23 CAR Part 139 — Orthotic and Prosthetic Reimbursement

Chapter I

Subchapter B

Subpart 1

23 CAR § 139-101 Purpose {#sec-23-car-139-101 omnilex-key=us-ar-regs-official--title-23-part-139--23 CAR § 139-101}

23 CAR § 139-101. Purpose.

(a) The purpose of this part is to require health benefit plans that are subject to Arkansas Code § 23-99-417 to update coverage for eligible charges for prosthetic and orthotic devices and services to no less than eighty percent (80%) of the Medicare allowable rates for such devices and services as of January 1 of each year in which the health benefit plan is issued or renewed.

(b) The current statutory requirement in Arkansas Code § 23-99-417(a)(1) ties the coverage requirements for such devices and services to January 1, 2009, Centers for Medicare & Medicaid Services Medicare coverage amounts under its Healthcare Common Procedure Coding System (CPT).

(c) The Insurance Commissioner intends in this part to establish the requirement that such coverage at least equal eighty percent (80%) of Centers for Medicare & Medicaid Services CPT allowable amounts as established by Centers for Medicare & Medicaid Services as of January 1 of each year in which the health benefit plan is issued or renewed, rather than promulgating an amendment to this part each year to require the adjustment.

23 CAR § 139-102 Applicability and scope {#sec-23-car-139-102 omnilex-key=us-ar-regs-official--title-23-part-139--23 CAR § 139-102}

23 CAR § 139-102. Applicability and scope.

This part applies to all health benefit plans as defined in Arkansas Code § 23-99-403(4).

23 CAR § 139-103 Reimbursement requirements {#sec-23-car-139-103 omnilex-key=us-ar-regs-official--title-23-part-139--23 CAR § 139-103}

23 CAR § 139-103. Reimbursement requirements.

Health benefit plans shall provide coverage for eligible charges for prosthetic and orthotic devices and services of no less than eighty percent (80%) of Centers for Medicare & Medicaid Services CPT allowable amounts for such devices and services, as established by Centers for Medicare & Medicaid Services, as of January 1 of each year in which the health benefit plan is issued or renewed.

History

• Codification Notes: “CPT” means Current Procedural Terminology. Authorities: Arkansas Code § 23-61-108; Arkansas Code § 23-99-417

23 CAR § 139-104 Penalties {#sec-23-car-139-104 omnilex-key=us-ar-regs-official--title-23-part-139--23 CAR § 139-104}

23 CAR § 139-104. Penalties.

The Insurance Commissioner is permitted to impose penalties for violations of Arkansas Code § 23-99-417 et seq., under Arkansas Code § 23-99-415 for provisions governed under the Arkansas Health Care Consumer Act, Arkansas Code § 23-99-401 et seq., as amended.