Shown verbatim: the complete text as captured from the official PDF posted by the Arkansas General Assembly, fetched 2026-07-23. Page and line markers are part of the official record; nothing is edited or removed. The official bill page.
Stricken language would be deleted from and underlined language would be added to present law.
1 State of Arkansas As Engrossed: H2/20/25
2 95th General Assembly
A Bill
3 Regular Session, 2025 HOUSE BILL 1299
4
5 By: Representative L. Johnson
6 By: Senator Irvin
7
8 For An Act To Be Entitled
9 AN ACT TO PROHIBIT HEALTHCARE INSURERS FROM
10 EXERCISING RECOUPMENT FOR PAYMENT OF HEALTHCARE
11 SERVICES MORE THAN ONE YEAR AFTER PAYMENT FOR
12 HEALTHCARE SERVICES WAS MADE; AND FOR OTHER PURPOSES.
13
14
15 Subtitle
16 TO PROHIBIT HEALTHCARE INSURERS FROM
17 EXERCISING RECOUPMENT FOR PAYMENT OF
18 HEALTHCARE SERVICES MORE THAN ONE YEAR
19 AFTER THE PAYMENT FOR HEALTHCARE
20 SERVICES WAS MADE.
21
22 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF ARKANSAS:
23
24 SECTION 1. Arkansas Code Title 23, Chapter 99, is amended to add an
25 additional subchapter to read as follows:
26
27 Subchapter 19 -- Recoupment
28
29 23-99-1901. Definitions.
30 As used in this subchapter:
31 (1) "Abuse" means provider practices that:
32 (A) Are inconsistent with sound fiscal, business, or
33 medical practices; and
34 (B) Result in unnecessary cost or reimbursement for
35 services that are not medically necessary or that fail to meet professionally
36 recognized standards for health care;
*ANS034* 02-20-2025 11:53:12 ANS034
As Engrossed: H2/20/25 HB1299
1 (2) "Covered person" means an individual who is entitled to
2 receive healthcare services under the terms of a health benefit plan;
3 (3)(A) "Fraud" means a purposeful deception or misrepresentation
4 made by a person with the knowledge that the deception could result in some
5 unauthorized benefit to the person or another person.
6 (B) "Fraud" includes an act that constitutes fraud under
7 applicable federal or state law;
8 (4)(A) "Health benefit plan" means an individual, blanket, or
9 group plan, policy, or contract for healthcare services issued, renewed, or
10 extended in this state by a healthcare insurer, health maintenance
11 organization, hospital medical service corporation, or self-insured
12 governmental or church plan in this state.
13 (B) "Health benefit plan" includes:
14 (i) Indemnity and managed care plans; and
15 (ii) Plans providing health benefits to state and
16 public school employees under � 21-5-401 et seq.
17 (C) "Health benefit plan" does not include:
18 (i) A plan that provides only dental benefits or eye
19 and vision care benefits;
20 (ii) A disability income plan;
21 (iii) A credit insurance plan;
22 (iv) Insurance coverage issued as a supplement to
23 liability insurance;
24 (v) Medical payments under an automobile or
25 homeowners insurance plan;
26 (vi) A health benefit plan provided under Arkansas
27 Constitution, Article 5, � 32, the Workers' Compensation Law, � 11-9-101 et
28 seq., or the Public Employee Workers' Compensation Act, � 21-5-601 et seq.;
29 (vii) A plan that provides only indemnity for
30 hospital confinement;
31 (viii) An accident-only plan;
32 (ix) A specified disease plan; or
33 (x) A plan provided under the Medicaid Provider-Led
34 Organized Care Act, � 20-77-2701;
35 (5)(A) "Healthcare insurer" means an entity that is subject to
36 state insurance regulation and provides coverage for health benefits in this
2 02-20-2025 11:53:12 ANS034
As Engrossed: H2/20/25 HB1299
1 state.
2 (B) "Healthcare insurer" includes:
3 (i) An insurance company;
4 (ii) A health maintenance organization;
5 (iii) A hospital and medical service corporation;
6 and
7 (iv) A sponsor of a nonfederal self-funded
8 governmental healthcare plan;
9 (6) "Healthcare provider" means a person or entity that is
10 licensed, certified, or otherwise authorized by the laws of this state to
11 provide healthcare services;
12 (7) "Recoupment" means an action or attempt by a healthcare
13 insurer to recover or collect payments already made to a healthcare provider
14 with respect to a claim by:
15 (A) Reducing other payments currently owed to the
16 healthcare provider;
17 (B) Withholding or setting off the amount against current
18 or future payments to the healthcare provider;
19 (C) Demanding repayment from a healthcare provider for a
20 claim already paid; or
21 (D) Any other means that reduce or affect the future claim
22 payments to the healthcare provider; and
23 (8) "Waste" means the overuse of services or practices that
24 directly or indirectly result in unnecessary cost to a health benefit plan.
25
26 23-99-1902. Time.
27 (a) Except in cases of fraud, waste, or abuse committed by a
28 healthcare provider, a healthcare insurer may exercise recoupment from a
29 healthcare provider only within three hundred sixty-five (365) days after the
30 date that the healthcare insurer paid the claim submitted by the healthcare
31 provider.
32 (b)(1) A healthcare insurer that exercises recoupment under subsection
33 (a) of this section shall give the healthcare provider a written or
34 electronic statement specifying the basis for the recoupment.
35 (2) The statement required under subdivision (b)(1) of this
36 section shall include:
3 02-20-2025 11:53:12 ANS034
As Engrossed: H2/20/25 HB1299
1 (A) The disclosure information required under � 23-99-
2 1904; and
3 (B)(i) Notice of any right to internal appeal by the
4 healthcare provider.
5 (ii) If the healthcare provider initiates an
6 internal appeal under subdivision (b)(2)(B)(i) of this section, the
7 healthcare insurer shall suspend recoupment efforts for the alleged
8 overpayment until such time as the healthcare insurer has prevailed after the
9 healthcare provider has exhausted all available internal appeals.
10
11 23-99-1903. Persons not covered.
12 (a) Except in the case of fraud, waste, or abuse committed by a
13 healthcare provider or as described under subdivision (b)(1) of this section,
14 a healthcare insurer shall not exercise recoupment if:
15 (1) The healthcare provider or other party on its behalf
16 verified the patient eligibility for a covered service from the healthcare
17 insurer or its agent; and
18 (2) The healthcare provider provided healthcare services to the
19 covered person in good-faith reliance on the verification.
20 (b)(1) A healthcare insurer has ninety (90) days from the date of
21 services to notify the healthcare provider of a verification error and the
22 fact that healthcare services rendered will not be covered if:
23 (A) The verification error was made in good-faith reliance
24 at the time of the verification upon information provided by the party
25 responsible for enrolling a covered person in the health benefit plan; and
26 (B) The party responsible for enrolling a covered person
27 in the health benefit plan is separate and independent from, and is not an
28 employee, representative, assignee, affiliate, subsidiary, or otherwise under
29 the common control of, the healthcare insurer.
30 (2) If a recoupment notice is sent based upon a verification
31 error under subdivision (b)(1) of this section, the healthcare insurer shall
32 include a specific explanation of the error.
33
34 23-99-1904. Disclosure required -- Exercising recoupment.
35 (a) A healthcare insurer shall give written notice to a healthcare
36 provider of the healthcare insurer's intent to exercise recoupment if the
4 02-20-2025 11:53:12 ANS034
As Engrossed: H2/20/25 HB1299
1 healthcare insurer determines that payment was made:
2 (1) For healthcare services not covered under the covered
3 person's health benefit plan; or
4 (2) To a person who was ineligible to receive benefits under the
5 health benefit plan.
6 (b) A healthcare insurer may:
7 (1) Request a refund from a healthcare provider; or
8 (2) Exercise recoupment of the payment from the healthcare
9 provider under this section.
10 (c) If a healthcare insurer exercises recoupment, then the healthcare
11 insurer shall provide the healthcare provider written documentation that
12 specifies the:
13 (1) Amount of the recoupment;
14 (2) Covered person's name to which the recoupment applies;
15 (3) Patient identification number;
16 (4) Date of the healthcare service;
17 (5) Healthcare service on which the recoupment is based;
18 (6) Pending claim being recouped or future claim that is
19 anticipated to be recouped; and
20 (7) Specific reason for the recoupment.
21 (d)(1) In a recoupment based upon medical necessity determinations,
22 level of service determinations, coding errors, or billing irregularities,
23 the healthcare insurer exercising recoupment shall ensure that the recoupment
24 is reconciled to specific claims and shall provide specific reasons for the
25 recoupment.
26 (2) A specific reason for recoupment under subdivision (d)(1) of
27 this section shall not consist of mere conclusionary statements but shall
28 contain specific information from which the healthcare provider can determine
29 the basis for the recoupment and make a reasoned determination about whether
30 to challenge the recoupment.
31 (3) If the healthcare provider obtained prior authorization for
32 the healthcare service for the covered person from the healthcare insurer or
33 the healthcare insurer's employee, agent, representative, or assign, the
34 healthcare insurer shall not exercise recoupment based upon a retroactive
35 medical necessity determination or level of service determination except in
36 instances of fraud, waste, or abuse by the healthcare provider in obtaining
5 02-20-2025 11:53:12 ANS034
As Engrossed: H2/20/25 HB1299
1 the prior authorization.
2 (e)(1) If a prior authorization is not obtained by the healthcare
3 provider and the healthcare insurer exercises recoupment based on a
4 determination that the healthcare provider billed the wrong level of care,
5 the healthcare insurer shall state in the notice of recoupment which level of
6 care the healthcare insurer has determined would have been appropriate.
7 (2) If a prior authorization is not obtained by a healthcare
8 provider and the healthcare insurer exercises recoupment based on a
9 determination that the healthcare service rendered was not medically
10 necessary, the healthcare insurer shall include with the notice of
11 recoupment:
12 (A) The specific criteria required for medical necessity
13 for the healthcare service; and
14
15 (B) The specific reason why the respective healthcare service failed to meet
16 the criteria described under subdivision (e)(2)(A) of this section.
17 (3) Upon notice being served under subdivision (e)(1) or
18 subdivision (e)(2) of this section, a healthcare provider shall have ninety
19 (90) days to correct the claim and resubmit the claim regardless of a timely
20 filing provision under a contract or policy or procedure restrictions.
21
22 23-99-1905. Unfair trade practices.
23 A healthcare insurer that fails to comply with this subchapter is
24 subject to and in violation of the Trade Practices Act, � 23-66-201 et seq.
25
26 /s/L. Johnson
27
28
29
30
31
32
33
34
35
36
6 02-20-2025 11:53:12 ANS034Every fact on this page links to its source, starting with the official bill record.