Browse Arkansas Code titles and sections
23-76-116. Complaint system.
Arkansas Code — all titles (historical 2020) · legal_authorities
23-76-116. Complaint system.
(a)(1) Every health maintenance organization shall establish and maintain a complaint system that has been approved by the Insurance Commissioner to provide reasonable procedures for the resolution of written complaints initiated by enrollees concerning healthcare services.
(2) Each health maintenance organization shall submit to the commissioner an annual report in a form prescribed by the commissioner that shall include:
(A) A description of the procedures of the complaint system;
(B) The total number of complaints handled through the complaint system and a compilation of causes underlying the complaints filed; and
(C) The number, amount, and disposition of malpractice claims settled during the year by the health maintenance organization.
(b)(1) The health maintenance organization shall maintain records of written complaints filed with it concerning issues and persons other than healthcare services and shall submit to the commissioner a summary report at such times and in such format as the commissioner may require.
(2) Complaints involving other persons shall be referred to the persons with a copy to the commissioner.
(c) The commissioner may examine the complaint system, subject to the limitation concerning medical records of individuals set forth in § 23-76-122(c).
Source: Arkansas Code — historical release 78 (November 6, 2020) · 23-76-116
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. A text match is a research starting point; applicability is not established.
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Record provenance
Stable record: arkansas_code:legal_authorities:23-76-116
Source file: gov.ar.code.title.23.odt
Pages: Not recorded – Not recorded
Passage SHA-256: 5ffed661d702939f68325a4ebc5ee9df4e3bb38e49ee46ecd3fc69216879a234
Source location: content.xml paragraph 43804
Stored source content
23-76-116. Complaint system.
(a)(1) Every health maintenance organization shall establish and maintain a complaint system that has been approved by the Insurance Commissioner to provide reasonable procedures for the resolution of written complaints initiated by enrollees concerning healthcare services.
(2) Each health maintenance organization shall submit to the commissioner an annual report in a form prescribed by the commissioner that shall include:
(A) A description of the procedures of the complaint system;
(B) The total number of complaints handled through the complaint system and a compilation of causes underlying the complaints filed; and
(C) The number, amount, and disposition of malpractice claims settled during the year by the health maintenance organization.
(b)(1) The health maintenance organization shall maintain records of written complaints filed with it concerning issues and persons other than healthcare services and shall submit to the commissioner a summary report at such times and in such format as the commissioner may require.
(2) Complaints involving other persons shall be referred to the persons with a copy to the commissioner.
(c) The commissioner may examine the complaint system, subject to the limitation concerning medical records of individuals set forth in § 23-76-122(c).
Cross-references
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Arkansas Code — all titles (historical 2020) · legal_authorities
23-76-122. Examinations.
(a) The Insurance Commissioner may make an examination of the affairs of any health maintenance organization as often as he or she deems it necessary for the protection of the interests of the people of this state but not less frequently than one (1) time every three (3) years.
(b) The commissioner may make an examination concerning the quality of healthcare services of any health maintenance organization as often as he or she deems it necessary for the protection of the interests of the people of this state but not less frequently than one (1) time every three (3) years.
(c)(1) Every health maintenance organization shall submit its books and records relating to the healthcare plan to the examinations and in every way facilitate them.
(2) For the purpose of examinations, the commissioner may administer oaths to and examine the officers and agents of the health maintenance organization.
(3) Medical records of individuals and records of physicians and hospitals providing services under a contract to the health maintenance organization shall be subject to the examination.
(d) The expenses of examinations under this section shall be assessed against the health maintenance organization being examined and remitted to the commissioner.
(e) In lieu of the examination, the commissioner may accept the report of an examination made by the insurance commissioner of another state or director of the department of health of another state.
(f)(1) Any examination under this section that is to commence within one (1) year prior to the date a health maintenance organization shall cease to provide healthcare services in this state, may be reduced in scope or waived in its entirety, upon application of the health maintenance organization and approval
Source: Arkansas Code — historical release 78 (November 6, 2020) · 23-76-122
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 23-76-122. This identifies an authority to review, not proof of applicability.