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Legislation Signed Into Law

2019

Primary Focus: Medical Management Limitation
Title/Description:  To Amend The Prior Authorization Transparency Act; To Prohibit Prior Authorization For Medication-Assisted Treatment; And To Declare An Emergency
Citation: A.C.A Section 23-99-11
Summary: This act amends Arkansas Code Title 23, Chapter 99, Subchapter 11 by prohibiting insurers from imposing prior authorization or any other requirement other than a prescription for coverage of specified drugs used for the purposes of MAT. Additionally, such MAT drugs must be placed on the lowest tier of the prescription drug formulary.
Effective Date: Effective upon approval per Emergency Clause
Notes: Enacted through HB 1656

2017

Primary Focus: Mandated Benefits
Title/Description: Minimum benefits for mental illness in group accident and health insurance policies or subscriber’s contracts.
Citation: A.C.A. § 23-86-113
Summary: All group accident and health insurance policy or group contract of hospital and medical services corporations providing hospitalization or medical benefits to Arkansas residents for conditions arising from mental illness shall provide a variety of minimum benefits, including services furnished by a psychiatric hospital or an outpatient psychiatric center, a psychologist or a community mental health center. Copayment requirements for mental illness shall not exceed a twenty percent copayment requirements.
Effective Date: April 5, 2017
Notes: Enacted through HB 1289 (2017 Regular Session)

Primary Focus: Mandated Benefits
Title/Description: Benefits for alcohol or drug dependency treatment.
Citation: A.C.A. § 23-79-139
Summary: Every insurer, hospital and medical service corporation, and HMO transacting accident and health insurance shall make available benefits for the necessary care and treatment of alcohol and other drug dependency that are not less favorable than for physical illness generally, subject to the same durational limits, dollar limits, deductibles and coinsurance factors. Any benefits provided under alcohol or drug dependency coverage shall be determined as necessary care and treatment in an alcohol or drug dependency treatment facility or care and treatment in a hospital.
Effective Date: April 5, 2017
Notes: Enacted through HB 1289 (2017 Regular Session)

Primary Focus: Risk-Based Providers and Improving Patient Outcomes
Title/Description: Characteristics and Duties of Risk-Based Provider Organization
Citation: ARK. CODE. ANN. § 20-77-2706
Summary: Arkansas enacted legislation designating risk-based provider organizations as equivalent to insurance companies under Arkansas law, and reforming the Arkansas Medicaid program to improve patient outcomes. ARK. CODE. ANN. § 20-77-2706 mandates that risk-based provider organizations and insurers must include an Arkansas licensed behavioral health services provider in their membership. In addition, upon licensure by the commissioner, a risk-based provider organization shall create a consumer advisory council consisting of consumers of developmental, behavioral health, and substance abuse treatment services. Finally, the Department of Human Services must create rules in conjunction with behavioral health service providers to establish criteria for quality incentive payments to encourage and reward the delivery of accessible, high quality behavioral health care. ARK. CODE. ANN. § 20-77-2706 aims to allow individuals with developmental and behavioral health disabilities to participate in decisions regarding their care, including the right to refuse treatment, the right to continuity of care, and the right to choose among providers who participate in his or her network.
Effective Date: Approved March 31, 2017
Notes: ARK. CODE. ANN. § 20-77-2706 adopted the provisions proposed in HB 1706.

2011

HB 1315
Introduced: 2/2011
Sponsor: Rep. Lindsey
Status: Signed into law 3/2011
Summary: This bill changed the state insurance law by adding the section about autism coverage. A summary of this section of the law is at the bottom of this page in the “Arkansas Parity Law” section.

2009-2010

Primary Focus: Mandated Benefits
Title/Description: Out-of-Network Providers
Citation: A.C.A. § 23-99-512
Summary: In the case of a health benefit plan that provides both medical benefits and mental illness benefits, if the health benefit plan provides coverage for medical benefits provided by out-of-network providers, the health benefit plan shall provide coverage for mental illness benefits provided by out-of-network providers.
Effective date: October 3, 2009
Notes: Enacted through HB2195 (2009 Regular Session)

Primary Focus: Parity-General
Title/Description: Parity Requirements
Citation: A.C.A. § 23-99-506
Summary: A health benefit plan that provides benefits for the diagnosis and treatment of mental illnesses shall provide the benefits under the same terms and conditions as provided for covered benefits offered under the health benefit plan for the treatment of other medical illnesses and conditions, including with regards to the duration or frequency of coverage, the dollar amount of coverage, or the financial requirements. That said, some limitations are in place, and this law does not require equal coverage between treatments for a mental illness with coverage for preventative care.
Effective Date: October 3, 2009
Notes: Enacted through HB2195 (2009 Regular Session)

HB 2195
Introduced: 3/2009
Sponsor: Rep. Pennartz
Status: Signed into Law 4/2009
Summary: This bill changed the section of the state insurance law relevant to parity. It changed this section law in several significant ways:

Arkansas Parity Law

The state insurance law of Arkansas has three sections about behavioral health coverage and a section about coverage for autism services:

Title 23 Chapter 99 Subchapters 501-512 (Addresses mental health conditions and substance use disorders and applies to large employer fully-insured plans, small employer fully-insured plans, and individual plans ) Title 23 Chapter 86 Subchapter 113 (only addresses mental health conditions and only applies to small employer fully-insured plans) Title 23 Chapter 79 Subchapter 139 (only addresses substance use disorders and only applies to small employer fully-insured plans) Title 23 Chapter 99 Section 515 (addresses autism and applies to large employer fully-insured plans, small employer fully-insured plans, and individual plans)

Please be aware that it is not possible to provide direct links to any of these sections of the law. To find these sections, go to this link click on the plus sign next to Title 23. Then click on the plus sign next to subtitle 3 (Insurance). Then click on the plus sign next to the appropriate chapter. Then click on the appropriate subchapter:
– Subchapter 5 for 23-99-501-512
– Subchapter 1 for 23-86-113
– Subchapter 1 for 23-79-139
– Subchapter 5 for 23-99-515

Behavioral Health

23-99-501-512

This section of the law (comprised of 12 subsections) applies to large employer fully-insured plans, small employer fully-insured plans, individual plans, state employee plans, and public school employee plans. Individual plans and small employer plans must offer optional coverage for behavioral health services that can be accepted or rejected by the individual or employer. Large employer fully-insured plans are not required to cover behavioral health services nor are they required to offer it to large employers. However, they must follow the other parts of these sections if they do cover behavioral health services. Before HB 2195 was signed into law in 2009 (summarized above), large employer fully-insured plans were required to cover behavioral health services.

For plans that do include behavioral health coverage, here are the significant provisions that are in place:

There is also very detailed instructions explaining when plans can apply for a cost exemption from this section of the law, how long they will be exempted, and the authority the Insurance Commissioner has to examine the financial data that determines if the plan is eligible for continued exemption.

23-86-113

This section only applies to small employer fully-insured plans (according to this bulletin (pdf | Get Adobe® Reader®) from the Arkansas Insurance Department). These plans must offer optional coverage for mental health services to small employers that can be accepted or rejected by the small employer. This optional coverage is not as extensive as the optional coverage for small employers described above in 23-99-501-512.

For plans that do include mental health coverage, here are the significant provisions that are in place:

23-79-139

This section only applies to small employer fully-insured plans (according to this bulletin (pdf | Get Adobe® Reader®) the Arkansas Insurance Department). These plans must offer optional coverage for substance use disorder services to small employers that can be accepted or rejected by the small employer. This optional coverage is not as extensive as the optional coverage for small employers described above in 23-99-501-512.

For plans that do include mental health coverage, here are the significant provisions that are in place:

  • $12,000 lifetime maximum
  • $6,000 24-month maximum
  • No more than $3,000 can be spent over the course of 30 days during a 24-month time period

Autism

23-99-515

This section requires large employer fully-insured plans, small employer plans, state employee plans, and public school employee plans to cover services for autism. Autism spectrum disorder is defined as “any of the pervasive developmental disorders” in the DSM including:

  • Autistic Disorder
  • Asperger’s Disorder
  • Pervasive developmental disorder not otherwise specified

Treatment for autism spectrum disorder is defined as:

  • Applied behavior analysis
  • Psychiatric care
  • Psychological care
  • Therapeutic care
  • Pharmacy care
  • Equipment determined necessary to provide evidence-based treatment

All of these are defined in more detail in this section of the law. It also requires coverage for any services “determined by a licensed physician to be medically necessary and evidence-based.”

The annual maximum for applied behavior analysis is $50,000 for children under 18.

All other annual maximums, lifetime maximums, deductibles, and coinsurance must be “no less favorable” than than those in place for other medical services.

Plans are not allowed to perform medical necessity reviews of autism services “to a greater extent” than they do for other medical services.

This section exempts plans that are offered on the state exchange through the Affordable Care Act.

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Common Violations

In seeking care or services, be aware of the common ways parity rights can be violated.

Common Violations

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