Stricken language would be deleted from and underlined language would be added to present law.
1 State of Arkansas
2 94th General Assembly A Bill
3 Regular Session, 2023 SENATE BILL 142
4
5 By: Senator Irvin
6 By: Representative D. Ferguson
7
8 For An Act To Be Entitled
9 AN ACT TO AMEND THE HEALTHCARE CONTRACTING
10 SIMPLIFICATION ACT; TO REGULATE NETWORK LEASING UNDER
11 THE HEALTHCARE CONTRACTING SIMPLIFICATION ACT; AND
12 FOR OTHER PURPOSES.
13
14
15 Subtitle
16 TO AMEND THE HEALTHCARE CONTRACTING
17 SIMPLIFICATION ACT; AND TO REGULATE
18 NETWORK LEASING UNDER THE HEALTHCARE
19 CONTRACTING SIMPLIFICATION ACT.
20
21
22 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF ARKANSAS:
23
24 SECTION 1. Arkansas Code § 23-99-1202 is amended to read as follows:
25 23-99-1202. Definitions.
26 As used in this subchapter:
27 (1) “All-products clause” means a provision in a healthcare
28 contract that requires a healthcare provider, as a condition of participation
29 or continuation in a provider network or a health benefit plan, to:
30 (A) Serve in another provider network utilized by the
31 contracting entity or a healthcare insurer affiliated with the contracting
32 entity; or
33 (B) Provide healthcare services under another health
34 benefit plan or product offered by a contracting entity or a healthcare
35 insurer affiliated with the contracting entity;
36 (2) “Contracting entity” means a healthcare insurer or a
*ANS129* 01/26/2023 11:27:49 AM ANS129
 SB142
1 subcontractor, affiliate, or other entity that contracts directly or
2 indirectly with a healthcare provider for the delivery of healthcare services
3 to enrollees;
4 (3) “Enrollee” means an individual who is entitled to receive
5 healthcare services under the terms of a health benefit plan;
6 (4)(A) “Health benefit plan” means a plan, policy, contract,
7 certificate, agreement, or other evidence of coverage for healthcare services
8 offered or issued by a healthcare insurer in this state.
9 (B) “Health benefit plan” includes:
10 (i) A nonfederal governmental plans plan as defined
11 in 29 U.S.C. § 1002(32), as it existed on January 1, 2019; and
12 (ii) A contract for providing benefits for dental
13 care whether or not the contract is pursuant to:
14 (a) A healthcare insurance policy or
15 certificate;
16 (b) A dental-only plan;
17 (c) A health maintenance organization provider
18 contract; or
19 (d) A managed healthcare plan.
20 (C) “Health benefit plan” does not include:
21 (i) A disability income plan;
22 (ii) A credit insurance plan;
23 (iii) Insurance coverage issued as a supplement to
24 liability insurance;
25 (iv) A medical payment under automobile or
26 homeowners insurance plans;
27 (v) A health benefit plan provided under Arkansas
28 Constitution, Article 5, § 32, the Workers' Compensation Law, § 11-9-101 et
29 seq., or the Public Employee Workers' Compensation Act, § 21-5-601 et seq.;
30 (vi) A plan that provides only indemnity for
31 hospital confinement;
32 (vii) An accident-only plan;
33 (viii) A specified disease plan;
34 (ix) A long-term care only plan; or
35 (x) A dental-only plan; or
36 (xi) A vision-only plan;
2 01/26/2023 11:27:49 AM ANS129
 SB142
1 (5) “Healthcare contract” means a contract entered into,
2 materially amended, or renewed between a contracting entity and a healthcare
3 provider that specifies the rights and responsibilities of the contracting
4 entity and provides for the delivery of and payment for healthcare services
5 to enrollees;
6 (6)(A) “Healthcare insurer” means an entity that is subject to
7 state insurance regulation and provides health insurance in this state.
8 (B) “Healthcare insurer” includes:
9 (i) An insurance company;
10 (ii) A health maintenance organization;
11 (iii) A hospital and medical service corporation;
12 (iv) A risk-based provider organization; and
13 (v) A sponsor of a nonfederal self-funded
14 governmental plan; and
15 (vi) A dental-only plan;
16 (7) “Healthcare provider” means a person or entity that is
17 licensed, certified, or otherwise authorized by the laws of this state to
18 provide healthcare services;
19 (8)(A) “Healthcare services” means services or goods provided
20 for the purpose of or incidental to the purpose of preventing, diagnosing,
21 treating, alleviating, relieving, curing, or healing human illness, disease,
22 condition, disability, or injury.
23 (B) "Healthcare services" includes services for the
24 diagnosis, prevention, treatment, or cure of a dental condition, illness,
25 injury, or disease;
26 (9) “Material amendment” means a change in a healthcare contract
27 that results in:
28 (A) A decrease in fees, payments, or reimbursement to a
29 participating healthcare provider;
30 (B) A change in the payment methodology for determining
31 fees, payments, or reimbursement to a participating healthcare provider;
32 (C) A new or revised coding guideline;
33 (D) A new or revised payment rule; or
34 (E) A change of procedures that may reasonably be expected
35 to significantly increase a healthcare provider's administrative expenses;
36 (10) “Most favored nation clause” means a provision in a
3 01/26/2023 11:27:49 AM ANS129
 SB142
1 healthcare contract that:
2 (A) Prohibits or grants a contracting entity an option to
3 prohibit a participating healthcare provider from contracting with another
4 contracting entity to provide healthcare services at a lower price than the
5 payment specified in the healthcare contract;
6 (B) Requires or grants a contracting entity an option to
7 require a participating healthcare provider to accept a lower payment in the
8 event the participating healthcare provider agrees to provide healthcare
9 services to another contracting entity at a lower price;
10 (C) Requires or grants a contracting entity an option to
11 require termination or renegotiation of an existing healthcare contract if a
12 participating healthcare provider agrees to provide healthcare services to
13 another contracting entity at a lower price; or
14 (D) Requires a participating healthcare provider to
15 disclose the participating healthcare provider's contractual reimbursement
16 rates with other contracting entities;
17 (11) “Participating healthcare provider” means a healthcare
18 provider that has a healthcare contract with a contracting entity to provide
19 healthcare services to enrollees with the expectation of receiving payment
20 from the contracting entity or a healthcare insurer affiliated with the
21 contracting entity; and
22 (12) “Provider network” means a group of healthcare providers
23 that are contracted to provide healthcare services to enrollees at contracted
24 rates; and
25 (13) "Third party" means an individual or entity that enters
26 into a contract with a contracting entity or with another third party to gain
27 access to the services or contractual discounts of a healthcare contract
28 through leasing the network.
29
30 SECTION 2. Arkansas Code § 23-99-1203 is amended to read as follows:
31 23-99-1203. All-products clause — Prohibition — Network leasing.
32 (a) Except as provided in subsections (b) and (d) of this section, a
33 contracting entity shall not:
34 (1) Offer to a healthcare provider a healthcare contract that
35 includes an all-products clause;
36 (2) Enter into a healthcare contract with a healthcare provider
4 01/26/2023 11:27:49 AM ANS129
 SB142
1 that includes an all-products clause; or
2 (3) Amend or renew an existing healthcare contract previously
3 entered into with a healthcare provider so that the healthcare contract as
4 amended or renewed adds or continues to include an all-products clause.
5 (b)(1) This section does not prohibit a contracting entity from:
6 (A) Offering a healthcare provider a contract that covers
7 multiple health benefit plans that have the same reimbursement rates and
8 other financial terms for the healthcare provider;
9 (B) Adding a new health benefit plan to an existing
10 healthcare contract with a healthcare provider under the same reimbursement
11 rates and other financial terms applicable under the original healthcare
12 contract; or
13 (C) Requiring a healthcare provider to accept multiple
14 health benefit plans that do not differ in reimbursement rates or other
15 financial terms for the healthcare provider.
16 (2) A healthcare contract may include health benefit plans or
17 coverage options for enrollees within a health benefit plan with different
18 cost-sharing structures, including different deductibles or copayments, as
19 long as the reimbursement rates and other financial terms between the
20 contracting entity and the healthcare provider remain the same for each plan
21 or coverage option included in the healthcare contract.
22 (3) This section does not authorize a healthcare provider to:
23 (A) Opt out of providing services to an enrollee of a
24 particular health benefit plan after the healthcare provider has entered into
25 a valid contract under this section to provide the services; or
26 (B) Refuse to disclose the provider networks or health
27 benefit plans in which the healthcare provider participates.
28 (c)(1) A violation of this section is:
29 (A) An unfair trade practice under § 23-66-206; and
30 (B) Subject to the Trade Practices Act, § 23-66-201 et
31 seq.
32 (2) If a healthcare contract contains a provision that violates
33 this section, the healthcare contract is void.
34 (d) A contracting entity may require a healthcare provider to
35 participate in the State and Public School Life and Health Insurance Program
36 as a condition of contracting or continuing to contract with the healthcare
5 01/26/2023 11:27:49 AM ANS129
 SB142
1 provider for healthcare services under another health benefit plan, if:
2 (1) The other health benefit plan is an individual health plan
3 not sold on the health insurance marketplace, as defined in § 23-64-602; and
4 (2) The rates offered to the healthcare provider for healthcare
5 services to program enrollees are no lower than the rates paid to the
6 healthcare provider under the other health benefit plan.
7 (e)(1) A healthcare contract, renewal, or amendment offered by a
8 healthcare insurer pertaining to granting access to a provider network for a
9 third party that otherwise complies with the requirements of this section
10 shall allow a healthcare provider to:
11 (A) Choose not to participate in any contract provisions
12 that provide third-party access to the contract; or
13 (B) Enter into a healthcare contract directly with the
14 healthcare insurer.
15 (2) A healthcare insurer shall not cancel or otherwise terminate
16 or deny a contractual relationship with a healthcare provider because the
17 healthcare provider exercises its rights as provided in subdivision (e)(1) of
18 this section.
19 (3) This subsection applies only to a dentist licensed under the
20 Arkansas Dental Practice Act, § 17-82-101 et seq.
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
6 01/26/2023 11:27:49 AM ANS129