054.01.20 Ark. Code R. 007
The purpose of this Rule is to temporarily reduce insurance barriers or limitations causing an increase in hospital occupancy and resources during the COVID-19 pandemic due to prior authorization protocols on post-acute transfers of patients.
The Arkansas Insurance Commissioner ("Commissioner") finds that insurance barriers exist causing unnecessary hospitalizations and hospital resource costs due to health plans applying prior authorization protocols for patients transferring from hospitals to post-acute facilities, skilled nursing facilities, and acute inpatient rehabilitation facilities. The Commissioner finds that a public emergency exists to temporarily eliminate prior authorization requirements that are burdening hospital occupancy and resources as patients wait on authorizations from an insurer, HMO, or Medicare Advantage organization before transitioning to a post-acute care facility from the hospital.
Pursuant to Ark. Code Ann. § 23-99-1118, the State Insurance Department may promulgate rules for the implementation of this subchapter governing the "Prior Authorization Transparency Act." Ark. Code Ann. § 25-15-204(b) (1) states that if an agency finds that imminent peril to the public health, safety, or welfare or compliance with federal laws or regulations requires adoption of a rule upon less than thirty (30) days' notice and states in writing its reasons for that finding, it may proceed without prior notice or hearing, or upon any abbreviated notice and hearing that it may choose, to adopt an emergency rule. The rule may be effective for no longer than one hundred twenty (120) days.
Unless otherwise stated in this Rule, the definitions in Ark. Code Ann. § 23-99-1103 shall apply to the provisions or sections of this Rule.
No health benefit plan, or Utilization Review entity, shall impose a prior authorization protocol, pre-certification requirement, or step therapy procedure for, or upon, transfers of insured patients from hospitals to a post-acute setting or facility which includes but is not limited to skilled nursing facilities, or acute inpatient rehabilitation facilities during the effective time period of this Rule.
This Emergency Rule shall be effective for one hundred and twenty (120) days following approval by the Arkansas Legislative Council, when it shall expire.
SUMMARY
RULE 122
PRIOR AUTHORIZATION WAIVERS FOR POST-ACUTE TRANSFERS
AID issues this emergency rule in order to help reduce insurance barriers which are operating to slow down or hinder hospital transfers of patients, from a hospital to a post-acute setting. Such barriers are adversely impacting hospital occupancy at a time that more occupancy and resources are needed by our hospitals for COVID-related responses. The primary insurer impediments are derived from insurer, HMO, or Medicare Advantage prior authorization or pre-certification requirements applying to such transfers, for transfers to. skilled nursing facilities as well as to post-acute inpatient rehabilitation centers or facilities.
The rule is simple as it entirely prohibits the imposition of any pre-cert requirement or step therapy protocol from the insurer to such transfers. The rule applies to all health benefit plans subject to the Arkansas Prior authorization Act. This a very broad Act. The definition of health benefit plan is in Ark. Code Ann. § 23-99-1103(7):
The authority for this rule is in two (2) parts. One is from the Prior Authorization Transparency Initiative which gives the Department authority to issue rules to implement the Prior Authorization Transparency Act in Ark. Code Ann. §§ 23-99-1101 et seq.; the other authority is the Administrative Procedures Act for issuance of an emergency rule in Ark. Code Ann. § 25-15-204(b) (1).
AID does NOT intend to adopt the currently proposed emergency rule as a permanent rule within 120 days. The proposed Emergency Rule will expire in 120 days.
054.01.20 Ark. Code R. 007