(xi) A policy, contract, certificate, or agreement 23
offered or issued by a healthcare insurer to provide, deliver, arrange for, 24
pay for, or reimburse any of the costs of healthcare services, including 25
pharmacy benefits, to an entity of the state under § 21 -5-401 et seq; 26
(xii) A qualified health plan that is a health 27
benefit plan under the Patient Protection and Affordable Care Act, Pub. L. 28
No. 111-148, and purchased on the Arkansas Health Insurance Marketplace 29
created under the Arkansas Health Insurance Marketplace Act, § 23 -61-801 et. 30
seq., for an individual up to four hundred percent (400%) of the federal 31
poverty level; 32
(xiii) A health benefit plan provided by a trust 33
established under § 14 -54-104 to provide benefits, including accident and 34
health benefits, death benefits, dental benefits, and disability income 35
benefits; or 36 HB1930
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(ix) A long-term care insurance plan 1
2
(5) "Health system" means an organization that owns or operates 3
more than one (1) hospital; 4
(6)(A) "Healthcare insurer" means an entity that is authorized 5
by this state to offer or provide health benefit plans, policies, subscriber 6
contracts, or any other contracts of a similar nature that indemnify or 7
compensate a healthcare provider for the provision of healthcare services. 8
(B) "Healthcare insurer" includes without limitation: 9
(i) An insurance company; 10
(ii) A health maintenance organization; 11
(iii) A hospital and medical service corporation; 12
and 13
(iv) An entity that provides or administers a self -14
funded health benefit plan. 15
(C) "Healthcare insurer" does not include: 16
(i) The Arkansas Medicaid Program; 17
(ii) The Arkansas Health and Opportunity for Me 18
Program under the Arkansas Health and Opportunity for Me Act of 2021, § 23 -19
61-1001 et seq., or any successor program; 20
(iii) A provider-led Arkansas shared savings entity; 21
or 22
(iv) An entity that offers a plan providing health 23
benefits to state and public school employees under § 21 -5-401 et seq.; 24
(7) "Healthcare provider" means: 25
(A) A hospital; 26
(B) A health system; 27
(C) A physician; 28
(D)(i) A physician extender. 29
(ii) A physician extender includes without 30
limitation: 31
(a) A physician assistant who is licensed in 32
this state; 33
(b) A nurse practitioner who is licensed in 34
this state; 35
(c) An advanced practice nurse who is licensed 36 HB1930
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in this state; and 1
(d) A certified midwife who is licensed in 2
this state; 3
(E) A licensed ambulatory surgery center; and 4
(F) An outpatient facility that performs healthcare 5
services, including without limitation primary care clinics, urgent care 6
centers, specialty clinics, dialysis centers, and imaging centers; 7
(8) "Healthcare service" means a service or good that is 8
provided for the purpose of or incidental to the purpose of preventing, 9
diagnosing, treating, alleviating curing, or healing human illness, disease, 10
condition, disability, or injury; 11
(9) “Hospital” means a healthcare facility licensed as a 12
hospital by the Division of Health Facilities Services under § 20 -9-213; 13
(10) "Minimum reimbursement level" means the minimum ratio of 14
reimbursement to equivalent Medicare reimbursement that a healthcare provider 15
or health system is entitled to by a healthcare insurer for healthcare 16
services; 17
(11) "Physician" means a person authorized or licensed to 18
practice medicine under the Arkansas Medical Practices Act, § 17 -95-201 et 19
seq., § 17-95-301 et seq., and § 17 -95-401 et seq.; and 20
(12) "Reimbursement rate" means the amount that a healthcare 21
provider is entitled to receive for healthcare services. 22
23
23-99-1902. Minimum reimbursement level. 24
(a)(1) A health benefit plan shall reimburse a healthcare provider 25
that provides a healthcare service the minimum reimbursement level for the 26
healthcare service as determined by the Insurance Commissioner. 27
(2) The commissioner is not required to establish a minimum 28
reimbursement level for each healthcare service. 29
(3) The minimum reimbursement level shall be established at the 30
healthcare provider's contract level based on the healthcare provider's 31
specific compliment of services. 32
(b) The minimum reimbursement level under subdivision (a)(1) of this 33
section shall be phased in according to the schedule below: 34
(1) On or after January 1, 2026, eighty -five percent (85%); 35
(2) On or after January 1, 2027, ninety -five percent (95%); and 36 HB1930
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(3) On or after January 1, 2028, one hundred percent (100%). 1
(c)(1) The commissioner shall determine the minimum reimbursement 2
level for a healthcare service by calculating the weighted average ratio of 3
commercial prices as a percentage of Medicare reimbursement for the 4
healthcare service in adjoining states as derived from the RAND Corporation's 5
Prices Paid to Hospitals by Private Plans findings as adopted by rule of the 6
commissioner. 7
(2) If the RAND Corporation's Prices Paid to Hospitals by 8
Private Plans findings are discontinued, delayed, or deemed unsuitable by the 9
commissioner, the commissioner shall compute an adjusted ratio of commercial 10
prices as a percentage of Medicare by applying a factor of the annual change 11
in the Consumer Price Index: Medical Care, commonly known as the "medical 12
care index", published by the United States Bureau of Labor Statistics and 13
adopted by rule of the commissioner to the weighted average increase of 14
Medicare reimbursement for a healthcare provider to the most recently 15
published minimum reimbursement level. 16
(d) Beginning September 1, 2025, the commissioner shall publish 17
annually on the State Insurance Department's website the minimum 18
reimbursement level as determined under subsection (c) of this section. 19
20
23-99-1903. Disclosures. 21
(a)(1) A healthcare insurer shall document compliance with this 22
subchapter for each healthcare provider. 23
(2) A healthcare insurer shall include documentation of 24
compliance required in subdivision (a)(1) of this section for each health 25
benefit plan offered by the healthcare insurer to a healthcare provider. 26
(b)(1) A healthcare insurer shall disclose to each contracted 27
healthcare provider summary documentation, including the supporting detailed 28
calculations and assumptions. 29
(2) The summary documentation under subdivision (b)(1) of this 30
section shall be made available to: 31
(A) The contracted healthcare provider before the 32
execution or renewal of a contract and within fifteen (15) days of a formal 33
request; and 34
(B) The Insurance Commissioner within fifteen (15) days of 35
a formal request. 36 HB1930
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1
23-99-1904. Enforcement. 2
(a) A dispute under this subchapter shall be filed with the Insurance 3
Commissioner. 4
(b)(1) After notice and opportunity for a hearing, if a healthcare 5
insurer or a health benefit plan is found to have violated this subchapter, 6
the commissioner may revoke or suspend the authority of the healthcare 7
insurer or health benefit plan to do business in this state. 8
(2) The commissioner shall rule on a dispute within sixty (60) 9
days. 10
(c) A healthcare insurer or health benefit plan that has violated this 11
subchapter shall be required to repay the healthcare provider all amounts in 12
violation of this subchapter plus eight percent (8%) interest and five 13
percent (5%) in administrative fees, inclusive of amounts otherwise due from 14
the patient. 15
16
23-99-1905. Rules. 17
The Insurance Commissioner may promulgate rules to implement and 18
enforce this subchapter. 19
20
SECTION 3. DO NOT CODIFY. Severability. 21
The provisions of this act are severable, and the invalidity of any 22
provision of this act shall not affect other provisions of this act that can 23
be given effect without the invalid provision. 24
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