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Stricken language would be deleted from and underlined language would be added to present law.
1 State of Arkansas A Bill
2 95th General Assembly
3 Regular Session, 2025 SENATE BILL 62
4
5 By: Senator B. King
6
7
8 For An Act To Be Entitled
9 AN ACT TO TERMINATE THE ARKANSAS HEALTH AND
10 OPPORTUNITY FOR ME PROGRAM; TO TRANSFER ALL
11 BENEFICIARIES IN THE ARKANSAS HEALTH AND OPPORTUNITY
12 FOR ME PROGRAM TO THE TRADITIONAL ARKANSAS MEDICAID
13 PROGRAM; TO REPEAL THE ARKANSAS HEALTH AND
14 OPPORTUNITY FOR ME ACT OF 2021; AND FOR OTHER
15 PURPOSES.
16
17
18 Subtitle
19 TO TERMINATE THE ARKANSAS HEALTH AND
20 OPPORTUNITY FOR ME PROGRAM; AND TO
21 TRANSFER ALL BENEFICIARIES IN THE
22 ARKANSAS HEALTH AND OPPORTUNITY FOR ME
23 PROGRAM TO THE TRADITIONAL ARKANSAS
24 MEDICAID PROGRAM.
25
26 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF ARKANSAS:
27
28 SECTION 1. DO NOT CODIFY. Legislative intent.
29 It is the intent of the General Assembly to:
30 (1) Repeal the Arkansas Health and Opportunity for Me Program;
31 (2) Amend various sections of the Arkansas Code to end
32 Arkansas's participation in the Arkansas Health and Opportunity for Me
33 Program; and
34 (3) Instruct the Governor to submit a waiver to:
35 (A) Transfer all individuals enrolled and participating in
36 the Arkansas Health and Opportunity for Me Program to the traditional
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1 Arkansas Medicaid program on and after July 1, 2025; and
2 (B) Terminate the Arkansas Health and Opportunity for Me
3 Program on December 31, 2026.
4
5 SECTION 2. DO NOT CODIFY. Arkansas Health and Opportunity for Me
6 Program -- Notification of termination -- Transfer of enrollees to the Arkansas
7 Medicaid Program.
8 (a) The Department of Human Services shall:
9 (1) Notify all persons enrolled in the Arkansas Health and
10 Opportunity for Me Program as of the effective date of this act that the
11 Arkansas Health and Opportunity for Me Program ends on December 31, 2026;
12 (2) Inform a new enrollee in the Arkansas Health and Opportunity
13 for Me Program after the effective date of this act that the Arkansas Health
14 and Opportunity for Me Program ends on December 31, 2026; and
15 (3) Transfer all persons enrolled in the Arkansas Health and
16 Opportunity for Me Program or any person who enrolled in the Arkansas Health
17 and Opportunity for Me Program after July 1, 2025, to coverage under the
18 traditional Arkansas Medicaid Program on July 1, 2025.
19 (b) The department may prohibit new enrollees in the Arkansas Health
20 and Opportunity for Me Program to begin the transition period before the
21 termination date of December 31, 2026.
22 (c) On the effective date of this act, the department shall submit any
23 Medicaid state plan amendments and federal waivers necessary to eliminate the
24 eligibility in the Arkansas Health and Opportunity for Me Program after
25 December 31, 2026.
26 (d) This section does not prohibit the payment of expenses incurred
27 before December 31, 2026, by persons participating in the Arkansas Health and
28 Opportunity for Me Program.
29
30 SECTION 3. Arkansas Code � 19-5-984(b)(2)(D), concerning the Division
31 of Workforce Services Special Fund, is repealed.
32 (D) The Arkansas Health and Opportunity for Me Act of
33 2021, � 23-61-1001 et seq., or its successor; and
34
35 SECTION 4. Arkansas Code � 19-5-1146 is repealed.
36 19-5-1146. Arkansas Health and Opportunity for Me Program Trust Fund.
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1 (a) There is created on the books of the Treasurer of State, the
2 Auditor of State, and the Chief Fiscal Officer of the State a trust fund to
3 be known as the "Arkansas Health and Opportunity for Me Program Trust Fund".
4 (b) The fund shall consist of:
5 (1) Moneys saved and accrued under the Arkansas Health and
6 Opportunity for Me Act of 2021, � 23-61-1001 et seq., including without
7 limitation:
8 (A) Increases in premium tax collections; and
9 (B) Other spending reductions resulting from the Arkansas
10 Health and Opportunity for Me Act of 2021, � 23-61-1001 et seq.; and
11 (2) Other revenues and funds authorized by law.
12 (c) The Department of Human Services shall use the fund to pay for
13 future obligations under the Arkansas Health and Opportunity for Me Program
14 created by the Arkansas Health and Opportunity for Me Act of 2021, � 23-61-
15 1001 et seq.
16
17 SECTION 5. Arkansas Code � 23-61-803(h), concerning the Arkansas
18 Health Insurance Marketplace, is amended to read as follows:
19 (h) The State Insurance Department and any eligible entity under
20 subdivision (e)(2) of this section shall provide claims and other plan and
21 enrollment data to the Department of Human Services upon request to:
22 (1) Facilitate facilitate compliance with reporting requirements
23 under state and federal law; and
24 (2) Assess the performance of the Arkansas Health and
25 Opportunity for Me Program established by the Arkansas Health and Opportunity
26 for Me Act of 2021, � 23-61-1001 et seq., including without limitation the
27 program's quality, cost, and consumer access.
28
29 SECTION 6. Arkansas Code Title 23, Chapter 16, Subchapter 10, is
30 repealed.
31 Subchapter 10 -- Arkansas Health and Opportunity for Me Act of 2021
32
33 23-61-1001. Title.
34 This subchapter shall be known and may be cited as the "Arkansas Health
35 and Opportunity for Me Act of 2021".
36
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1 23-61-1002. Legislative intent.
2 Notwithstanding any general or specific laws to the contrary, it is the
3 intent of the General Assembly for the Arkansas Health and Opportunity for Me
4 Program to be a fiscally sustainable, cost-effective, and opportunity-driven
5 program that:
6 (1) Achieves comprehensive and innovative healthcare reform that
7 reduces the rate of growth in state and federal obligations for providing
8 healthcare coverage to low-income adults in Arkansas;
9 (2) Reduces the maternal and infant mortality rates in the state
10 through initiatives that promote healthy outcomes for eligible women with
11 high-risk pregnancies;
12 (3) Promotes the health, welfare, and stability of mothers and
13 their infants after birth through hospital-based community bridge
14 organizations;
15 (4) Encourages personal responsibility for individuals to
16 demonstrate that they value healthcare coverage and understand their roles
17 and obligations in maintaining private insurance coverage;
18 (5) Increases opportunities for full-time work and attainment of
19 economic independence, especially for certain young adults, to reduce long-
20 term poverty that is associated with additional risk for disease and
21 premature death;
22 (6) Addresses health-related social needs of Arkansans in rural
23 counties through hospital-based community bridge organizations and reduces
24 the additional risk for disease and premature death associated with living in
25 a rural county;
26 (7) Strengthens the financial stability of the critical access
27 hospitals and other small, rural hospitals; and
28 (8) Fills gaps in the continuum of care for individuals in need
29 of services for serious mental illness and substance use disorders.
30
31 23-61-1003. Definitions.
32 As used in this subchapter:
33 (1) "Acute care hospital" means a hospital that:
34 (A) Is licensed by the Department of Health under � 20-9-
35 201 et seq., as a general hospital or a surgery and general medical care
36 hospital; and
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1 (B) Is enrolled as a provider with the Arkansas Medicaid
2 Program;
3 (2) "Birthing hospital" means a hospital in this state or in a
4 border state that:
5 (A) Is licensed as a general hospital;
6 (B) Provides obstetrics services; and
7 (C) Is enrolled as a provider with the Arkansas Medicaid
8 Program;
9 (3) "Community bridge organization" means an organization that
10 is authorized by the Department of Human Services to participate in the
11 economic independence initiative or the health improvement initiative to:
12 (A) Screen and refer Arkansans to resources available in
13 their communities to address health-related social needs; and
14 (B) Assist eligible individuals identified as target
15 populations most at risk of disease and premature death and who need a higher
16 level of intervention to improve their health outcomes and succeed in meeting
17 their long-term goals to achieve independence, including economic
18 independence;
19 (4) "Cost sharing" means the portion of the cost of a covered
20 medical service that is required to be paid by or on behalf of an eligible
21 individual;
22 (5) "Critical access hospital" means an acute care hospital that
23 is:
24 (A) Designated by the Centers for Medicare & Medicaid
25 Services as a critical access hospital; and
26 (B) Is enrolled as a provider in the Arkansas Medicaid
27 Program;
28 (6) "Economic independence initiative" means an initiative
29 developed by the Department of Human Services that is designed to promote
30 economic stability by encouraging participation of program participants to
31 engage in full-time, full-year work, and to demonstrate the value of
32 enrollment in an individual qualified health insurance plan through
33 incentives and disincentives;
34 (7) "Eligible individual" means an individual who is in the
35 eligibility category created by section 1902(a)(10)(A)(i)(VIII) of the Social
36 Security Act, 42 U.S.C. � 1396a;
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1 (8) "Employer health insurance coverage" means a health
2 insurance benefit plan offered by an employer or, as authorized by this
3 subchapter, an employer self-funded insurance plan governed by the Employee
4 Retirement Income Security Act of 1974, Pub. L. No. 93-406, as amended;
5 (9) "Health improvement initiative" means an initiative
6 developed by an individual qualified health insurance plan or the Department
7 of Human Services that is designed to encourage the participation of eligible
8 individuals in health assessments and wellness programs, including fitness
9 programs and smoking or tobacco cessation programs;
10 (10) "Health insurance benefit plan" means a policy, contract,
11 certificate, or agreement offered or issued by a health insurer to provide,
12 deliver, arrange for, pay for, or reimburse any of the costs of healthcare
13 services, but not including excepted benefits as defined under 42 U.S.C. �
14 300gg-91(c), as it existed on January 1, 2021;
15 (11) "Health insurance marketplace" means the applicable
16 entities that were designed to help individuals, families, and businesses in
17 Arkansas shop for and select health insurance benefit plans in a way that
18 permits comparison of available plans based upon price, benefits, services,
19 and quality, and refers to either:
20 (A) The Arkansas Health Insurance Marketplace created
21 under the Arkansas Health Insurance Marketplace Act, � 23-61-801 et seq., or
22 a successor entity; or
23 (B) The federal health insurance marketplace or federal
24 health benefit exchange created under the Patient Protection and Affordable
25 Care Act, Pub. L. No. 111-148;
26 (12) "Health insurer" means an insurer authorized by the State
27 Insurance Department to provide health insurance or a health insurance
28 benefit plan in the State of Arkansas, including without limitation:
29 (A) An insurance company;
30 (B) A medical services plan;
31 (C) A hospital plan;
32 (D) A hospital medical service corporation;
33 (E) A health maintenance organization;
34 (F) A fraternal benefits society;
35 (G) Any other entity providing health insurance or a
36 health insurance benefit plan subject to state insurance regulation; or
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1 (H) A risk-based provider organization licensed by the
2 Insurance Commissioner under � 20-77-2704;
3 (13) "Healthcare coverage" means coverage provided under this
4 subchapter through either an individual qualified health insurance plan, a
5 risk-based provider organization, employer health insurance coverage, or the
6 fee-for-service Arkansas Medicaid Program;
7 (14) "Individual qualified health insurance plan" means an
8 individual health insurance benefit plan offered by a health insurer that
9 participates in the health insurance marketplace to provide coverage in
10 Arkansas that covers only essential health benefits as defined by Arkansas
11 rule and 45 C.F.R. � 156.110 and any federal insurance regulations, as they
12 existed on January 1, 2021;
13 (15) "Member" means a program participant who is enrolled in an
14 individual qualified health insurance plan;
15 (16) "Premium" means a monthly fee that is required to be paid
16 by or on behalf of an eligible individual to maintain some or all health
17 insurance benefits;
18 (17) "Program participant" means an eligible individual who:
19 (A) Is at least nineteen (19) years of age and no more
20 than sixty-four (64) years of age with an income that meets the income
21 eligibility standards established by rule of the Department of Human
22 Services;
23 (B) Is authenticated to be a United States citizen or
24 documented qualified alien according to the Personal Responsibility and Work
25 Opportunity Reconciliation Act of 1996, Pub. L. No. 104-193;
26 (C) Is not eligible for Medicare or advanced premium tax
27 credits through the health insurance marketplace; and
28 (D) Is not determined by the Department of Human Services
29 to be medically frail or eligible for services through a risk-based provider
30 organization;
31 (18) "Risk-based provider organization" means the same as
32 defined in � 20-77-2703; and
33 (19) "Small rural hospital" means a critical access hospital or
34 a general hospital that:
35 (A) Is located in a rural area;
36 (B) Has fifty (50) or fewer staffed beds; and
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1 (C) Is enrolled as a provider in the Arkansas Medicaid
2 Program.
3
4 23-61-1004. Administration.
5 (a)(1) The Department of Human Services, in coordination with the
6 State Insurance Department and other state agencies, as necessary, shall:
7 (A) Provide healthcare coverage under this subchapter to
8 eligible individuals;
9 (B) Create and administer the Arkansas Health and
10 Opportunity for Me Program by:
11 (i) Applying for any federal waivers, Medicaid state
12 plan amendments, or other authority necessary to implement the Arkansas
13 Health and Opportunity for Me Program in a manner consistent with this
14 subchapter; and
15 (ii) Administering the Arkansas Health and
16 Opportunity for Me Program as approved by the Centers for Medicare & Medicaid
17 Services;
18 (C)(i) Administer the economic independence initiative
19 designed to reduce the short-term effects of the work penalty and the long-
20 term effects of poverty on health outcomes among program participants through
21 incentives and disincentives.
22 (ii) The Department of Human Services shall align
23 the economic independence initiative with other state-administered work-
24 related programs to the extent practicable;
25 (D) Screen, refer, and assist eligible individuals through
26 community bridge organizations under agreements with the Department of Human
27 Services;
28 (E) Offer incentives to promote personal responsibility,
29 individual health, and economic independence through individual qualified
30 health insurance plans and community bridge organizations; and
31 (F) Seek a waiver to reduce the period of retroactive
32 eligibility for an eligible individual under this subchapter to thirty (30)
33 days before the date of the application.
34 (2) The Governor shall request the assistance and involvement of
35 other state agencies that he or she deems necessary for the implementation of
36 the Arkansas Health and Opportunity for Me Program.
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1 (b) Healthcare coverage under this subchapter shall be provided
2 through enrollment in:
3 (1) An individual qualified health insurance plan through a
4 health insurer;
5 (2) A risk-based provider organization;
6 (3) An employer-sponsored health insurance coverage; or
7 (4) The fee-for-service Arkansas Medicaid Program.
8 (c) Annually, the Department of Human Services shall develop
9 purchasing guidelines that:
10 (1) Describe which individual qualified health insurance plans
11 are suitable for purchase in the next demonstration year, including without
12 limitation:
13 (A) The level of the plan;
14 (B) The amounts of allowable premiums;
15 (C) Cost sharing;
16 (D) Auto-assignment methodology; and
17 (E) The total per-member-per-month enrollment range; and
18 (2) Ensure that:
19 (A) Payments to an individual qualified health insurance
20 plan do not exceed budget neutrality limitations in each demonstration year;
21 (B) The total payments to all of the individual qualified
22 health insurance plans offered by the health insurers for eligible
23 individuals combined do not exceed budget targets for the Arkansas Health and
24 Opportunity for Me Program in each demonstration year that the Department of
25 Human Services may achieve by:
26 (i) Setting in advance an enrollment range to
27 represent the minimum and a maximum total monthly number of enrollees into
28 all individual qualified health insurance plans no later than April 30 of
29 each demonstration year in order for the individual qualified health
30 insurance plans to file rates for the following demonstration year;
31 (ii) Temporarily suspending auto-assignment into the
32 individual qualified health insurance plans at any time in a demonstration
33 year if necessary, to remain within the enrollment range and budget targets
34 for the demonstration year; and
35 (iii) Developing a methodology for random auto-
36 assignment of program participants into the individual qualified health
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1 insurance plans after a suspension period has ended;
2 (C) Individual qualified health insurance plans meet and
3 report quality and performance measurement targets set by the Department of
4 Human Services; and
5 (D) At least two (2) health insurers offer individual
6 qualified health insurance plans in each county in the state.
7 (d)(1) The Department of Human Services, the State Insurance
8 Department, and each of the individual qualified health insurance plans shall
9 enter into a memorandum of understanding that shall specify the duties and
10 obligations of each party in the operation of the Arkansas Health and
11 Opportunity for Me Program, including provisions necessary to effectuate the
12 purchasing guidelines and reporting requirements, at least thirty (30)
13 calendar days before the annual open enrollment period.
14 (2) If a memorandum of understanding is not fully executed with
15 a health insurer by January 1 of each new demonstration year, the Department
16 of Human Services shall suspend auto-assignment of new members to the health
17 insurers until the first day of the month after the new memorandum of
18 understanding is fully executed.
19 (3) The memorandum of understanding shall include financial
20 sanctions determined appropriate by the Department of Human Services that may
21 be applied if the Department of Human Services determines that an individual
22 qualified health insurance plan has not met the quality and performance
23 measurement targets or any other condition of the memorandum of
24 understanding.
25 (4)(A) If the Department of Human Services determines that the
26 individual qualified health insurance plans have not met the quality and
27 health performance targets for two (2) years, the Department of Human
28 Services shall develop additional reforms to achieve the quality and health
29 performance targets.
30 (B) If legislative action is required to implement the
31 additional reforms described in subdivision (d)(4)(A) of this section, the
32 Department of Human Services may take the action to the Legislative Council
33 or the Executive Subcommittee of the Legislative Council for immediate
34 action.
35 (e) The Department of Human Services shall:
36 (1) Adopt premiums and cost-sharing levels for individuals
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1 enrolled in the Arkansas Health and Opportunity for Me Program, not to exceed
2 aggregate limits under 42 C.F.R. � 447.56;
3 (2)(A) Establish and maintain a process for premium payments,
4 advanced cost-sharing reduction payments, and reconciliation payments to
5 health insurers.
6 (B) The process described in subdivision (e)(2)(A) of this
7 section shall attribute any unpaid member liabilities as solely the financial
8 obligation of the individual member.
9 (C) The Department of Human Services shall not include any
10 unpaid individual member obligation in any payment or financial
11 reconciliation with health insurers or in a future premium rate; and
12 (3)(A) Calculate a total per-member-per-month amount for each
13 individual qualified health insurance plan based on all payments made by the
14 Department of Human Services on behalf of an individual enrolled in the
15 individual qualified health insurance plan.
16 (B)(i) The amount described in subdivision (e)(3)(A) of
17 this section shall include premium payments, advanced cost-sharing reduction
18 payments for services provided to covered individuals during the
19 demonstration year, and any other payments accruing to the budget neutrality
20 target for plan-enrolled individuals made during the demonstration year and
21 the member months for each demonstration year.
22 (ii) The total per-member-per-month upper limit is
23 the budget neutrality per-member-per-month limit established in the approved
24 demonstration for each demonstration year.
25 (C) If the Department of Human Services calculates that
26 the total per-member-per-month limit for an individual qualified health
27 insurance plan for that demonstration year exceeds the budget neutrality per-
28 member-per-month limit for that demonstration year, the Department of Human
29 Services shall not make any additional reconciliation payments to the health
30 insurer for that individual qualified health insurance plan.
31 (D) If the Department of Human Services determines that
32 the budget neutrality limit has been exceeded, the Department of Human
33 Services shall recover the excess funds from the health insurer for that
34 individual qualified health insurance plan.
35 (f)(1) If the federal medical assistance percentages for the Arkansas
36 Health and Opportunity for Me Program are reduced to below ninety percent
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1 (90%), the Department of Human Services shall present to the Centers for
2 Medicare & Medicaid Services a plan within thirty (30) days of the reduction
3 to terminate the Arkansas Health and Opportunity for Me Program and
4 transition eligible individuals out of the Arkansas Health and Opportunity
5 for Me Program within one hundred twenty (120) days of the reduction.
6 (2) An eligible individual shall maintain coverage during the
7 process to implement the plan to terminate the Arkansas Health and
8 Opportunity for Me Program and the transition of eligible individuals out of
9 the Arkansas Health and Opportunity for Me Program.
10 (g)(1) A health insurer that is providing an individual qualified
11 health insurance plan or employer health insurance coverage for an eligible
12 individual shall submit claims and enrollment data to the Department of Human
13 Services to facilitate reporting required under this subchapter or other
14 state or federally required reporting or evaluation activities.
15 (2) A health insurer may utilize existing mechanisms with
16 supplemental enrollment information to fulfill requirements under this
17 subchapter, including without limitation the state's all-payer claims
18 database established under the Arkansas Healthcare Transparency Initiative
19 Act of 2015, � 23-61-901 et seq., for claims and enrollment data submission.
20 (h)(1) The Governor shall request a block grant under relevant federal
21 law and regulations for the funding of the Arkansas Medicaid Program as soon
22 as practical if the federal law or regulations change to allow the approval
23 of a block grant for this purpose.
24 (2) The Governor shall request a waiver under relevant federal
25 law and regulations for a work requirement as a condition of maintaining
26 coverage in the Arkansas Medicaid Program as soon as practical if the federal
27 law or regulations change to allow the approval of a waiver for this purpose.
28
29 23-61-1005. Requirements for eligible individuals.
30 (a) An eligible individual is responsible for all applicable cost-
31 sharing and premium payment requirements as determined by the Department of
32 Human Services.
33 (b) An eligible individual may participate in a health improvement
34 initiative, as developed and implemented by either the eligible individual's
35 individual qualified health insurance plan or the department.
36 (c)(1)(A) An eligible individual who is determined by the department
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1 to meet the eligibility criteria for a risk-based provider organization due
2 to serious mental illness or substance use disorder shall be enrolled in a
3 risk-based provider organization under criteria established by the
4 department.
5 (B) An eligible individual who is enrolled in a risk-based
6 provider organization is exempt from the requirements of subsections (a) and
7 (b) of this section.
8 (2)(A) An eligible individual who is determined by the
9 department to be medically frail shall receive healthcare coverage through
10 the fee-for-service Arkansas Medicaid Program.
11 (B) An eligible individual who is enrolled in the fee-for-
12 service Arkansas Medicaid Program is exempt from the requirements of
13 subsection (a) of this section.
14 (d) An eligible individual shall receive notice that:
15 (1) The Arkansas Health and Opportunity for Me Program is not a
16 perpetual federal or state right or a guaranteed entitlement;
17 (2) The Arkansas Health and Opportunity for Me Program is
18 subject to cancellation upon appropriate notice;
19 (3) Enrollment in an individual qualified health insurance plan
20 is not a right; and
21 (4) If the individual chooses not to participate or fails to
22 meet participation goals in the economic independence initiative, the
23 individual may lose incentives provided through enrollment in an individual
24 qualified health insurance plan or be unenrolled from the individual
25 qualified health insurance plan after notification by the department.
26
27 23-61-1006. Requirements for program participants.
28 (a) The economic independence initiative applies to all program
29 participants in accordance with the implementation schedule of the Department
30 of Human Services.
31 (b) Incentives established by the department for participation in the
32 economic independence initiative and the health improvement initiative may
33 include, without limitation, the waiver of premium payments and cost-sharing
34 requirements as determined by the department for participation in one (1) or
35 more initiatives.
36 (c) Failure by a program participant to meet the cost-sharing and
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1 premium payment requirement under � 23-61-1005(a) may result in the accrual
2 of a personal debt to the health insurer or provider.
3 (d)(1)(A) Failure by the program participant to meet the initiative
4 participation requirements of subsection (b) of this section may result in:
5 (i) Being unenrolled from the individual qualified
6 health insurance plan; or
7 (ii) The loss of incentives, as defined by the
8 department.
9 (B) However, an individual who is unenrolled shall not
10 lose Medicaid healthcare coverage based solely on disenrollment from the
11 individual qualified health insurance plan.
12 (2) The department shall develop and notify program participants
13 of the criteria for restoring eligibility for incentive benefits that were
14 removed as a result of the program participants' failure to meet the
15 initiative participation requirements of subsection (b) of this section.
16 (3)(A) A program participant who also meets the criteria of a
17 community bridge organization target population may qualify for additional
18 incentives by successfully completing the economic independence initiative
19 provided through a community bridge organization.
20 (B) If successfully completing the initiative results in
21 an increase in the program participant's income that exceeds the program's
22 financial eligibility limits, a program participant may receive, for a
23 specified period of time, financial assistance to pay:
24 (i) The individual's share of employer-sponsored
25 health insurance coverage not to exceed a limit determined by the department;
26 or
27 (ii) A share of the individual's cost-sharing
28 obligation, as determined by the department, if the individual enrolls in a
29 health insurance benefit plan offered through the Arkansas Health Insurance
30 Marketplace.
31
32 23-61-1007. Insurance standards for individual qualified health
33 insurance plans.
34 (a) Insurance coverage for a member enrolled in an individual
35 qualified health insurance plan shall be obtained, at a minimum, through
36 silver-level metallic plans as provided in 42 U.S.C. � 18022(d) and � 18071,
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1 as they existed on January 1, 2021, that restrict out-of-pocket costs to
2 amounts that do not exceed applicable out-of-pocket cost limitations.
3 (b) As provided under � 23-61-1004(e)(2), health insurers shall track
4 the applicable premium payments and cost sharing collected from members to
5 ensure that the total amount of an individual's payments for premiums and
6 cost sharing does not exceed the aggregate cap imposed by 42 C.F.R. � 447.56.
7 (c) All health benefit plans purchased by the Department of Human
8 Services shall:
9 (1) Conform to the requirements of this section and applicable
10 insurance rules;
11 (2) Be certified by the State Insurance Department;
12 (3)(A) Maintain a medical-loss ratio of at least eighty percent
13 (80%) for an individual qualified health insurance plan as required under 45
14 C.F.R. � 158.210(c), as it existed on January 1, 2021, or rebate the
15 difference to the Department of Human Services for members.
16 (B) However, the Department of Human Services may approve
17 up to one percent (1%) of revenues as community investments and as benefit
18 expenses in calculating the medical-loss ratio of a plan in accordance with
19 45 C.F.R. � 158.150;
20 (4) Develop:
21 (A) An annual quality assessment and performance
22 improvement strategic plan to be approved by the Department of Human Services
23 that aligns with federal quality improvement initiatives and quality and
24 reporting requirements of the Department of Human Services; and
25 (B) Targeted initiatives based on requirements established
26 by the Department of Human Services in consultation with the Department of
27 Health; and
28 (5) Make reports to the Department of Human Services and the
29 Department of Health regarding quality and performance metrics in a manner
30 and frequency established by a memorandum of understanding.
31 (d) A health insurer offering individual qualified health insurance
32 plans for members shall participate in the Arkansas Patient-Centered Medical
33 Home Program, including:
34 (1) Attributing enrollees in individual qualified health
35 insurance plans, including members, to a primary care physician;
36 (2) Providing financial support to patient-centered medical
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1 homes to meet practice transformation milestones; and
2 (3) Supplying clinical performance data to patient-centered
3 medical homes, including data to enable patient-centered medical homes to
4 assess the relative cost and quality of healthcare providers to whom patient-
5 centered medical homes refer patients.
6 (e)(1) Each individual qualified health insurance plan shall provide
7 for a health improvement initiative, subject to the review and approval of
8 the Department of Human Services, to provide incentives to its enrolled
9 members to participate in one (1) or more health improvement initiatives as
10 defined in � 23-61-1003(9).
11 (2)(A) The Department of Human Services shall work with health
12 insurers offering individual qualified health insurance plans to ensure the
13 economic independence initiative offered by the health insurer includes a
14 robust outreach and communications effort which targets specific health,
15 education, training, employment, and other opportunities appropriate for its
16 enrolled members.
17 (B) The outreach and communications effort shall recognize
18 that enrolled members receive information from multiple channels, including
19 without limitation:
20 (i) Community service organizations;
21 (ii) Local community outreach partners;
22 (iii) Email;
23 (iv) Radio;
24 (v) Religious organizations;
25 (vi) Social media;
26 (vii) Television;
27 (viii) Text message; and
28 (ix) Traditional methods such as newspaper or mail.
29 (f) On or before January 1, 2022, the State Insurance Department and
30 the Department of Human Services may implement through certification
31 requirements or rule, or both, the applicable provisions of this section.
32
33 23-61-1009. Sunset.
34 This subchapter shall expire on December 31, 2026.
35
36 23-61-1010. Community bridge organizations.
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1 (a) The Department of Human Services shall develop requirements and
2 qualifications for community bridge organizations to provide assistance to
3 one (1) or more of the following target populations:
4 (1) Individuals who become pregnant with a high-risk pregnancy
5 and the child, throughout the pregnancy and up to twenty-four (24) months
6 after birth;
7 (2) Individuals in rural areas of the state in need of treatment
8 for serious mental illness or substance use disorder;
9 (3) Individuals who are young adults most at risk of poor health
10 due to long-term poverty and who meet criteria established by the Department
11 of Human Services, including without limitation the following:
12 (A) An individual between nineteen (19) and twenty-four
13 (24) years of age who has been previously placed under the supervision of
14 the:
15 (i) Division of Youth Services; or
16 (ii) Department of Corrections;
17 (B) An individual between nineteen (19) and twenty-seven
18 (27) years of age who has been previously placed under the supervision of the
19 Division of Children and Family Services; or
20 (C) An individual between nineteen (19) and thirty (30)
21 years of age who is a veteran; and
22 (4) Any other target populations identified by the Department of
23 Human Services.
24 (b)(1) Each community bridge organization shall be administered by a
25 hospital under conditions established by the Department of Human Services.
26 (2) A hospital is eligible to serve eligible individuals under
27 subdivision (a)(1) of this section if the hospital:
28 (A) Is a birthing hospital;
29 (B) Provides or contracts with a qualified entity for the
30 provision of a federally recognized evidence-based home visitation model to a
31 woman during pregnancy and to the woman and child for a period of up to
32 twenty-four (24) months after birth; and
33 (C) Meets any additional criteria established by the
34 Department of Human Services.
35 (3)(A) A hospital is eligible to serve eligible individuals
36 under subdivision (a)(2) of this section if the hospital:
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1 (i) Is a small rural hospital;
2 (ii) Screens all Arkansans who seek services at the
3 hospital for health-related social needs;
4 (iii) Refers Arkansans identified as having health-
5 related social needs for social services available in the community;
6 (iv) Employs local qualified staff to assist
7 eligible individuals in need of treatment for serious mental illness or
8 substance use disorder in accessing medical treatment from healthcare
9 professionals and supports to meet health-related social needs;
10 (v) Enrolls with the Arkansas Medicaid Program as an
11 acute crisis unit provider; and
12 (vi) Meets any additional criteria established by
13 the Department of Human Services.
14 (B) The hospital may use funding available through the
15 Department of Human Services to improve the hospital's ability to deliver
16 care through coordination with other healthcare professionals and with the
17 local emergency response system that may include training of personnel and
18 improvements in equipment to support the delivery of medical services through
19 telemedicine.
20 (4) A hospital is eligible to serve eligible individuals under
21 subdivision (a)(3) of this section if the hospital:
22 (A) Is an acute care hospital;
23 (B) Administers or contracts for the administration of
24 programs using proven models, as defined by the Department of Human Services,
25 to provide employment, training, education, or other social supports; and
26 (C) Meets any additional criteria established by the
27 Department of Human Services.
28 (c) An individual is not required or entitled to enroll in a community
29 bridge organization as a condition of Medicaid eligibility.
30 (d) A hospital is not:
31 (1) Required to apply to become a community bridge organization;
32 or
33 (2) Entitled to be selected as a community bridge organization.
34
35 23-61-1011. Health and Economic Outcomes Accountability Oversight
36 Advisory Panel.
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1 (a) There is created the Health and Economic Outcomes Accountability
2 Oversight Advisory Panel.
3 (b) The advisory panel shall be composed of the following members:
4 (1) The following members of the General Assembly:
5 (A) The Chair of the Senate Committee on Public Health,
6 Welfare, and Labor;
7 (B) The Chair of the House Committee on Public Health,
8 Welfare, and Labor;
9 (C) The Chair of the Senate Committee on Education;
10 (D) The Chair of the House Committee on Education;
11 (E) The Chair of the Senate Committee on Insurance and
12 Commerce;
13 (F) The Chair of the House Committee on Insurance and
14 Commerce;
15 (G) An at-large member of the Senate appointed by the
16 President Pro Tempore of the Senate;
17 (H) An at-large member of the House of Representatives
18 appointed by the Speaker of the House of Representatives;
19 (I) An at-large member of the Senate appointed by the
20 minority leader of the Senate; and
21 (J) An at-large member of the House of Representatives
22 appointed by the minority leader of the House of Representatives;
23 (2) The Secretary of the Department of Human Services;
24 (3) The Arkansas Surgeon General;
25 (4) The Insurance Commissioner;
26 (5) The heads of the following executive branch agencies or
27 their designees:
28 (A) Department of Health;
29 (B) Department of Education;
30 (C) Department of Corrections;
31 (D) Department of Commerce; and
32 (E) Department of Finance and Administration;
33 (6) The Executive Director of the Arkansas Minority Health
34 Commission; and
35 (7)(A) Three (3) community members who represent health,
36 business, or education, who reflect the broad racial and geographic diversity
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1 in the state, and who have demonstrated a commitment to improving the health
2 and welfare of Arkansans, appointed as follows:
3 (i) One (1) member shall be appointed by and serve
4 at the will of the Governor;
5 (ii) One (1) member shall be appointed by and serve
6 at the will of the President Pro Tempore of the Senate; and
7 (iii) One (1) member shall be appointed by and serve
8 at the will of the Speaker of the House of Representatives.
9 (B) Members serving under subdivision (b)(7)(A) of this
10 section may receive mileage reimbursement.
11 (c)(1) The Secretary of the Department of Human Services and one (1)
12 legislative member shall serve as the cochairs of the Health and Economic
13 Outcomes Accountability Oversight Advisory Panel and shall convene meetings
14 quarterly of the advisory panel.
15 (2) The legislative member who serves as the cochair shall be
16 selected by majority vote of all legislative members serving on the advisory
17 panel.
18 (d)(1) The advisory panel shall review, make nonbinding
19 recommendations, and provide advice concerning the proposed quality
20 performance targets presented by the Department of Human Services for each
21 participating individual qualified health insurance plan.
22 (2) The advisory panel shall deliver all nonbinding
23 recommendations to the Secretary of the Department of Human Services.
24 (3)(A) The Secretary of the Department of Human Services, in
25 consultation with the State Medicaid Director, shall determine all quality
26 performance targets for each participating individual qualified health
27 insurance plan.
28 (B) The Secretary of the Department of Human Services may
29 consider the nonbinding recommendations of the advisory panel when
30 determining quality performance targets for each participating individual
31 qualified health insurance plan.
32 (e) The advisory panel shall review:
33 (1) The annual quality assessment and performance improvement
34 strategic plan for each participating individual qualified health insurance
35 plan;
36 (2) Financial performance of the Arkansas Health and Opportunity
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1 for Me Program against the budget neutrality targets in each demonstration
2 year;
3 (3) Quarterly reports prepared by the Department of Human
4 Services, in consultation with the Department of Commerce, on progress
5 towards meeting economic independence outcomes and health improvement
6 outcomes, including without limitation:
7 (A) Community bridge organization outcomes;
8 (B) Individual qualified health insurance plan health
9 improvement outcomes;
10 (C) Economic independence initiative outcomes; and
11 (D) Any sanctions or penalties assessed on participating
12 individual qualified health insurance plans;
13 (4) Quarterly reports prepared by the Department of Human
14 Services on the Arkansas Health and Opportunity for Me Program, including
15 without limitation:
16 (A) Eligibility and enrollment;
17 (B) Utilization;
18 (C) Premium and cost-sharing reduction costs; and
19 (D) Health insurer participation and competition; and
20 (5) Any other topics as requested by the Secretary of the
21 Department of Human Services.
22 (f)(1) The advisory panel may furnish advice, gather information, make
23 recommendations, and publish reports.
24 (2) However, the advisory panel shall not administer any portion
25 of the Arkansas Health and Opportunity for Me Program or set policy.
26 (g) The Department of Human Services shall provide administrative
27 support necessary for the advisory panel to perform its duties.
28 (h) The Department of Human Services shall produce and submit a
29 quarterly report incorporating the advisory panel's findings to the President
30 Pro Tempore of the Senate, the Speaker of the House of Representatives, and
31 the public on the progress in health and economic improvement resulting from
32 the Arkansas Health and Opportunity for Me Program, including without
33 limitation:
34 (1) Eligibility and enrollment;
35 (2) Participation in and the impact of the economic independence
36 initiative and the health improvement initiative of the eligible individuals,
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1 health insurers, and community bridge organizations;
2 (3) Utilization of medical services;
3 (4) Premium and cost-sharing reduction costs; and
4 (5) Health insurer participation and completion.
5
6 23-61-1012. Rules.
7 The Department of Human Services shall adopt rules necessary to
8 implement this subchapter.
9
10 SECTION 7. Arkansas Code � 26-57-604(a)(1)(B)(ii), concerning the
11 allowance of a credit to be applied against the insurance premium tax, is
12 amended to read as follows:
13 (ii) However, the credit shall not be applied as an
14 offset against the premium tax on collections resulting from an eligible
15 individual insured under the Arkansas Health and Opportunity for Me Act of
16 2021, � 23-61-1001 et seq., the Arkansas Health Insurance Marketplace Act, �
17 23-61-801 et seq., or individual qualified health insurance plans, including
18 without limitation stand-alone dental plans, issued through the health
19 insurance marketplace as defined by � 23-61-1003.
20
21 SECTION 8. Arkansas Code � 26-57-610(b)(2), concerning the disposition
22 of the insurance premium tax, is amended to read as follows:
23 (2) The taxes based on premiums collected under the Arkansas
24 Health and Opportunity for Me Act of 2021, � 23-61-1001 et seq., the Arkansas
25 Health Insurance Marketplace Act, � 23-61-801 et seq., or individual
26 qualified health insurance plans, including without limitation stand-alone
27 dental plans, issued through the health insurance marketplace as defined by �
28 23-61-1003 shall be:
29 (A) At the time of deposit, separately Separately
30 certified by the commissioner to the Treasurer of State at the time of
31 deposit for classification and distribution under this section; and
32 (B) Transferred to the Arkansas Health and Opportunity for
33 Me Program Trust Fund and used as required by the Arkansas Health and
34 Opportunity for Me Program Trust Fund;
35
36
22 01/14/2025 9:49:23 AM JMB152Every fact on this page links to its source, starting with the official bill record.