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23-79-1502. Craniofacial anomaly — Coverage for reconstructive surgery required.
Arkansas Code — all titles (historical 2020) · legal_authorities
23-79-1502. Craniofacial anomaly — Coverage for reconstructive surgery required.
(a)(1) A health benefit plan that is offered, issued, provided, or renewed in this state shall include coverage and benefits for reconstructive surgery and related medical care for a person of any age who is diagnosed as having a craniofacial anomaly if the surgery and treatment are medically necessary to improve a functional impairment that results from the craniofacial anomaly as determined by a nationally approved cleft-craniofacial team, approved by the American Cleft Palate-Craniofacial Association in Chapel Hill, North Carolina.
(2) A nationally approved cleft-craniofacial team for cleft-craniofacial conditions shall:
(A) Evaluate a person with a craniofacial anomaly; and
(B) Coordinate a treatment plan for each person.
(3) After one (1) denial or any limitation of coverage that is based on the lack of medical necessity to improve a functional impairment, the case shall be referred for an external review under State Insurance Department Rule 76, the Arkansas External Review Regulation, if applicable, or under a similar procedure for external review established by a third-party administrator of a health benefit plan.
(b) Medical care coverage required under this section includes coverage for reconstructive surgery, dental care, vision care, and the use of at least one (1) hearing aid.
Source: Arkansas Code — historical release 78 (November 6, 2020) · 23-79-1502
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:23-79-1502
Source file: gov.ar.code.title.23.odt
Pages: Not recorded – Not recorded
Passage SHA-256: 9868e5656803ca8b7f7f4af7fb82316db39a40157e888b65c46d4b8a356e47a8
Source location: content.xml paragraph 47969
Stored source content
23-79-1502. Craniofacial anomaly — Coverage for reconstructive surgery required.
(a)(1) A health benefit plan that is offered, issued, provided, or renewed in this state shall include coverage and benefits for reconstructive surgery and related medical care for a person of any age who is diagnosed as having a craniofacial anomaly if the surgery and treatment are medically necessary to improve a functional impairment that results from the craniofacial anomaly as determined by a nationally approved cleft-craniofacial team, approved by the American Cleft Palate-Craniofacial Association in Chapel Hill, North Carolina.
(2) A nationally approved cleft-craniofacial team for cleft-craniofacial conditions shall:
(A) Evaluate a person with a craniofacial anomaly; and
(B) Coordinate a treatment plan for each person.
(3) After one (1) denial or any limitation of coverage that is based on the lack of medical necessity to improve a functional impairment, the case shall be referred for an external review under State Insurance Department Rule 76, the Arkansas External Review Regulation, if applicable, or under a similar procedure for external review established by a third-party administrator of a health benefit plan.
(b) Medical care coverage required under this section includes coverage for reconstructive surgery, dental care, vision care, and the use of at least one (1) hearing aid.
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