§ 23-61-1007. Insurance standards for individual qualified health insurance plans

(a) Insurance coverage for a program participant enrolled in an individual qualified health insurance plan shall be obtained through silver-level metallic plans as provided in 42 U.S.C. § 18022(d) and § 18071, as they existed on January 1, 2016, that restrict out-of-pocket costs to amounts that do not exceed applicable out-of-pocket cost limitations.

(b) The Department of Human Services shall pay premiums and supplemental cost sharing reductions directly to a health insurer for a program participant enrolled in an individual qualified health insurance plan.

(c) All participating health insurers offering individual qualified health insurance plans in the health insurance marketplace shall:

1. (1)

   1. (A) Offer individual qualified health insurance plans conforming to the requirements of this section and applicable insurance rules.

   2. (B) The individual qualified health insurance plans shall be approved by the State Insurance Department; and

2. (2) Maintain a medical-loss ratio of at least eighty percent (80%) for an individual qualified health insurance plan as required under 45 C.F.R. § 158.210(c), as it existed on January 1, 2016, or rebate the difference to the Department of Human Services for program participants.

(d) The State of Arkansas shall assure that at least two (2) individual qualified health insurance plans are offered in each county in the state.

(e) A health insurer offering individual qualified health insurance plans for program participants shall participate in the Arkansas Patient-Centered Medical Home Program, including:

1. (1) Attributing enrollees in individual qualified health insurance plans, including program participants, to a primary care physician;

2. (2) Providing financial support to patient-centered medical homes to meet practice transformation milestones; and

3. (3) Supplying clinical performance data to patient-centered medical homes, including data to enable patient-centered medical homes to assess the relative cost and quality of healthcare providers to whom patient-centered medical homes refer patients.

(f) On or before January 1, 2017, the State Insurance Department and the Department of Human Services may implement through certification requirements or rule, or both, the applicable provisions of this section.