reglab/housing_qa huggingface dataset:
AR Code § 23-76-101 (2020)
2020 Arkansas Code|Title 23 - Public Utilities and Regulated Industries|Subtitle 3 - Insurance|Chapter 76 - Health Maintenance Organizations|§ 23-76-101. Purpose

 (a) The General Assembly determines that health maintenance organizations, when properly regulated, encourage methods of treatment and controls over the quality of care which effectively contain costs and provide for continuous health care by undertaking responsibility for the provision, availability, and accessibility of services.  (b) For this reason, and because the primary responsibility of a health maintenance organization lies in providing quality healthcare services on a prepaid basis without regard to the type and number of services actually rendered, rather than providing indemnification against the cost of the services, the General Assembly finds it necessary to provide a statutory framework for the establishment and continuing regulation of health maintenance organizations which is separate from the insurance laws of this state, except as otherwise provided in this chapter.
AR Code § 23-76-102 (2020)
2020 Arkansas Code|Title 23 - Public Utilities and Regulated Industries|Subtitle 3 - Insurance|Chapter 76 - Health Maintenance Organizations|§ 23-76-102. Definitions

 As used in this chapter:   (1) “Commissioner” means the Insurance Commissioner;  (2) “Domestic corporation” means any corporation organized pursuant to the Arkansas Business Corporation Act, § 4-26-101 et seq., and the Arkansas Nonprofit Corporation Act, § 4-28-201 et seq.;  (3) “Enrollee” means an individual who has been enrolled in a healthcare plan;  (4) “Evidence of coverage” means any certificate, agreement, contract, identification card, or document issued to an enrollee setting out the coverage to which the enrollee is entitled;  (5) “Healthcare plan” means any arrangement whereby any person undertakes to provide, arrange for, pay for, or reimburse any part of the cost of any healthcare services through an individually underwritten or group master contract, and at least part of the arrangement consists of arranging for, or the provision of, healthcare services as distinguished from mere indemnification against the cost of the services on a prepaid basis through insurance or otherwise;  (6) “Healthcare services” means any services included in the furnishing to any individual of medical or dental care, or hospitalization, or services incident to the furnishing of care or hospitalization, as well as the furnishing to any person of all other services or goods for the purpose of preventing, alleviating, curing, or healing human illness or injury;  (7) “Health maintenance organization” means any person which undertakes to provide or arrange for one (1) or more healthcare plans;  (8) “Health professional” means physicians, dentists, optometrists, nurses, podiatrists, pharmacists, and other individuals engaged in the delivery of health services as are or may be designated under the Health Maintenance Organization Act of 1973 or any amendment thereto or regulation adopted thereunder;  (9) “Person” means any natural or artificial person, including, but not limited to, individuals, partnerships, associations, trusts, or corporations; and  (10) “Provider” means any person who is licensed in this state to furnish healthcare services as a health professional.
AR Code § 23-76-103 (2020)
2020 Arkansas Code|Title 23 - Public Utilities and Regulated Industries|Subtitle 3 - Insurance|Chapter 76 - Health Maintenance Organizations|§ 23-76-103. Applicability of Arkansas Insurance Code and laws concerning hospital and medical service corporations

 (a)  (1) Except as otherwise provided in this chapter, provisions of the insurance law and provisions of hospital and medical service corporation laws shall not be applicable to any health maintenance organization granted a certificate of authority under this chapter.  (2) Subdivision (a)(1) of this section shall not apply to an insurer or hospital and medical service corporation licensed and regulated pursuant to the insurance laws or the hospital and medical service corporation laws of this state, except with respect to its health maintenance organization activities authorized and regulated pursuant to this chapter.    (b) The provisions of this chapter, the Arkansas Insurance Code, and the law concerning hospital and medical service corporations, § 23-75-101 et seq., shall not be applicable to any nonprofit vision service plan corporation composed of at least fifty (50) participating licensed optometrists or ophthalmologists licensed by the State of Arkansas to provide vision care services on a prepaid basis, when each licensed optometrist or ophthalmologist is subject to the rules of the professional's respective state board, and when each participating licensed optometrist or ophthalmologist agrees to assume responsibility for completion of the provisions of the vision care services contracted for, so that no element of risk is incurred by any subscriber group or person.  (c) This chapter does not apply to a:  (1) Health care sharing ministry as defined in § 23-60-104(b); or  (2) Direct primary care agreement as defined in § 23-60-104(b).
AR Code § 23-76-105 (2020)
2020 Arkansas Code|Title 23 - Public Utilities and Regulated Industries|Subtitle 3 - Insurance|Chapter 76 - Health Maintenance Organizations|§ 23-76-105. Penalties — Enforcement

 (a) In lieu of suspension or revocation of a certificate of authority under § 23-76-123, the Insurance Commissioner may levy an administration penalty in an amount not less than two hundred fifty dollars ($250), nor more than two thousand five hundred dollars ($2,500), if reasonable notice in writing is given of the intent to levy the penalty and the health maintenance organization has a reasonable time within which to remedy the defect in its operations which gave rise to the penalty citation. The commissioner may augment this penalty by an amount equal to the sum that he or she calculates to be the damages suffered by the enrollees or other members of the public.  (b) Any person who willfully violates this chapter shall be guilty of a Class A misdemeanor.  (c)  (1) If the commissioner shall for any reason have cause to believe that any violation of this chapter has occurred or is threatened, the commissioner may give notice to the health maintenance organization and to the representatives, or other persons who appear to be involved in the suspected violation, to arrange a conference with the alleged violators or their authorized representatives for the purpose of attempting to ascertain the facts relating to the suspected violation and, in the event it appears that any violation has occurred or is threatened, to arrive at an adequate and effective means of correcting or preventing the violations.  (2) Proceedings under this subsection shall not be governed by formal procedural requirements and may be conducted in the manner the commissioner deems appropriate under the circumstances.    (d)  (1) The commissioner may issue an order directing a health maintenance organization or a representative of a health maintenance organization to cease and desist from engaging in any act or practice in violation of the provisions of this chapter.  (2) Within thirty (30) days after service of the order of cease and desist, the respondent may request a hearing on the questions of whether acts or practices in violation of this chapter have occurred. The hearings shall be conducted pursuant to the provisions of §§ 23-61-303 — 23-61-307, and judicial review shall be available as provided in § 23-66-212.    (e) In the case of any violation of the provisions of this chapter, if the commissioner elects not to issue a cease and desist order or in the event of noncompliance with a cease and desist order issued pursuant to subsection (d) of this section, the commissioner may institute a proceeding to obtain injunctive relief or, seeking other appropriate relief, in Pulaski County Circuit Court for actions of this nature.
AR Code § 23-76-106 (2020)
2020 Arkansas Code|Title 23 - Public Utilities and Regulated Industries|Subtitle 3 - Insurance|Chapter 76 - Health Maintenance Organizations|§ 23-76-106. License to practice, sell, or dispense required

 No person shall perform any of the services or procedures or sell or dispense any goods or devices in the field of the healing arts for which a license is required under the laws of the State of Arkansas unless the person holds a valid license authorizing him or her to perform the procedures, render the services, or sell or dispense the goods or devices.
AR Code § 23-76-108 (2020)
2020 Arkansas Code|Title 23 - Public Utilities and Regulated Industries|Subtitle 3 - Insurance|Chapter 76 - Health Maintenance Organizations|§ 23-76-108. Issuance of certificate of authority

 (a) Upon receipt of an application for issuance of a certificate of authority, the Insurance Commissioner shall determine whether the applicant furnishes or proposes to furnish adequate and accessible healthcare services for its healthcare plans subject to the requirements or rules of the State Insurance Department.  (b) The commissioner shall issue a certificate of authority to any person filing an application pursuant to § 23-76-107 within sixty (60) days of receipt of the application if the commissioner is satisfied that:  (1) The persons responsible for the conduct of the affairs of the applicant are competent, trustworthy, and possess good reputations;  (2) The health maintenance organization's proposed plan of operation meets the requirements of subsection (a) of this section;  (3) The healthcare plan will allow the health maintenance organization effectively to provide or arrange for the provision of basic healthcare services through insurance or otherwise on a prepaid basis, subject to reasonable requirements for copayments;  (4) The health maintenance organization is financially responsible and may reasonably be expected to meet its obligations to enrollees and prospective enrollees;  (5) The healthcare plan's arrangements for healthcare services and the schedule of charges for use therewith are financially sound and reasonable;  (6) Any agreements with insurers, hospitals, medical service corporations, governmental entities, or any other organizations for insuring the payment of the cost of healthcare services or the provision for automatic applicability of alternative coverage in the event of discontinuance of the healthcare plan are reasonable and adequate;  (7) Agreements with providers for the provision of healthcare services are reasonable and adequate;  (8) The enrollees will be afforded an opportunity to participate in matters of policy and operation pursuant to § 23-76-110;  (9) Nothing in the proposed method of operation, as shown by the information submitted pursuant to § 23-76-107 or by independent investigation, is contrary to the public interest;  (10) Any deposit of cash or securities, in an amount determined to be appropriate by the commissioner pursuant to § 23-76-118, is sufficient to guarantee that the obligations to provide the promised benefits will be performed; and  (11) The applicant has paid-in capital in an amount not less than one hundred thousand dollars ($100,000) and additional working capital or surplus funds in an amount deemed by the commissioner to be adequate in relation to the proposed plan of operation.    (c) A certificate of authority shall be denied by the commissioner only after compliance with the requirements of § 23-76-126.
AR Code § 23-76-110 (2020)
2020 Arkansas Code|Title 23 - Public Utilities and Regulated Industries|Subtitle 3 - Insurance|Chapter 76 - Health Maintenance Organizations|§ 23-76-110. Advisory board

 (a) The advisory board of any health maintenance organization shall include at least one (1) physician, one (1) dentist, one (1) pharmacist, one (1) nurse, one (1) consumer, and one (1) enrollee.  (b) The advisory board shall establish a mechanism to afford the enrollees an opportunity to participate in matters of policy and operation through the establishment of advisory panels, by the use of advisory referenda on major policy decisions, or through the use of other mechanisms.  (c) The advisory board shall not be deemed to be the governing body of the health maintenance organization licensed under this chapter.
AR Code § 23-76-111 (2020)
2020 Arkansas Code|Title 23 - Public Utilities and Regulated Industries|Subtitle 3 - Insurance|Chapter 76 - Health Maintenance Organizations|§ 23-76-111. Fiduciary responsibilities of director, officer, or partner

 (a) Any director, officer, or partner of a health maintenance organization who receives, collects, disburses, or invests funds in connection with the activities of the health maintenance organization shall be responsible for the funds in a fiduciary relationship to the enrollees.  (b) A health maintenance organization shall maintain in force a fidelity bond or fidelity insurance on these employees, officers, directors, and partners in an amount not less than two hundred fifty thousand dollars ($250,000) for each health maintenance organization or a maximum of five million dollars ($5,000,000) in aggregate maintained on behalf of health maintenance organizations owned by a common parent corporation, or the sum prescribed by the Insurance Commissioner.
AR Code § 23-76-114 (2020)
2020 Arkansas Code|Title 23 - Public Utilities and Regulated Industries|Subtitle 3 - Insurance|Chapter 76 - Health Maintenance Organizations|§ 23-76-114. Information to enrollees

 (a) A health maintenance organization shall make available to its subscribers a list of providers upon enrollment and re-enrollment.  (b) Every health maintenance organization shall provide within thirty (30) days to its subscribers a notice of any material change in the operation of the health maintenance organization, including any major change in its provider network, that will affect them directly.  (c)  (1) An enrollee shall be notified in writing by the health maintenance organization of the termination of the primary care provider who provided healthcare services to that enrollee.  (2) The health maintenance organization shall provide assistance to the enrollee in transferring to another participating primary care provider.    (d) The health maintenance organization shall provide to subscribers information on how services may be obtained, where additional information on access to services can be obtained, and a telephone number where the enrollee can contact the health maintenance organization, at no cost to the enrollee.
AR Code § 23-76-115 (2020)
2020 Arkansas Code|Title 23 - Public Utilities and Regulated Industries|Subtitle 3 - Insurance|Chapter 76 - Health Maintenance Organizations|§ 23-76-115. Open enrollment

 (a)  (1) After a health maintenance organization has been in operation twenty-four (24) months, it shall have an annual open enrollment period of at least one (1) month during which it accepts enrollees up to the limits of its capacity, as determined by the health maintenance organization, in the order in which they apply for enrollment.  (2) A health maintenance organization may apply to the Insurance Commissioner for authorization to impose such underwriting restrictions upon enrollment as are necessary to preserve its financial stability, to prevent excessive adverse selection by prospective enrollees, or to avoid unreasonably high or unmarketable charges for enrollee coverage for healthcare services.  (3) The commissioner shall approve or deny the application within sixty (60) days of its receipt from the health maintenance organization.    (b) Health maintenance organizations providing or arranging for services on a group contract basis may limit the open enrollment provided for in subsection (a) of this section to all members of the groups covered by the contracts.
AR Code § 23-76-116 (2020)
2020 Arkansas Code|Title 23 - Public Utilities and Regulated Industries|Subtitle 3 - Insurance|Chapter 76 - Health Maintenance Organizations|§ 23-76-116. Complaint system

 (a)  (1) Every health maintenance organization shall establish and maintain a complaint system that has been approved by the Insurance Commissioner to provide reasonable procedures for the resolution of written complaints initiated by enrollees concerning healthcare services.  (2) Each health maintenance organization shall submit to the commissioner an annual report in a form prescribed by the commissioner that shall include:  (A) A description of the procedures of the complaint system;  (B) The total number of complaints handled through the complaint system and a compilation of causes underlying the complaints filed; and  (C) The number, amount, and disposition of malpractice claims settled during the year by the health maintenance organization.      (b)  (1) The health maintenance organization shall maintain records of written complaints filed with it concerning issues and persons other than healthcare services and shall submit to the commissioner a summary report at such times and in such format as the commissioner may require.  (2) Complaints involving other persons shall be referred to the persons with a copy to the commissioner.    (c) The commissioner may examine the complaint system, subject to the limitation concerning medical records of individuals set forth in § 23-76-122(c).
AR Code § 23-76-117 (2020)
2020 Arkansas Code|Title 23 - Public Utilities and Regulated Industries|Subtitle 3 - Insurance|Chapter 76 - Health Maintenance Organizations|§ 23-76-117. Investments

 With the exception of investments made in accordance with § 23-76-109(a)(1) and (2) and § 23-76-109(b), the investable funds of a health maintenance organization shall be invested only in securities or other investments permitted by the laws of this state for the investment of assets constituting the legal reserves of life insurance companies or other securities or investments as the Insurance Commissioner may permit.
AR Code § 23-76-120 (2020)
2020 Arkansas Code|Title 23 - Public Utilities and Regulated Industries|Subtitle 3 - Insurance|Chapter 76 - Health Maintenance Organizations|§ 23-76-120. Regulation of agents — Definition

 (a) After notice and hearing, the Insurance Commissioner may promulgate such reasonable rules as are necessary to provide for the licensing of agents.  (b) “Agent” means a person directly or indirectly associated with a healthcare plan who engages in solicitation or enrollment.
AR Code § 23-76-121 (2020)
2020 Arkansas Code|Title 23 - Public Utilities and Regulated Industries|Subtitle 3 - Insurance|Chapter 76 - Health Maintenance Organizations|§ 23-76-121. Powers of insurers and hospital and medical service corporations

 (a) An insurance company licensed in this state, or a hospital or medical service corporation authorized to do business in this state, may either directly, or through a subsidiary or affiliate, organize and operate a health maintenance organization under the provisions of this chapter.  (b)  (1) Notwithstanding any provision of the Hospital and Medical Service Corporations Act, § 23-75-101 et seq., an insurer or a hospital and medical service corporation may contract with a health maintenance organization to provide insurance or similar protection against the cost of care provided through health maintenance organizations and to provide coverage in the event of the failure of the health maintenance organization to meet its obligations.  (2) The enrollees of a health maintenance organization constitute a permissible group under such laws.  (3) Among other things, under the contracts, the insurer or hospital or medical service corporation may make benefit payments to health maintenance organizations for healthcare services rendered by providers pursuant to the healthcare plan.
AR Code § 23-76-122 (2020)
2020 Arkansas Code|Title 23 - Public Utilities and Regulated Industries|Subtitle 3 - Insurance|Chapter 76 - Health Maintenance Organizations|§ 23-76-122. Examinations

 (a) The Insurance Commissioner may make an examination of the affairs of any health maintenance organization as often as he or she deems it necessary for the protection of the interests of the people of this state but not less frequently than one (1) time every three (3) years.  (b) The commissioner may make an examination concerning the quality of healthcare services of any health maintenance organization as often as he or she deems it necessary for the protection of the interests of the people of this state but not less frequently than one (1) time every three (3) years.  (c)  (1) Every health maintenance organization shall submit its books and records relating to the healthcare plan to the examinations and in every way facilitate them.  (2) For the purpose of examinations, the commissioner may administer oaths to and examine the officers and agents of the health maintenance organization.  (3) Medical records of individuals and records of physicians and hospitals providing services under a contract to the health maintenance organization shall be subject to the examination.    (d) The expenses of examinations under this section shall be assessed against the health maintenance organization being examined and remitted to the commissioner.  (e) In lieu of the examination, the commissioner may accept the report of an examination made by the insurance commissioner of another state or director of the department of health of another state.  (f)  (1) Any examination under this section that is to commence within one (1) year prior to the date a health maintenance organization shall cease to provide healthcare services in this state, may be reduced in scope or waived in its entirety, upon application of the health maintenance organization and approval of the commissioner.  (2) The commissioner shall consider the following in determining whether a full or partial waiver may be granted:  (A) Claims payment history;  (B) Consumer complaint history;  (C) Financial condition; and  (D) Compliance with § 23-76-118.    (3) Any health maintenance organization requesting a waiver of an examination shall continue to comply with § 23-76-118 until such time as it is no longer providing healthcare services in this state.
AR Code § 23-76-124 (2020)
2020 Arkansas Code|Title 23 - Public Utilities and Regulated Industries|Subtitle 3 - Insurance|Chapter 76 - Health Maintenance Organizations|§ 23-76-124. Rehabilitation, liquidation, or conservation of health maintenance organization

 (a) Any rehabilitation, liquidation, or conservation of a health maintenance organization shall be deemed to be the rehabilitation, liquidation, or conservation of an insurance company and shall be conducted under the supervision of the Insurance Commissioner pursuant to the law governing the rehabilitation, liquidation, or conservation of insurance companies.  (b) The commissioner may apply for an order directing him or her to rehabilitate, liquidate, or conserve a health maintenance organization upon any one (1) or more grounds set out in § 23-68-107 or when in his or her opinion the continued operation of the health maintenance organization would be hazardous either to the enrollees or to the people of this state.
AR Code § 23-76-125 (2020)
2020 Arkansas Code|Title 23 - Public Utilities and Regulated Industries|Subtitle 3 - Insurance|Chapter 76 - Health Maintenance Organizations|§ 23-76-125. Rules

 (a) After notice and hearing, the Insurance Commissioner may promulgate reasonable rules, not inconsistent with existing statutes of this state, as are necessary or proper to carry out the provisions of this chapter.  (b) The rules shall be subject to review in accordance with § 23-61-307.