1. (a) Health insurers shall be subject to all sections of this part.
2. (b) Pursuant to Arkansas Code § 23-79-1502(b), a health benefit plan shall provide coverage for dental and vision care as approved by an ACPA-approved surgical team member following the requirements of this section.

3. (c) A health benefit plan shall include coverage for the following:

   1. (1) On an annual basis, or during the course of a year:

      1. (A) Sclera contact lenses, including coatings;
      2. (B) Office visits;
      3. (C) An ocular impression of each eye;
      4. (D) Autologous serum eye drops; and
      5. (E) Eye weights, either surgically and/or external eye weights in one (1) or both eyes as directed by an eye specialist, as needed; and

   2. (2)

      1. (A) Every two (2) years, two (2) hearing aids and two (2) hearing aid molds for each ear.
      2. (B) As used in this section, "hearing aids" includes behind the ear, in the ear, wearable bone conductions, surgically implanted bone conduction services, and cochlear implants.
4. (d) A health benefit plan, or any third-party administrator for the plan, shall not require mail order, walk-in clinics, or in-network protocols for compliance with any audiology or other services, as mandated by this part.
5. (e) Any additional tests or procedures that are medically necessary for a craniofacial patient and any diagnostic service incidental to the provision of these benefits in this section.

6. (f) For healthcare services to be performed by a nationally approved cleft-craniofacial team, or recommended healthcare services to be performed by a medical provider that is not on a nationally approved cleft-craniofacial team, a request for written authorization or approval shall be reviewed by the administrator (health insurer) of the health benefit plan:

   1. (1) Within two (2) working days from the request by a nationally approved cleft­craniofacial surgical team member, or by a medical provider that is not on a nationally approved cleft-craniofacial team if the request is accompanied by an attestation in the form established by this part that is signed by a surgical team member of an ACPA-approved team, for a nonurgent case; or

   2. (2)

      1. (A) Within twenty-four (24) hours from the request by a nationally approved cleft-craniofacial surgical team member, or by a medical provider that is not on a nationally approved cleft-craniofacial team if the request is accompanied by an attestation in the form established by this part that is signed by a surgical team member of an ACPA-approved team for an urgent case.
      2. (B) The health insurer must be familiar with or willing to become familiar with the particular craniofacial diagnoses in question and recommended procedure prior to making a determination.
      3. (C) The standards in this section shall follow the Prior Authorization Transparency Initiative.

Codification Notes: “ACPA” means American Cleft Palate-Craniofacial Association.