§ 23-99-407. “Gag clause” prohibition
No participating provider may be prohibited, restricted, or penalized in any way from disclosing to any covered person any healthcare information that the participating provider deems appropriate regarding the nature of treatment, risks, or alternatives thereto, the availability of alternate therapies, consultations, or tests, the decision of utilization reviewers or similar persons to authorize or […]
§ 23-99-408. Continuity of care
(a) When healthcare insurers use participating providers, the healthcare insurers shall develop procedures to provide for the continuity of care of their covered persons. At a minimum, the procedures shall: (1) Ensure that when a new patient is enrolled in a health benefit plan and is being treated by a nonparticipating provider for a current […]
§ 23-99-409. Prescription drug formulary
When a healthcare insurer uses a formulary for prescription drugs, the insurer shall include a written procedure whereby covered persons can obtain, without penalty and in a timely fashion, specific drugs and medications not included in the formulary when: (1) The formulary’s equivalent has been ineffective in the treatment of the covered person’s disease or […]
§ 23-99-410. Grievance procedures
(a) A healthcare insurer issuing or delivering a managed care plan shall establish for those managed care plans a grievance procedure which provides covered persons with a prompt and meaningful review on the issue of denial, in whole or in part, of a healthcare treatment or service. (b) (1) The covered person shall be provided […]
§ 23-99-411. Processing applications of providers
(a) (1) (A) Healthcare insurers shall establish mechanisms to ensure timely processing of requests for participation or renewal by providers and in making decisions that affect participation status. (B) These mechanisms shall include, at a minimum, provisions for the provider to receive a written statement of reasons for the healthcare insurer’s denial of a request […]
§ 23-99-412. Provider input
All healthcare insurers issuing or delivering managed care plans shall be required to establish a mechanism whereby participating providers provide input into the healthcare insurer’s medical policy, utilization review criteria and procedures, quality and credentialing criteria, and medical management procedures.
§ 23-99-413. Disclosure requirements
Upon request, healthcare insurers must provide the following information in a clear and understandable form to all prospective policyholders, policyholders, and covered persons. Insurers shall notify policyholders and covered persons of their right to request the information, which must include: (1) Coverage provisions, benefits, and exclusions by category of service and provider; (2) A description […]
§ 23-99-414. Rules
The Insurance Commissioner may promulgate necessary rules for carrying out this subchapter.
§ 23-99-415. Enforcement and penalties
The Insurance Commissioner shall have all the powers to enforce this subchapter as are granted to the commissioner elsewhere in the Arkansas Insurance Code.
§ 23-99-416. Application of subchapter
This subchapter applies to all health benefit plans issued, renewed, extended, or modified on or after August 1, 1997. “Renewed, extended, or modified” shall include all health benefit plans in which the insurer has reserved the right to change the premium.