Stricken language would be deleted from and underlined language would be added to present law.
Act 530 of the Regular Session
1 State of Arkansas As Engrossed: S3/8/21
2 93rd General Assembly A Bill
3 Regular Session, 2021 SENATE BILL 410
4
5 By: Senator Irvin
6 By: Representative M. Gray
7
8 For An Act To Be Entitled
9 AN ACT TO AMEND TITLE 23 OF THE ARKANSAS CODE TO
10 ENSURE THE STABILITY OF THE INSURANCE MARKET IN
11 ARKANSAS; TO PROMOTE ECONOMIC AND PERSONAL HEALTH,
12 PERSONAL INDEPENDENCE, AND OPPORTUNITY FOR ARKANSANS
13 THROUGH PROGRAM PLANNING AND INITIATIVES; TO CREATE
14 THE ARKANSAS HEALTH AND OPPORTUNITY FOR ME ACT OF
15 2021 AND THE ARKANSAS HEALTH AND OPPORTUNITY FOR ME
16 PROGRAM; AND FOR OTHER PURPOSES.
17
18
19 Subtitle
20 TO AMEND TITLE 23 OF THE ARKANSAS CODE TO
21 ENSURE THE STABILITY OF THE INSURANCE
22 MARKET IN ARKANSAS; AND TO CREATE THE
23 ARKANSAS HEALTH AND OPPORTUNITY FOR ME
24 ACT OF 2021 AND THE ARKANSAS HEALTH AND
25 OPPORTUNITY FOR ME PROGRAM.
26
27
28 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF ARKANSAS:
29
30 SECTION 1. Arkansas Code Title 23, Chapter 61, Subchapter 10 is
31 amended to read as follows:
32 Subchapter 10 Arkansas Works Act of 2016 Arkansas Health and Opportunity
33 for Me Act of 2021
34
35 23-61-1001. Title.
36 This subchapter shall be known and may be cited as the Arkansas Works
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1 Act of 2016 Arkansas Health and Opportunity for Me Act of 2021.
2
3 23-61-1002. Legislative intent.
4 Notwithstanding any general or specific laws to the contrary, it is the
5 intent of the General Assembly for the Arkansas Works Program Arkansas Health
6 and Opportunity for Me Program to be a fiscally sustainable, cost-effective,
7 and opportunity-driven program that:
8 (1) Empowers individuals to improve their economic security and
9 achieve self-reliance;
10 (2) Builds on private insurance market competition and value-
11 based insurance purchasing models;
12 (3) Strengthens the ability of employers to recruit and retain
13 productive employees; and
14 (4)(1) Achieves comprehensive and innovative healthcare reform
15 that reduces the rate of growth in state and federal obligations for
16 entitlement spending providing healthcare coverage to low-income adults in
17 Arkansas;
18 (2) Reduces the maternal and infant mortality rates in the state
19 through initiatives that promote healthy outcomes for eligible women with
20 high-risk pregnancies;
21 (3) Promotes the health, welfare, and stability of mothers and
22 their infants after birth through hospital-based community bridge
23 organizations;
24 (4) Encourages personal responsibility for individuals to
25 demonstrate that they value healthcare coverage and understand their roles
26 and obligations in maintaining private insurance coverage;
27 (5) Increases opportunities for full-time work and attainment of
28 economic independence, especially for certain young adults, to reduce long-
29 term poverty that is associated with additional risk for disease and
30 premature death;
31 (6) Addresses health-related social needs of Arkansans in rural
32 counties through hospital-based community bridge organizations and reduces
33 the additional risk for disease and premature death associated with living in
34 a rural county;
35 (7) Strengthens the financial stability of the critical access
36 hospitals and other small, rural hospitals; and
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1 (8) Fills gaps in the continuum of care for individuals in need
2 of services for serious mental illness and substance use disorders.
3
4 23-61-1003. Definitions.
5 As used in this subchapter:
6 (1) Cost-effective means that the cost of covering employees
7 who are:
8 (A) Program participants, either individually or together
9 within an employer health insurance coverage, is the same or less than the
10 cost of providing comparable coverage through individual qualified health
11 insurance plans; or
12 (B) Eligible individuals who are not program participants,
13 either individually or together within an employer health insurance coverage,
14 is the same or less than the cost of providing comparable coverage through a
15 program authorized under Title XIX of the Social Security Act, 42 U.S.C.
16 1396 et seq., as it existed on January 1, 2016;
17 (1) "Acute care hospital" means a hospital that:
18 (A) Is licensed by the Department of Health under 20-9-
19 201 et seq., as a general hospital or a surgery and general medical care
20 hospital; and
21 (B) Is enrolled as a provider with the Arkansas Medicaid
22 Program;
23 (2) "Birthing hospital" means a hospital in this state or in a
24 border state that:
25 (A) Is licensed as a general hospital;
26 (B) Provides obstetrics services; and
27 (C) Is enrolled as a provider with the Arkansas Medicaid
28 Program;
29 (3) "Community bridge organization" means an organization that
30 is authorized by the Department of Human Services to participate in the
31 economic independence initiative or the health improvement initiative to:
32 (A) Screen and refer Arkansans to resources available in
33 their communities to address health-related social needs; and
34 (B) Assist eligible individuals identified as target
35 populations most at risk of disease and premature death and who need a higher
36 level of intervention to improve their health outcomes and succeed in meeting
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1 their long-term goals to achieve independence, including economic
2 independence;
3 (2)(4) Cost sharing means the portion of the cost of a covered
4 medical service that is required to be paid by or on behalf of an eligible
5 individual;
6 (5) "Critical access hospital" means an acute care hospital that
7 is:
8 (A) Designated by the Centers for Medicare and Medicaid
9 Services as a critical access hospital; and
10 (B) Is enrolled as a provider in the Arkansas Medicaid
11 Program;
12 (6) "Economic independence initiative" means an initiative
13 developed by the Department of Human Services that is designed to promote
14 economic stability by encouraging participation of program participants to
15 engage in full-time, full-year work, and to demonstrate the value of
16 enrollment in an individual qualified health insurance plan through
17 incentives and disincentives;
18 (3)(7) Eligible individual means an individual who is in the
19 eligibility category created by section 1902(a)(10)(A)(i)(VIII) of the Social
20 Security Act, 42 U.S.C. 1396a;
21 (4)(8) Employer health insurance coverage means a health
22 insurance benefit plan offered by an employer or, as authorized by this
23 subchapter, an employer self-funded insurance plan governed by the Employee
24 Retirement Income Security Act of 1974, Pub. L. No. 93-406, as amended;
25 (9) "Health improvement initiative" means an initiative
26 developed by an individual qualified health insurance plan or the Department
27 of Human Services that is designed to encourage the participation of eligible
28 individuals in health assessments and wellness programs, including fitness
29 programs and smoking or tobacco cessation programs;
30 (5)(10) Health insurance benefit plan means a policy,
31 contract, certificate, or agreement offered or issued by a health insurer to
32 provide, deliver, arrange for, pay for, or reimburse any of the costs of
33 healthcare services, but not including excepted benefits as defined under 42
34 U.S.C. 300gg-91(c), as it existed on January 1, 2016 January 1, 2021;
35 (6)(11) Health insurance marketplace means the applicable
36 entities that were designed to help individuals, families, and businesses in
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1 Arkansas shop for and select health insurance benefit plans in a way that
2 permits comparison of available plans based upon price, benefits, services,
3 and quality, and refers to either:
4 (A) The Arkansas Health Insurance Marketplace created
5 under the Arkansas Health Insurance Marketplace Act, 23-61-801 et seq., or
6 a successor entity; or
7 (B) The federal health insurance marketplace or federal
8 health benefit exchange created under the Patient Protection and Affordable
9 Care Act, Pub. L. No. 111-148;
10 (7)(12) Health insurer means an insurer authorized by the
11 State Insurance Department to provide health insurance or a health insurance
12 benefit plan in the State of Arkansas, including without limitation:
13 (A) An insurance company;
14 (B) A medical services plan;
15 (C) A hospital plan;
16 (D) A hospital medical service corporation;
17 (E) A health maintenance organization;
18 (F) A fraternal benefits society; or
19 (G) Any other entity providing health insurance or a
20 health insurance benefit plan subject to state insurance regulation; or
21 (H) A risk-based provider organization licensed by the
22 Insurance Commissioner under 20-77-2704;
23 (13) "Healthcare coverage" means coverage provided under this
24 subchapter through either an individual qualified health insurance plan, a
25 risk-based provider organization, employer health insurance coverage, or the
26 fee-for-service Arkansas Medicaid Program;
27 (8)(14) Individual qualified health insurance plan means an
28 individual health insurance benefit plan offered by a health insurer through
29 that participates in the health insurance marketplace to provide coverage in
30 Arkansas that covers only essential health benefits as defined by Arkansas
31 rule and 45 C.F.R. 156.110 and any federal insurance regulations, as they
32 existed on January 1, 2016 January 1, 2021;
33 (15) "Member" means a program participant who is enrolled in an
34 individual qualified health insurance plan;
35 (9)(16) Premium means a monthly fee that is required to be
36 paid by or on behalf of an eligible individual to maintain some or all health
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1 insurance benefits;
2 (10)(17) Program participant means an eligible individual who:
3 (A) Is at least nineteen (19) years of age and no more
4 than sixty-four (64) years of age with an income that meets the income
5 eligibility standards established by rule of the Department of Human
6 Services;
7 (B) Is authenticated to be a United States citizen or
8 documented qualified alien according to the Personal Responsibility and Work
9 Opportunity Reconciliation Act of 1996, Pub. L. No. 104-193;
10 (C) Is not eligible for Medicare or advanced premium tax
11 credits through the health insurance marketplace; and
12 (D) Is not determined to be more effectively covered
13 through the traditional Arkansas Medicaid Program, including without
14 limitation: by the Department of Human Services to be medically frail or
15 eligible for services through a risk-based provider organization;
16 (i) An individual who is medically frail; or
17 (ii) An individual who has exceptional medical needs
18 for whom coverage offered through the health insurance marketplace is
19 determined to be impractical, overly complex, or would undermine continuity
20 or effectiveness of care; and
21 (11)(A) Small group plan means a health insurance benefit plan
22 for a small employer that employed an average of at least two (2) but no more
23 than fifty (50) employees during the preceding calendar year.
24 (B) Small group plan does not include a grandfathered
25 health insurance plan as defined in 45 C.F.R. 147.140(a)(1)(i), as it
26 existed on January 1, 2016
27 (18) "Risk-based provider organization" means the same as
28 defined in 20-77-2703; and
29 (19) "Small rural hospital" means a critical access hospital or
30 a general hospital that:
31 (A) Is located in a rural area;
32 (B) Has fifty (50) or fewer staffed beds; and
33 (C) Is enrolled as a provider in the Arkansas Medicaid
34 Program.
35
36 23-61-1004. Administration of Arkansas Works Program.
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1 (a)(1) The Department of Human Services, in coordination with the
2 State Insurance Department and other necessary state agencies, as necessary,
3 shall:
4 (A) Provide health insurance or medical assistance
5 healthcare coverage under this subchapter to eligible individuals;
6 (B) Create and administer the Arkansas Works Program
7 Arkansas Health and Opportunity for Me Program by:;
8 (C)(i) Submit and apply Applying for any federal waivers,
9 Medicaid state plan amendments, or other authority necessary to implement the
10 Arkansas Works Program Arkansas Health and Opportunity for Me Program in a
11 manner consistent with this subchapter; and
12 (ii) Administering the Arkansas Health and
13 Opportunity for Me Program as approved by the Centers for Medicare and
14 Medicaid Services;
15 (C)(i) Administer the economic independence initiative
16 designed to reduce the short-term effects of the work penalty and the long-
17 term effects of poverty on health outcomes among program participants through
18 incentives and disincentives.
19 (ii) The Department of Human Services shall align
20 the economic independence initiative with other state-administered work-
21 related programs to the extent practicable;
22 (D) Screen, refer, and assist eligible individuals through
23 community bridge organizations under agreements with the Department of Human
24 Services;
25 (D)(E) Offer incentive benefits incentives to promote
26 personal responsibility, individual health, and economic independence through
27 individual qualified health insurance plans and community bridge
28 organizations; and
29 (E)(F) Seek a waiver to eliminate reduce the period of
30 retroactive eligibility for an eligible individual under this subchapter to
31 thirty (30) days before the date of the application.
32 (2) The Governor shall request the assistance and involvement of
33 other state agencies that he or she deems necessary for the implementation of
34 the Arkansas Works Program Arkansas Health and Opportunity for Me Program.
35 (b) Health insurance benefits Healthcare coverage under this
36 subchapter shall be provided through enrollment in:
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1 (1) Individual premium assistance for enrollment of Arkansas
2 Works Program participants in An individual qualified health insurance plans
3 plan through a health insurer; and
4 (2) Supplemental benefits to incentivize personal responsibility
5 A risk-based provider organization;
6 (3) An employer-sponsored health insurance coverage; or
7 (4) Fee-for-service Medicaid program.
8 (c) The Annually, the Department of Human Services, the State
9 Insurance Department,