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This page lists some of the action toward parity compliance undertaken by Arkansas regulatory agencies since 2008.

Are we missing any actions taken by state regulatory agencies? Let us know at info@paritytrack.org.

Action in the Regulatory Arena

9/2012

The Arkansas Insurance Department issued a directive (pdf | Get Adobe® Reader®) that identified and explained which insurance plan it selected to be the benchmark plan for small employer plans and individual plans offered on the health insurance exchange created by the Affordable Care Act. This directive explained that the selected plan did not meet the requirements of the Federal Parity Law and therefore must be supplemented with the behavioral health coverage from a different plan in order to be the state’s benchmark plan.

8/2009

The Arkansas Insurance Department issued a bulletin (pdf | Get Adobe® Reader®) to insurers that explained what was required of them by the parity section of the Arkansas insurance law and the Federal Parity Law. The most significant points of clarification were:

  • Stated that the Department would probably need to issue a regulation regarding the Federal Parity Law but would wait until the federal regulation was issued
  • Explained which plans the Federal Parity Law applied to and to which plans the section of state insurance law applied
  • Explained that a small employer is defined as it is in Arkansas law (2-50 employees)
  • Explained that plans need to provide those they cover with the criteria they use for medical necessity
  • Listed the documents and information plans must provide to those they cover if there is a denial of coverage
  • Clarified that the parity section of the state insurance law supersedes other sections of the state insurance law about behavioral health coverage

1998

Primary Focus: Parity-General

Agency: Insurance Department

Title/Description: Mental Health Parity

Citation: 054 00 CARR 071

Summary: Upon the filing of a group policy or certificate applicable to more than fifty lives, the Department will seek verification of whether mental health benefits will, in fact, be offered. If they are offered, the Department of Insurance will seek verification that the annual and lifetime limits are equal to those provided for medical coverage. If mental health benefits are offered and annual and lifetime limits are not equal to similar medical coverage limits, then the health care insurer shall provide an actuarial certification that the cost calculated retrospectively, has increased by one percent (1%) or more, with supporting documentation based on the appropriate Actuarial Standards of Practice.

Effective Date:  July 6, 1998

Notes: N/A

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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, and individual 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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Arkansas Insurance Division

Common Violations

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

Common Violations

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