Arkansas Code Title 23, Subtitle 3, Chapter 99, Subchapter 11 - Prior Authorization Transparency Act

• § 23-99-1101 - Title.
  This subchapter shall be known and may be cited as the "Prior Authorization Transparency Act".
• § 23-99-1102 - Legislative Findings and Intent.
  (a) The General Assembly finds that: (1) A physician-patient relationship is paramount and should not be subject to third-party intrusion; and (2) Prior authorizations...
• § 23-99-1103 - Definitions.
  As used in this subchapter: (1) (A) "Adverse determination" means a decision by a utilization review entity to deny, reduce, or terminate coverage for...
• § 23-99-1104 - Disclosure Required.
  (a) (1) A utilization review entity shall post all of its prior authorization and nonmedical review requirements and restrictions, including any written clinical criteria,...
• § 23-99-1105 - Prior Authorization -- Nonurgent Healthcare Service.
  (a) If a utilization review entity requires prior authorization of a nonurgent healthcare service, the utilization review entity shall make an authorization or adverse...
• § 23-99-1106 - Prior Authorization -- Urgent Healthcare Service.
  A utilization review entity shall render an expedited authorization or adverse determination concerning an urgent healthcare service and notify the subscriber and the subscriber's...
• § 23-99-1107 - Prior Authorization -- Emergency Healthcare Service.
  (a) A utilization review entity shall not require prior authorization for prehospital transportation or for provision of an emergency healthcare service.(b) (1) A utilization...
• § 23-99-1108 - Retrospective Denial.
  (a) A utilization review entity shall not revoke, limit, condition, or restrict an authorization for a period of forty-five (45) business days from the...
• § 23-99-1109 - Waiver Prohibited.
  (a) The provisions of this subchapter shall not be waived by contract.(b) Any contractual arrangements or actions taken in conflict with this subchapter or...
• § 23-99-1110 - State Physician Required.
  A physician shall be licensed by the Arkansas State Medical Board before making recommendations or decisions regarding prior authorization or nonmedical review requests.
• § 23-99-1111 - Application.
  (a) This subchapter applies to: (1) A healthcare insurer, whether or not the healthcare insurer is acting directly or indirectly through a private utilization...
• § 23-99-1112 - Form of Notice.
  (a) (1) Notice of an adverse determination or a nonmedical denial shall be provided to the healthcare provider that initiated the prior authorization or...
• § 23-99-1113 - Failure to Comply With Subchapter -- Requested Healthcare Services Deemed Approved.
  If a healthcare insurer or self-insured health plan for employees of governmental entities fails to comply with this subchapter, the requested healthcare services shall...
• § 23-99-1114 - Standardized Form Required.
  (a) On and after January 1, 2014, to establish uniformity in the submission of prior authorization and nonmedical review forms, a healthcare insurer shall...

Last modified: November 15, 2016