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 79 - INSURANCE POLICIES GENERALLY (§§ 23-79-101 — 23-79-2802) › Subchapter 26 - COVERAGE FOR BIOMARKER TESTING FOR EARLY DETECTION AND MANAGEMENT FOR CANCER DIAGNOSES (§§ 23-79-2601 — 23-79-2602) › Section 23-79-2601 - Definitions

As used in this subchapter:
(1)
(A)
"Biomarker" means a characteristic that is objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes, or pharmacologic responses to a specific therapeutic intervention, including known gene-drug interactions for medications being considered for use or already being administered.
(B)
"Biomarker" includes without limitation gene mutations or protein expression;
(2)
(A)
"Biomarker testing" means the analysis of a patient's tissue, blood, or other biospecimen for the presences of a biomarker.
(B)
"Biomarker testing" includes without limitation single-analyte tests, multiplex panel tests, protein expression, and whole exome, whole genome, and whole transcriptome sequencing;
(3)
"Consensus statement" means a statement that:
(A)
Is developed by an independent, multidisciplinary panel of experts that uses a transparent methodology and reporting structure that includes a conflict of interest policy;
(B)
Is based on the best available evidence for the purpose of optimizing clinical care outcomes; and
(C)
Is aimed at specific clinical circumstances;
(4)
(A)
"Health benefit plan" means an individual, blanket, or group plan, policy, or contract for healthcare services issued, renewed, or extended in this state by a healthcare insurer, health maintenance organization, hospital medical service corporation, or self-insured governmental or church plan in this state.
(B)
"Health benefit plan" includes indemnity and managed care plans.
(C)
"Health benefit plan" does not include:
(i)
A plan that provides only dental benefits or eye and vision care benefits;
(ii)
A disability income plan;
(iii)
A credit insurance plan;
(iv)
Insurance coverage issued as a supplement to liability insurance;
(v)
Medical payments under an automobile or homeowners insurance plan;
(vi)
A health benefit plan provided under Arkansas Constitution, Article 5, § 32, the Workers' Compensation Law, §
11-9-101
et seq., and the Public Employee Workers' Compensation Act, §
21-5-601
et seq.;
(vii)
A plan that provides only indemnity for hospital confinement;
(viii)
An accident-only plan;
(ix)
A specified disease plan;
(x)
The Arkansas Medicaid Program; or
(xi)
A program established by the Arkansas Health and Opportunity for Me Act of 2021, §
23-61-1001
et seq.;
(5)
(A)
"Healthcare insurer" means any insurance company, hospital and medical service corporation, or health maintenance organization that issues or delivers health benefit plans in this state and is subject to any of the following laws:
(i)
The insurance laws of this state;
(ii)
Section
23-75-101
et seq., pertaining to hospital and medical service corporations; or
(iii)
Section
23-76-101
et seq., pertaining to health maintenance organizations.
(B)
"Healthcare insurer" does not include an entity that provides only dental benefits or eye and vision care benefits;
(6)
"Healthcare professional" means a person who is licensed, certified, or otherwise authorized by the laws of this state to administer health care in the ordinary course of the practice of his or her profession;
(7)
"Nationally recognized clinical practice guidelines" means evidence-based clinical practice guidelines that:
(A)
Are developed by independent organizations or medical professional societies using a:
(i)
Transparent methodology and reporting structure; and
(ii)
Conflict of interest policy; and
(B)
Establish standards of care that are informed by:
(i)
A systemic review of evidence; and
(ii)
An assessment of the benefits and costs of alternative care options that includes recommendations intended to optimize patient care;
(8)
(A)
"Subscriber" means an individual eligible to receive coverage of healthcare services by a healthcare professional under a health benefit plan.
(B)
"Subscriber" includes a subscriber's legally authorized representative;
(9)
"Urgent healthcare service" means a healthcare service for a non-life-threatening condition that, in the opinion of a physician with knowledge of a subscriber's medical condition, requires prompt medical care in order to prevent:
(A)
A serious threat to life, limb, or eyesight;
(B)
Worsening impairment of a bodily function that threatens the body's ability to regain maximum function;
(C)
Worsening dysfunction or damage of any bodily organ or part that threatens the body's ability to recover from the dysfunction or damage; or
(D)
Severe pain that cannot be managed without prompt medical care; and
(10)
(A)
"Utilization review entity" means an individual or entity that performs prior authorization for at least one (1) of the following:
(i)
A healthcare insurer;
(ii)
A preferred provider organization or health maintenance organization; or
(iii)
Any other individual or entity that provides, offers to provide, or administers hospital, outpatient, medical, or other health benefits to a person treated by a healthcare provider in this state under a policy, health benefit plan, or contract.
(B)
A healthcare insurer is a utilization review entity if the healthcare insurer performs prior authorization.
(C)
"Utilization review entity" does not include an insurer of automobile, homeowners, or casualty and commercial liability insurance or the insurer's employees, agents, or contractors.
Added by Act 2023, No. 429,§ 1, eff. 8/1/2023.