Arkansas Administrative Code › Agency 054 - Arkansas Insurance Department › Rule 054.00.96-007 - Reg. 45 - Children's Preventive Health Care Reimbursement Levels

Current through Register Vol. 49, No. 6, June, 2024
PROPOSED RULE AND REGULATION 45 CHILDREN'S PREVENTIVE HEALTH CARE
			 REIMBURSEMENT LEVELS
Section 1.
		  Purpose
The purpose of this Regulation is to implement and coordinate
			 insurers' compliance with Arkansas Code §
								23-79-141,
			 as amended by Act 685 of 1995.
Section
		  2. Authority
This Rule is issued pursuant to the authority vested in the
			 Commissioner under Ark. Code Ann. §§
								23-61-108,
			 23-76-125,
			 23-79-141
			 as amended by Act 685 of 1995, and
			 25-15-203,
			 and other applicable provisions of Arkansas law.
Section 3. Applicability and Scope
This Rule applies to every disability (health) insurer, hospital
			 or medical service corporation, health maintenance organization ("HMO"), and
			 fraternal benefit society licensed by the Arkansas Insurance Commissioner
			 ("Commissioner'1), and to each self-insured plan
			 transacting disability insurance or providing disability coverage in this State
			 which delivers, issues for delivery in this State, or renews, extends, or
			 modifies disability policies, contracts, certificates and plans providing
			 hospital and medical coverage on an expense incurred, service, or prepaid basis
			 and which contracts provide coverage for a family member of the insured
			 person.
This Regulation does not apply to disability income, specified
			 disease, medicare supplement, hospital indemnity, or accident only
			 policies.
Section 4.
		  Effective Date
The effective date of this Rule is July 1, 1997, upon signature
			 of the Commissioner and statutory filing.
Section 5. Definitions
A. Anticipatory Guidance
Anticipatory guidance shall- include such things as visual
			 evaluation (titmus machine or other ophthalmological testing not required),
			 hearing evaluation (machine audiology test not required), dental inspection for
			 children under two years of age, and a nutritional assessment.
B. Children's Preventive Health
		  Care Services
This term means physician-delivered or physician-supervised
			 services for eligible dependents from birth through age eighteen (18), with
			 periodic preventive care visits, including medical history, physical
			 examination, developmental assessment, anticipatory guidance and appropriate
			 immunizations and laboratory tests, in keeping with prevailing medical
			 standards for the purposes of this Rule and Regulation.
C. Developmental Assessment
A developmental assessment should be obtained by history and
			 observation of the child, or by one recognized developmental tests. This
			 portion of the screening should include assessment of eye-hand coordination,
			 gross motor function (walking, hopping, climbing), fine motor skills (use of
			 finger dexterity and hand usage), speech development, daily living personal
			 skills such as dressing, feeding and grooming oneself, behavioral development,
			 and proofs of mind with body integration.
D. Lab Test/Immunizations
Laboratory procedures and immunizations should be performed as
			 appropriate for the child's age. A hematocrit or hemoglobin test is recommended
			 for children one (1) year of age and older and a urinalysis is recommended for
			 children five (5) years of age and older. Other laboratory procedures are to be
			 performed if it is deemed appropriate by the child's age and/or health history
			 (i.e., lead toxicity, sickle cell, tuberculin, pap smear),
E. Medical History
A medical history is to be obtained from the parent, legal
			 guardian, or other responsible adult who is familiar with the child's health
			 history. The child's height and weight should also be recorded and compared
			 with the ranges considered normal for children of that age. '
F. Periodic Preventive Care Visits
Routine tests and procedures performed for the purpose of
			 detection of abnormalities or malfunctions of bodily systems and parts
			 according to accepted medical practice.
G. Physical Examination
A physical examination is to be performed to note obvious
			 physical defects including orthopedic, genital, skin, and other observable
			 deviations.