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Arkansas Code Title 23. Public Utilities and Regulated Industries § 23-99-1602. Definitions

Current as of March 28, 2024 | Updated by Findlaw Staff

<Text of section effective Jan. 1, 2024.>

As used in this subchapter:

(1) “Authorized designee” means an entity that is:

(A) Designated by a healthcare payor to operate on its behalf; and

(B) Authorized to access an enrollee's protected health information under the Health Insurance Portability and Accountability Act of 1996, Pub. L. No. 104-191, as it existed on January 1, 2023;

(2) “Enrollee” means an individual who is entitled to receive healthcare services under the terms of a health benefit plan;

(3)(A) “Health benefit plan” means an individual, blanket, or group plan, policy, or contract for healthcare services issued, renewed, or extended in this state by a healthcare insurer, health maintenance organization, hospital medical service corporation, or self-insured governmental or church plan in this state.

(B) “Health benefit plan” includes:

(i) Indemnity and managed care plans; and

(ii) Plans providing health benefits to state and public school employees under § 21-5-401 et seq.

(C) “Health benefit plan” does not include:

(i) A plan that provides only dental benefits or eye and vision care benefits;

(ii) A disability income plan;

(iii) A credit insurance plan;

(iv) Insurance coverage issued as a supplement to liability insurance;

(v) Medical payments under an automobile or homeowners insurance plan;

(vi) A health benefit plan provided under Arkansas Constitution, Article 5, § 32, the Workers' Compensation Law, § 11-9-101 et seq., and the Public Employee Workers' Compensation Act, § 21-5-601 et seq.;

(vii) A plan that provides only indemnity for hospital confinement;

(viii) An accident-only plan; or

(ix) A specified disease plan;

(4)(A) “Healthcare payor” means:

(i) A health insurance company;

(ii) A health maintenance organization;

(iii) A hospital and medical service corporation; or

(iv) An entity that:

(a) Provides or administers a self-funded health benefit plan, including a governmental plan; or

(b) Performs utilization review for a self-funded health benefit plan, including a governmental plan.

(B) “Healthcare payor” includes any entity that is subject to any of the following laws:

(i) The insurance laws of this state;

(ii) Section 23-75-101 et seq., pertaining to hospital and medical service corporations; or

(iii) Section 23-76-101 et seq., pertaining to health maintenance organizations.

(C) “Healthcare payor” does not include an entity that provides only dental benefits or eye and vision care benefits;

(5)(A) “Healthcare provider” means a person that is licensed, certified, or otherwise authorized by the laws of this state to provide healthcare services.

(B) “Healthcare provider” includes only:

(i) Advanced practice nurses;

(ii) Athletic trainers;

(iii) Audiologists;

(iv) Certified behavioral health providers;

(v) Certified orthotists;

(vi) Chiropractors;

(vii) Community mental health centers or clinics;

(viii) Dentists;

(ix) Home health care;

(x) Hospice care;

(xi) Hospital-based services;

(xii) Hospitals;

(xiii) Licensed ambulatory surgery centers;

(xiv) Licensed certified social workers;

(xv) Licensed dieticians;

(xvi) Licensed intellectual and developmental disabilities service providers;

(xvii) Licensed professional counselors;

(xviii) Licensed psychological examiners;

(xix) Long-term care facilities;

(xx) Occupational therapists;

(xxi) Optometrists;

(xxii) Pharmacists;

(xxiii) Physical therapists;

(xxiv) Physicians and surgeons;

(xxv) Podiatrists;

(xxvi) Prosthetists;

(xxvii) Psychologists;

(xxviii) Respiratory therapists;

(xxix) Rural health clinics; and

(xxx) Speech pathologists;

(6) “Healthcare services” means services and products, including prescription medication, provided by a healthcare provider within the scope of the healthcare provider's license;

(7)(A) “Medical records” means the hospital or clinic records, physicians' records, or other healthcare records that a healthcare provider retains on an enrollee related to the enrollee's medical conditions.

(B) “Medical records” includes other reports, documents, or records that a healthcare provider has concerning:

(i) The healthcare services provided to the enrollee;

(ii) The enrollee's medical history; and

(iii) Prescription medications written, procedures ordered, or any other information related to the patient's overall health; and

(8) “Prescription medication” means a drug or biologic that is prescribed by a healthcare provider to an enrollee for the purpose of alleviating, curing, preventing, or healing illness, injury, or physical disability.

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Cite this article: FindLaw.com - Arkansas Code Title 23. Public Utilities and Regulated Industries § 23-99-1602. Definitions - last updated March 28, 2024 | https://codes.findlaw.com/ar/title-23-public-utilities-and-regulated-industries/ar-code-sect-23-99-1602/

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