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: S4/8/25
2 95th General Assembly
A Bill
3 Regular Session, 2025 SENATE BILL 626
4
5 By: Senator Irvin
6 By: Representative L. Johnson
7
8 For An Act To Be Entitled
9 AN ACT TO AMEND THE LAW CONCERNING HEALTHCARE
10 PROVIDER REIMBURSEMENT; TO REQUIRE FAIR AND
11 TRANSPARENT REIMBURSEMENT RATES FOR LICENSED
12 AMBULATORY SURGICAL CENTERS, OUTPATIENT PSYCHIATRIC
13 CENTERS, AND OUTPATIENT IMAGING FACILITIES; TO ENSURE
14 PARITY IN INSURANCE PAYMENTS FOR HEALTHCARE SERVICES;
15 TO AMEND THE BILLING IN THE BEST INTEREST OF PATIENTS
16 ACT; TO DECLARE AN EMERGENCY; AND FOR OTHER PURPOSES.
17
18
19 Subtitle
20 TO REQUIRE FAIR AND TRANSPARENT
21 REIMBURSEMENT RATES; TO ENSURE PARITY OF
22 HEALTHCARE SERVICES; TO AMEND THE
23 BILLING IN THE BEST INTEREST OF PATIENTS
24 ACT; AND TO DECLARE AN EMERGENCY.
25
26 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF ARKANSAS:
27
28 SECTION 1. DO NOT CODIFY. Legislative findings and intent.
29 (a) The General Assembly finds that:
30 (1) Arkansas's healthcare providers are at a significant
31 disadvantage as a result of national reimbursement methodologies and receive
32 some of the lowest commercial rates in the country;
33 (2) In Ark. Blue Cross & Blue Shield v. Freeway Surgery Ctr.,
34 2024 Ark. App. 540, the Arkansas Court of Appeals interpreted Arkansas law in
35 a manner that permits insurers to reimburse licensed ambulatory surgical
36 centers at rates lower than those paid to hospital-based facilities for the
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1 same outpatient services despite the clear legislative intent to ensure
2 reimbursement on an equal basis;
3 (3) The interpretation in Ark. Blue Cross & Blue Shield v.
4 Freeway Surgery Ctr., 2024 Ark. App. 540. undermines competition in the
5 healthcare marketplace, disincentivizes cost-efficient alternatives to
6 hospital-based care, and imposes financial hardships on providers operating
7 in nonhospital settings; and
8 (4) Transparency in reimbursement methodologies will promote
9 fairness in the healthcare marketplace and ensure that insurers comply with
10 existing state laws governing provider reimbursement.
11 (b) It is the intent of the General Assembly to:
12 (1) Ensure fair and equitable reimbursement rates for healthcare
13 clinics, hospitals, medical or imaging services performed at licensed
14 ambulatory surgical centers, outpatient psychiatric centers, and outpatient
15 imaging facilities; and
16 (2) Require insurers to:
17 (A) Reimburse healthcare clinics, hospitals, medical or
18 imaging services performed at licensed ambulatory surgical centers,
19 outpatient psychiatric centers, and outpatient imaging facilities fairly and
20 equitably;
21 (B) Disclose the insurer's reimbursement methodologies;
22 and
23 (C) Ensure minimum reimbursement rates for healthcare
24 clinics, hospitals, medical or imaging services performed at licensed
25 ambulatory surgical centers, outpatient psychiatric centers, and outpatient
26 imaging facilities.
27
28 SECTION 2. Arkansas Code Title 23, Chapter 99, is amended to add an
29 additional subchapter to read as follows:
30 Subchapter 20 -- Minimum Reimbursement Rates for Healthcare Services
31
32 23-99-2001. Definitions.
33 As used in this subchapter:
34 (1) "Adjoining states" means Louisiana, Mississippi, Missouri,
35 Oklahoma, Tennessee, and Texas;
36 (2) "Ambulatory surgery center" means an entity certified by the
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1 Department of Health as an ambulatory surgery center that operates for the
2 purpose of providing surgical services to patients;
3 (3)(A) "Equivalent Medicare reimbursement" means the amount,
4 based on prevailing reimbursement rates and methodologies, that a healthcare
5 provider or health system is entitled to for healthcare services.
6 (B)(i) "Equivalent Medicare reimbursement" includes
7 services that are not covered by Medicare or are set locally by Medicare
8 contractors.
9 (ii) Services under this subdivision (3) will be
10 priced at the healthcare provider's overall prevailing Medicare reimbursement
11 collection-to-charge ratio;
12 (4)(A) "Health benefit plan" means an individual, blanket, or
13 group plan, policy, or contract for healthcare services issued, renewed, or
14 extended in this state by a healthcare insurer.
15 (B) "Health benefit plan" includes any group plan, policy,
16 or contract for healthcare services issued outside this state that provides
17 benefits to residents of this state.
18 (C) "Health benefit plan" does not include:
19 (i) A plan that provides only dental benefits;
20 (ii) A plan that provides only eye and vision
21 benefits;
22 (iii) A disability income plan;
23 (iv) A credit insurance plan;
24 (v) Insurance coverage issued as a supplement to
25 liability insurance;
26 (vi) Medical payments under an automobile or
27 homeowners' insurance plan;
28 (vii) A health benefit plan provided under Arkansas
29 Constitution, Article 5, � 32, the Workers' Compensation Law, � 11-9-101 et
30 seq., or the Public Employee Workers' Compensation Act, � 21-5-601 et seq.;
31 (viii) A plan that provides only indemnity for
32 hospital confinement;
33 (ix) An accident-only plan;
34 (x) A specified disease plan;
35 (xi) A policy, contract, certificate, or agreement
36 offered or issued by a healthcare insurer to provide, deliver, arrange for,
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1 pay for, or reimburse any of the costs of healthcare services, including
2 pharmacy benefits, to an entity of the state under � 21-5-401 et seq;
3 (xii) A qualified health plan that is a health
4 benefit plan under the Patient Protection and Affordable Care Act, Pub. L.
5 No. 111-148, and purchased on the Arkansas Health Insurance Marketplace
6 created under the Arkansas Health Insurance Marketplace Act, � 23-61-801 et
7 seq., for an individual up to four hundred percent (400%) of the federal
8 poverty level;
9 (xiii) A health benefit plan provided by a trust
10 established under � 14-54-104 to provide benefits, including accident and
11 health benefits, death benefits, dental benefits, and disability income
12 benefits;
13 (xiv) A long-term care insurance plan; or
14 (xv) A health benefit plan provided by an
15 institution of higher education;
16 (5) "Health system" means an organization that owns or operates
17 more than one (1) hospital;
18 (6)(A) "Healthcare insurer" means an entity that is authorized
19 by this state to offer or provide health benefit plans, policies, subscriber
20 contracts, or any other contracts of a similar nature that indemnify or
21 compensate a healthcare provider for the provision of healthcare services.
22 (B) "Healthcare insurer" includes without limitation:
23 (i) An insurance company;
24 (ii) A health maintenance organization;
25 (iii) A hospital and medical service corporation;
26 and
27 (iv) An entity that provides or administers a self-
28 funded health benefit plan.
29 (C) "Healthcare insurer" does not include:
30 (i) The Arkansas Medicaid Program;
31 (ii) The Arkansas Health and Opportunity for Me
32 Program under the Arkansas Health and Opportunity for Me Act of 2021, � 23-
33 61-1001 et seq., or any successor program;
34 (iii) A provider-led Arkansas shared savings entity;
35 (iv) An entity that offers a plan providing health
36 benefits to state and public school employees under � 21-5-401 et seq.; or
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1 (v) An entity that offers a plan providing health
2 benefits to an institution of higher education;
3 (7) "Healthcare provider" means:
4 (A) A hospital;
5 (B) A health system;
6 (C) A physician;
7 (D)(i) A physician extender.
8 (ii) A physician extender includes without
9 limitation:
10 (a) A physician assistant who is licensed in
11 this state;
12 (b) A nurse practitioner who is licensed in
13 this state;
14 (c) An advanced practice nurse who is licensed
15 in this state; and
16 (d) A certified midwife who is licensed in
17 this state;
18 (E) A licensed ambulatory surgery center; and
19 (F) An outpatient facility that performs healthcare
20 services, including without limitation primary care clinics, urgent care
21 centers, specialty clinics, dialysis centers, and imaging centers;
22 (8) "Healthcare service" means a service or good that is
23 provided for the purpose of or incidental to the purpose of preventing,
24 diagnosing, treating, alleviating curing, or healing human illness, disease,
25 condition, disability, or injury;
26 (9) "Hospital" means a healthcare facility licensed as a
27 hospital by the Division of Health Facilities Services under � 20-9-213;
28 (10) "Minimum reimbursement level" means the minimum ratio of
29 reimbursement to equivalent Medicare reimbursement that a healthcare provider
30 or health system is entitled to by a healthcare insurer for healthcare
31 services;
32 (11) "Outpatient imaging facility" means a healthcare facility
33 or provider that provides diagnostic and advanced imaging services to
34 patients and uses Current Procedural Terminology codes 70010�79999 to bill
35 for the facility component of imaging services;
36 (12) "Physician" means a person authorized or licensed to
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1 practice medicine under the Arkansas Medical Practices Act, � 17-95-201 et
2 seq., � 17-95-301 et seq., and � 17-95-401 et seq.; and
3 (13) "Reimbursement rate" means the amount that a healthcare
4 provider is entitled to receive for healthcare services.
5
6 23-99-2002. Minimum reimbursement level.
7 (a)(1) A health benefit plan shall reimburse a healthcare provider
8 that provides a healthcare service the minimum reimbursement level for the
9 healthcare service as determined by the Insurance Commissioner.
10 (2) The commissioner is not required to establish a minimum
11 reimbursement level for each healthcare service.
12 (3) The minimum reimbursement level shall be established at the
13 healthcare provider's contract level based on the healthcare provider's
14 specific compliment of services.
15 (b) The minimum reimbursement level under subdivision (a)(1) of this
16 section shall be phased in according to the schedule below:
17 (1) On or after January 1, 2026, forty-five percent (45%);
18 (2) On or after January 1, 2027, fifty-five percent (55%);
19 (3) On or after January 1, 2028, sixty-five percent (65%);
20 (4) On or after January 1, 2029, seventy-five percent (75%); and
21 (5) On or after January 1, 2030, one hundred percent (100%).
22 (c)(1) The commissioner shall determine the minimum reimbursement
23 level for a healthcare service by calculating the weighted average ratio of
24 commercial prices as a percentage of Medicare reimbursement for the
25 healthcare service in adjoining states as derived from the RAND Corporation's
26 Prices Paid to Hospitals by Private Plans findings as adopted by rule of the
27 commissioner.
28 (2) If the RAND Corporation's Prices Paid to Hospitals by
29 Private Plans findings are discontinued, delayed, or deemed unsuitable by the
30 commissioner, the commissioner shall compute an adjusted ratio of commercial
31 prices as a percentage of Medicare by applying a factor of the annual change
32 in the Consumer Price Index: Medical Care, commonly known as the "medical
33 care index", published by the United States Bureau of Labor Statistics and
34 adopted by rule of the commissioner to the weighted average increase of
35 Medicare reimbursement for a healthcare provider to the most recently
36 published minimum reimbursement level.
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1 (d) Beginning September 1, 2025, the commissioner shall publish
2 annually on the State Insurance Department's website the minimum
3 reimbursement level as determined under subsection (c) of this section.
4
5 23-99-2003. Disclosures.
6 (a)(1) A healthcare insurer shall document compliance with this
7 subchapter for each healthcare provider.
8 (2) A healthcare insurer shall include documentation of
9 compliance required in subdivision (a)(1) of this section for each health
10 benefit plan offered by the healthcare insurer to a healthcare provider.
11 (b)(1) A healthcare insurer shall disclose to each contracted
12 healthcare provider summary documentation, including the supporting detailed
13 calculations and assumptions.
14 (2) The summary documentation under subdivision (b)(1) of this
15 section shall be made available to:
16 (A) The contracted healthcare provider before the
17 execution or renewal of a contract and within fifteen (15) days of a formal
18 request; and
19 (B) The Insurance Commissioner within fifteen (15) days of
20 a formal request.
21
22 23-99-2004. Enforcement.
23 (a) A dispute under this subchapter shall be filed with the Insurance
24 Commissioner.
25 (b)(1) After notice and opportunity for a hearing, if a healthcare
26 insurer or a health benefit plan is found to have violated this subchapter,
27 the commissioner may revoke or suspend the authority of the healthcare
28 insurer or health benefit plan to do business in this state.
29 (2) The commissioner shall rule on a dispute within sixty (60)
30 days.
31 (c) A healthcare insurer or health benefit plan that has violated this
32 subchapter shall be required to repay the healthcare provider all amounts in
33 violation of this subchapter plus eight percent (8%) interest and five
34 percent (5%) in administrative fees, inclusive of amounts otherwise due from
35 the patient.
36
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1 23-99-2005. Prohibition on pricing increases.
2 (a) Before a healthcare insurer's implementation of an increase in
3 premium rates, cost sharing, or per-member-per-month costs or payments for
4 rates or insurance policies that are required to be reviewed by the Insurance
5 Commissioner under �� 23-79-109 and 23-79-110, the commissioner shall
6 consider the following additional factors in his or her review:
7 (1) The extent to which the healthcare insurer's RBC level as
8 defined in � 23-63-1302 is less than six hundred fifty percent (650%); and
9 (2)(A) To the extent permitted by federal law, whether the
10 healthcare insurer's medical loss ratio is greater than eighty-five percent
11 (85%) on clinical services and quality improvement.
12 (B) The calculation of medical claims and quality
13 improvements for a healthcare insurer's medical loss ratio under subdivision
14 (a)(2)(A) of this section should exclude:
15 (i) Any performance-based compensation, bonus, or
16 other financial incentive paid directly or indirectly to a contracting entity
17 employee, affiliate, contractor, or other entity or individual;
18 (ii) Any expense associated with carrying enrollee
19 medical debt; and
20 (iii) Cost sharing.
21 (b) A healthcare insurer in the fully insured group market shall
22 consider the factors in subsection (a) of this section before implementing an
23 increased premium rate, cost sharing, or enrollee per-member-per-month fee.
24
25 23-99-2006. Rules.
26 The Insurance Commissioner may promulgate rules to implement and
27 enforce this subchapter.
28
29 23-99-2007. Remedies and penalties.
30 (a) This subchapter shall not be waived by contract.
31 (b) An agreement or other arrangement that violates this subchapter is
32 void.
33 (c) All remedies, penalties, and authority granted to the Insurance
34 Commissioner under the Trade Practices Act, � 23-66-201 et seq., including
35 the award of restitution and damages, shall be made available to the
36 commissioner for the enforcement of this subchapter.
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1 (d) A violation of this section is a deceptive act, as defined by the
2 Trade Practices Act, � 23-66-201 et seq., and � 4-88-101 et seq. except that
3 the statute of limitations for private causes of action against an insurer by
4 a healthcare provider shall be five (5) years for a violation of this
5 section.
6
7 SECTION 3. DO NOT CODIFY. Severability.
8 If any provision of this act or application of this act to any person
9 or circumstances is held invalid, the invalidity shall not affect other
10 provisions or applications of this act which can be given effect without the
11 invalid provision of application, and to this end, the provisions of this act
12 are declared severable.
13
14 SECTION 4. DO NOT CODIFY. Retroactivity.
15 This act shall apply retroactively to a reimbursement claim and
16 contract in effect as of the effective date of this act, including any
17 pending claims, disputes, or litigation concerning the reimbursement of
18 services provided by a ambulatory surgical center, outpatient imaging
19 provider, facility or center, and outpatient psychiatric center.
20
21 SECTION 5. EMERGENCY CLAUSE. It is found and determined by the
22 General Assembly of the State of Arkansas that the absence of adequate
23 statutory enforcement of Arkansas Code � 23-79-115 has resulted in arbitrary
24 and discriminatory reimbursement practices that threaten the financial
25 viability of ambulatory surgical centers and outpatient psychiatric centers;
26 that without immediate intervention by the General Assembly to pass
27 legislation to clarify enforcement, discriminatory reimbursement practices
28 will continue to restrict patient access to cost-effective healthcare
29 providers causing irreparable harm to Arkansas residents; and that this act
30 is immediately necessary because current Arkansas law does not sufficiently
31 address transparency in healthcare pricing, the absence of proper enforcement
32 of health insurer reimbursement rate laws has allowed health insurers to
33 ignore the application of Arkansas Code � 23-79-115 that has been the law
34 since November 17, 1979, that any willing provider laws are subordinate to
35 the requirements of Arkansas Code � 23-79-115 and proper adherence to pay-
36 parity statutes ensures patient access to healthcare providers of their
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1 choice, and that it is immediately necessary to protect against deceptive
2 insurance practices that harm the delivery of healthcare and reimbursement
3 for healthcare services in Arkansas. Therefore, an emergency is declared to
4 exist, and this act being immediately necessary for the preservation of the
5 public peace, health, and safety shall become effective on:
6 (1) The date of its approval by the Governor;
7 (2) If the bill is neither approved nor vetoed by the Governor,
8 the expiration of the period of time during which the Governor may veto the
9 bill; or
10 (3) If the bill is vetoed by the Governor and the veto is
11 overridden, the date the last house overrides the veto.
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10 04-08-2025 19:27:35 ANS427Every fact on this page links to its source, starting with the official bill record.