The bill amends the Prior Authorization Transparency Act in Arkansas by introducing a new definition for the "Gold card program," which allows healthcare providers to qualify for exemptions from prior authorization requirements set by healthcare insurers or pharmacy benefits managers. It revises the criteria and processes for obtaining and maintaining these exemptions, including changes to evaluation periods and conditions for rescinding exemptions. The bill mandates that healthcare insurers provide at least sixty days for providers to submit medical records upon request and establishes clearer guidelines for communicating exemption statuses to providers. Additionally, it modifies the conditions under which insurers can deny or reduce payments for services provided under an exemption, ensuring that such actions cannot be based on requests for information or delays in reimbursement.

Moreover, the bill requires certain Medicaid programs and health plans to develop programs aimed at reducing or eliminating prior authorizations by 2025 to qualify for exemptions from the act's requirements. It stipulates that qualified health plans can be exempt from certain regulations if they submit and conform to a program approved by the State Insurance Department and the Legislative Council at least every two years. The bill also outlines the process for reviewing prescription drugs and services for exemption from prior authorization, including criteria for approval by the Arkansas State Board of Pharmacy and the Arkansas State Medical Board, and establishes an appeals process for disallowed prior authorizations. If an appeal is successful, the healthcare insurer or pharmacy benefits manager will be reimbursed for part of the costs incurred during the review process.

Statutes affected:
Old version HB1301 V2 - 2-5-2025 09:42 AM: 23-99-1103, 23-99-1120, 02-05-2025, 23-99-1122(c), 23-99-1125, 23-99-1121(a), 23-99-1122(a), 23-99-1126(a), 23-99-1126(d)
Old version HB1301 V3 - 2-20-2025 11:51 AM: 23-99-1103, 23-99-1120, 02-20-2025, 23-99-1122(c), 23-99-1125, 23-99-1121(a), 23-99-1122(a), 23-99-1126(a), 23-99-1126(d)
Old version HB1301 V4 - 3-13-2025 10:02 AM: 23-99-1103, 23-99-1120, 03-13-2025, 23-99-1122(c), 23-99-1125, 23-99-1121(a), 23-99-1122(a), 23-99-1126(a), 23-99-1126(d)
Old version HB1301 Original - 1-29-2025 01:48 PM: 23-99-1120, 23-99-1122(c), 23-99-1125, 23-99-1121(a), 23-99-1122(a), 23-99-1126(a), 23-99-1126(d), 23-99-1127, 20-77-2701, 23-99-1126, 23-61-801, 23-61-1001, 23-99-1128, 25-20-104, 23-99-1128(a)
HB 1301: 23-99-1120, 23-99-1122(c), 23-99-1125, 23-99-1121(a), 23-99-1122(a), 23-99-1126(a), 23-99-1126(d), 23-99-1127, 20-77-2701, 23-99-1126, 23-61-801, 23-61-1001, 23-99-1128, 25-20-104, 23-99-1128(a)
Act 511: 23-99-1103, 23-99-1120, 03-13-2025, 23-99-1122(c), 23-99-1125, 23-99-1121(a), 23-99-1122(a), 23-99-1126(a), 23-99-1126(d)