Arkansas

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

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:

• Financial requirements must be on the same terms and conditions as those in place for other medical services
• Annual maximums and lifetime maximums must be on the same terms and conditions as those in place for other medical services
• Outpatient visit limits and inpatient day limits must be on the same terms and conditions as limits for other medical services
• Reimbursement rates for behavioral health providers do not have to be equal to those for comparable providers of other medical services
• Medical necessity criteria used by a plan and explanations of denials of care must be disclosed to patients
• Plans are required to cover out-of-network services for behavioral health treatment if they do so for other medical treatment
• Plans are allowed to use utilization management, prior authorization, and other non-quantitative treatment limitations even if they do not use them for treatment of other medical conditions

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:

• Annual maximum of $7,500
• Deductibles, payments for outpatient care, and payments for partial hospitalization must be the same as those in place for other medical care until the annual maximum is reached
• Coinsurance for any mental health service cannot be higher than 20%

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

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.