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23-79-1602. Coverage for telemedicine.
Arkansas Code — all titles (historical 2020) · legal_authorities
23-79-1602. Coverage for telemedicine.
(a)(1) This subchapter applies to all health benefit plans delivered, issued for delivery, reissued, or extended in Arkansas on or after January 1, 2016, or at any time when any term of the health benefit plan is changed or any premium adjustment is made thereafter.
(2) Notwithstanding subdivision (a)(1) of this section, this subchapter applies to the Arkansas Medicaid Program on and after January 1, 2016.
(b) A healthcare professional providing a healthcare service provided through telemedicine shall comply with the requirements of the Telemedicine Act, § 17-80-401 et seq.
(c)(1) A health benefit plan shall provide coverage and reimbursement for healthcare services provided through telemedicine on the same basis as the health benefit plan provides coverage and reimbursement for health services provided in person, unless this subchapter specifically provides otherwise.
(2) A health benefit plan is not required to reimburse for a healthcare service provided through telemedicine that is not comparable to the same service provided in person.
(3) A health benefit plan may voluntarily reimburse for healthcare services provided through means described in § 23-79-1601(7)(C).
(d)(1) A health benefit plan shall provide a reasonable facility fee to an originating site operated by a healthcare professional or a licensed healthcare entity if the healthcare professional or licensed healthcare entity is authorized to bill the health benefit plan directly for healthcare services.
(2) The combined amount of reimbursement that a health benefit plan allows for the compensation to the distant site and the originating site shall not be less than the total amount allowed for healthcare services provided in person.
(3) Payment for heal
Source: Arkansas Code — historical release 78 (November 6, 2020) · 23-79-1602
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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Stable record: arkansas_code:legal_authorities:23-79-1602
Source file: gov.ar.code.title.23.odt
Pages: Not recorded – Not recorded
Passage SHA-256: d83b5e81f5c87f2d24c6438b8b2b332b6e668565a6ae1dcb5ce930401ceb05c9
Source location: content.xml paragraph 48045
Stored source content
23-79-1602. Coverage for telemedicine.
(a)(1) This subchapter applies to all health benefit plans delivered, issued for delivery, reissued, or extended in Arkansas on or after January 1, 2016, or at any time when any term of the health benefit plan is changed or any premium adjustment is made thereafter.
(2) Notwithstanding subdivision (a)(1) of this section, this subchapter applies to the Arkansas Medicaid Program on and after January 1, 2016.
(b) A healthcare professional providing a healthcare service provided through telemedicine shall comply with the requirements of the Telemedicine Act, § 17-80-401 et seq.
(c)(1) A health benefit plan shall provide coverage and reimbursement for healthcare services provided through telemedicine on the same basis as the health benefit plan provides coverage and reimbursement for health services provided in person, unless this subchapter specifically provides otherwise.
(2) A health benefit plan is not required to reimburse for a healthcare service provided through telemedicine that is not comparable to the same service provided in person.
(3) A health benefit plan may voluntarily reimburse for healthcare services provided through means described in § 23-79-1601(7)(C).
(d)(1) A health benefit plan shall provide a reasonable facility fee to an originating site operated by a healthcare professional or a licensed healthcare entity if the healthcare professional or licensed healthcare entity is authorized to bill the health benefit plan directly for healthcare services.
(2) The combined amount of reimbursement that a health benefit plan allows for the compensation to the distant site and the originating site shall not be less than the total amount allowed for healthcare services provided in person.
(3) Payment for healthcare services provided through telemedicine shall be provided to the distant site and the originating site upon submission of the appropriate procedure codes.
(4) This section does not:
(A) Prohibit a health benefit plan from paying a facility fee to a provider at the distant site in addition to a fee paid to the healthcare professional; or
(B) Require a health benefit plan to pay more for a healthcare service provided through telemedicine than would have been paid if the healthcare service was delivered in person.
(e) A health benefit plan shall not impose on coverage for healthcare services provided through telemedicine:
(1) An annual or lifetime dollar maximum on coverage for services provided through telemedicine other than an annual or lifetime dollar maximum that applies to the aggregate of all items and services covered;
(2) A deductible, copayment, coinsurance, benefit limitation, or maximum benefit that is not equally imposed upon all healthcare services covered under the health benefit plan; or
(3) A prior authorization requirement for services provided through telemedicine that exceeds the prior authorization requirement for in-person healthcare services under the health benefit plan.
(f) This subchapter does not prohibit a health benefit plan from:
(1) Limiting coverage of healthcare services provided through telemedicine to medically necessary services, subject to the same terms and conditions of the covered person's health benefit plan that apply to services provided in person; or
(2)(A) Undertaking utilization review, including prior authorization, to determine the appropriateness of healthcare services provided through telemedicine, provided that:
(i) The determination of appropriateness is made in the same manner as determinations are made for the treatment of any illness, condition, or disorder covered by the health benefit plan whether the service was provided in-person or through telemedicine; and
(ii) All adverse determinations for healthcare services, medications, or equipment prescribed by a physician are made by a physician who possesses a current and valid unrestricted license to practice medicine in Arkansas.
(B) Utilization review shall not require prior authorization of emergent telemedicine services.
(g)(1) A health benefit plan may adopt policies to ensure that healthcare services provided through telemedicine submitted for payment comply with the same coding, documentation, and other requirements necessary for payment as an in-person service other than the in-person requirement.
(2) If deemed necessary, the State Insurance Department may promulgate rules containing additional standards and procedures for the utilization of telemedicine to provide healthcare services through health benefit plans if the additional standards and procedures do not conflict with this subchapter or § 17-80-117 and are applied uniformly by all health benefit plans.
(h) A health benefit plan shall not prohibit a healthcare professional from charging a patient enrolled in a health benefit plan for healthcare services provided by audio-only communication that are not reimbursed under the health benefit plan.
Cross-references
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Arkansas Code — all titles (historical 2020) · legal_authorities
17-80-117. Definitions — Substance Abuse Reporting Act.
(a) As used in this section:
(1) “Disciplinary action” means an action taken by a required reporter to terminate:
(A) The employment of a healthcare professional;
(B) A contractual arrangement with a healthcare professional; or
(C) The clinical privileges of a healthcare professional;
(2) “Healthcare professional” means an individual who is licensed, certified, or otherwise authorized by a licensing authority of this state to administer healthcare services in the ordinary course of his or her business or practice;
(3) “Licensing authority” means a government agency or board charged with licensing, certifying, or authorizing a healthcare professional to administer health care in this state; and
(4) “Required reporter” means:
(A) A facility licensed by the Division of Health Facilities Services;
(B) A facility licensed by the Office of Long-Term Care of the Division of Medical Services of the Department of Human Services; and
(C) Any other entity that employs or contracts with healthcare professionals to provide healthcare services to individuals in the State of Arkansas.
(b) The chief executive officer or an official agent of a required reporter or his or her designee shall report to the appropriate licensing authority the following:
(1) A final disciplinary action taken against a healthcare professional as a result of the diversion, misuse, or abuse of illicit drugs or controlled substances as defined by state and federal law by a healthcare professional; and
(2) The voluntary resignation of any healthcare professional against whom a disciplinary action arising from the diversion, misuse, or abuse of illicit drugs or controlled substances as defined by state and federal law by a healthca
Source: Arkansas Code — historical release 78 (November 6, 2020) · 17-80-117
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 17-80-117. This identifies an authority to review, not proof of applicability.
Arkansas Code — all titles (historical 2020) · legal_authorities
17-80-401. Title.
This subchapter shall be known and may be cited as the “Telemedicine Act”.
Source: Arkansas Code — historical release 78 (November 6, 2020) · 17-80-401
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 17-80-401. This identifies an authority to review, not proof of applicability.
Arkansas Code — all titles (historical 2020) · legal_authorities
23-79-1601. Definitions.
As used in this subchapter:
(1) “Distant site” means the location of the healthcare professional delivering healthcare services through telemedicine at the time the services are provided;
(2)(A) “Health benefit plan” means:
(i) An individual, blanket, or group plan, policy, or contract for healthcare services issued or delivered by an insurer, health maintenance organization, hospital medical service corporation, or self-insured governmental or church plan in this state; and
(ii) Any health benefit program receiving state or federal appropriations from the State of Arkansas, including the Arkansas Medicaid Program, the Health Care Independence Program [expired], commonly referred to as the “Private Option”, and the Arkansas Works Program, or any successor program.
(B) “Health benefit plan” includes:
(i) Indemnity and managed care plans; and
(ii) Nonfederal governmental plans as defined in 29 U.S.C. § 1002(32), as it existed on January 1, 2015.
(C) “Health benefit plan” does not include:
(i) Disability income plans;
(ii) Credit insurance plans;
(iii) Insurance coverage issued as a supplement to liability insurance;
(iv) Medical payments under automobile or homeowners insurance plans;
(v) Health benefit plans provided under Arkansas Constitution, Article 5, § 32, the Workers' Compensation Law, § 11-9-101 et seq., or the Public Employee Workers' Compensation Act, § 21-5-601 et seq.;
(vi) Plans that provide only indemnity for hospital confinement;
(vii) Accident-only plans;
(viii) Specified disease plans; or
(ix) Long-term-care-only plans;
(3) “Healthcare professional” means a person who is licensed, certified, or otherwise authorized by the laws of this state to administer health care in the ordinary course of t
Source: Arkansas Code — historical release 78 (November 6, 2020) · 23-79-1601
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 23-79-1601. This identifies an authority to review, not proof of applicability.