§ 23-99-1110. Waiver prohibited
(a) The provisions of this subchapter shall not be waived by contract. (b) Any contractual arrangements or actions taken in conflict with this subchapter or that purport to waive any requirements of this subchapter are void.
§ 23-99-1111. Requests for prior authorization — Qualified persons authorized to review and approve — Adverse determinations to be made only by Arkansas-licensed physicians
(a) The initial review of information submitted in support of a request for prior authorization may be conducted by a qualified person employed or contracted by a utilization review entity. (b) A request for prior authorization may be approved by a qualified person employed or contracted by a utilization review entity. (c) (1) An adverse […]
§ 23-99-1112. Application of subchapter
This subchapter applies to a healthcare insurer, whether or not the healthcare insurer is acting directly or indirectly through a private utilization review entity.
§ 23-99-1113. Benefit inquiries authorized
(a) (1) An in-network or out-of-network healthcare provider may submit a benefit inquiry to a healthcare insurer or utilization review entity for a healthcare service not yet provided to determine whether or not the healthcare service meets medical necessity and all other requirements for payment under a health benefit plan if the healthcare service were […]
§ 23-99-1114. Limitations on step therapy — Definition
(a) If a utilization review entity has required a healthcare provider to utilize step therapy for a specific prescription drug for a subscriber, the utilization review entity shall not require the healthcare provider to utilize step therapy a second time for that same prescription drug, even though the utilization review entity or healthcare insurer may […]
§ 23-99-1115. Notice requirements — Process for appealing adverse determination and restriction or denial of healthcare service
(a) (1) Notice of an adverse determination shall be provided to the healthcare provider that initiated the prior authorization. (2) Notice may be made by electronic mail, fax, or hard copy letter sent by regular mail, or verbally, as requested by the subscriber’s healthcare provider. (b) The written or verbal notice required under this section […]
§ 23-99-1116. Failure to comply with subchapter — Requested healthcare services deemed approved
(a) If a healthcare insurer or utilization review entity fails to comply with this subchapter, the requested healthcare services shall be deemed authorized or approved. (b) A healthcare service that is authorized or approved under this section is not subject to audit recoupment under § 23-63-1801 et seq.
§ 23-99-1101. Title
This subchapter shall be known and may be cited as the “Prior Authorization Transparency Act”.
§ 23-99-1102. Legislative findings and intent
(a) The General Assembly finds that: (1) A physician-patient relationship is paramount and should not be subject to third-party intrusion; and (2) Prior authorizations can place attempted cost savings ahead of optimal patient care. (b) The General Assembly intends for this subchapter to: (1) Ensure that prior authorizations do not hinder patient care or intrude […]