reglab/housing_qa huggingface dataset:
AR Code § 23-99-1001 (2020)
2020 Arkansas Code|Title 23 - Public Utilities and Regulated Industries|Subtitle 3 - Insurance|Chapter 99 - Healthcare Providers|Subchapter 10 - Vision Care Plan Act of 2015|§ 23-99-1001. Title

 This subchapter shall be known and may be cited as the “Vision Care Plan Act of 2015”.
AR Code § 23-99-1002 (2020)
2020 Arkansas Code|Title 23 - Public Utilities and Regulated Industries|Subtitle 3 - Insurance|Chapter 99 - Healthcare Providers|Subchapter 10 - Vision Care Plan Act of 2015|§ 23-99-1002. Definitions

 As used in this subchapter:   (1) “Covered materials” means materials for which reimbursement from the insurer, vision care plan, or vision care discount plan is provided to a vision care provider by an individual's vision benefit plan or contract and that are reimbursable subject to a deductible, copayment, coinsurance, or other contractual limitations;  (2) “Covered services” means services for which reimbursement from the insurer, vision care plan, or vision care discount plan is provided to a vision care provider by an individual's vision benefit plan or contract and that are reimbursable subject to a deductible, copayment, coinsurance, or other contractual limitations;  (3) “Insurer” means an insurance company, a health maintenance organization, a hospital and medical service corporation, or a self-insured health plan for employees of a governmental entity;  (4) “Materials” means ophthalmic devices, including without limitation:  (A) Lenses;  (B) Devices containing lenses;  (C) Artificial intraocular lenses;  (D) Ophthalmic frames;  (E) Lens-mounting apparatus;  (F) Prisms;  (G) Spectacle or contact lens treatments and coatings; and  (H) Prosthetic devices to correct, relieve, or treat defects or abnormal conditions of the human eye or its adnexa;    (5) “Noncovered materials” means materials that are not covered by an insurer, a vision care plan, or a vision care discount plan;  (6) “Noncovered services” means services that are not covered by an insurer, a vision care plan, or a vision care discount plan;  (7) “Participating provider agreement” means an agreement between a vision care provider and an insurer that obligates a vision care provider to provide for compensation services and materials to an individual who is insured by the insurer;  (8) “Services” means benefits or services provided by a vision care provider;  (9) “Vision benefit plan or contract” means a plan, contract, or policy of insurance issued by an insurer that provides for vision care benefits or services;  (10) “Vision care discount plan” means a separate plan to provide benefits or services under a rider to a health benefit plan or as a stand-alone agreement that is authorized by a vision care provider to provide discounts to individuals under the Primary Eye Care Provider Act, § 23-99-301 et seq.;  (11) “Vision care plan” means an entity that provides health benefits and that creates, promotes, sells, provides, advertises, or administers an integrated or stand-alone vision benefit plan or contract; and  (12) “Vision care provider” means an individual licensed as an optometrist under § 17-90-301 et seq., or a licensed osteopathic or medical physician licensed under § 17-91-101 et seq. or § 17-95-401 et seq., if the physician has also completed a residency in ophthalmology.
AR Code § 23-99-1003 (2020)
2020 Arkansas Code|Title 23 - Public Utilities and Regulated Industries|Subtitle 3 - Insurance|Chapter 99 - Healthcare Providers|Subchapter 10 - Vision Care Plan Act of 2015|§ 23-99-1003. Prohibited practices — Agreements

 (a) A participating provider agreement between an insurer, vision care plan, or vision care discount plan and a vision care provider shall not establish a fee that a vision care provider shall charge for services or materials that are not covered by a vision benefit plan or contract.  (b) A vision care provider shall not charge a fee for services or materials that is more than the vision care provider's normal rate for the services or materials if the services or materials are noncovered services or noncovered materials.  (c)  (1) An insurer, vision care plan, or vision care discount plan shall not require a vision care provider to apply a discount to an individual who is insured by the insurer with a participating vision care provider for noncovered services or noncovered materials.  (2) An insurer, vision care plan, or vision care discount plan shall not avoid the restriction under subdivision (c)(1) of this section by providing minimal reimbursement for a service or materials to apply a discount.    (d) A participating provider agreement between an insurer, vision care plan, or vision care discount plan and a vision care provider shall not require that a vision care provider participate with or be credentialed by any specific vision care plan or vision care discount plan as a condition to join an insurer's provider panel.  (e) A participating provider agreement between an insurer, vision care plan, or vision care discount plan and a vision care provider shall not restrict or limit, directly or indirectly, the vision care provider's choice of optical labs or choice of sources and suppliers of services or materials provided by the vision care provider to an individual who is insured by the insurer.  (f) The terms, discounts, and reimbursement rates in a participating contract between an insurer, vision care plan, or vision care discount plan with a vision care provider shall not be modified during the term of a participating contract absent written authorization from the vision care provider.  (g) An optician licensed under the Ophthalmic Dispensing Act, § 17-89-101 et seq., is subject to:  (1) Subsections (c) and (e) of this section; and  (2) Subsection (b) of this section in regard to materials.
AR Code § 23-99-1004 (2020)
2020 Arkansas Code|Title 23 - Public Utilities and Regulated Industries|Subtitle 3 - Insurance|Chapter 99 - Healthcare Providers|Subchapter 10 - Vision Care Plan Act of 2015|§ 23-99-1004. Private civil action

 (a) A vision care provider adversely affected by any violation of this subchapter by an insurer, vision care plan, or a vision care discount plan may bring a civil action in a court of competent jurisdiction against the insurer, vision care plan, or a vision care discount plan for injunctive relief.  (b) If a person prevails in the civil action under subsection (a) of this section, the person shall recover:  (1) Monetary damages not less than one thousand dollars ($1,000);  (2) Three (3) times the amount of actual damages, if any; and  (3) Reasonable attorney's fees, costs, and any other proper relief.
AR Code § 23-99-1005 (2020)
2020 Arkansas Code|Title 23 - Public Utilities and Regulated Industries|Subtitle 3 - Insurance|Chapter 99 - Healthcare Providers|Subchapter 10 - Vision Care Plan Act of 2015|§ 23-99-1005. Rules — Enforcement — Effective date

 (a) The State Insurance Department shall develop and promulgate rules for the implementation and administration of this subchapter.  (b) The Insurance Commissioner shall enforce this subchapter and may seek injunctive relief for violations of this subchapter.  (c) This subchapter is applicable to a vision benefit plan or contract issued, renewed, or recredentialed in this state on and after July 22, 2015.
AR Code § 23-99-1101 (2020)
2020 Arkansas Code|Title 23 - Public Utilities and Regulated Industries|Subtitle 3 - Insurance|Chapter 99 - Healthcare Providers|Subchapter 11 - Prior Authorization Transparency Act|§ 23-99-1101. Title

 This subchapter shall be known and may be cited as the “Prior Authorization Transparency Act”.
AR Code § 23-99-1102 (2020)
2020 Arkansas Code|Title 23 - Public Utilities and Regulated Industries|Subtitle 3 - Insurance|Chapter 99 - Healthcare Providers|Subchapter 11 - 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 on the practice of medicine; and  (2) Guarantee that prior authorizations include the use of written clinical criteria and reviews by appropriate physicians to secure a fair authorization review process for patients.
AR Code § 23-99-1104 (2020)
2020 Arkansas Code|Title 23 - Public Utilities and Regulated Industries|Subtitle 3 - Insurance|Chapter 99 - Healthcare Providers|Subchapter 11 - Prior Authorization Transparency Act|§ 23-99-1104. Disclosure required

 (a)  (1) A utilization review entity shall disclose all of its prior authorization requirements and restrictions, including any written clinical criteria, in a publicly accessible manner on its website.  (2) The information described in subdivision (a)(1) of this section shall be explained in detail and in clear and ordinary terms.  (3)  (A) Utilization review entities that have agreed, by contract with vendors or third-party administrators, to use licensed, proprietary, or copyrighted protected clinical criteria from the vendors or administrators may satisfy the disclosure requirement under subdivision (a)(1) of this section by making all relevant proprietary clinical criteria available to a healthcare provider that submits a prior authorization request to the utilization review entity through a secured link on the utilization review entity's website that is accessible to the healthcare provider from the public part of its website as long as any link or access restrictions to the information do not cause any delay to the healthcare provider.  (B) For out-of-network providers, a utilization review entity may meet the requirements of this subdivision (a)(3) by:  (i) Providing the healthcare provider with temporary electronic access in a timely manner to a secure site to review copyright-protected clinical criteria; or  (ii) Disclosing copyright-protected clinical criteria in a timely manner to a healthcare provider through other electronic or telephonic means.        (b) Before a utilization review entity implements a new or amended prior authorization requirement or restriction as described in subdivision (a)(1) of this section, the utilization review entity shall update its website to reflect the new or amended requirement or restriction.  (c) Before implementing a new or amended prior authorization requirement or restriction, a utilization review entity shall provide contracted healthcare providers written notice of the new or amended requirement or restriction at least sixty (60) days before implementation of the new or amended requirement or restriction.  (d)  (1) A utilization review entity shall make statistics available regarding prior authorization approvals and denials on its website in a readily accessible format.  (2) The statistics made available by a utilization review entity under this subsection shall categorize approvals and denials by:  (A) Physician specialty;  (B) Medication or diagnostic test or procedure;  (C) Medical indication offered as justification for the prior authorization request; and  (D) Reason for denial.
AR Code § 23-99-1105 (2020)
2020 Arkansas Code|Title 23 - Public Utilities and Regulated Industries|Subtitle 3 - Insurance|Chapter 99 - Healthcare Providers|Subchapter 11 - Prior Authorization Transparency Act|§ 23-99-1105. Prior authorization — Nonurgent healthcare service

 (a) If a utilization review entity requires prior authorization of a nonurgent healthcare service, the utilization review entity shall make an authorization or adverse determination and notify the subscriber and the subscriber's nonurgent healthcare provider of the decision within two (2) business days of obtaining all necessary information to make the authorization or adverse determination.  (b) For purposes of this section, “necessary information” includes the results of any face-to-face clinical evaluation or second opinion that may be required.
AR Code § 23-99-1106 (2020)
2020 Arkansas Code|Title 23 - Public Utilities and Regulated Industries|Subtitle 3 - Insurance|Chapter 99 - Healthcare Providers|Subchapter 11 - Prior Authorization Transparency Act|§ 23-99-1106. Prior authorization — Urgent healthcare service

 A utilization review entity shall render an expedited authorization or adverse determination concerning an urgent healthcare service and notify the subscriber and the subscriber's healthcare provider of that expedited prior authorization or adverse determination no later than one (1) business day after receiving all information needed to complete the review of the requested urgent healthcare service.
AR Code § 23-99-1107 (2020)
2020 Arkansas Code|Title 23 - Public Utilities and Regulated Industries|Subtitle 3 - Insurance|Chapter 99 - Healthcare Providers|Subchapter 11 - Prior Authorization Transparency Act|§ 23-99-1107. Prior authorization — Emergency healthcare service

 (a) A utilization review entity shall not require prior authorization for prehospital transportation or for provision of an emergency healthcare service.  (b)  (1) A utilization review entity shall allow a subscriber and the subscriber's healthcare provider a minimum of twenty-four (24) hours following an emergency admission or provision of an emergency healthcare service for the subscriber or healthcare provider to notify the utilization review entity of the admission or provision of an emergency healthcare service.  (2) If the admission or emergency healthcare service occurs on a holiday or weekend, a utilization review entity shall not require notification until the next business day after the admission or provision of the emergency healthcare service.    (c)  (1) A utilization review entity shall cover emergency healthcare services necessary to evaluate and assess the health condition of a subscriber or to stabilize a subscriber.  (2) If a healthcare provider certifies in writing to a utilization review entity within seventy-two (72) hours of a subscriber's admission that the subscriber's condition required an emergency healthcare service, that certification will create a presumption that the emergency healthcare service was medically necessary, and such presumption may be rebutted only if the utilization review entity can establish, with clear and convincing evidence, that the emergency healthcare service was not medically necessary.    (d)  (1) The determination by a utilization review entity of medical necessity of an emergency healthcare service shall not be based on whether the emergency healthcare service was provided by a healthcare provider that is a member of the health benefit plan's provider network.  (2) Restrictions on coverage for an emergency healthcare service provided by a healthcare provider that is not a member of the health benefit plan's provider network shall not be greater than restrictions on coverage for an emergency healthcare service provided by a healthcare provider that is a member of the health benefit plan's provider network.    (e)  (1) If a subscriber receives an emergency healthcare service that requires an immediate post-evaluation or post-stabilization healthcare service, a utilization review entity shall make an authorization within sixty (60) minutes of receiving a request.  (2) If the authorization is not made within sixty (60) minutes, the emergency healthcare service shall be approved.
AR Code § 23-99-1108 (2020)
2020 Arkansas Code|Title 23 - Public Utilities and Regulated Industries|Subtitle 3 - Insurance|Chapter 99 - Healthcare Providers|Subchapter 11 - Prior Authorization Transparency Act|§ 23-99-1108. Subscribers with terminal illness — Denial of prior authorization for covered prescription pain medication prohibited

 If a subscriber's covered prescription pain medication requires a prior authorization, then the prior authorization shall not be denied if the subscriber has a terminal illness.
AR Code § 23-99-1110 (2020)
2020 Arkansas Code|Title 23 - Public Utilities and Regulated Industries|Subtitle 3 - Insurance|Chapter 99 - Healthcare Providers|Subchapter 11 - Prior Authorization Transparency Act|§ 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.
AR Code § 23-99-1111 (2020)
2020 Arkansas Code|Title 23 - Public Utilities and Regulated Industries|Subtitle 3 - Insurance|Chapter 99 - Healthcare Providers|Subchapter 11 - Prior Authorization Transparency Act|§ 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 determination regarding a request for prior authorization shall be made by a physician who possesses a current and unrestricted license to practice medicine in the State of Arkansas issued by the Arkansas State Medical Board.  (2)  (A) A utilization review entity shall provide a method by which a physician may request that a prior authorization request be reviewed by a physician in the same specialty as the physician making the request, by a physician in another appropriate specialty, or by a pharmacologist.  (B) If a request is made under subdivision (c)(2)(A) of this section, the reviewing physician or pharmacologist is not required to meet the requirements of subdivision (c)(1) of this section.
AR Code § 23-99-1112 (2020)
2020 Arkansas Code|Title 23 - Public Utilities and Regulated Industries|Subtitle 3 - Insurance|Chapter 99 - Healthcare Providers|Subchapter 11 - Prior Authorization Transparency Act|§ 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.
AR Code § 23-99-1113 (2020)
2020 Arkansas Code|Title 23 - Public Utilities and Regulated Industries|Subtitle 3 - Insurance|Chapter 99 - Healthcare Providers|Subchapter 11 - Prior Authorization Transparency Act|§ 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 to be provided to a specific subscriber.  (2)  (A) The State Insurance Department shall issue a rule on or before January 1, 2018, that defines which benefits are subject to the requirements of this section.  (B) Until a rule is promulgated under subdivision (a)(2)(A) of this section, all benefit inquiries shall be processed according to this section.      (b) If a healthcare insurer or utilization review entity lacks sufficient information to respond to a benefit inquiry, the healthcare insurer or utilization review entity shall notify the healthcare provider within two (2) business days of the additional information that is required to respond to the benefit inquiry.  (c)  (1) A healthcare insurer, either directly or through a utilization review entity, shall respond to a benefit inquiry authorized in subsection (a) of this section within ten (10) business days of receipt of information required to make a decision on the benefit inquiry.  (2) Responses to a benefit inquiry shall be provided in the same form and manner as responses to requests for prior authorization.    (d) Every healthcare insurer shall provide a convenient and accessible procedure for healthcare providers to submit benefit inquiries under this section.  (e) Sections 23-99-1109 — 23-99-1111 and 23-99-1114 — 23-99-1116 apply to the benefit inquiry process of any healthcare insurer or utilization review entity.  (f) A healthcare service approved under the benefit inquiry process authorized in this section is not subject to audit recoupment under § 23-63-1801 et seq., except as provided for in § 23-99-1109(b).
AR Code § 23-99-1114 (2020)
2020 Arkansas Code|Title 23 - Public Utilities and Regulated Industries|Subtitle 3 - Insurance|Chapter 99 - Healthcare Providers|Subchapter 11 - Prior Authorization Transparency Act|§ 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 change its prescribed drug formulary or change to a new or different pharmacy benefits manager or utilization review entity.  (b) In order to ensure compliance with this section, if a healthcare insurer or utilization review entity changes its pharmacy benefits manager, the healthcare insurer or utilization review entity shall provide the new pharmacy benefits manager with adequate historical claims data to identify all subscribers who have been required to utilize step therapy and the results of that step therapy.  (c) Except as provided in subsection (d) of this section, notwithstanding subsection (a) of this section, a utilization review entity may require the utilization of step therapy if:  (1) A new drug has been introduced to treat the patient's condition or an existing therapy is considered clinically appropriate for treatment of the patient's condition; or  (2) The patient's medical or physical condition has changed substantially since the step therapy was required that makes the use of repeat step therapy appropriate.    (d)  (1) An insurance policy that provides coverage for the treatment of metastatic cancer shall not limit or exclude coverage under the health benefit plan for a drug approved by the United States Food and Drug Administration that is on the prescription drug formulary of the insurance policy by mandating that a covered person with metastatic cancer undergo step therapy unless the preferred drug is consistent with best practices that:  (A) Are used for the treatment of metastatic cancer or associated conditions under:  (i) The United States Food and Drug Administration-approved indication; or  (ii) The National Comprehensive Cancer Network Drugs and Biologics Compendium indication; or    (B) Use evidence-based, peer-reviewed, recognized medical literature.    (2) As used in subdivision (d)(1) of this section, “metastatic cancer” means cancer that has spread from a primary or original site of the cancer to surrounding or nearby tissues, lymph nodes, or other parts of the body.
AR Code § 23-99-1116 (2020)
2020 Arkansas Code|Title 23 - Public Utilities and Regulated Industries|Subtitle 3 - Insurance|Chapter 99 - Healthcare Providers|Subchapter 11 - Prior Authorization Transparency Act|§ 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.