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 9 - ARKANSAS HEALTHCARE TRANSPARENCY INITIATIVE ACT OF 2015 (§§ 23-61-901 — 23-61-910) › Section 23-61-903 - Definitions

As used in this subchapter:
(1)
"Arkansas Healthcare Transparency Initiative" means an initiative to create a database, including ongoing all-payer claims database projects funded through the State Insurance Department, that receives and stores data from a submitting entity relating to medical, dental, and pharmaceutical and other insurance claims information, unique identifiers, and geographic and demographic information for covered individuals as permitted in this subchapter, and provider files, for the purposes of this subchapter;
(2)
"Arkansas resident" means an individual for whom the submitting entity has identified an Arkansas address as the individual's primary place of residence;
(3)
"Claims data" means information included in an institutional, professional, or pharmacy claim or equivalent information transaction for a covered individual, including the amount paid to a provider of healthcare services plus any amount owed by the covered individual;
(4)
"Covered individual" means a natural person who is an Arkansas resident and is eligible to receive medical, dental, or pharmaceutical benefits under any policy, contract, certificate, evidence of coverage, rider, binder, or endorsement that provides for or describes coverage;
(5)
(A)
"Direct personal identifiers" means information relating to a covered individual that contains primary or obvious identifiers, such as the individual's name, street address, e-mail address, telephone number, and Social Security number.
(B)
"Direct personal identifiers" does not include geographic or demographic information that would not allow the identification of a covered individual;
(6)
"Enrollment data" means demographic information and other identifying information relating to covered individuals, including direct personal identifiers;
(7)
"Protected health information" means health information as protected by the Health Insurance Portability and Accountability Act of 1996, Pub. L. No. 104-191, as it existed on January 1, 2015;
(8)
"Provider" means an individual or entity licensed by the state to provide healthcare services;
(9)
(A)
"Submitting entity" means:
(i)
An entity that provides health or dental insurance or a health or dental benefit plan in the state, including without limitation an insurance company, medical services plan, managed care organization, hospital plan, hospital medical service corporation, health maintenance organization, or fraternal benefit society, provided that the entity has covered individuals and the entity had at least two thousand (2,000) covered individuals in the previous calendar year;
(ii)
A health benefit plan offered or administered by or on behalf of the state or an agency or instrumentality of the state, including without limitation benefits administered by a managed care organization whether or not the managed care organization had two thousand (2,000) covered individuals in the previous year;
(iii)
A health benefit plan offered or administered by or on behalf of the United States Government with the agreement of the United States Government;
(iv)
The Workers' Compensation Commission;
(v)
Any other entity providing a plan of health insurance or health benefits subject to state insurance regulation, a third-party administrator, or a pharmacy benefits manager, provided that the entity has covered individuals and the entity had at least two thousand (2,000) covered individuals in the previous calendar year;
(vi)
A health benefit plan subject to the Employee Retirement Income Security Act of 1974, Pub. L. No. 93-406, and that is fully insured;
(vii)
A risk-based provider organization licensed by the State Insurance Department; and
(viii)
An entity that contracts with institutions of the Division of Correction or the Division of Community Correction to provide medical, dental, or pharmaceutical care to inmates.
(B)
"Submitting entity" does not include:
(i)
An entity that provides health insurance or a health benefit plan that is accident-only, specified disease, hospital indemnity, long-term care, disability income, or other supplemental benefit coverage;
(ii)
An employee of a welfare benefit plan as defined by federal law that is also a trust established pursuant to collective bargaining subject to the Labor Management Relations Act, 1947, Pub. L. No. 80-101; or
(iii)
A health benefit plan subject to the Employee Retirement Income Security Act of 1974, Pub. L. No. 93-406, that is self-funded; and
(10)
"Unique identifier" means any identifier that is guaranteed to be unique among all identifiers for covered individuals but does not include direct personal identifiers.
Amended by Act 2019, No. 910,§ 1017, eff. 7/1/2019.
Amended by Act 2017, No. 979,§ 3, eff. 8/1/2017.
Added by Act 2015, No. 1233,§ 1, eff. 4/7/2015.