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 61 - STATE INSURANCE DEPARTMENT (§§ 23-61-101 — 23-61-1111) › Subchapter 10 - ARKANSAS HEALTH AND OPPORTUNITY FOR ME ACT OF 2021 (§§ 23-61-1001 — 23-61-1012) › Section 23-61-1003 - Definitions

As used in this subchapter:
(1)
"Acute care hospital" means a hospital that:
(A)
Is licensed by the Department of Health under §
20-9-201
et seq., as a general hospital or a surgery and general medical care hospital; and
(B)
Is enrolled as a provider with the Arkansas Medicaid Program;
(2)
"Birthing hospital" means a hospital in this state or in a border state that:
(A)
Is licensed as a general hospital;
(B)
Provides obstetrics services; and
(C)
Is enrolled as a provider with the Arkansas Medicaid Program;
(3)
"Community bridge organization" means an organization that is authorized by the Department of Human Services to participate in the economic independence initiative or the health improvement initiative to:
(A)
Screen and refer Arkansans to resources available in their communities to address health-related social needs; and
(B)
Assist eligible individuals identified as target populations most at risk of disease and premature death and who need a higher level of intervention to improve their health outcomes and succeed in meeting their long-term goals to achieve independence, including economic independence;
(4)
"Cost sharing" means the portion of the cost of a covered medical service that is required to be paid by or on behalf of an eligible individual;
(5)
"Critical access hospital" means an acute care hospital that is:
(A)
Designated by the Centers for Medicare & Medicaid Services as a critical access hospital; and
(B)
Is enrolled as a provider in the Arkansas Medicaid Program;
(6)
"Economic independence initiative" means an initiative developed by the Department of Human Services that is designed to promote economic stability by encouraging participation of program participants to engage in full-time, full-year work, and to demonstrate the value of enrollment in an individual qualified health insurance plan through incentives and disincentives;
(7)
"Eligible individual" means an individual who is in the eligibility category created by section 1902(a)(10)(A)(i)(VIII) of the Social Security Act,
42 U.S.C. § 1396a
;
(8)
"Employer health insurance coverage" means a health insurance benefit plan offered by an employer or, as authorized by this subchapter, an employer self-funded insurance plan governed by the Employee Retirement Income Security Act of 1974, Pub. L. No. 93-406, as amended;
(9)
"Health improvement initiative" means an initiative developed by an individual qualified health insurance plan or the Department of Human Services that is designed to encourage the participation of eligible individuals in health assessments and wellness programs, including fitness programs and smoking or tobacco cessation programs;
(10)
"Health insurance benefit plan" means a policy, contract, certificate, or agreement offered or issued by a health insurer to provide, deliver, arrange for, pay for, or reimburse any of the costs of healthcare services, but not including excepted benefits as defined under
42 U.S.C. § 300gg-91(c)
, as it existed on January 1, 2021;
(11)
"Health insurance marketplace" means the applicable entities that were designed to help individuals, families, and businesses in Arkansas shop for and select health insurance benefit plans in a way that permits comparison of available plans based upon price, benefits, services, and quality, and refers to either:
(A)
The Arkansas Health Insurance Marketplace created under the Arkansas Health Insurance Marketplace Act, §
23-61-801
et seq., or a successor entity; or
(B)
The federal health insurance marketplace or federal health benefit exchange created under the Patient Protection and Affordable Care Act, Pub. L. No. 111-148;
(12)
"Health insurer" means an insurer authorized by the State Insurance Department to provide health insurance or a health insurance benefit plan in the State of Arkansas, including without limitation:
(A)
An insurance company;
(B)
A medical services plan;
(C)
A hospital plan;
(D)
A hospital medical service corporation;
(E)
A health maintenance organization;
(F)
A fraternal benefits society;
(G)
Any other entity providing health insurance or a health insurance benefit plan subject to state insurance regulation; or
(H)
A risk-based provider organization licensed by the Insurance Commissioner under §
20-77-2704
;
(13)
"Healthcare coverage" means coverage provided under this subchapter through either an individual qualified health insurance plan, a risk-based provider organization, employer health insurance coverage, or the fee-for-service Arkansas Medicaid Program;
(14)
"Individual qualified health insurance plan" means an individual health insurance benefit plan offered by a health insurer that participates in the health insurance marketplace to provide coverage in Arkansas that covers only essential health benefits as defined by Arkansas rule and
45 C.F.R. § 156.110
and any federal insurance regulations, as they existed on January 1, 2021;
(15)
"Member" means a program participant who is enrolled in an individual qualified health insurance plan;
(16)
"Premium" means a monthly fee that is required to be paid by or on behalf of an eligible individual to maintain some or all health insurance benefits;
(17)
"Program participant" means an eligible individual who:
(A)
Is at least nineteen (19) years of age and no more than sixty-four (64) years of age with an income that meets the income eligibility standards established by rule of the Department of Human Services;
(B)
Is authenticated to be a United States citizen or documented qualified alien according to the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, Pub. L. No. 104-193;
(C)
Is not eligible for Medicare or advanced premium tax credits through the health insurance marketplace; and
(D)
Is not determined by the Department of Human Services to be medically frail or eligible for services through a risk-based provider organization;
(18)
"Risk-based provider organization" means the same as defined in §
20-77-2703
; and
(19)
"Small rural hospital" means a critical access hospital or a general hospital that:
(A)
Is located in a rural area;
(B)
Has fifty (50) or fewer staffed beds; and
(C)
Is enrolled as a provider in the Arkansas Medicaid Program.
Amended by Act 2021, No. 530,§ 1, eff. on and after January 1, 2022.
Amended by Act 2017EX1, No. 6,§ 4, eff. 5/4/2017.
Amended by Act 2017EX1, No. 3,§ 4, eff. 5/4/2017.
Added by Act 2016EX2, No. 2,§ 1, eff. 4/8/2016.
Added by Act 2016EX2, No. 1,§ 1, eff. 4/8/2016.