Stricken language would be deleted from and underlined language would be added to present law.
*JMB152* 01/14/2025 9:49:23 AM JMB152
State of Arkansas 1
95th General Assembly A Bill 2
Regular Session, 2025 SENATE BILL 62 3
4
By: Senator B. King 5
6
7
For An Act To Be Entitled 8
AN ACT TO TERMINATE THE ARKANSAS HEALTH AND 9
OPPORTUNITY FOR ME PROGRAM; TO TRANSFER ALL 10
BENEFICIARIES IN THE ARKANSAS HEALTH AND OPPORTUNITY 11
FOR ME PROGRAM TO THE TRADITIONAL ARKANSAS MEDICAID 12
PROGRAM; TO REPEAL THE ARKANSAS HEALTH AND 13
OPPORTUNITY FOR ME ACT OF 2021; AND FOR OTHER 14
PURPOSES. 15
16
17
Subtitle 18
TO TERMINATE THE ARKANSAS HEALTH AND 19
OPPORTUNITY FOR ME PROGRAM; AND TO 20
TRANSFER ALL BENEFICIARIES IN THE 21
ARKANSAS HEALTH AND OPPORTUNITY FOR ME 22
PROGRAM TO THE TRADITIONAL ARKANSAS 23
MEDICAID PROGRAM. 24
25
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF ARKANSAS: 26
27
SECTION 1. DO NOT CODIFY. Legislative intent. 28
It is the intent of the General Assembly to: 29
(1) Repeal the Arkansas Health and Opportunity for Me Program; 30
(2) Amend various sections of the Arkansas Code to end 31
Arkansas's participation in the Arkansas Health and Opportunity for Me 32
Program; and 33
(3) Instruct the Governor to submit a waiver to: 34
(A) Transfer all individuals enrolled and participating in 35
the Arkansas Health and Opportunity for Me Program to the traditional 36 SB62
2 01/14/2025 9:49:23 AM JMB152
Arkansas Medicaid program on and after July 1, 2025; and 1
(B) Terminate the Arkansas Health and Opportunity for Me 2
Program on December 31, 2026. 3
4
SECTION 2. DO NOT CODIFY. Arkansas Health and Opportunity for Me 5
Program — Notification of termination — Transfer of enrollees to the Arkansas 6
Medicaid Program. 7
(a) The Department of Human Services shall: 8
(1) Notify all persons enrolled in the Arkansas Health and 9
Opportunity for Me Program as of the effective date of this act that the 10
Arkansas Health and Opportunity for Me Program ends on December 31, 2026; 11
(2) Inform a new enrollee in the Arkansas Health and Opportunity 12
for Me Program after the effective date of this act that the Arkansas Health 13
and Opportunity for Me Program ends on December 31, 2026; and 14
(3) Transfer all persons enrolled in the Arkansas Health and 15
Opportunity for Me Program or any person who enrolled in the Arkansas Health 16
and Opportunity for Me Program after July 1, 2025, to coverage under the 17
traditional Arkansas Medicaid Program on July 1, 2025. 18
(b) The department may prohibit new enrollees in the Arkansas Health 19
and Opportunity for Me Program to begin the transition period before the 20
termination date of December 31, 2026. 21
(c) On the effective date of this act, the department shall submit any 22
Medicaid state plan amendments and federal waivers necessary to eliminate the 23
eligibility in the Arkansas Health and Opportunity for Me Program after 24
December 31, 2026. 25
(d) This section does not prohibit the payment of expenses incurred 26
before December 31, 2026, by persons participating in the Arkansas Health and 27
Opportunity for Me Program. 28
29
SECTION 3. Arkansas Code § 19 -5-984(b)(2)(D), concerning the Division 30
of Workforce Services Special Fund, is repealed. 31
(D) The Arkansas Health and Opportunity for Me Act of 32
2021, § 23-61-1001 et seq., or its successor; and 33
34
SECTION 4. Arkansas Code § 19 -5-1146 is repealed. 35
19-5-1146. Arkansas Health and Opportunity for Me Program Trust Fund. 36 SB62
3 01/14/2025 9:49:23 AM JMB152
(a) There is created on the books of the Treasurer of State, the 1
Auditor of State, and the Chief Fiscal Officer of the State a trust fund to 2
be known as the “Arkansas Health and Opportunity for Me Program Trust Fund”. 3
(b) The fund shall consist of: 4
(1) Moneys saved and accrued under the Arkansas Health and 5
Opportunity for Me Act of 2021, § 23 -61-1001 et seq., including without 6
limitation: 7
(A) Increases in premium tax collections; and 8
(B) Other spending reductions resulting from the Arkansas 9
Health and Opportunity for Me Act of 2021, § 23 -61-1001 et seq.; and 10
(2) Other revenues and funds authorized by law. 11
(c) The Department of Human Services shall use the fund to pay for 12
future obligations under the Arkansas Health and Opportunity for Me Program 13
created by the Arkansas Health and Opportunity for Me Act of 2021, § 23-61-14
1001 et seq. 15
16
SECTION 5. Arkansas Code § 23 -61-803(h), concerning the Arkansas 17
Health Insurance Marketplace, is amended to read as follows: 18
(h) The State Insurance Department and any eligible entity under 19
subdivision (e)(2) of this section shall provide claims and other plan and 20
enrollment data to the Department of Human Services upon request to : 21
(1) Facilitate facilitate compliance with reporting requirements 22
under state and federal law ; and 23
(2) Assess the performance of the Arkansas Health and 24
Opportunity for Me Program established by the Arkansas Health and Opportunity 25
for Me Act of 2021, § 23 -61-1001 et seq., including without limitation the 26
program's quality, cost, and consumer access . 27
28
SECTION 6. Arkansas Code Title 23, Chapter 16, Subchapter 10, is 29
repealed. 30
Subchapter 10 — Arkansas Health and Opportunity for Me Act of 2021 31
32
23-61-1001. Title. 33
This subchapter shall be known and may be cited as the “Arkansas Health 34
and Opportunity for Me Act of 2021”. 35
36 SB62
4 01/14/2025 9:49:23 AM JMB152
23-61-1002. Legislative intent. 1
Notwithstanding any general or specific laws to the contrary, it is the 2
intent of the General Assembly for the Arkansas Health and Opportunity for Me 3
Program to be a fiscally sustainable, cost -effective, and opportunity -driven 4
program that: 5
(1) Achieves comprehensive and innovative healthcare reform that 6
reduces the rate of growth in state and federal obligations for providing 7
healthcare coverage to low -income adults in Arkansas; 8
(2) Reduces the maternal and infant mortality rates in the state 9
through initiatives that promote healthy outcomes for eligible women with 10
high-risk pregnancies; 11
(3) Promotes the health, welfare, and stability of mothers and 12
their infants after birth through hospital -based community bridge 13
organizations; 14
(4) Encourages personal responsibility for individuals to 15
demonstrate that they value healthcare coverage and understand their roles 16
and obligations in maintaining private insurance coverage; 17
(5) Increases opportunities for full -time work and attainment of 18
economic independence, especially for certain young adults, to reduce long -19
term poverty that is associated with additional risk for disease and 20
premature death; 21
(6) Addresses health -related social needs of Arkansans in rural 22
counties through hospital -based community bridge organizations and reduces 23
the additional risk for disease and premature death associated with living in 24
a rural county; 25
(7) Strengthens the financial stability of the critical access 26
hospitals and other small, rural hospitals; and 27
(8) Fills gaps in the continuum of care for individuals in need 28
of services for serious mental illness and substance use disorders. 29
30
23-61-1003. Definitions. 31
As used in this subchapter: 32
(1) “Acute care hospital” means a hospital that: 33
(A) Is licensed by the Department of Health under § 20 -9-34
201 et seq., as a general hospital or a surgery and general medical care 35
hospital; and 36 SB62
5 01/14/2025 9:49:23 AM JMB152
(B) Is enrolled as a provider with the Arkansas Medicaid 1
Program; 2
(2) “Birthing hospital” means a hospital in this state or in a 3
border state that: 4
(A) Is licensed as a general hospital; 5
(B) Provides obstetrics services; and 6
(C) Is enrolled as a provider with the Arkansas Medicaid 7
Program; 8
(3) “Community bridge organization” means an organization that 9
is authorized by the Department of Human Services to participate in the 10
economic independence initiative or the health improvement initiative to: 11
(A) Screen and refer Arkansans to resources available in 12
their communities to address health -related social needs; and 13
(B) Assist eligible individuals identified as target 14
populations most at risk of disease and premature death and who need a higher 15
level of intervention to improve their health outcomes and succeed in meeting 16
their long-term goals to achieve independence, including economic 17
independence; 18
(4) “Cost sharing” means the portion of the cost of a covered 19
medical service that is required to be paid by or on behalf of an eligible 20
individual; 21
(5) “Critical access hospital” means an acute care hospital that 22
is: 23
(A) Designated by the Centers for Medicare & Medicaid 24
Services as a critical access hospital; and 25
(B) Is enrolled as a provider in the Arkansas Medicaid 26
Program; 27
(6) “Economic independence initiative” means an initiative 28
developed by the Department of Human Services that is designed to promote 29
economic stability by encouraging participation of program participants to 30
engage in full-time, full-year work, and to demonstrate the value of 31
enrollment in an individual qualified health insurance plan through 32
incentives and disincentives; 33
(7) “Eligible individual” means an individual who is in the 34
eligibility category created by section 1902(a)(10)(A)(i)(VIII) of the Social 35
Security Act, 42 U.S.C. § 1396a; 36 SB62
6 01/14/2025 9:49:23 AM JMB152
(8) “Employer health insurance coverage” means a health 1
insurance benefit plan offered by an employer or, as authorized by this 2
subchapter, an employer self -funded insurance plan governed by the Employee 3
Retirement Income Security Act of 1974, Pub. L. No. 93 -406, as amended; 4
(9) “Health improvement initiative” means an initiative 5
developed by an individual qualified health insurance plan or the Department 6
of Human Services that is designed to encourage the participation of eligible 7
individuals in health assessments and wellness programs, including fitness 8
programs and smoking or tobacco cessation programs; 9
(10) “Health insurance benefit plan” means a policy, contract, 10
certificate, or agreement offered or issued by a health insurer to provide, 11
deliver, arrange for, pay for, or reimburse any of the costs of healthcare 12
services, but not including excepted benefits as defined under 42 U.S.C. § 13
300gg-91(c), as it existed on January 1, 2021; 14
(11) “Health insurance marketplace” means the applicable 15
entities that were designed to help individuals, families, and businesses in 16
Arkansas shop for and select health insurance benefit plans in a way that 17
permits comparison of available plans based upon price, benefits, services, 18
and quality, and refers to either: 19
(A) The Arkansas Health Insurance Marketplace created 20
under the Arkansas Health Insurance Marketplace Act, § 23 -61-801 et seq., or 21
a successor entity; or 22
(B) The federal health insurance marketplace or federal 23
health benefit exchange created under the Patient Protection and Affordable 24
Care Act, Pub. L. No. 111 -148; 25
(12) “Health insurer” means an insurer authorized by the State 26
Insurance Department to provide health insurance or a health insurance 27
benefit plan in the State of Arkansas, including without limitation: 28
(A) An insurance company; 29
(B) A medical services plan; 30
(C) A hospital plan; 31
(D) A hospital medical service corporation; 32
(E) A health maintenance organization; 33
(F) A fraternal benefits society; 34
(G) Any other entity providing health insurance or a 35
health insurance benefit plan subject to state insurance regulation; or 36 SB62
7 01/14/2025 9:49:23 AM JMB152
(H) A risk-based provider organization licensed by the 1
Insurance Commissioner under § 20 -77-2704; 2
(13) “Healthcare coverage” means coverage provided under this 3
subchapter through either an individual qualified health insurance plan, a 4
risk-based provider organization, employer health insurance coverage, or the 5
fee-for-service Arkansas Medicaid Program; 6
(14) “Individual qualified health insurance plan” means an 7
individual health insurance benefit plan offered by a health insurer that 8
participates in the health insurance marketplace to provide coverage in 9
Arkansas that covers only essential health benefits as defined by Arkansas 10
rule and 45 C.F.R. § 156.110 and any federal insurance regulations, as they 11
existed on January 1, 2021; 12
(15) “Member” means a program participant who is enrolled in an 13
individual qualified health insurance plan; 14
(16) “Premium” means a monthly fee that is required to be paid 15
by or on behalf of an eligible individual to maintain some or all health 16
insurance benefits; 17
(17) “Program participant” means an eligible individual who: 18
(A) Is at least nineteen (19) years of age and no more 19
than sixty-four (64) years of age with an income that meets the income 20
eligibility standards established by rule of the Department of Human 21
Services; 22
(B) Is authenticated to be a United States citizen or 23
documented qualified alien according to the Personal Responsibility and Work 24
Opportunity Reconciliation Act of 1996, Pub. L. No. 104 -193; 25
(C) Is not eligible for Medicare or advanced premium tax 26
credits through the health insurance marketplace; and 27
(D) Is not determined by the Department of Human Services 28
to be medically frail or eligible for services through a risk -based provider 29
organization; 30
(18) “Risk-based provider organization” means the same as 31
defined in § 20-77-2703; and 32
(19) “Small rural hospital” means a critical access hospital or 33
a general hospital that: 34
(A) Is located in a rural area; 35
(B) Has fifty (50) or fewer staffed beds; and 36 SB62
8 01/14/2025 9:49:23 AM JMB152
(C) Is enrolled as a provider in the Arkansas Medicaid 1
Program. 2
3
23-61-1004. Administration. 4
(a)(1) The Department of Human Services, in coordination with the 5
State Insurance Department and other state agencies, as necessary, shall: 6
(A) Provide healthcare coverage under this subchapter to 7
eligible individuals; 8
(B) Create and administer the Arkansas Health and 9
Opportunity for Me Program by: 10
(i) Applying for any federal waivers, Medicaid state 11
plan amendments, or other authority necessary to implement the Arkansas 12
Health and Opportunity for Me Program in a manner consistent with this 13
subchapter; and 14
(ii) Administering the Arkansas Health and 15
Opportunity for Me Program as approved by the Centers for Medicare & Medicaid 16
Services; 17
(C)(i) Administer the economic independence initiative 18
designed to reduce the short -term effects of the work penalty and the long -19
term effects of poverty on health outcomes among program participants through 20
incentives and disincentives. 21
(ii) The Department of Human Services shall align 22
the economic independence initiative with other state -administered work-23
related programs to the extent practicable; 24
(D) Screen, refer, and assist eligible individuals through 25
community bridge organizations under agreements with the Department of Human 26
Services; 27
(E) Offer incentives to promote personal responsibility, 28
individual health, and economic independence through individual qualified 29
health insurance plans and community bridge organizations; and 30
(F) Seek a waiver to reduce the period of retroactive 31
eligibility for an eligible individual under this subchapter to thirty (30) 32
days before the date of the application. 33
(2) The Governor shall request the assistance and involvement of 34
other state agencies that he or she deems necessary for the implementation of 35
the Arkansas Health and Opportunity for Me Program. 36 SB62
9 01/14/2025 9:49:23 AM JMB152
(b) Healthcare coverage under this subchapter shall be provided 1
through enrollment in: 2
(1) An individual qualified health insurance plan through a 3
health insurer; 4
(2) A risk-based provider organization; 5
(3) An employer-sponsored health insurance coverage; or 6
(4) The fee-for-service Arkansas Medicaid Program. 7
(c) Annually, the Department of Human Services shall develop 8
purchasing guidelines that: 9
(1) Describe which individual qualified health insurance plans 10
are suitable for purchase in the next demonstration year, including without 11
limitation: 12
(A) The level of the plan; 13
(B) The amounts of allowable premiums; 14
(C) Cost sharing; 15
(D) Auto-assignment methodology; and 16
(E) The total per-member-per-month enrollment range; and 17
(2) Ensure that: 18
(A) Payments to an individual qualified health insurance 19
plan do not exceed budget neutrality limitations in each demonstration year; 20
(B) The total payments to all of the individual qualified 21
health insurance plans offered by the health insurers for eligible 22
individuals combined do not exceed budget targets for the Arkansas Health and 23
Opportunity for Me Program in each demonstration year that the Department of 24
Human Services may achieve by: 25
(i) Setting in advance an enrollment range to 26
represent the minimum and a maximum total monthly number of enrollees into 27
all individual qualified health insurance plans no later than April 30 of 28
each demonstration year in order for the individual qualified health 29
insurance plans to file rates for the following demonstration year; 30
(ii) Temporarily suspending auto -assignment into the 31
individual qualified health insurance plans at any time in a demonstration 32
year if necessary, to remain within the enrollment range and budget targets 33
for the demonstration year; and 34
(iii) Developing a methodology for random auto -35
assignment of program participants into the individual qualified health 36 SB62
10 01/14/2025 9:49:23 AM JMB152
insurance plans after a suspension period has ended; 1
(C) Individual qualified health insurance plans meet and 2
report quality and performance measurement targets set by the Department of 3
Human Services; and 4
(D) At least two (2) health insurers offer individual 5
qualified health insurance plans in each county in the state. 6
(d)(1) The Department of Human Services, the State Insurance 7
Department, and each of the individual qualified health insurance plans shall 8
enter into a memorandum of understanding that shall specify the duties and 9
obligations of each party in the operation of the Arkansas Health and 10
Opportunity for Me Program, including provisions necessary to effectuate the 11
purchasing guidelines and reporting requirements, at least thirty (30) 12
calendar days before the annual open enrollment period. 13
(2) If a memorandum of understanding is not fully executed with 14
a health insurer by January 1 of each new demonstration year, the Department 15
of Human Services shall suspend auto -assignment of new members to the health 16
insurers until the first day of the month after the new memorandum of 17
understanding is fully executed. 18
(3) The memorandum of understanding shall include financial 19
sanctions determined appropriate by the Department of Human Services that may 20
be applied if the Department of Human Services determines that an individual 21
qualified health insurance plan has not met the quality and performance 22
measurement targets or any other condition of the memorandum of 23
understanding. 24
(4)(A) If the Department of Human Services determines that the 25
individual qualified health insurance plans have not met the quality and 26
health performance targets for two (2) years, the Department of Human 27
Services shall develop additional reforms to achieve the quality and health 28
performance targets. 29
(B) If legislative action is required to implement the 30
additional reforms described in subdivision (d)(4)(A) of this section, the 31
Department of Human Services may take the action to the Legislative Council 32
or the Executive Subcommittee of the Legislative Council for immediate 33
action. 34
(e) The Department of Human Services shall: 35
(1) Adopt premiums and cost -sharing levels for individuals 36 SB62
11 01/14/2025 9:49:23 AM JMB152
enrolled in the Arkansas Health and Opportunity for Me Program, not to exceed 1
aggregate limits under 42 C.F.R. § 447.56; 2
(2)(A) Establish and maintain a process for premium payments, 3
advanced cost-sharing reduction payments, and reconciliation payments to 4
health insurers. 5
(B) The process described in subdivision (e)(2)(A) of this 6
section shall attribute any unpaid member liabilities as solely the financial 7
obligation of the individual member. 8
(C) The Department of Human Services shall not include any 9
unpaid individual member obligation in any payment or financial 10
reconciliation with health insurers or in a future premium rate; and 11
(3)(A) Calculate a total per -member-per-month amount for each 12
individual qualified health insurance plan based on all payments made by the 13
Department of Human Services on behalf of an individual enrolled in the 14
individual qualified health insurance plan. 15
(B)(i) The amount described in subdivision (e)(3)(A) of 16
this section shall include premium payments, advanced cost -sharing reduction 17
payments for services provided to covered individuals during the 18
demonstration year, and any other payments accruing to the budget neutrality 19
target for plan-enrolled individuals made during the demonstration year and 20
the member months for each demonstration year. 21
(ii) The total per-member-per-month upper limit is 22
the budget neutrality per -member-per-month limit established in the approved 23
demonstration for each demonstration year. 24
(C) If the Department of Human Services calculates that 25
the total per-member-per-month limit for an individual qualified health 26
insurance plan for that demonstration year exceeds the budget neutrality per -27
member-per-month limit for that demonstration year, the Department of Human 28
Services shall not make any additional reconciliation payments to the health 29
insurer for that individual qualified health insurance plan. 30
(D) If the Department of Human Services determines that 31
the budget neutrality limit has been exceeded, the Department of Human 32
Services shall recover the excess funds from the health insurer for that 33
individual qualified health insurance plan. 34
(f)(1) If the federal medical assistance percentages for the Arkansas 35
Health and Opportunity for Me Program are reduced to below ninety percent 36 SB62
12 01/14/2025 9:49:23 AM JMB152
(90%), the Department of Human Services shall present to the Centers for 1
Medicare & Medicaid Services a plan within thirty (30) days of the reduction 2
to terminate the Arkansas Health and Opportunity for Me Program and 3
transition eligible individuals out of the Arkansas Health and Opportunity 4
for Me Program within one hundred twenty (120) days of the reduction. 5
(2) An eligible individual shall maintain coverage during the 6
process to implement the plan to terminate the Arkansas Health and 7
Opportunity for Me Program and the transition of eligible individuals out of 8
the Arkansas Health and Opportunity for Me Program. 9
(g)(1) A health insurer that is providing an individual qualified 10
health insurance plan or employer health insurance coverage for an eligible 11
individual shall submit claims and enrollment data to the Department of Human 12
Services to facilitate reporting required under this subchapter or other 13
state or federally required reporting or evaluation activities. 14
(2) A health insurer may utilize existing mechanisms with 15
supplemental enrollment information to fulfill requirements under this 16
subchapter, including without limitation the state's all -payer claims 17
database established under the Arkansas Healthcare Transparency Initiative 18
Act of 2015, § 23-61-901 et seq., for claims and enrollment data submission. 19
(h)(1) The Governor shall request a block grant under relevant federal 20
law and regulations for the funding of the Arkansas Medicaid Program as soon 21
as practical if the federal law or regulations change to allow the approval 22
of a block grant for this purpose. 23
(2) The Governor shall request a waiver under relevant federal 24
law and regulations for a work requirement as a condition of maintaining 25
coverage in the Arkansas Medicaid Program as soon as practical if the federal 26
law or regulations change to allow the approval of a waiver for this purpose. 27
28
23-61-1005. Requirements for eligible individuals. 29
(a) An eligible individual is responsible for all applicable cost-30
sharing and premium payment requirements as determined by the Department of 31
Human Services. 32
(b) An eligible individual may participate in a health improvement 33
initiative, as developed and implemented by either the eligible individual's 34
individual qualified health insurance plan or the department. 35
(c)(1)(A) An eligible individual who is determined by the department 36 SB62
13 01/14/2025 9:49:23 AM JMB152
to meet the eligibility criteria for a risk -based provider organization due 1
to serious mental illness or substance use disorder shall be enrolled in a 2
risk-based provider organization under criteria established by the 3
department. 4
(B) An eligible individual who is enrolled in a risk -based 5
provider organization is exempt from the requirements of subsections (a) and 6
(b) of this section. 7
(2)(A) An eligible individual who is determined by the 8
department to be medically frail shall receive healthcare coverage through 9
the fee-for-service Arkansas Medicaid Program. 10
(B) An eligible individual who is enrolled in the fee -for-11
service Arkansas Medicaid Program is exempt from the requirements of 12
subsection (a) of this section. 13
(d) An eligible individual shall receive notice that: 14
(1) The Arkansas Health and Opportunity for Me Program is not a 15
perpetual federal or state right or a guaranteed entitlement; 16
(2) The Arkansas Health and Opportunity for Me Program is 17
subject to cancellation upon appropriate notice; 18
(3) Enrollment in an individual qualified health insurance plan 19
is not a right; and 20
(4) If the individual chooses not to participate or fails to 21
meet participation goals in the economic independence initiative, the 22
individual may lose incentives provided through enrollment in an individual 23
qualified health insurance plan or be unenrolled from the individual 24
qualified health insurance plan after notification by the department. 25
26
23-61-1006. Requirements for program participants. 27
(a) The economic independence initiative applies to all program 28
participants in accordance with the implementation schedule of the Department 29
of Human Services. 30
(b) Incentives established by the department for participation in the 31
economic independence initiative and the health improvement initiative may 32
include, without limitation, the waiver of premium payments and cost -sharing 33
requirements as determined by the department for participation in one (1) or 34
more initiatives. 35
(c) Failure by a program participant to meet the cost -sharing and 36 SB62
14 01/14/2025 9:49:23 AM JMB152
premium payment requirement under § 23 -61-1005(a) may result in the accrual 1
of a personal debt to the health insurer or provider. 2
(d)(1)(A) Failure by the program participant to meet the initiative 3
participation requirements of subsection (b) of this section may result in: 4
(i) Being unenrolled from the individual qualified 5
health insurance plan; or 6
(ii) The loss of incentives, as defined by the 7
department. 8
(B) However, an individual who is unenrolled shall not 9
lose Medicaid healthcare coverage based solely on disenrollment from the 10
individual qualified health insurance plan. 11
(2) The department shall develop and notify program participants 12
of the criteria for restoring eligibility for incentive benefits that were 13
removed as a result of the program participants' failure to meet the 14
initiative participation requirements of subsection (b) of this section. 15
(3)(A) A program participant who also meets the criteria of a 16
community bridge organization target population may qualify for additional 17
incentives by successfully completing the economic independence initiative 18
provided through a community bridge organization. 19
(B) If successfully completing the initiative results in 20
an increase in the program participant's income that exceeds the program's 21
financial eligibility limits, a program participant may receive, for a 22
specified period of time, financial assistance to pay: 23
(i) The individual's share of employer -sponsored 24
health insurance coverage not to exceed a limit determined by the department; 25
or 26
(ii) A share of the individual's cost -sharing 27
obligation, as determined by the department, if the individual enrolls in a 28
health insurance benefit plan offered through the Arkansas Health Insurance 29
Marketplace. 30
31
23-61-1007. Insurance standards for individual qualified health 32
insurance plans. 33
(a) Insurance coverage for a member enrolled in an individual 34
qualified health insurance plan shall be obtained, at a minimum, through 35
silver-level metallic plans as provided in 42 U.S.C. § 18022(d) and § 18071, 36 SB62
15 01/14/2025 9:49:23 AM JMB152
as they existed on January 1, 2021, that restrict out -of-pocket costs to 1
amounts that do not exceed applicable out -of-pocket cost limitations. 2
(b) As provided under § 23 -61-1004(e)(2), health insurers shall track 3
the applicable premium payments and cost sharing collected from members to 4
ensure that the total amount of an individual's payments for premiums and 5
cost sharing does not exceed the aggregate cap imposed by 42 C.F.R. § 447.56. 6
(c) All health benefit plans purchased by the Department of Human 7
Services shall: 8
(1) Conform to the requirements of this section and applicable 9
insurance rules; 10
(2) Be certified by the State Insurance Department; 11
(3)(A) Maintain a medical -loss ratio of at least eighty percent 12
(80%) for an individual qualified health insurance plan as required under 45 13
C.F.R. § 158.210(c), as it existed on January 1, 2021, or rebate the 14
difference to the Department of Human Services for members. 15
(B) However, the Department of Human Services may approve 16
up to one percent (1%) of revenues as community investments and as benefit 17
expenses in calculating the medical -loss ratio of a plan in accordance with 18
45 C.F.R. § 158.150; 19
(4) Develop: 20
(A) An annual quality assessment and performance 21
improvement strategic plan to be approved by the Department of Human Services 22
that aligns with federal quality improvement initiatives and quality and 23
reporting requirements of the Department of Human Services; and 24
(B) Targeted initiatives based on requirements established 25
by the Department of Human Services in consultation with the Department of 26
Health; and 27
(5) Make reports to the Department of Human Services and the 28
Department of Health regarding quality and performance metrics in a manner 29
and frequency established by a memorandum of understanding. 30
(d) A health insurer offering individual qualified health insurance 31
plans for members shall participate in the Arkansas Patient -Centered Medical 32
Home Program, including: 33
(1) Attributing enrollees in individual qualified health 34
insurance plans, including members, to a primary care physician; 35
(2) Providing financial support to patient -centered medical 36 SB62
16 01/14/2025 9:49:23 AM JMB152
homes to meet practice transformation milestones; and 1
(3) Supplying clinical performance data to patient -centered 2
medical homes, including data to enable patient -centered medical homes to 3
assess the relative cost and quality of healthcare providers to whom patient -4
centered medical homes refer patients. 5
(e)(1) Each individual qualified health insurance plan shall provide 6
for a health improvement initiative, subject to the review and approval of 7
the Department of Human Services, to provide incentives to its enrolled 8
members to participate in one (1) or more health improvement initiatives as 9
defined in § 23-61-1003(9). 10
(2)(A) The Department of Human Services shall work with health 11
insurers offering individual qualified health insurance plans to ensure the 12
economic independence initiative offered by the health insurer includes a 13
robust outreach and communications effort which targets specific health, 14
education, training, employment, and other opportunities appropriate for its 15
enrolled members. 16
(B) The outreach and communications effort shall recognize 17
that enrolled members receive information from multiple channels, including 18
without limitation: 19
(i) Community service organizations; 20
(ii) Local community outreach partners; 21
(iii) Email; 22
(iv) Radio; 23
(v) Religious organizations; 24
(vi) Social media; 25
(vii) Television; 26
(viii) Text message; and 27
(ix) Traditional methods such as newspaper or mail. 28
(f) On or before January 1, 2022, the State Insurance Department and 29
the Department of Human Services may implement through certification 30
requirements or rule, or both, the applicable provisions of this section. 31
32
23-61-1009. Sunset. 33
This subchapter shall expire on December 31, 2026. 34
35
23-61-1010. Community bridge organizations. 36 SB62
17 01/14/2025 9:49:23 AM JMB152
(a) The Department of Human Services shall develop requirements and 1
qualifications for community bridge organizations to provide assistance to 2
one (1) or more of the following target populations: 3
(1) Individuals who become pregnant with a high -risk pregnancy 4
and the child, throughout the pregnancy and up to twenty -four (24) months 5
after birth; 6
(2) Individuals in rural areas of the state in need of treatment 7
for serious mental illness or substance use disorder; 8
(3) Individuals who are young adults most at risk of poor health 9
due to long-term poverty and who meet criteria established by the Department 10
of Human Services, including without limitation the following: 11
(A) An individual between nineteen (19) and twenty -four 12
(24) years of age who has been previously placed under the supervision of 13
the: 14
(i) Division of Youth Services; or 15
(ii) Department of Corrections; 16
(B) An individual between nineteen (19) and twenty -seven 17
(27) years of age who has been previously placed under the supervision of the 18
Division of Children and Family Services; or 19
(C) An individual between nineteen (19) and thirty (30) 20
years of age who is a veteran; and 21
(4) Any other target populations identified by the Department of 22
Human Services. 23
(b)(1) Each community bridge organization shall be administered by a 24
hospital under conditions established by the Department of Human Services. 25
(2) A hospital is eligible to serve eligible individuals under 26
subdivision (a)(1) of this section if the hospital: 27
(A) Is a birthing hospital; 28
(B) Provides or contracts with a qualified entity for the 29
provision of a federally recognized evidence -based home visitation model to a 30
woman during pregnancy and to the woman and child for a period of up to 31
twenty-four (24) months after birth; and 32
(C) Meets any additional criteria established by the 33
Department of Human Services. 34
(3)(A) A hospital is eligible to serve eligible individuals 35
under subdivision (a)(2) of this section if the hospital: 36 SB62
18 01/14/2025 9:49:23 AM JMB152
(i) Is a small rural hospital; 1
(ii) Screens all Arkansans who seek services at the 2
hospital for health-related social needs; 3
(iii) Refers Arkansans identified as having health -4
related social needs for social services available in the community; 5
(iv) Employs local qualified staff to assist 6
eligible individuals in need of treatment for serious mental illness or 7
substance use disorder in accessing medical treatment from healthcare 8
professionals and supports to meet health -related social needs; 9
(v) Enrolls with the Arkansas Medicaid Program as an 10
acute crisis unit provider; and 11
(vi) Meets any additional criteria established by 12
the Department of Human Services. 13
(B) The hospital may use funding available through the 14
Department of Human Services to improve the hospital's ability to deliver 15
care through coordination with other healthcare professionals and with the 16
local emergency response system that may include training of personnel and 17
improvements in equipment to support the delivery of medical services through 18
telemedicine. 19
(4) A hospital is eligible to serve eligible individuals under 20
subdivision (a)(3) of this section if the hospital: 21
(A) Is an acute care hospital; 22
(B) Administers or contracts for the administration of 23
programs using proven models, as defined by the Department of Human Services, 24
to provide employment, training, education, or other social supports; and 25
(C) Meets any additional criteria established by the 26
Department of Human Services. 27
(c) An individual is not required or entitled to enroll in a community 28
bridge organization as a condition of Medicaid eligibility. 29
(d) A hospital is not: 30
(1) Required to apply to become a community bridge organization; 31
or 32
(2) Entitled to be selected as a community bridge organization. 33
34
23-61-1011. Health and Economic Outcomes Accountability Oversight 35
Advisory Panel. 36 SB62
19 01/14/2025 9:49:23 AM JMB152
(a) There is created the Health and Economic Outcomes Accountability 1
Oversight Advisory Panel. 2
(b) The advisory panel shall be composed of the following members: 3
(1) The following members of the General Assembly: 4
(A) The Chair of the Senate Committee on Public Health, 5
Welfare, and Labor; 6
(B) The Chair of the House Committee on Public Health, 7
Welfare, and Labor; 8
(C) The Chair of the Senate Committee on Education; 9
(D) The Chair of the House Committee on Education; 10
(E) The Chair of the Senate Committee on Insurance and 11
Commerce; 12
(F) The Chair of the House Committee on Insurance and 13
Commerce; 14
(G) An at-large member of the Senate appointed by the 15
President Pro Tempore of the Senate; 16
(H) An at-large member of the House of Representatives 17
appointed by the Speaker of the House of Representatives; 18
(I) An at-large member of the Senate appointed by the 19
minority leader of the Senate; and 20
(J) An at-large member of the House of Representatives 21
appointed by the minority leader of the House of Representatives; 22
(2) The Secretary of the Department of Human Services; 23
(3) The Arkansas Surgeon General; 24
(4) The Insurance Commissioner; 25
(5) The heads of the following executive branch agencies or 26
their designees: 27
(A) Department of Health; 28
(B) Department of Education; 29
(C) Department of Corrections; 30
(D) Department of Commerce; and 31
(E) Department of Finance and Administration; 32
(6) The Executive Director of the Arkansas Minority Health 33
Commission; and 34
(7)(A) Three (3) community members who represent health, 35
business, or education, who reflect the broad racial and geographic diversity 36 SB62
20 01/14/2025 9:49:23 AM JMB152
in the state, and who have demonstrated a commitment to improving the health 1
and welfare of Arkansans, appointed as follows: 2
(i) One (1) member shall be appointed by and serve 3
at the will of the Governor; 4
(ii) One (1) member shall be appointed by and serve 5
at the will of the President Pro Tempore of the Senate; and 6
(iii) One (1) member shall be appointed by and serve 7
at the will of the Speaker of the House of Representatives. 8
(B) Members serving under subdivision (b)(7)(A) of this 9
section may receive mileage reimbursement. 10
(c)(1) The Secretary of the Department of Human Services and one (1) 11
legislative member shall serve as the cochairs of the Health and Economic 12
Outcomes Accountability Oversight Advisory Panel and shall convene meetings 13
quarterly of the advisory panel. 14
(2) The legislative member who serves as the cochair shall be 15
selected by majority vote of all legislative members serving on the advisory 16
panel. 17
(d)(1) The advisory panel shall review, make nonbinding 18
recommendations, and provide advice concerning the proposed quality 19
performance targets presented by the Department of Human Services for each 20
participating individual qualified health insurance plan. 21
(2) The advisory panel shall deliver all nonbinding 22
recommendations to the Secretary of the Department of Human Services. 23
(3)(A) The Secretary of the Department of Human Services, in 24
consultation with the State Medicaid Director, shall determine all quality 25
performance targets for each participating individual qualified health 26
insurance plan. 27
(B) The Secretary of the Department of Human Services may 28
consider the nonbinding recommendations of the advisory panel when 29
determining quality performance targets for each participating individual 30
qualified health insurance plan. 31
(e) The advisory panel shall review: 32
(1) The annual quality assessment and performance improvement 33
strategic plan for each participating individual qualified health insurance 34
plan; 35
(2) Financial performance of the Arkansas Health and Opportunity 36 SB62
21 01/14/2025 9:49:23 AM JMB152
for Me Program against the budget neutrality targets in each demonstration 1
year; 2
(3) Quarterly reports prepared by the Department of Human 3
Services, in consultation with the Department of Commerce, on progress 4
towards meeting economic independence outcomes and health improvement 5
outcomes, including without limitation: 6
(A) Community bridge organization outcomes; 7
(B) Individual qualified health insurance plan health 8
improvement outcomes; 9
(C) Economic independence initiative outcomes; and 10
(D) Any sanctions or penalties assessed on participating 11
individual qualified health insurance plans; 12
(4) Quarterly reports prepared by the Department of Human 13
Services on the Arkansas Health and Opportunity for Me Program, including 14
without limitation: 15
(A) Eligibility and enrollment; 16
(B) Utilization; 17
(C) Premium and cost -sharing reduction costs; and 18
(D) Health insurer participation and competition; and 19
(5) Any other topics as requested by the Secretary of the 20
Department of Human Services. 21
(f)(1) The advisory panel may furnish advice, gather information, make 22
recommendations, and publish reports. 23
(2) However, the advisory panel shall not administer any portion 24
of the Arkansas Health and Opportunity for Me Program or set policy. 25
(g) The Department of Human Services shall provide administrative 26
support necessary for the advisory panel to perform its duties. 27
(h) The Department of Human Services shall produce and submit a 28
quarterly report incorporating the advisory panel's findings to the President 29
Pro Tempore of the Senate, the Speaker of the House of Representatives, and 30
the public on the progress in health and economic improvement resulting from 31
the Arkansas Health and Opportunity for Me Program, including without 32
limitation: 33
(1) Eligibility and enrollment; 34
(2) Participation in and the impact of the economic independence 35
initiative and the health improvement initiative of the eligible individuals, 36 SB62
22 01/14/2025 9:49:23 AM JMB152
health insurers, and community bridge organizations; 1
(3) Utilization of medical services; 2
(4) Premium and cost -sharing reduction costs; and 3
(5) Health insurer participation and completion. 4
5
23-61-1012. Rules. 6
The Department of Human Services shall adopt rules necessary to 7
implement this subchapter. 8
9
SECTION 7. Arkansas Code § 26 -57-604(a)(1)(B)(ii), concerning the 10
allowance of a credit to be applied against the insurance premium tax, is 11
amended to read as follows: 12
(ii) However, the credit shall not be applied as an 13
offset against the premium tax on collections resulting from an eligible 14
individual insured under the Arkansas Health and Opportunity for Me Act of 15
2021, § 23-61-1001 et seq., the Arkansas Health Insurance Marketplace Act, § 16
23-61-801 et seq., or individual qualified health insurance plans, including 17
without limitation stand -alone dental plans, issued through the health 18
insurance marketplace as defined by § 23 -61-1003. 19
20
SECTION 8. Arkansas Code § 26 -57-610(b)(2), concerning the disposition 21
of the insurance premium tax, is amended to read as follows: 22
(2) The taxes based on premiums collected under the Arkansas 23
Health and Opportunity for Me Act of 2021, § 23 -61-1001 et seq., the Arkansas 24
Health Insurance Marketplace Act, § 23 -61-801 et seq., or individual 25
qualified health insurance plans, including without limitation stand -alone 26
dental plans, issued through the health insurance marketplace as defined by § 27
23-61-1003 shall be: 28
(A) At the time of deposit, separately Separately 29
certified by the commissioner to the Treasurer of State at the time of 30
deposit for classification and distribution under this section; and 31
(B) Transferred to the Arkansas Health and Opportunity for 32
Me Program Trust Fund and used as required by the Arkansas Health and 33
Opportunity for Me Program Trust Fund; 34
35
36