Arkansas Administrative Code › Agency 003 - DEPARTMENT OF COMMERCE › Division 22 - Insurance Department › Rule 003.22.23-003 - Proposed New Rule 69 - Establishment of Audit Process Concerning Qualified Payment Amounts for No Surprises Act

Current through Register Vol. 49, No. 6, June, 2024
Section
			 1.
Authority
This Rule is issued pursuant to the authority granted the
				Arkansas Insurance Commissioner ("Commissioner") under Ark. Code Ann. §
									23-61-108(a)(1)
				and by Ark. Code Arm. §
									23-61-108(b)(l)
				to promulgate rules necessary for the effective regulation of the business of
				insurance and as required for this State to be in compliance with federal laws,
				namely the No Surprises Act (NBA) of the Consolidated Appropriations Act, 2021,
				Pub. L. No.
				116-120, and Act 580 of 2023, codified as A.C.A.
				§
									23-66-216.
Section 2.
Purpose
The purpose of this Rule is to authorize the Commissioner to
				establish an effective state audit process to ensure compliance with the
				requirements of the NBA related to the determination and development of
				methodology concerning the calculation of a qualified payment amount.
Section 3.
Definitions
Unless otherwise separately defined in this rule and consistent
				with state law, the terms or phrases as used in this rule shall follow the
				definitions of such terms or phrases as defined in A.C.
A.
									§
									23-66-216, and the Consolidated
			 Appropriations Act, 2021, Pub. L. No. 116-120.
(1) "Commissioner" means the Arkansas
			 Insurance Commissioner.
(2) "Health
			 benefit plan" means any individual, blanket, or group plan, policy or contract
			 for health care services issued, renewed or extended in this state by a health
			 carrier on or after January 1, 2024. "Health benefit plan" does not include a
			 plan providing health care services pursuant to 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., nor include an
			 accident-only, specified disease, hospital indemnity, long-term care,
			 disability incorae, or limited-benefit health insurance policy. The provisions
			 of this Rule shall not apply to Medicare supplement or Medicare Advantage
			 policies or policies offering coverage through Medicare. This Rule shall also
			 not apply to vision or dental only plans.
(3) "Health carrier" means an entity subject
			 to the insurance laws and regulations of this State, or subject to the
			 jurisdiction of the Commissioner, that contracts or offers to contract, or
			 enters into an agreement to provide, deliver, arrange for, pay for or reimburse
			 any of the costs of health care services, including a sickness and accident
			 insurance company, a health maintenance organization, a nonprofit hospital and
			 health service corporation, or any other entity providing a plan of health
			 insurance, health benefits or health services. A Health Carrier does not
			 include an automobile insurer paying medical or hospital benefits under Ark.
			 Code Ann. §
										23-89-202(1) nor
			 shall it include a self-insured employer health benefits plan. A Health Carrier
			 also does not include any person, company, or organization, licensed or
			 registered to issue or who issues any insurance policy or insurance contract in
			 this State providing medical or hospital benefits for accidental injury or
			 accidental disability.