Publication of prior authorization and nonmedical review criteria and statistics
Arkansas Code § 23-61-108; Arkansas Code § 23-99-1113; Arkansas Code § 23-99-1118
- (a) A utilization review entity shall follow the disclosure requirements under Arkansas Code § 23-99-1104.
- (b) Updating statistical reporting data required under Arkansas Code § 23-99-1104. For the statistical reporting data required under Arkansas Code § 23-99-1104(d), a utilization review entity shall update the required statistics in the format and manner as required by Arkansas Code § 23-99-1104(d) once each quarter of each year from the effective date of this part.
(c) Effective date for reporting, retention of statistical information, and application of statistics and clinical criteria.
- (1) A utilization review entity is required to disclose the statistical information required under Arkansas Code § 23-99-1104(d) for statistics from health benefit plans occurring on and after July 22, 2015.
- (2) A utilization review entity shall disclose and maintain the statistical information as required under Arkansas Code § 23-99-1104(d) for at least a three-year rolling time period.
- (3) A utilization review entity is required to disclose statistical reporting data under Arkansas Code § 23-99-1104(d) for Arkansas resident insureds in the individual market or Arkansas resident enrollees or certificate holders in health benefit plans as defined under Arkansas Code § 23-99-1103(7).
(4)
- (A) For purposes of interpretation of Arkansas Code § 23-99-1104(d)(2)(A) related to the disclosure of prior authorization data, the term "physician specialty" refers to the medical specialty of the treating physician who has submitted the prior authorization request and not to the specialty of the medical reviewer of the utilization review entity.
- (B) A utilization review entity shall disclose the physician specialty data to the extent that the utilization review entity has received physician specialty information at the time the prior authorization request is submitted.
- (5) For purposes of interpretation of Arkansas Code § 23-99-1104(d)(2)(C) related to the disclosure of prior authorization data, the term "indication offered" means the medical indication, i.e., relevant diagnosis, given by the healthcare provider for the medication, test, or procedure.