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054.00.45-6. Reimbursement Levels

AR ADC 054.00.45-6Arkansas Administrative Code

West's Arkansas Administrative Code
Title 054. Insurance Department
Division 00.
Rule 45. Rule and Regulation 45: Children's Preventative Health Care Reimbursement Levels
Ark. Admin. Code 054.00.45-6
054.00.45-6. Reimbursement Levels
Currentness
A. Pursuant to Ark. Code Ann. 23-79-141 (f), as amended by Act 685 of 1995, reimbursements levels shall be approved by the Commissioner at minimum amounts equal to current Arkansas Medicaid reimbursement levels; and thereafter shall comply with each and every future alteration in Medicaid's payment mechanisms; further these minimum reimbursement levels shall be provided for the services mandated under this section of the Insurance Code, although payments under insurance policies and contracts exceeding these levels are permissible. For any pharmaceutical products for which reimbursement levels are not established under the Medicaid Program in the State of Arkansas, benefits shall be reimbursed at minimum levels equal to the “Average Wholesale Price” for said pharmaceutical products, as defined in the most current edition of the Drug Topics Annual Redbook. Reimbursement levels shall cover both the cost of pharmaceutical material and administration fees for providers administering vaccines and immunizations.
B. (1) Each disability insurance policy, contract, certificate or plan providing benefits for children's preventive health care services on a periodic basis shall include at a minimum twenty (20) visits at approximately the following age intervals: birth, 2 weeks, 2 months, 4 months, 6 months, 9 months, 12 months, 15 months, 18 months, 2 years, 3 years, 4 years, 5 years, 6 years, 8 years, 10 years, 12 years, 14 years, 16 years and 18 years. A disability insurance policy, contract, certificate or plan may provide that children's preventive health care services which are rendered during a periodic review shall only be covered to the extent that these services are provided by or under the supervision of a single physician during the course of one (1) visit.
(2) Benefits for recommended vaccine and immunization services shall be exempt from any co-payment, coinsurance, deductible or dollar limit provisions in the disability insurance policy. Insurers and HMO's and other licensees required to comply with this Rule shall explicitly state in their policy and subscriber contracts that all other children's preventive health care services shall be subject to co-payment, coinsurance, deductible, or dollar limit provisions in the policy or contract. In this regard, insurers, HMO's and other licensees required to obtain the Department's prior approval of forms and endorsements under Ark. Code Ann. § 23-79-109 and other applicable laws shall make form or endorsement filings with this Department to ensure current Arkansas policies and contracts are in compliance with this Rule and Regulation by or before July 1, 1997.
C. On and after July 1, 1997, insurers, HMO's and self-insured plans shall adhere to the provisions outlined in Section 6 (A).
Upon any subsequent increase in Medicaid's reimbursement levels for the State of Arkansas, insurers, HMO's, and self-insured plans may adjust their minimum reimbursement levels accordingly.
Upon any adjustment of minimum reimbursement levels necessitated by subsequent changes in Arkansas' Medicaid Program, insurers and HMO's shall comply with form, rate and/or rule filings required under the Arkansas Insurance Code to disclose such amendments.
Current with amendments received through May 15, 2024. Some sections may be more current, see credit for details.
Ark. Admin. Code 054.00.45-6, AR ADC 054.00.45-6
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