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23-99-204. Terms of health benefit plan.
Arkansas Code — all titles (historical 2020) · legal_authorities
23-99-204. Terms of health benefit plan.
(a) A healthcare insurer shall not, directly or indirectly:
(1)(A) Impose a monetary advantage or penalty under a health benefit plan that would affect a beneficiary's choice among those healthcare providers who participate in the health benefit plan according to the terms offered.
(B) “Monetary advantage or penalty” includes:
(i) A higher copayment;
(ii) A reduction in reimbursement for services; or
(iii) Promotion of one healthcare provider over another by these methods;
(2) Impose upon a beneficiary of healthcare services under a health benefit plan any copayment, fee, or condition that is not equally imposed upon all beneficiaries in the same benefit category, class, or copayment level under that health benefit plan when the beneficiary is receiving services from a participating healthcare provider pursuant to that health benefit plan; or
(3) Prohibit or limit a healthcare provider that is qualified under § 23-99-203(d) and is willing to accept the health benefit plan's operating terms and conditions, schedule of fees, covered expenses, and utilization rules and quality standards, from the opportunity to participate in that health benefit plan.
(b) Nothing in this subchapter shall prevent a health benefit plan from instituting measures designed to maintain quality and to control costs, including, but not limited to, the utilization of a gatekeeper system, as long as such measures are imposed equally on all providers in the same class.
(c)(1) A healthcare insurer may pay a claim for healthcare services by any lawful method, including the alternative payment method by gift card, credit card, or other type of electronic payment or virtual credit card as payment if the healthcare provider is given clear instru
Source: Arkansas Code — historical release 78 (November 6, 2020) · 23-99-204
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:23-99-204
Source file: gov.ar.code.title.23.odt
Pages: Not recorded – Not recorded
Passage SHA-256: b0df7af1764d9e251729785ceb6ed20889c417cc9c5c432db68c95ef5d6f1df3
Source location: content.xml paragraph 58431
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23-99-204. Terms of health benefit plan.
(a) A healthcare insurer shall not, directly or indirectly:
(1)(A) Impose a monetary advantage or penalty under a health benefit plan that would affect a beneficiary's choice among those healthcare providers who participate in the health benefit plan according to the terms offered.
(B) “Monetary advantage or penalty” includes:
(i) A higher copayment;
(ii) A reduction in reimbursement for services; or
(iii) Promotion of one healthcare provider over another by these methods;
(2) Impose upon a beneficiary of healthcare services under a health benefit plan any copayment, fee, or condition that is not equally imposed upon all beneficiaries in the same benefit category, class, or copayment level under that health benefit plan when the beneficiary is receiving services from a participating healthcare provider pursuant to that health benefit plan; or
(3) Prohibit or limit a healthcare provider that is qualified under § 23-99-203(d) and is willing to accept the health benefit plan's operating terms and conditions, schedule of fees, covered expenses, and utilization rules and quality standards, from the opportunity to participate in that health benefit plan.
(b) Nothing in this subchapter shall prevent a health benefit plan from instituting measures designed to maintain quality and to control costs, including, but not limited to, the utilization of a gatekeeper system, as long as such measures are imposed equally on all providers in the same class.
(c)(1) A healthcare insurer may pay a claim for healthcare services by any lawful method, including the alternative payment method by gift card, credit card, or other type of electronic payment or virtual credit card as payment if the healthcare provider is given clear instructions about how to select the alternative payment method.
(2) However, a healthcare insurer is prohibited from requiring a healthcare provider to accept a gift card, credit card, or other type of electronic payment or virtual credit card as payment of a claim for healthcare services if the method of payment charges the healthcare provider a service fee to process.
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Arkansas Code — all titles (historical 2020) · legal_authorities
23-99-203. Definitions.
(a)(1) “Copayment” means a type of cost sharing whereby insured or covered persons pay a specified predetermined amount per unit of service or percentage of healthcare costs with their healthcare insurer paying the remainder of the charge.
(2) The copayment is incurred at the time the service is rendered.
(3) The copayment may be a fixed or variable amount.
(b) “Gatekeeper system” means a system of administration used by any health benefit plan in which a primary care provider furnishes basic patient care and coordinates diagnostic testing, indicated treatment, and specialty referral for persons covered by the health benefit plan.
(c) “Health benefit plan” means any entity or program that provides reimbursement, including capitation, for healthcare services, except and excluding any entity or program that provides reimbursement and benefits pursuant to Arkansas Constitution, Amendment 26, Acts 1993, No. 796, or the Public Employee Workers' Compensation Act, § 21-5-601 et seq., and rules and schedules adopted thereunder.
(d) “Healthcare provider” means those individuals or entities licensed by the State of Arkansas to provide healthcare services, limited to the following:
(1) Advanced practice nurses;
(2) Athletic trainers;
(3) Audiologists;
(4) Certified behavioral health providers;
(5) Certified orthotists;
(6) Chiropractors;
(7) Community mental health centers or clinics;
(8) Dentists;
(9) Home health care;
(10) Hospice care;
(11) Hospital-based services;
(12) Hospitals;
(13) Licensed ambulatory surgery centers;
(14) Licensed certified social workers;
(15) Licensed dieticians;
(16) Licensed intellectual and developmental disabilities service providers;
(17) Licensed professional counselors;
(18) L
Source: Arkansas Code — historical release 78 (November 6, 2020) · 23-99-203
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 23-99-203. This identifies an authority to review, not proof of applicability.