Arkansas Code of 1987 (2023) › Title 23 - PUBLIC UTILITIES AND REGULATED INDUSTRIES (§§ 23-1-101 — 23-119-105) › Subtitle 3 - INSURANCE (§§ 23-60-101 — 23-103-417) › Chapter 99 - HEALTH CARE PROVIDERS (§§ 23-99-201 — 23-99-1802) › Subchapter 11 - PRIOR AUTHORIZATION TRANSPARENCY ACT (§§ 23-99-1101 — 23-99-1130) › Section 23-99-1127 - Applicability

(a)
(1)
An organization or entity directly or indirectly providing a plan or services to patients under the Medicaid Provider-Led Organized Care Act, §
20-77-2701
et seq., or any other Medicaid-managed care program operating in this state is exempt from §§
23-99-1120
-
23-99-1126
if the program, without limiting the program's application to any other plan or program, develops a program to reduce or eliminate prior authorizations for a healthcare provider on or before January 1, 2025.
(2)
The Arkansas Health and Opportunity for Me Program established by the Arkansas Health and Opportunity for Me Act of 2021, §
23-61-1001
et seq., or its successor program is exempt from §§
23-99-1120
-
23-99-1126
, provided that the Arkansas Health and Opportunity for Me Program, without limiting the Arkansas Health and Opportunity for Me Program's application to any other plan or program, develops a program to reduce or eliminate prior authorizations for a healthcare provider on or before January 1, 2025.
(3)
A qualified health plan that is a health benefit plan under the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, and purchased on the Arkansas Health Insurance Marketplace created under the Arkansas Health Insurance Marketplace Act, §
23-61-801
et seq., for an individual up to four hundred percent (400%) of the federal poverty level, operating in this state is exempt from §§
23-99-1120
-
23-99-1126
if the qualified health plan, without limiting the program's application to any other plan or program, develops a program to reduce or eliminate prior authorizations for a healthcare provider on or before January 1, 2025.
(b)
(1)
The programs under subsection (a) of this section to reduce or eliminate prior authorization shall be:
(A)
Submitted to the State Insurance Department; and
(B)
Subject to approval by the Legislative Council.
(2)
If a program is not submitted to the department and approved by the Legislative Council on or before January 1, 2025, the Medicaid-managed care program operating in this state, the Arkansas Health and Opportunity for Me Program established by the Arkansas Health and Opportunity for Me Act of 2021, §
23-61-1001
et seq., or its successor program, and qualified health plans under the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, and purchased on the Arkansas Health Insurance Marketplace created under the Arkansas Health Insurance Marketplace Act, §
23-61-801
et seq., for an individual up to four hundred percent (400%) of the federal poverty level, operating in this state shall be subject to §§
23-99-1120
-
23-99-1126
and §
23-99-1128
as of January 1, 2025.
(c)
Any state or local governmental employee plan is exempt from §§
23-99-1120
-
23-99-1126
and §
23-99-1128
.
(d)
A health benefit plan provided by a trust established under §§
14-54-101
and
25-20-104
to provide benefits, including accident and health benefits, death benefits, dental benefits, and disability income benefits, is exempt from §§
23-99-1120
-
23-99-1126
.
(e)
(1)
Prescription drugs, medicines, biological products, pharmaceuticals, or pharmaceutical services are exempt as a healthcare service for purposes of §§
23-99-1120
-
23-99-1126
until December 31, 2024.
(2)
(A)
As of January 1, 2025, the provisions of §§
23-99-1120
-
23-99-1126
shall apply to prescription drugs, medicines, biological products, pharmaceuticals, or pharmaceutical services that have not been approved for continuation of prior authorization under §
23-99-1128
.
(B)
For the products in subdivision (e)(2)(A) of this section that have not been approved for continuation of prior authorization, for purposes of §
23-99-1120
, then:
(i)
Provisions regarding time periods specified during calendar year 2022 shall instead apply to the same months during calendar year 2023; and
(ii)
Provisions regarding time periods specified during calendar year 2024 shall instead apply to the same months during calendar year 2025.
Added by Act 2023, No. 575,§ 5, eff. 8/1/2023.