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23-99-804. Health insurer — Healthcare provider contracts.
Arkansas Code — all titles (historical 2020) · legal_authorities
23-99-804. Health insurer — Healthcare provider contracts.
(a) A healthcare provider, including without limitation a physician, nurse, pharmacist, dentist, physical therapist, physician assistant, or any other healthcare provider licensed and in good standing with the state licensing board responsible for the licensing of the healthcare provider, shall not be excluded from contracting with a health insurer, third-party administrator, pharmacy benefits manager, or other entity that is subject to § 23-99-802, if the healthcare provider is permitted to participate in Medicare, Medicaid, or any other federal health benefit plan.
(b) This section does not preempt § 23-99-204 regarding the requirement that a healthcare provider accept a health benefit plan's operating terms and conditions, schedule of fees, covered expenses, and utilization regulations and quality standards to participate in that health benefit plan.
Source: Arkansas Code — historical release 78 (November 6, 2020) · 23-99-804
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:23-99-804
Source file: gov.ar.code.title.23.odt
Pages: Not recorded – Not recorded
Passage SHA-256: b736d837f07104180064f9a6b2429dbd68e7a3b42165ed2ad6779312d637710e
Source location: content.xml paragraph 59385
Stored source content
23-99-804. Health insurer — Healthcare provider contracts.
(a) A healthcare provider, including without limitation a physician, nurse, pharmacist, dentist, physical therapist, physician assistant, or any other healthcare provider licensed and in good standing with the state licensing board responsible for the licensing of the healthcare provider, shall not be excluded from contracting with a health insurer, third-party administrator, pharmacy benefits manager, or other entity that is subject to § 23-99-802, if the healthcare provider is permitted to participate in Medicare, Medicaid, or any other federal health benefit plan.
(b) This section does not preempt § 23-99-204 regarding the requirement that a healthcare provider accept a health benefit plan's operating terms and conditions, schedule of fees, covered expenses, and utilization regulations and quality standards to participate in that health benefit plan.
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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. The source passage cites 23-99-204. This identifies an authority to review, not proof of applicability.
Arkansas Code — all titles (historical 2020) · legal_authorities
23-99-802. Definitions.
As used in this subchapter:
(1) “Any willing provider law” means a law that prohibits discrimination against a provider willing to meet the terms and conditions for participation established by a health insurer or that otherwise precludes an insurer from prohibiting or limiting participation by a provider who is willing to accept a health insurer's terms and conditions for participation in the provision of services through a health benefit plan;
(2) “ERISA” means the Employee Retirement Income Security Act of 1974, as amended, 29 U.S.C. § 1001 et seq.;
(3) “Health benefit plan” means any health insurance policy or certificate, health maintenance organization contract, hospital and medical service corporation contract or certificate, a self-insured plan or a plan provided by a multiple employer welfare arrangement, to the extent permitted by ERISA, the Employee Retirement Income Security Act of 1974, as amended, 29 U.S.C. § 1001 et seq., or any health benefit plan that affects the rights of an Arkansas insured and bears a reasonable relation to Arkansas, whether delivered or issued for delivery in Arkansas;
(4) “Healthcare provider” or “provider” means those individuals or entities licensed by the State of Arkansas to provide healthcare services, limited to the following:
(A) Advanced practice nurses;
(B) Athletic trainers;
(C) Audiologists;
(D) Certified behavioral health providers;
(E) Certified orthotists;
(F) Chiropractors;
(G) Community mental health centers or clinics;
(H) Dentists;
(I) Home health care;
(J) Hospice care;
(K) Hospital-based services;
(L) Hospitals;
(M) Licensed ambulatory surgery centers;
(N) Licensed certified social workers;
(O) Licensed dieticians;
(P) Licensed durable medical equi
Source: Arkansas Code — historical release 78 (November 6, 2020) · 23-99-802
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 23-99-802. This identifies an authority to review, not proof of applicability.