On Apr. 10, ARK LEG enacted bill re transparency in prior authorization
ARK LEG passed Bill HB 1300, to amend the Prior authorization transparency act.
Amends provisions in Arkansas code, ARK INS 23-3-99 (healthcare providers), adds new ARK LEG 19-5-11-1161 (Prior Authorization Transparency Act Trust Fund).
Prior Authorization
Created a trust fund known as the Prior Authorization Transparency Act Trust Fund.
Consist of moneys related to Ins Commissioner for fines under ARK INS 23-3-99-11-23-99-1116 for failure to comply, and specific uses for which funds can be allocated.
Revised definitions for healthcare service,prior authorization, and includes clinical criteria as required in disclosure of an entity's prior authorization requirements.
Disclosure must be available in easily understandable and machine-readable format for automated retrieval and processing, and include name and applicable billing codes.
If prior authorization not required, the utilization review entity will disclose any other restriction, limitation, or requirement that may preclude coverage of specific service.
Does not apply if utilization review entity provides a document on its website or in a format available to download from its website with certain data, and required notices.
Also allows healthcare insurer to pay certain claims for a healthcare service under the medical benefit of a health benefit plan in the absence of a prior authorization.
Monetary penalties may be issued for noncompliance by issuer/utilization review entity
Exceptions if person knew/reasonably should have known he/she was in violation.
If commissioner finds that insurer or utilization review entity failed to comply with such frequency that indicates general business practice, fines will be $5k daily up to $100k.
Legislative History
On Jan. 29, 2025, bill was introduced in House; on Mar. 17, 2025, bill passed House.
On Mar. 17, 2025, bill was introduced in Senate; on Apr. 3, 2025, bill passed Senate.
On Apr. 4, 2025, bill delivered to the governor; on Apr. 10, 2025, bill assigned Act 510.
Effectiveness
Act effective 91 days after legislature adjourned sine die (May 5), so Aug. 4, 2025.
Regulators
ARK LEG
Entity Types
CNSM; Ins
Reference
Act 510, Bill HB1300, 4/10/2025; Citation: *ARK INS* 23-3-99, 23-3-99-11-23-99-1116; ARK LEG 19-5-11;
Functions
Claims/Accelerated Benefits; Compliance; Legal; Product Administration; Record Retention
