The proposed bill seeks to amend existing laws related to healthcare provider reimbursement, specifically for licensed ambulatory surgical centers, outpatient psychiatric centers, and outpatient imaging facilities. It aims to establish fair reimbursement rates, ensuring these facilities receive compensation comparable to hospital-based outpatient departments for similar services. The bill addresses current disparities in reimbursement rates that can limit competition and access to affordable care, particularly in light of a recent court ruling that permitted insurers to reimburse these centers at lower rates. Key provisions include a requirement for insurers to reimburse these facilities at no less than 90% of the average hospital-based outpatient rate and to disclose their reimbursement methodologies, with retroactive application to relevant claims and contracts.

Additionally, the bill enhances transparency in reimbursement practices by mandating insurers to provide a detailed schedule of reimbursement rates based on factors like geographic location and service type. It prohibits insurers from setting reimbursement rates below 90% of the average for similar services and ensures that coverage for outpatient services from nonhospital facilities is not restricted. The bill also imposes conditions on insurers regarding cost-sharing and premium increases, requiring approval from the Insurance Commissioner to maintain competitive practices in the healthcare marketplace. With provisions for severability and retroactivity, the bill emphasizes the urgent need for reforms to protect the financial viability of outpatient healthcare providers and ensure equitable access to healthcare services for residents of Arkansas.

Statutes affected:
Old version SB626 Original - 4-3-2025 05:45 PM: 23-79-101, 23-79-115, 20-9-201, 20-10-213, 20-9-214, 20-9-215, 23-99-201, 23-99-801, 23-66-201, 4-88-101
SB 626: 23-79-101, 23-79-115, 20-9-201, 20-10-213, 20-9-214, 20-9-215, 23-99-201, 23-99-801, 23-66-201, 4-88-101