Arkansas Administrative Code › Agency 054 - Arkansas Insurance Department › Division 01 - Legal Division › Rule 054.01.20-007 - Emergency Rule 122: "Prior Authorization Waivers for Post-Acute Transfer"

Current through Register Vol. 49, No. 6, June, 2024
SECTION 1.
PURPOSE
The purpose of this Rule is to temporarily reduce insurance
				barriers or limitations causing an increase in hospital occupancy and resources
				during the COVID-19 pandemic due to prior authorization protocols on post-acute
				transfers of patients.
SECTION
			 2.
STATEMENT OF EMERGENCY
The Arkansas Insurance Commissioner ("Commissioner") finds that
				insurance barriers exist causing unnecessary hospitalizations and hospital
				resource costs due to health plans applying prior authorization protocols for
				patients transferring from hospitals to post-acute facilities, skilled nursing
				facilities, and acute inpatient rehabilitation facilities. The Commissioner
				finds that a public emergency exists to temporarily eliminate prior
				authorization requirements that are burdening hospital occupancy and resources
				as patients wait on authorizations from an insurer, HMO, or Medicare Advantage
				organization before transitioning to a post-acute care facility from the
				hospital.
SECTION 3.
AUTHORITY
Pursuant to Ark. Code Ann. §
									23-99-1118, the State Insurance
				Department may promulgate rules for the implementation of this subchapter
				governing the "Prior Authorization Transparency Act." Ark. Code Ann. §
									25-15-204(b) (1)
				states that if an agency finds that imminent peril to the public health,
				safety, or welfare or compliance with federal laws or regulations requires
				adoption of a rule upon less than thirty (30) days' notice and states in
				writing its reasons for that finding, it may proceed without prior notice or
				hearing, or upon any abbreviated notice and hearing that it may choose, to
				adopt an emergency rule. The rule may be effective for no longer than one
				hundred twenty (120) days.
SECTION
			 4.
DEFINITIONS
Unless otherwise stated in this Rule, the definitions in Ark.
				Code Ann. §
									23-99-1103 shall apply to the
				provisions or sections of this Rule.
SECTION 5.
PRIOR AUTHORIZATION WAIVERS
			 FOR POST-ACUTE TRANSFERS
No health benefit plan, or Utilization Review entity, shall
				impose a prior authorization protocol, pre-certification requirement, or step
				therapy procedure for, or upon, transfers of insured patients from hospitals to
				a post-acute setting or facility which includes but is not limited to skilled
				nursing facilities, or acute inpatient rehabilitation facilities during the
				effective time period of this Rule.
SECTION 6.
EFFECTIVE DATE
This Emergency Rule shall be effective for one hundred and
				twenty (120) days following approval by the Arkansas Legislative Council, when
				it shall expire.
SUMMARY
RULE 122
PRIOR AUTHORIZATION WAIVERS FOR POST-ACUTE
				TRANSFERS
AID issues this emergency rule in order to help reduce
				insurance barriers which are operating to slow down or hinder hospital
				transfers of patients, from a hospital to a post-acute setting. Such barriers
				are adversely impacting hospital occupancy at a time that more occupancy and
				resources are needed by our hospitals for COVID-related responses. The primary
				insurer impediments are derived from insurer, HMO, or Medicare Advantage prior
				authorization or pre-certification requirements applying to such transfers, for
				transfers to. skilled nursing facilities as well as to post-acute inpatient
				rehabilitation centers or facilities.
The rule is simple as it entirely prohibits the imposition of
				any pre-cert requirement or step therapy protocol from the insurer to such
				transfers. The rule applies to all health benefit plans subject to the Arkansas
				Prior authorization Act. This a very broad Act. The definition of health
				benefit plan is in Ark. Code Ann. §
									23-99-1103(7):
(A) "Health benefit plan" means any
			 individual, blanket, or group plan, policy, or contract for healthcare services
			 issued or delivered by a healthcare insurer in this state. "Healthcare insurer"
			 means an entity that is subject to state insurance regulation, including an
			 insurance company, a health maintenance organization, a hospital and medical
			 service corporation, a risk-based provider organization, and a sponsor of a
			 nonfederal self-funded governmental plan. This would include EBD and the PASSE
			 program.
The authority for this rule is in two (2) parts. One is from
				the Prior Authorization Transparency Initiative which gives the Department
				authority to issue rules to implement the Prior Authorization Transparency Act
				in Ark. Code Ann. §§
										23-99-1101 et seq.; the other
				authority is the Administrative Procedures Act for issuance of an emergency
				rule in Ark. Code Ann. §
										25-15-204(b)
				(1).
AID does NOT intend to adopt the currently proposed emergency
				rule as a permanent rule within 120 days. The proposed Emergency Rule will
				expire in 120 days.