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.
Section 4.
Applicability and
Scope
This Rule applies to all health carriers that offer health
benefit plans in this State which are issued or renewed on or after January 1,
2024.
Section 5.
Audit
Requirement
(a) The Commissioner shall
develop a state audit process to ensure that a health benefit plan or health
carrier calculates the qualified payment amount established under the No
Surprises Act of the Consolidated Appropriations Act, 2021,
Pub. L.
116-220.
(b) The federal qualified health payment
amount methodologies shall be included in all health policy forms for review
and approval by the Commissioner.
(c) The audit process required pursuant to
this rule, and specifically §5(a) above, shall be consistent with and
included in the already required examination of insurers as contemplated by
A.C.A. §
23-61-201 et seq. The
Commissioner, per his or her discretion may conduct an examination of health
carriers concerning potential violations of the administration the qualified
payment amount methodology of the NSA to ensure compliance with the
requirements not more often than every five (5) years on an as needed basis if
and when justified by a significant number of complaints against a particular
carrier.
(d) The resulting
examination report concerning potential violations of the NSA as it relates to
the qualified payment amount calculation methodology shall be shared with the
federal Departraent of Health and Human Services (HHS) in order that the
Commissioner and HHS may impose appropriate sanctions and engage is proper
administration to carry out all requirements of state and federal
law.
Section 6.
Enforcement
The penalties, license actions or orders as authorized under
Ark. Code Arm. §
23-66-210 shall apply to
violations of this Rule.
Section
7.
Effective Date
This Rule shall be effective upon approval by the Arkansas
Legislative Council and shall go into effect ten (10) days after filing a final
rule with the Secretary of State.
Notes
003.22.23 Ark. Code R. 003
Adopted by
Arkansas
Register Volume 49, Number 01, Effective
1/15/2024
