AR
Arkansas Senate Bill SB527

Arkansas 2025 Regular Session

Arkansas Senate Bill SB527 Compare Versions

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11 Stricken language would be deleted from and underlined language would be added to present law.
2-Act 774 of the Regular Session
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5-State of Arkansas As Engrossed: S4/7/25 1
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3+State of Arkansas 1
64 95th General Assembly A Bill 2
75 Regular Session, 2025 SENATE BILL 527 3
86 4
97 By: Senators Irvin, Hester, J. Dismang, Gilmore, J. Boyd, B. Johnson, Stone 5
108 By: Representatives L. Johnson, Achor, Bentley, Clowney, Eaves, Eubanks, Evans, Gramlich, Hudson, 6
119 Ladyman, Lundstrum, Maddox, Perry, Pilkington, M. Shepherd, Vaught, Walker, Wardlaw 7
1210 8
1311 For An Act To Be Entitled 9
1412 AN ACT TO AMEND THE ARKANSAS HEALTH AND OPPORTUNITY 10
1513 FOR ME ACT OF 2021; TO INCREASE THE MEDICAL -LOSS 11
1614 RATIO IN THE ARKANSAS HEALTH AND OPPORTUNITY FOR ME 12
1715 PROGRAM; TO AUTHORIZE THE STATE TO OBTAIN PHARMACY 13
1816 REBATES UNDER THE ARKANSAS HEALTH AND OPPORTUNITY FOR 14
1917 ME PROGRAM; AND FOR OTHER PURPOSES. 15
2018 16
2119 17
2220 Subtitle 18
2321 TO AMEND THE ARKANSAS HEALTH AND 19
2422 OPPORTUNITY FOR ME ACT OF 2021; AND TO 20
2523 INCREASE THE MEDICAL -LOSS RATIO IN THE 21
2624 ARKANSAS HEALTH AND OPPORTUNITY FOR ME 22
2725 PROGRAM. 23
2826 24
2927 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF ARKANSAS: 25
3028 26
3129 SECTION 1. Arkansas Code §§ 23 -61-1002 and 23-61-1003 are amended to 27
3230 read as follows: 28
3331 23-61-1002. Legislative intent. 29
3432 Notwithstanding any general or specific laws to the contrary, it is the 30
3533 intent of the General Assembly for the Arkansas Health and Opportunity for Me 31
3634 Program to be a fiscally sustainable, cost -effective, and opportunity -driven 32
3735 program that: 33
3836 (1) Achieves comprehensive and innovative healthcare reform that 34
3937 reduces the rate of growth in state and federal obligations for providing 35
40-healthcare coverage to low -income adults in Arkansas; 36 As Engrossed: S4/7/25 SB527
38+healthcare coverage to low -income adults in Arkansas; 36 SB527
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44-
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4541 (2) Reduces the maternal and infant mortality rates in the state 1
4642 through initiatives that promote healthy outcomes for eligible women with 2
4743 high-risk pregnancies; 3
4844 (3) Promotes the health, welfare, and stability of mothers and 4
4945 their infants after birth through hospital -based community bridge 5
5046 organizations; 6
5147 (4) Encourages personal responsibility for individuals to 7
5248 demonstrate that they value healthcare coverage and understand their roles 8
5349 and obligations in maintaining private insurance coverage; 9
5450 (5) Increases opportunities for full -time work and attainment of 10
5551 economic independence, especially for certain young adults previously 11
5652 incarcerated individuals , to reduce long-term poverty that is associated with 12
5753 additional risk for disease and premature death; 13
5854 (6) Addresses health -related social needs of Arkansans in rural 14
5955 counties through hospital -based community bridge organizations and reduces 15
6056 the additional risk for disease and premature death associated with living in 16
6157 a rural county; 17
6258 (7) Strengthens the financial stability of the critical access 18
6359 hospitals and other small, rural hospitals; and 19
6460 (8) Fills gaps in the continuum of care for individuals in need 20
6561 of services for serious mental illness and substance use disorders ; and 21
6662 (9) Recognizes that rebates are an important instrument to 22
6763 ensure affordability and access to pharmaceutical products by eligible 23
6864 individuals and to maximize the use of rebates when available to ensure the 24
6965 fiscal sustainability of the program . 25
7066 26
7167 23-61-1003. Definitions. 27
7268 As used in this subchapter: 28
7369 (1) “Acute care hospital” means a hospital that: 29
7470 (A) Is licensed by the Department of Health under § 20 -9-30
7571 201 et seq., as a general hospital or a surgery and general medical care 31
7672 hospital; and 32
7773 (B) Is enrolled as a provider with the Arkansas Medicaid 33
7874 Program; 34
7975 (2) “Birthing hospital” means a hospital in this state or in a 35
80-border state that: 36 As Engrossed: S4/7/25 SB527
76+border state that: 36 SB527
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83-
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8579 (A) Is licensed as a general hospital; 1
8680 (B) Provides obstetrics services; and 2
8781 (C) Is enrolled as a provider with the Arkansas Medicaid 3
8882 Program; 4
89- (3) “Community bridge organization” means an a hospital, 5
90-federally qualified health center, or another organization that is authorized 6
91-by the Department of Human Services to participate in the economic 7
92-independence initiative or the health improvement initiative to: 8
93- (A) Screen and refer Arkansans to resources available in 9
94-their communities to address health -related social needs; and 10
95- (B) Assist eligible individuals identified as target 11
96-populations most at risk of disease and premature death and who need a higher 12
97-level of intervention to improve their health outcomes and succeed in meeting 13
98-their long-term goals to achieve independence, including economic 14
99-independence; 15
100- (4) “Cost sharing” means the portion of the cost of a covered 16
101-medical service that is required to be paid by or on behalf of an eligible 17
102-individual; 18
103- (5) “Critical access hospital” means an acute care hospital that 19
104-is: 20
105- (A) Designated by the Centers for Medicare & Medicaid 21
106-Services as a critical access hospital; and 22
107- (B) Is enrolled as a provider in the Arkansas Medicaid 23
108-Program; 24
109- (6) “Economic independence initiative” means an initiative 25
110-developed by the Department of Human Services that is designed to promote 26
111-economic stability by encouraging participation of program participants to 27
112-engage in full-time, full-year work, and to demonstrate the value of 28
113-enrollment in an individual qualified health insurance plan through 29
114-incentives and disincentives; 30
115- (7) “Eligible individual” means an individual who is in the 31
116-eligibility category created by section 1902(a)(10)(A)(i)(VIII) of the Social 32
117-Security Act, 42 U.S.C. § 1396a , as existing on January 1, 2025 ; 33
118- (8) “Employer health insurance coverage” means a health 34
119-insurance benefit plan offered by an employer or, as authorized by this 35
120-subchapter, an employer self -funded insurance plan governed by the Employee 36 As Engrossed: S4/7/25 SB527
83+ (3) “Community bridge organization” means an organization that 5
84+is authorized by the Department of Human Services to participate in the 6
85+economic independence initiative or the health improvement initiative to: 7
86+ (A) Screen and refer Arkansans to resources available in 8
87+their communities to address health -related social needs; and 9
88+ (B) Assist eligible individuals identified as target 10
89+populations most at risk of disease and premature death and who need a higher 11
90+level of intervention to improve their health outcomes and succeed in meeting 12
91+their long-term goals to achieve independence, including economic 13
92+independence; 14
93+ (4) “Cost sharing” means the portion of the cost of a covered 15
94+medical service that is required to be paid by or on behalf of an eligible 16
95+individual; 17
96+ (5) “Critical access hospital” means an acute care hospital that 18
97+is: 19
98+ (A) Designated by the Centers for Medicare & Medicaid 20
99+Services as a critical access hospital; and 21
100+ (B) Is enrolled as a provider in the Arkansas Medicaid 22
101+Program; 23
102+ (6) “Economic independence initiative” means an initiative 24
103+developed by the Department of Human Services that is designed to promote 25
104+economic stability by encouraging participation of program participants to 26
105+engage in full-time, full-year work, and to demonstrate the value of 27
106+enrollment in an individual qualified health insurance plan through 28
107+incentives and disincentives; 29
108+ (7) “Eligible individual” means an individual who is in the 30
109+eligibility category created by section 1902(a)(10)(A)(i)(VIII) of the Social 31
110+Security Act, 42 U.S.C. § 1396a , as existing on January 1, 2025 ; 32
111+ (8) “Employer health insurance coverage” means a health 33
112+insurance benefit plan offered by an employer or, as authorized by this 34
113+subchapter, an employer self -funded insurance plan governed by the Employee 35
114+Retirement Income Security Act of 1974, Pub. L. No. 93 -406, as amended; 36 SB527
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117+ (9) "Federally qualified health center” means an entity as 1
118+defined by 42 C.F.R. § 405.2401, as existing on January 1, 2025, and that has 2
119+entered into an agreement with the Centers for Medicare & Medicaid Services 3
120+to meet Medicare program requirements under 42 C.F.R. § 405.2434, as existing 4
121+on January 1, 2025; 5
122+ (9)(10) “Health improvement initiative” means an initiative 6
123+developed by an individual qualified health insurance plan or the Department 7
124+of Human Services that is designed to encourage the participation of eligible 8
125+individuals in health assessments and wellness programs, including fitness 9
126+programs and smoking or tobacco cessation programs; 10
127+ (10)(11) “Health insurance benefit plan” means a policy, 11
128+contract, certificate, or agreement offered or issued by a health insurer to 12
129+provide, deliver, arrange for, pay for, or reimburse any of the costs of 13
130+healthcare services, but not including excepted benefits as defined under 42 14
131+U.S.C. § 300gg-91(c), as it existed on January 1, 2021 January 1, 2025; 15
132+ (11)(12) “Health insurance marketplace” means the applicable 16
133+entities that were designed to help individuals, families, and businesses in 17
134+Arkansas shop for and select health insurance benefit plans in a way that 18
135+permits comparison of available plans based upon price, benefits, services, 19
136+and quality, and refers to either: 20
137+ (A) The Arkansas Health Insurance Marketplace created 21
138+under the Arkansas Health Insurance Marketplace Act, § 23 -61-801 et seq., or 22
139+a successor entity; or 23
140+ (B) The federal health insurance marketplace or federal 24
141+health benefit exchange created under the Patient Protection and Affordable 25
142+Care Act, Pub. L. No. 111 -148; 26
143+ (12)(13) “Health insurer” means an insurer authorized by the 27
144+State Insurance Department to provide health insurance or a health insurance 28
145+benefit plan in the State of Arkansas, including without limitation: 29
146+ (A) An insurance company; 30
147+ (B) A medical services plan; 31
148+ (C) A hospital plan; 32
149+ (D) A hospital medical service corporation; 33
150+ (E) A health maintenance organization; 34
151+ (F) A fraternal benefits society; 35
152+ (G) Any other entity providing health insurance or a 36 SB527
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155+health insurance benefit plan subject to state insurance regulation; or 1
156+ (H) A risk-based provider organization licensed by the 2
157+Insurance Commissioner under § 20 -77-2704; 3
158+ (13)(14) “Healthcare coverage” means coverage provided under 4
159+this subchapter through either an individual qualified health insurance plan, 5
160+a risk-based provider organization, employer health insurance coverage, or 6
161+the fee-for-service Arkansas Medicaid Program; 7
162+ (14)(15) “Individual qualified health insurance plan” means an 8
163+individual health insurance benefit plan offered by a health insurer that 9
164+participates in the health insurance marketplace to provide coverage in 10
165+Arkansas that covers only essential health benefits as defined by Arkansas 11
166+rule and 45 C.F.R. § 156.110 and any federal insurance regulations, as they 12
167+existed on January 1, 2021 January 1, 2025; 13
168+ (16) "Medical-loss ratio” means the percentage of premium income 14
169+that health insurers spend on medical care and quality improvement as opposed 15
170+to administration, marketing, and, if applicable, profit; 16
171+ (15)(17) “Member” means a program participant who is enrolled in 17
172+an individual qualified health insurance plan; 18
173+ (18)(A) ”Pharmacy rebate” means a discount, other price 19
174+concession, or a payment that is: 20
175+ (i) Based on utilization of a prescription drug; and 21
176+ (ii) Paid by a manufacturer or third party, directly 22
177+or indirectly, to a pharmacy benefits manager, pharmacy services 23
178+administrative organization, or pharmacy after a claim has been processed and 24
179+paid at a pharmacy. 25
180+ (B) "Pharmacy rebate" includes without limitation 26
181+incentives, disbursements, and reasonable estimates of a volume -based 27
182+discount; 28
183+ (16)(19) “Premium” means: 29
184+ (A) A a monthly fee that is required to be paid by or on 30
185+behalf of an eligible individual to maintain some or all health insurance 31
186+benefits; and 32
187+ (B) The amount paid by the Department of Human Services to 33
188+a health insurer on behalf of a program participant for cost -sharing 34
189+obligations in excess of or other than the program participant's cost -sharing 35
190+obligations; 36 SB527
124191
125-Retirement Income Security Act of 1974, Pub. L. No. 93 -406, as amended; 1
126- (9) "Federally qualified health center” means an entity as 2
127-defined by 42 C.F.R. § 405.2401, as existing on January 1, 2025, and that has 3
128-entered into an agreement with the Centers for Medicare & Medicaid Services 4
129-to meet Medicare program requirements under 42 C.F.R. § 405.2434, as existing 5
130-on January 1, 2025; 6
131- (9)(10) “Health improvement initiative” means an initiative 7
132-developed by an individual qualified health insurance plan or the Department 8
133-of Human Services that is designed to encourage the participation of eligible 9
134-individuals in health assessments and wellness programs, including fitness 10
135-programs and smoking or tobacco cessation programs; 11
136- (10)(11) “Health insurance benefit plan” means a policy, 12
137-contract, certificate, or agreement offered or issued by a health insurer to 13
138-provide, deliver, arrange for, pay for, or reimburse any of the costs of 14
139-healthcare services, but not including excepted benefits as defined under 42 15
140-U.S.C. § 300gg-91(c), as it existed on January 1, 2021 January 1, 2025; 16
141- (11)(12) “Health insurance marketplace” means the applicable 17
142-entities that were designed to help individuals, families, and businesses in 18
143-Arkansas shop for and select health insurance benefit plans in a way that 19
144-permits comparison of available plans based upon price, benefits, services, 20
145-and quality, and refers to either: 21
146- (A) The Arkansas Health Insurance Marketplace created 22
147-under the Arkansas Health Insurance Marketplace Act, § 23 -61-801 et seq., or 23
148-a successor entity; or 24
149- (B) The federal health insurance marketplace or federal 25
150-health benefit exchange created under the Patient Protection and Affordable 26
151-Care Act, Pub. L. No. 111 -148; 27
152- (12)(13) “Health insurer” means an insurer authorized by the 28
153-State Insurance Department to provide health insurance or a health insurance 29
154-benefit plan in the State of Arkansas, including without limitation: 30
155- (A) An insurance company; 31
156- (B) A medical services plan; 32
157- (C) A hospital plan; 33
158- (D) A hospital medical service corporation; 34
159- (E) A health maintenance organization; 35
160- (F) A fraternal benefits society; 36 As Engrossed: S4/7/25 SB527
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193+ (17)(20) “Program participant” means an eligible individual who: 1
194+ (A) Is at least nineteen (19) years of age and no more 2
195+than sixty-four (64) years of age with an income that meets the income 3
196+eligibility standards established by rule of the Department of Human 4
197+Services; 5
198+ (B) Is authenticated to be a United States citizen or 6
199+documented qualified alien according to the Personal Responsibility and Work 7
200+Opportunity Reconciliation Act of 1996, Pub. L. No. 104 -193; 8
201+ (C) Is not eligible for Medicare or advanced premium tax 9
202+credits through the health insurance marketplace; and 10
203+ (D) Is not determined by the Department of Human Services 11
204+to be medically frail or eligible for services through a risk -based provider 12
205+organization; 13
206+ (18)(21) “Risk-based provider organization” means the same as 14
207+defined in § 20-77-2703; and 15
208+ (19)(22) “Small rural hospital” means a critical access hospital 16
209+or a general hospital that: 17
210+ (A) Is located in a rural area; 18
211+ (B) Has fifty (50) or fewer staffed beds; and 19
212+ (C) Is enrolled as a provider in the Arkansas Medicaid 20
213+Program. 21
214+ 22
215+ SECTION 2. Arkansas Code § 23 -61-1004(c)(2)(D), concerning the 23
216+administration of the Arkansas Health and Opportunity for Me Program, is 24
217+amended to read as follows: 25
218+ (D) At least two (2) health insurers offer individual 26
219+qualified health insurance plans are offered in each county in the state. 27
220+ 28
221+ SECTION 3. Arkansas Code § 23 -61-1004(d)(1), concerning a memorandum 29
222+of understanding specifying duties and obligations of each party in the 30
223+operation of the Arkansas Health and Opportunity for Me Program, is amended 31
224+to read as follows: 32
225+ (d)(1) The Department of Human Services, the State Insurance 33
226+Department, and each of the individual qualified health insurance plans shall 34
227+enter into a memorandum of understanding that shall specify , consistent with 35
228+this subchapter, the duties and obligations of each party in the operation of 36 SB527
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231+the Arkansas Health and Opportunity for Me Program, including provisions 1
232+necessary to effectuate the purchasing guidelines and reporting requirements, 2
233+at least thirty (30) calendar days before the annual open enrollment period. 3
234+ 4
235+ SECTION 4. Arkansas Code § 23 -61-1004(e)(2), concerning the duties of 5
236+the Department of Human Services under the Arkansas Health and Opportunity 6
237+for Me Act of 2021, is amended to read as follows: 7
238+ (2)(A) Establish and maintain a process for premium payments, 8
239+advanced cost-sharing reduction payments, and reconciliation payments to 9
240+health insurers. 10
241+ (B) The process described in subdivision (e)(2)(A) of this 11
242+section shall attribute any unpaid member liabilities as solely the financial 12
243+obligation of the individual member. 13
244+ (C) The Department of Human Services shall not include any 14
245+unpaid individual member obligation in any payment or financial 15
246+reconciliation with health insurers or in a future premium rate . 16
247+ (D) The Department of Human Services shall establish and 17
248+maintain a process for tracking all pharmacy rebates obtained by 18
249+participating health plans from pharmaceutical companies and ensure that an 19
250+amount equal to the pharmacy rebates is remitted to this state on a quarterly 20
251+basis; and 21
252+ 22
253+ SECTION 5. Arkansas Code § 23 -61-1004(g), concerning the 23
254+administration of the Arkansas Health and Opportunity for Me Program, is 24
255+amended to add an additional subdivision to read as follows: 25
256+ (3) A health insurer shall seek all available pharmacy rebates 26
257+from pharmaceutical companies for products covered through qualified health 27
258+plans participating in the Arkansas Health and Opportunity for Me Program. 28
259+ 29
260+ SECTION 6. Arkansas Code § 23 -61-1004(h), concerning the 30
261+administration of the Arkansas Health and Opportunity for Me Act of 2021 31
262+relating to the authority for a block grant, is amended to read as follows: 32
263+ (h)(1) The Governor shall request a block grant under relevant federal 33
264+law and regulations for the funding of the Arkansas Medicaid Program as soon 34
265+as practical if the federal law or regulations change to allow the approval 35
266+of a block grant for this purpose. 36 SB527
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269+ (2)(A) The Governor shall request a waiver under relevant 1
270+federal law and regulations for a work requirement as a condition of 2
271+maintaining coverage in the Arkansas Medicaid Program as soon as practical if 3
272+the federal law or regulations change to allow the approval of a waiver for 4
273+this purpose. 5
274+ (B) An eligible individual enrolled in the Arkansas Health 6
275+and Opportunity for Me Program shall: 7
276+ (i) Comply with any and all federal and state work 8
277+requirements under the Arkansas Medicaid Program; and 9
278+ (ii) Be exempt from the work requirement under this 10
279+section if the eligible individual: 11
280+ (a) Volunteers twenty (20) hours or more per 12
281+week as determined by the Department of Human Services; 13
282+ (b) Meets any combination of working and 14
283+participating in a work program for a total of twenty (20) hours or more per 15
284+week as determined by the Department of Human Services; 16
285+ (c) Participates and complies with the 17
286+requirements of a workfare program; 18
287+ (d) Receives unemployment compensation and 19
288+complies with work requirements that are a part of the unemployment 20
289+compensation system; 21
290+ (e) Participates in a drug addiction or 22
291+alcoholic treatment or rehabilitation program; 23
292+ (f) Provides care for a dependent child who: 24
293+ (1) Has a serious medical condition or a 25
294+disability; or 26
295+ (2) Is under six (6) years of age; or 27
296+ (g) Is at least one (1) of the following: 28
297+ (1) Medically certified as physically or 29
298+mentally unfit for employment; 30
299+ (2) Pregnant; 31
300+ (3) Under nineteen (19) years of age; or 32
301+ (4) Over fifty-nine (59) years of age. 33
302+ 34
303+ SECTION 7. Arkansas Code § 23 -61-1007(a), concerning the insurance 35
304+standards for individual qualified health insurance plans within the Arkansas 36 SB527
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165- (G) Any other entity providing health insurance or a 1
166-health insurance benefit plan subject to state insurance regulation; or 2
167- (H) A risk-based provider organization licensed by the 3
168-Insurance Commissioner under § 20 -77-2704; 4
169- (13)(14) “Healthcare coverage” means coverage provided under 5
170-this subchapter through either an individual qualified health insurance plan, 6
171-a risk-based provider organization, employer health insurance coverage, or 7
172-the fee-for-service Arkansas Medicaid Program; 8
173- (14)(15) “Individual qualified health insurance plan” means an 9
174-individual health insurance benefit plan offered by a health insurer that 10
175-participates in the health insurance marketplace to provide coverage in 11
176-Arkansas that covers only essential health benefits as defined by Arkansas 12
177-rule and 45 C.F.R. § 156.110 and any federal insurance regulations, as they 13
178-existed on January 1, 2021 January 1, 2025; 14
179- (16) "Medical-loss ratio” means the percentage of premium income 15
180-that health insurers spend on medical care and quality improvement as opposed 16
181-to administration, marketing, and, if applicable, profit; 17
182- (15)(17) “Member” means a program participant who is enrolled in 18
183-an individual qualified health insurance plan; 19
184- (18)(A) ”Pharmacy rebate” means a discount, other price 20
185-concession, or a payment that is: 21
186- (i) Based on utilization of a prescription drug; and 22
187- (ii) Paid by a manufacturer or third party, directly 23
188-or indirectly, to a pharmacy benefits manager, pharmacy services 24
189-administrative organization, or pharmacy after a claim has been processed and 25
190-paid at a pharmacy. 26
191- (B) "Pharmacy rebate" includes without limitation 27
192-incentives, disbursements, and reasonable estimates of a volume -based 28
193-discount; 29
194- (16)(19) “Premium” means: 30
195- (A) A a monthly fee that is required to be paid by or on 31
196-behalf of an eligible individual to maintain some or all health insurance 32
197-benefits; and 33
198- (B) The amount paid by the Department of Human Services to 34
199-a health insurer on behalf of a program participant for cost -sharing 35
200-obligations in excess of or other than the program participant's cost -sharing 36 As Engrossed: S4/7/25 SB527
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307+Health and Opportunity for Me Act of 2021, is amended to read as follows: 1
308+ (a) Insurance coverage for a member enrolled in an individual 2
309+qualified health insurance plan shall be obtained, at a minimum, through 3
310+silver-level metallic plans as provided in 42 U.S.C. § 18022(d) and 42 U.S.C. 4
311+§ 18071, as they existed on January 1, 2021 January 1, 2025, that restrict 5
312+out-of-pocket costs to amounts that do not exceed applicable out -of-pocket 6
313+cost limitations. 7
314+ 8
315+ SECTION 8. Arkansas Code § 23 -61-1007(c)(3)(A), concerning the 9
316+insurance standards for individual qualified health insurance plans, is 10
317+amended to read as follows: 11
318+ (3)(A) Maintain a medical -loss ratio of at least eighty percent 12
319+(80%) ninety percent (90%) for an individual qualified health insurance plan 13
320+as required permitted under 45 C.F.R. § 158.210(c) 45 C.F.R. § 158.211, as it 14
321+existed on January 1, 2021 January 1, 2025, or rebate the difference between 15
322+the health insurer’s actual medical -loss ratio and ninety percent (90%) to 16
323+the Department of Human Services for members. 17
324+ 18
325+ SECTION 9. Arkansas Code § 23 -61-1007(c)(5), concerning the insurance 19
326+standards for individual qualified health insurance plans, is amended to read 20
327+as follows: 21
328+ (5) Make reports to the Department of Human Services and the 22
329+Department of Health regarding quality and performance metrics in a manner 23
330+and frequency established by a memorandum of understanding. 24
331+ 25
332+ SECTION 10. Arkansas Code § 23 -61-1009 is amended to read as follows: 26
333+ 23-61-1009. Sunset. 27
334+ This subchapter shall expire on December 31, 2026 expires December 31, 28
335+2031. 29
336+ 30
337+ SECTION 11. Arkansas Code § 23 -61-1011(h), concerning the Health and 31
338+Economic Outcomes Accountability Oversight Advisory Panel, is amended to read 32
339+as follows: 33
340+ (h) The Department of Human Services shall produce and submit a 34
341+quarterly report incorporating the advisory panel's findings recommendations 35
342+to the President Pro Tempore of the Senate, the Speaker of the House of 36 SB527
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203-
204-
205-obligations; 1
206- (17)(20) “Program participant” means an eligible individual who: 2
207- (A) Is at least nineteen (19) years of age and no more 3
208-than sixty-four (64) years of age with an income that meets the income 4
209-eligibility standards established by rule of the Department of Human 5
210-Services; 6
211- (B) Is authenticated to be a United States citizen or 7
212-documented qualified alien according to the Personal Responsibility and Work 8
213-Opportunity Reconciliation Act of 1996, Pub. L. No. 104 -193; 9
214- (C) Is not eligible for Medicare or advanced premium tax 10
215-credits through the health insurance marketplace; and 11
216- (D) Is not determined by the Department of Human Services 12
217-to be medically frail or eligible for services through a risk -based provider 13
218-organization; 14
219- (18)(21) “Risk-based provider organization” means the same as 15
220-defined in § 20-77-2703; and 16
221- (19)(22) “Small rural hospital” means a critical access hospital 17
222-or a general hospital that: 18
223- (A) Is located in a rural area; 19
224- (B) Has fifty (50) or fewer staffed beds; and 20
225- (C) Is enrolled as a provider in the Arkansas Medicaid 21
226-Program. 22
227- 23
228- SECTION 2. Arkansas Code § 23 -61-1004(c)(2)(D), concerning the 24
229-administration of the Arkansas Health and Opportunity for Me Program, is 25
230-amended to read as follows: 26
231- (D) At least two (2) health insurers offer individual 27
232-qualified health insurance plans are offered in each county in the state. 28
233- 29
234- SECTION 3. Arkansas Code § 23 -61-1004(d)(1), concerning a memorandum 30
235-of understanding specifying duties and obligations of each party in the 31
236-operation of the Arkansas Health and Opportunity for Me Program, is amended 32
237-to read as follows: 33
238- (d)(1) The Department of Human Services, the State Insurance 34
239-Department, and each of the individual qualified health insurance plans shall 35
240-enter into a memorandum of understanding that shall specify , consistent with 36 As Engrossed: S4/7/25 SB527
241-
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243-
244-
245-this subchapter, the duties and obligations of each party in the operation of 1
246-the Arkansas Health and Opportunity for Me Program, including provisions 2
247-necessary to effectuate the purchasing guidelines and reporting requirements, 3
248-at least thirty (30) calendar days before the annual open enrollment period. 4
249- 5
250- SECTION 4. Arkansas Code § 23 -61-1004(e)(2), concerning the duties of 6
251-the Department of Human Services under the Arkansas Health and Opportunity 7
252-for Me Act of 2021, is amended to read as follows: 8
253- (2)(A) Establish and maintain a process for premium payments, 9
254-advanced cost-sharing reduction payments, and reconciliation payments to 10
255-health insurers. 11
256- (B) The process described in subdivision (e)(2)(A) of this 12
257-section shall attribute any unpaid member liabilities as solely the financial 13
258-obligation of the individual member. 14
259- (C) The Department of Human Services shall not include any 15
260-unpaid individual member obligation in any payment or financial 16
261-reconciliation with health insurers or in a future premium rate . 17
262- (D) The Department of Human Services shall establish and 18
263-maintain a process for tracking all pharmacy rebates obtained by 19
264-participating health plans from pharmaceutical companies and ensure that an 20
265-amount equal to the pharmacy rebates is remitted to this state on a quarterly 21
266-basis; and 22
267- 23
268- SECTION 5. Arkansas Code § 23 -61-1004(g), concerning the 24
269-administration of the Arkansas Health and Opportunity for Me Program, is 25
270-amended to add an additional subdivision to read as follows: 26
271- (3) A health insurer shall seek all available pharmacy rebates 27
272-from pharmaceutical companies for products covered through qualified health 28
273-plans participating in the Arkansas Health and Opportunity for Me Program. 29
274- 30
275- SECTION 6. Arkansas Code § 23 -61-1004(h), concerning the 31
276-administration of the Arkansas Health and Opportunity for Me Act of 2021 32
277-relating to the authority for a block grant, is amended to read as follows: 33
278- (h)(1) The Governor shall request a block grant under relevant federal 34
279-law and regulations for the funding of the Arkansas Medicaid Program as soon 35
280-as practical if the federal law or regulations change to allow the approval 36 As Engrossed: S4/7/25 SB527
281-
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284-
285-of a block grant for this purpose. 1
286- (2)(A) The Governor shall request a waiver under relevant 2
287-federal law and regulations for a work requirement as a condition of 3
288-maintaining coverage in the Arkansas Medicaid Program as soon as practical if 4
289-the federal law or regulations change to allow the approval of a waiver for 5
290-this purpose. 6
291- (B) An eligible individual enrolled in the Arkansas Health 7
292-and Opportunity for Me Program shall: 8
293- (i) Comply with any and all federal and state work 9
294-requirements under the Arkansas Medicaid Program, including providing 10
295-required information to demonstrate compliance; and 11
296- (ii) Be exempt from the work requirement under this 12
297-section if the eligible individual: 13
298- (a) Volunteers twenty (20) hours or more per 14
299-week as determined by the Department of Human Services; 15
300- (b) Meets any combination of working and 16
301-participating in a work program for a total of twenty (20) hours or more per 17
302-week as determined by the Department of Human Services; 18
303- (c) Participates and complies with the 19
304-requirements of a workfare program; 20
305- (d) Receives unemployment compensation and 21
306-complies with work requirements that are a part of the unemployment 22
307-compensation system; 23
308- (e) Participates in a drug addiction or 24
309-alcoholic treatment or rehabilitation program; 25
310- (f) Provides care for a dependent child who: 26
311- (1) Has a serious medical condition or a 27
312-disability; or 28
313- (2) Is under six (6) years of age; or 29
314- (g) Is at least one (1) of the following: 30
315- (1) Medically certified as physically or 31
316-mentally unfit for employment; 32
317- (2) Pregnant; 33
318- (3) Under nineteen (19) years of age; or 34
319- (4) Over fifty-nine (59) years of age. 35
320- (C)(i) An individual who is not exempt under subdivision 36 As Engrossed: S4/7/25 SB527
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324-
325-(h)(2)(B) of this section and who refuses to cooperate and declines to make 1
326-efforts to comply with the work requirements under this section shall have 2
327-coverage under the Arkansas Health and Opportunity for Me Program suspended 3
328-for the remainder of the plan year. 4
329- (ii) An individual who has coverage suspended under 5
330-subdivision (h)(2)(C)(i) of this section may regain active coverage under the 6
331-Arkansas Health and Opportunity for Me Program if he or she cooperates and 7
332-demonstrates a clear intention to comply with the work requirements under 8
333-this section. 9
334- (iii) The Department of Human Services shall not 10
335-make monthly premium payments or advanced cost -sharing reduction payments to 11
336-a health insurer during a period of suspended coverage of the individual 12
337-under this subdivision (h)(2)(C). 13
338- 14
339- SECTION 7. Arkansas Code § 23 -61-1007(a), concerning the insurance 15
340-standards for individual qualified health insurance plans within the Arkansas 16
341-Health and Opportunity for Me Act of 2021, is amended to read as follows: 17
342- (a) Insurance coverage for a member enrolled in an individual 18
343-qualified health insurance plan shall be obtained, at a minimum, through 19
344-silver-level metallic plans as provided in 42 U.S.C. § 18022(d) and 42 U.S.C. 20
345-§ 18071, as they existed on January 1, 2021 January 1, 2025, that restrict 21
346-out-of-pocket costs to amounts that do not exceed applicable out -of-pocket 22
347-cost limitations. 23
348- 24
349- SECTION 8. Arkansas Code § 23 -61-1007(c)(3)(A), concerning the 25
350-insurance standards for individual qualified health insurance plans, is 26
351-amended to read as follows: 27
352- (3)(A) Maintain a medical -loss ratio of at least eighty percent 28
353-(80%) eighty-five percent (85%) for an individual qualified health insurance 29
354-plan as required permitted under 45 C.F.R. § 158.210(c) 45 C.F.R. § 158.211, 30
355-as it existed on January 1, 2021 January 1, 2025, or rebate the difference 31
356-between the health insurer’s actual medical -loss ratio and eighty-five 32
357-percent (85%) to the Department of Human Services for members. 33
358- 34
359- SECTION 9. Arkansas Code § 23 -61-1007(c)(5), concerning the insurance 35
360-standards for individual qualified health insurance plans, is amended to read 36 As Engrossed: S4/7/25 SB527
361-
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363-
364-
365-as follows: 1
366- (5) Make reports to the Department of Human Services and the 2
367-Department of Health regarding quality and performance metrics in a manner 3
368-and frequency established by a memorandum of understanding. 4
369- 5
370- SECTION 10. Arkansas Code § 23 -61-1009 is amended to read as follows: 6
371- 23-61-1009. Sunset. 7
372- This subchapter shall expire on December 31, 2026 expires December 31, 8
373-2031. 9
374- 10
375- SECTION 11. Arkansas Code § 23 -61-1011(h), concerning the Health and 11
376-Economic Outcomes Accountability Oversight Advisory Panel, is amended to read 12
377-as follows: 13
378- (h) The Department of Human Services shall produce and submit a 14
379-quarterly report incorporating the advisory panel's findings recommendations 15
380-to the President Pro Tempore of the Senate, the Speaker of the House of 16
381-Representatives, and the public on the progress in health and economic 17
382-improvement resulting from the Arkansas Health and Opportunity for Me 18
383-Program, including without limitation: 19
384- (1) Eligibility and enrollment; 20
385- (2) Participation in and the impact of the economic independence 21
386-initiative and the health improvement initiative of the eligible individuals, 22
387-health insurers, and community bridge organizations; 23
388- (3) Utilization of medical services; 24
389- (4) Premium and cost -sharing reduction costs; and 25
390- (5) Health insurer participation and completion. 26
391- 27
392- SECTION 12. Arkansas Code § 26 -57-603(a), concerning the tax reports 28
393-relating to the insurance premium tax, is amended to read as follows: 29
394- (a) Each authorized, each formerly authorized, and each unauthorized 30
395-insurer as defined in § 23 -60-102(12) shall file with the Insurance 31
396-Commissioner on or before March 1 of each year a report in form as prescribed 32
397-by the commissioner showing, except as to wet marine and foreign trade 33
398-insurance as defined in § 26 -57-605(d), total direct premium income including 34
399-policy, membership, and other fees, and all other considerations for 35
400-insurance, from all kinds and classes of insurance, whether designated as 36 As Engrossed: S4/7/25 SB527
401-
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403-
404-
405-premium or otherwise, including all amounts paid for cost sharing by the 1
406-Department of Human Services to a health insurer under the Arkansas Health 2
407-and Opportunity for Me Act of 2021, § 23 -61-1001 et seq., written by it 3
408-during the preceding calendar year on account of policies and contracts 4
409-covering property, subjects, or risks located, resident, or to be performed 5
410-in this state, with proper proportionate allocation of premium as to the 6
411-persons, property, subjects, or risks in this state insured under policies or 7
412-contracts covering persons, property, subjects, or risks located or resident 8
413-in more than one (1) state, after deducting from the total direct premium 9
414-income dividends and similar returns paid or credited to policyholders other 10
415-than as to life insurance, applicable cancellations, returned premiums, the 11
416-unabsorbed portion of any deposit premium, and the amount of reduction in, or 12
417-refund of, premiums allowed to industrial life policyholders for payment of 13
418-premiums directly to an office of the insurer. 14
419- 15
420-/s/Irvin 16
421- 17
422- 18
423-APPROVED: 4/17/25 19
424- 20
425- 21
426- 22
427- 23
428- 24
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432- 28
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438- 34
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345+Representatives, and the public on the progress in health and economic 1
346+improvement resulting from the Arkansas Health and Opportunity for Me 2
347+Program, including without limitation: 3
348+ (1) Eligibility and enrollment; 4
349+ (2) Participation in and the impact of the economic independence 5
350+initiative and the health improvement initiative of the eligible individuals, 6
351+health insurers, and community bridge organizations; 7
352+ (3) Utilization of medical services; 8
353+ (4) Premium and cost -sharing reduction costs; and 9
354+ (5) Health insurer participation and completion. 10
355+ 11
356+ SECTION 12. Arkansas Code § 26 -57-603(a), concerning the tax reports 12
357+relating to the insurance premium tax, is amended to read as follows: 13
358+ (a) Each authorized, each formerly authorized, and each unauthorized 14
359+insurer as defined in § 23 -60-102(12) shall file with the Insurance 15
360+Commissioner on or before March 1 of each year a report in form as prescribed 16
361+by the commissioner showing, except as to wet marine and foreign trade 17
362+insurance as defined in § 26 -57-605(d), total direct premium income including 18
363+policy, membership, and other fees, and all other considerations for 19
364+insurance, from all kinds and classes of insurance, whether designated as 20
365+premium or otherwise, including all amounts paid for cost sharing by the 21
366+Department of Human Services to a health insurer under the Arkansas Health 22
367+and Opportunity for Me Act of 2021, § 23 -61-1001 et seq., written by it 23
368+during the preceding calendar year on account of policies and contracts 24
369+covering property, subjects, or risks located, resident, or to be performed 25
370+in this state, with proper proportionate allocation of premium as to the 26
371+persons, property, subjects, or risks in this state insured under policies or 27
372+contracts covering persons, property, subjects, or risks located or resident 28
373+in more than one (1) state, after deducting from the total direct premium 29
374+income dividends and similar returns paid or credited to policyholders other 30
375+than as to life insurance, applicable cancellations, returned premiums, the 31
376+unabsorbed portion of any deposit premium, and the amount of reduction in, or 32
377+refund of, premiums allowed to industrial life policyholders for payment of 33
378+premiums directly to an office of the insurer. 34
439379 35
440380 36