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23-61-1003. Definitions.
Arkansas Code — all titles (historical 2020) · legal_authorities
23-61-1003. Definitions.
As used in this subchapter:
(1) “Cost-effective” means that the cost of covering employees who are:
(A) Program participants, either individually or together within an employer health insurance coverage, is the same or less than the cost of providing comparable coverage through individual qualified health insurance plans; or
(B) Eligible individuals who are not program participants, either individually or together within an employer health insurance coverage, is the same or less than the cost of providing comparable coverage through a program authorized under Title XIX of the Social Security Act, 42 U.S.C. § 1396 et seq., as it existed on January 1, 2016;
(2) “Cost sharing” means the portion of the cost of a covered medical service that is required to be paid by or on behalf of an eligible individual;
(3) “Eligible individual” means an individual who is in the eligibility category created by section 1902(a)(10)(A)(i)(VIII) of the Social Security Act, 42 U.S.C. § 1396a;
(4) “Employer health insurance coverage” means a health insurance benefit plan offered by an employer or, as authorized by this subchapter, an employer self-funded insurance plan governed by the Employee Retirement Income Security Act of 1974, Pub. L. No. 93-406, as amended;
(5) “Health insurance benefit plan” means a policy, contract, certificate, or agreement offered or issued by a health insurer to provide, deliver, arrange for, pay for, or reimburse any of the costs of healthcare services, but not including excepted benefits as defined under 42 U.S.C. § 300gg-91(c), as it existed on January 1, 2016;
(6) “Health insurance marketplace” means the applicable entities that were designed to help individuals, families, and businesses in Arkansas shop for and select h
Source: Arkansas Code — historical release 78 (November 6, 2020) · 23-61-1003
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23-61-1003. Definitions.
As used in this subchapter:
(1) “Cost-effective” means that the cost of covering employees who are:
(A) Program participants, either individually or together within an employer health insurance coverage, is the same or less than the cost of providing comparable coverage through individual qualified health insurance plans; or
(B) Eligible individuals who are not program participants, either individually or together within an employer health insurance coverage, is the same or less than the cost of providing comparable coverage through a program authorized under Title XIX of the Social Security Act, 42 U.S.C. § 1396 et seq., as it existed on January 1, 2016;
(2) “Cost sharing” means the portion of the cost of a covered medical service that is required to be paid by or on behalf of an eligible individual;
(3) “Eligible individual” means an individual who is in the eligibility category created by section 1902(a)(10)(A)(i)(VIII) of the Social Security Act, 42 U.S.C. § 1396a;
(4) “Employer health insurance coverage” means a health insurance benefit plan offered by an employer or, as authorized by this subchapter, an employer self-funded insurance plan governed by the Employee Retirement Income Security Act of 1974, Pub. L. No. 93-406, as amended;
(5) “Health insurance benefit plan” means a policy, contract, certificate, or agreement offered or issued by a health insurer to provide, deliver, arrange for, pay for, or reimburse any of the costs of healthcare services, but not including excepted benefits as defined under 42 U.S.C. § 300gg-91(c), as it existed on January 1, 2016;
(6) “Health insurance marketplace” means the applicable entities that were designed to help individuals, families, and businesses in Arkansas shop for and select health insurance benefit plans in a way that permits comparison of available plans based upon price, benefits, services, and quality, and refers to either:
(A) The Arkansas Health Insurance Marketplace created under the Arkansas Health Insurance Marketplace Act, § 23-61-801 et seq., or a successor entity; or
(B) The federal health insurance marketplace or federal health benefit exchange created under the Patient Protection and Affordable Care Act, Pub. L. No. 111-148;
(7) “Health insurer” means an insurer authorized by the State Insurance Department to provide health insurance or a health insurance benefit plan in the State of Arkansas, including without limitation:
(A) An insurance company;
(B) A medical services plan;
(C) A hospital plan;
(D) A hospital medical service corporation;
(E) A health maintenance organization;
(F) A fraternal benefits society; or
(G) Any other entity providing health insurance or a health insurance benefit plan subject to state insurance regulation;
(8) “Individual qualified health insurance plan” means an individual health insurance benefit plan offered by a health insurer through the health insurance marketplace that covers only essential health benefits as defined by Arkansas rule and 45 C.F.R. § 156.110 and any federal insurance regulations, as they existed on January 1, 2016;
(9) “Premium” means a monthly fee that is required to be paid to maintain some or all health insurance benefits;
(10) “Program participant” means an eligible individual who:
(A) Is at least nineteen (19) years of age and no more than sixty-four (64) years of age with an income that meets the income eligibility standards established by rule of the Department of Human Services;
(B) Is authenticated to be a United States citizen or documented qualified alien according to the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, Pub. L. No. 104-193;
(C) Is not eligible for Medicare or advanced premium tax credits through the health insurance marketplace; and
(D) Is not determined to be more effectively covered through the traditional Arkansas Medicaid Program, including without limitation:
(i) An individual who is medically frail; or
(ii) An individual who has exceptional medical needs for whom coverage offered through the health insurance marketplace is determined to be impractical, overly complex, or would undermine continuity or effectiveness of care; and
(11)(A) “Small group plan” means a health insurance benefit plan for a small employer that employed an average of at least two (2) but no more than fifty (50) employees during the preceding calendar year.
(B) “Small group plan” does not include a grandfathered health insurance plan as defined in 45 C.F.R. § 147.140(a)(1)(i), as it existed on January 1, 2016.
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Federal law — U.S. Code and appendices · legal_authorities
**(a) Establishment** There is hereby established the Medicaid and CHIP Payment and Access Commission (in this section referred to as “MACPAC”).
**(b) Duties**
(1) **Review of access policies for all States and annual reports** — MACPAC shall—
(A) review policies of the Medicaid program established under this subchapter (in this section referred to as “Medicaid”) and the State Children’s Health Insurance Program established under subchapter XXI (in this section referred to as “CHIP”) affecting access to covered items and services, including topics described in paragraph (2);
(B) make recommendations to Congress, the Secretary, and States concerning such access policies;
(C) by not later than March 15 of each year (beginning with 2010), submit a report to Congress containing the results of such reviews and MACPAC’s recommendations concerning such policies; and
(D) by not later than June 15 of each year (beginning with 2010), submit a report to Congress containing an examination of issues affecting Medicaid and CHIP, including the implications of changes in health care delivery in the United States and in the market for health care services on such programs.
(2) **Specific topics to be reviewed** — Specifically, MACPAC shall review and assess the following:
(A) *Medicaid and CHIP payment policies* — Payment policies under Medicaid and CHIP, including—
(i) the factors affecting expenditures for the efficient provision of items and services in different sectors, including the process for updating payments to medical, dental, and health professionals, hospitals, residential and long-term care providers, providers of home and community based services, Federally-qualified health centers and rural health clinics, managed care entities, and providers of ot
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1396
Stored review status: release_metadata_unconfirmed. The source passage cites 42 U.S.C. § 1396. This identifies an authority to review, not proof of applicability.
Federal law — U.S. Code and appendices · legal_authorities
Page 4009
TITLE 42—THE PUBLIC HEALTH AND WELFARE
§ 1396
of the enactment of this Act [Oct. 6, 2014], the Sec-
retary shall develop and report to Congress on a stra-
tegic plan for collecting or otherwise accessing data on
race and ethnicity for purposes of specifying quality
measures and resource use and other measures under
subsections (c) and (d) of section 1899B of the Social Se-
curity Act, as added by subsection (a), and, as the Sec-
retary determines appropriate, other similar provisions
of, including payment adjustments under, title XVIII of
such Act (42 U.S.C. 1395 et seq.).’’
SUBCHAPTER XIX—GRANTS TO STATES
FOR MEDICAL ASSISTANCE PROGRAMS
§ 1396. Medicaid and CHIP Payment and Access
Commission
(a) Establishment
There is hereby established the Medicaid and
CHIP Payment and Access Commission (in this
section referred to as ‘‘MACPAC’’).
(b) Duties
(1) Review of access policies for all States and
annual reports
MACPAC shall—
(A) review policies of the Medicaid pro-
gram established under this subchapter (in
this section referred to as ‘‘Medicaid’’) and
the State Children’s Health Insurance Pro-
gram established under subchapter XXI (in
this section referred to as ‘‘CHIP’’) affecting
access to covered items and services, includ-
ing topics described in paragraph (2);
(B) make recommendations to Congress,
the Secretary, and States concerning such
access policies;
(C) by not later than March 15 of each year
(beginning with 2010), submit a report to
Congress containing the results of such re-
views and MACPAC’s recommendations con-
cerning such policies; and
(D) by not later than June 15 of each year
(beginning with 2010), submit a report to
Congress
containing
an
examination
of
issues affecting Medicaid and CHIP, includ-
ing the impli
Source: Supplied 2024 U.S. Code historical extraction · 42 U.S.C. § 1396
Stored review status: historical_2024_not_currentness_verified. The source passage cites 42 U.S.C. § 1396. This identifies an authority to review, not proof of applicability.
Federal law — U.S. Code and appendices · legal_authorities
**(a) Contents** A State plan for medical assistance must—
(1) provide that it shall be in effect in all political subdivisions of the State, and, if administered by them, be mandatory upon them;
(2) provide for financial participation by the State equal to not less than 40 per centum of the non-Federal share of the expenditures under the plan with respect to which payments under [section 1396b of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1396b&num=0&edition=prelim) are authorized by this subchapter; and, effective July 1, 1969, provide for financial participation by the State equal to all of such non-Federal share or provide for distribution of funds from Federal or State sources, for carrying out the State plan, on an equalization or other basis which will assure that the lack of adequate funds from local sources will not result in lowering the amount, duration, scope, or quality of care and services available under the plan;
(3) provide for granting an opportunity for a fair hearing before the State agency to any individual whose claim for medical assistance under the plan is denied or is not acted upon with reasonable promptness;
(4) provide (A) such methods of administration (including methods relating to the establishment and maintenance of personnel standards on a merit basis, except that the Secretary shall exercise no authority with respect to the selection, tenure of office, and compensation of any individual employed in accordance with such methods, including provision for utilization of professional medical personnel in the administration and, where administered locally, supervision of administration of the plan, and, subject to [section 1396b(i) of this title](https://uscode.house.gov/view.xhtml?req=granulei
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1396a
Stored review status: release_metadata_unconfirmed. The source passage cites 42 U.S.C. § 1396a. This identifies an authority to review, not proof of applicability.
Federal law — U.S. Code and appendices · legal_authorities
Page 4015
TITLE 42—THE PUBLIC HEALTH AND WELFARE
§ 1396a
‘‘(1) work with States, pediatric dentists, and other
dental providers (including providers that are, or are
affiliated with, a school of dentistry) to include, not
later than 6 months after the date of the enactment
of this Act [Feb. 4, 2009], on the Insure Kids Now
website (http://www.insurekidsnow.gov/) and hotline
(1–877–KIDS–NOW) (or on any successor websites or
hotlines) a current and accurate list of all such den-
tists and providers within each State that provide
dental services to children enrolled in the State plan
(or waiver) under Medicaid or the State child health
plan (or waiver) under CHIP, and shall ensure that
such list is updated at least quarterly; and
‘‘(2) work with States to include, not later than 6
months after the date of the enactment of this Act,
a description of the dental services provided under
each State plan (or waiver) under Medicaid and each
State child health plan (or waiver) under CHIP on
such Insure Kids Now website, and shall ensure that
such list is updated at least annually.’’
DEADLINE FOR INITIAL APPOINTMENTS
Pub. L. 111–3, title V, § 506(b), Feb. 4, 2009, 123 Stat. 95,
provided that: ‘‘Not later than January 1, 2010, the
Comptroller General of the United States shall appoint
the initial members of the Medicaid and CHIP Payment
and Access Commission established under section 1900
of the Social Security Act [42 U.S.C. 1396] (as added by
subsection (a)).’’
ANNUAL REPORT
Pub. L. 111–3, title V, § 506(c), Feb. 4, 2009, 123 Stat. 95,
provided that: ‘‘Not later than January 1, 2010, and an-
nually thereafter, the Secretary [of Health and Human
Services], in consultation with the Secretary of the
Treasury, the Secretary of Labor, and the States (as
d
Source: Supplied 2024 U.S. Code historical extraction · 42 U.S.C. § 1396a
Stored review status: historical_2024_not_currentness_verified. The source passage cites 42 U.S.C. § 1396a. This identifies an authority to review, not proof of applicability.
Federal law — U.S. Code and appendices · legal_authorities
Page 1655
TITLE 42—THE PUBLIC HEALTH AND WELFARE
§ 300gg–91
1 See References in Text note below.
111–148, title I, § 1563(c)(15), formerly § 1562(c)(15),
title X, § 10107(b)(1), Mar. 23, 2010, 124 Stat. 269,
911.)
Editorial Notes
AMENDMENTS
2010—Pub.
L.
111–148,
§ 1563(c)(15)(A),
formerly
§ 1562(c)(15)(A), as renumbered by Pub. L. 111–148,
§ 10107(b)(1), inserted ‘‘and application’’ after ‘‘Preemp-
tion’’ in section catchline.
Subsec. (c). Pub. L. 111–148, § 1563(c)(15)(B), formerly
§ 1562(c)(15)(B), as renumbered by Pub. L. 111–148,
§ 10107(b)(1), added subsec. (c).
1996—Subsec. (b). Pub. L. 104–204, § 605(b)(3), des-
ignated existing provisions as par. (1) and added par.
(2).
Statutory Notes and Related Subsidiaries
EFFECTIVE DATE OF 1996 AMENDMENT
Amendment by Pub. L. 104–204 applicable to health
insurance coverage offered, sold, issued, renewed, in ef-
fect, or operated in the individual market on or after
Jan. 1, 1998, see section 605(c) of Pub. L. 104–204, set out
as a note under section 300gg–44 of this title.
EFFECTIVE DATE
Section applicable with respect to health insurance
coverage offered, sold, issued, renewed, in effect, or op-
erated in the individual market after June 30, 1997, re-
gardless of when a period of creditable coverage occurs,
see section 111(b) of Pub. L. 104–191, set out as a note
under section 300gg–41 of this title.
§ 300gg–63. General exceptions
(a) Exception for certain benefits
The requirements of this part shall not apply
to any health insurance coverage in relation to
its provision of excepted benefits described in
section 300gg–91(c)(1) of this title.
(b) Exception for certain benefits if certain con-
ditions met
The requirements of this part shall not apply
to any health insurance coverage in relati
Source: Supplied 2024 U.S. Code historical extraction · 42 U.S.C. § 300gg-91
Stored review status: historical_2024_not_currentness_verified. The source passage cites 42 U.S.C. § 300gg-91. This identifies an authority to review, not proof of applicability.
Arkansas Code — all titles (historical 2020) · legal_authorities
23-61-801. Title.
This subchapter shall be known and may be cited as the “Arkansas Health Insurance Marketplace Act”.
Source: Arkansas Code — historical release 78 (November 6, 2020) · 23-61-801
Stored review status: Historical 2020-11-06 source release; later amendments not reconciled; machine-extracted, not independently legally reviewed; source heading status: text_in_historical_source. The source passage cites 23-61-801. This identifies an authority to review, not proof of applicability.