23-61-804. Duties of Arkansas Health Insurance Marketplace.

23-61-804. Duties of Arkansas Health Insurance Marketplace. (a) The Arkansas Health Insurance Marketplace shall: (1) Implement procedures and criteria for the certification, recertification, and decertification of health benefit plans as qualified health plans in compliance with state and federal law; (2) Provide for the operation of a toll-free telephone hotline to respond to requests for assistance; (3) Require that a health carrier offering a qualified health plan post on the public part of its website in a readily accessible format the formulary list for each individual qualified health plan and the following information: (A) The qualified health plan to which the formulary applies; (B) Any exclusions from coverage or restrictions, including: (i) Any tiering structure, including copay and coinsurance requirements; (ii) Prior authorization requirements; (iii) Step-therapy requirements; (iv) Deductibles and cost sharing; (v) Quantity limits; and (vi) Whether access is dependent upon the location where a prescription drug is obtained or administered; and (C) The appeal process for a denial of coverage or adverse determination for an item or service for a prescription drug; (4)(A) Establish a small business health options program through which qualified employers may access coverage for their employees. (B) The small business health options program, without limitation, shall enable a qualified employer to specify a level of coverage so that any of its employees may enroll in a qualified health plan offered through the program at the specified level of coverage. (C) This subdivision (a)(4) does not apply if an available qualified health carrier does not offer a health benefit plan under the small business health options program; (5)(A) Select entities qualified to serve as navigators and award grants to enable navigators to: (i) Conduct public education activities to raise awareness of the availability of qualified health plans; (ii) Distribute fair and impartial information concerning enrollment in qualified health plans and the availability of premium tax credits under 26 U.S.C. § 36B, as existing on April 23, 2013, and cost-sharing reductions under section 1402 of the federal act; (iii) Facilitate enrollment in qualified health plans; (iv) Provide referrals to any applicable office of health insurance consumer assistance or health insurance ombudsman or to any other appropriate state agency for any enrollee with a grievance, complaint, or question regarding his or her health benefit plan or health benefit coverage or a determination under his or her health benefit plan or health benefit coverage; and (v) Provide information in a manner that is culturally and linguistically appropriate to the needs of the population being served by the Arkansas Health Insurance Marketplace. (B) The Insurance Commissioner shall ensure in the navigator selection process that the navigators are geographically, culturally, ethnically, and racially representative of the populations served; and (6) Otherwise comply with a requirement the commissioner determines is necessary to obtain or maintain the approval to administer a health insurance marketplace. (b) If the Governor determines that a state-based exchange not on the federal platform for the individual health insurance marketplace is beneficial and appropriate, the Arkansas Health Insurance Marketplace shall: (1)(A) Maintain a website through which enrollees and prospective enrollees of qualified health plans may obtain standardized comparative information on such plans. (B) The commissioner shall ensure that an entity offering a qualified health plan through the Arkansas Health Insurance Marketplace posts the information described in § 23-79-159 on the Arkansas Health Insurance Marketplace website in a readily accessible format; (2) Assign a rating to each qualified health plan offered through the Arkansas Health Insurance Marketplace and determine each qualified health plan's level of coverage in accordance with regulations issued by the United States Secretary of Health and Human Services under section 1302(d)(2)(A) of the federal act; (3) Use a standardized format for presenting health benefit options in the Arkansas Health Insurance Marketplace; and (4) Establish and make available by electronic means a calculator to determine the actual cost of coverage after application of a premium tax credit under section 36B of the Internal Revenue Code of 1986 as existing on April 23, 2013, and any cost-sharing reduction under section 1402 of the federal act.