Bill Summary – FastDemocracy

Stricken language would be deleted from and underlined language would be added to present law.
 State of Arkansas
 93rd General Assembly                        A Bill
 Regular Session, 2021                                                             HOUSE BILL 1064
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 By: Representatives Pilkington, McCollum
 By: Senators B. Davis, T. Garner
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                                    For An Act To Be Entitled
                AN ACT TO PROMOTE PRICE TRANSPARENCY IN REIMBURSEMENT
                OF HOSPITALS BY INSURERS; TO ESTABLISH THE DISCLOSURE
                OF REIMBURSEMENT RATES FOR HOSPITALS ACT; TO REQUIRE
                DISCLOSURE BY AN INSURER OF REIMBURSEMENT RATES FOR
                HOSPITALS; AND FOR OTHER PURPOSES.
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                                               Subtitle
                         TO PROMOTE PRICE TRANSPARENCY IN
                         REIMBURSEMENT OF HOSPITALS BY INSURERS;
                         TO ESTABLISH THE DISCLOSURE OF
                         REIMBURSEMENT RATES FOR HOSPITALS ACT;
                         AND TO REQUIRE DISCLOSURE BY AN INSURER
                         OF REIMBURSEMENT RATES FOR HOSPITALS.
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 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF ARKANSAS:
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        SECTION 1.       Arkansas Code Title 23, Chapter 63, is amended to add an
 additional subchapter to read as follows:
        Subchapter 21  Disclosure of Reimbursement Rates for Hospitals Act
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        23-63-2101.       Title.
        This subchapter shall be known and may be cited as the "Disclosure of
 Reimbursement Rates for Hospitals Act".
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        23-63-2102.       Findings and intent.
        (a)    The General Assembly finds that as a result of rising healthcare
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 costs and the concerns expressed by healthcare providers, consumers, third-
 party payors, and others involved with planning for health care, there is an
 urgent need to understand patterns and trends in the availability, use, and
 costs of these healthcare services.
      (b)    It is the intent of the General Assembly to:
             (1)   Establish an electronic and educational source of
 information for patients, health professionals, and hospitals concerning
 insurers' hospital reimbursement rates; and
             (2)   Promote the appropriate and efficient use of healthcare
 services and healthcare initiatives within the state, including initiatives
 taken by the State Insurance Department to regulate the business of insurance
 in this state.
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      23-63-2103.      Definitions.
      As used in this subchapter:
             (1)   "Covered individual" means a natural person who is a
 resident of this state and is eligible to receive medical or pharmaceutical
 benefits under any policy, contract, certificate, evidence of coverage,
 rider, binder, or endorsement that provides for or describes coverage;
             (2)(A)     "Direct personal identifiers" means information relating
 to a covered individual that contains primary or obvious identifiers, such as
 the covered individual's name, street address, email address, telephone
 number, and Social Security number.
                      (B)   "Direct personal identifiers" does not include
 geographic or demographic information that would not allow the identification
 of a covered individual;
             (3)(A)     "Hospital" means an entity that provides healthcare
 services to covered individuals.
                      (B)   "Hospital" includes outpatient surgery centers
 licensed in this state;
             (4)(A)     "Insurer" means an entity that submits reimbursement to a
 hospital.
                      (B)   "Insurer" includes:
                            (i)   An entity that had at least two thousand (2,000)
 covered individuals in the previous calendar year, and provides health or
 dental insurance or a health or dental benefit plan in the state, including:
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                                 (a)   An insurance company;
                                 (b)   A medical services plan;
                                 (c)   A managed care organization;
                                 (d)   A hospital plan;
                                 (e)   A hospital medical service corporation;
                                 (f)   A health maintenance organization; or
                                 (g)   A fraternal benefit society;
                        (ii)     A health benefit plan offered or administered
 by or on behalf of the state or an agency or instrumentality of the state,
 including without limitation benefits administered by a managed care
 organization whether or not the managed care organization had two thousand
 (2,000) covered individuals in the previous year;
                        (iii)     A health benefit plan offered or administered
 by or on behalf of the United States Government with the agreement of the
 United States Government;
                        (iv)     The Workers' Compensation Commission;
                        (v)     Any other entity providing a plan of health
 insurance or health benefits subject to state insurance regulation, a third-
 party administrator, or a pharmacy benefits manager, provided that the entity
 has covered individuals and the entity had at least two thousand (2,000)
 covered individuals in the previous calendar year;
                        (vi)     A health benefit plan subject to the Employee
 Retirement Income Security Act of 1974, Pub. L. No. 93-406, that is fully
 insured;
                        (vii)     A risk-based provider organization licensed by
 the State Insurance Department; and
                        (viii)     An entity that contracts with institutions of
 the Department of Correction or the Division of Community Correction to
 provide medical, dental, or pharmaceutical care to inmates.
                  (C)   Insurer does not include:
                        (i)     An entity that provides health insurance or a
 health benefit plan that is accident-only, specified disease-only, hospital
 indemnity, long-term care, or disability income, or that is another form of
 supplemental benefit coverage;
                        (ii)     An employee of a welfare benefit plan as
 defined by federal law that is also a trust established pursuant to
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 collective bargaining subject to the Labor Management Relations Act, 1947,
 Pub. L. No. 80-101; or
                           (iii)    A health benefit plan subject to the Employee
 Retirement Income Security Act of 1974, Pub. L. No. 93-406, that is self-
 funded; and
               (5)   "Reimbursement rate" means the amount paid to a hospital by
 an insurer for certain procedures based on Current Procedural Terminology
 (CPT) codes or the Healthcare Common Procedure Coding System (HCPCS) codes
 and the costs of healthcare services.
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      23-63-2104.      Collection and dissemination of reimbursement rates.
      (a)   The State Insurance Department may:
               (1)   Collect, validate, analyze, and present health data,
 including claims data;
               (2)   Assess penalties for noncompliance with this subchapter; and
               (3)   Establish and convene additional subcommittees within the
 department to carry out the purposes of this subchapter.
      (b)   A hospital licensed by the state shall submit information in a
 form and manner as prescribed by rules promulgated by the Insurance
 Commissioner under this act.
      (c)   The commissioner shall compile and publish an insurer's
 reimbursement rate for a hospital in this state as collected by the
 department from the insurer and a hospital licensed in this state.
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      23-63-2105.      Publication of reimbursement rates.
      (a)   The Insurance Commissioner shall release and publish on the State
 Insurance Department's website reimbursement rate information collected under
 this subchapter.
      (b)   Reimbursement rate information released and published under
 subsection (a) of this section shall not include:
               (1)   Information that identifies or could be used to identify any
 individual patient; or
               (2)   Any other direct personal identifiers.
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      23-63-2106.      Penalties.
      (a)   A person, firm, corporation, organization, or institution that
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 violates any of the rules adopted by the Insurance Commissioner under this
 subchapter may be assessed a penalty by the commissioner.
      (b)   The State Insurance Department shall adopt a schedule of penalties
 not to exceed one hundred dollars ($100) per day of violation.
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      SECTION 2.      TEMPORARY LANGUAGE.   DO NOT CODIFY.     Rules.
      (a)   The State Insurance Department shall promulgate rules necessary to
 implement this act.
      (b)(1)     When adopting the initial rules to implement this act, the
 final rule shall be filed with the Secretary of State for adoption under 
 25-15-204(f):
                      (A)   On or before January 1, 2022; or
                      (B)   If approval under  10-3-309 has not occurred by
 January 1, 2022, as soon as practicable after approval under  10-3-309.
               (2)   The department shall file the proposed rule with the
 Legislative Council under  10-3-309(c) sufficiently in advance of January 1,
 2022, so that the Legislative Council may consider the rule for approval
 before January 1, 2022.
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