(a) Requirements.

1. (1)

   1. (A) A risk-based provider organization (RBPO) may apply for a certificate of authority on a form prescribed by the Insurance Commissioner.
   2. (B) Each application for a certificate of authority shall be verified by an officer or authorized representative of the applicant.

2. (2) If no form application is available by the State Insurance Department, an RBPO may apply for a certificate of authority in writing to the commissioner and, in the request for a certificate of authority, provide the following information:

   1. (A)

(i) The name of the RBPO and the contact information of the RBPO, including business address and phone number of the RBPO.

1. (ii) Provide the name, address, and contact information for the principal contact person of the RBPO for the department;

   1. (B) A list of the names, addresses, and official positions of the persons who are to be responsible for the conduct of the affairs of the applicant, including:

      1. (i) All members of the board of the directors, board of trustees, executive committee, or other governing board or committee;
      2. (ii) The principal officers in the case of a corporation; and
      3. (iii) The partners or members in the case of a partnership or association;
   2. (C) Pay a nonrefundable filing fee of two thousand dollars ($2,000) to the department;

   3. (D)

      1. (i) A detailed summary of its proposed business plan with respect to its proposed plan as an RBPO.
      2. (ii) This business plan shall include, but not be limited to:

(b) (b) A description or plan of the RBPO to ensure that the requirements are met in Arkansas Code § 20-77-2706(f)(2)(A) – (D) and that the RBPO shall timely process claims under Arkansas Code § 20-77-2706(f)(3);

1. (c) (c) A description of the projected population or numbers of enrollees or beneficiaries to be serviced on an annual basis by the RBPO;

   1. (d) (d) Describe the network's form of ownership, including the name and the percentage of ownership interest of all members;

(h) (h) A description of the network's geographical service area;

1. (i)
2. (1) (i)(1) An explanation of the techniques to be implemented to ensure continuity of care or benefits for all enrolled Medicaid beneficiaries should the RBPO incur a change in its providers, geographical area, or become financially impaired or insolvent.
3. (2) (2) Explain or describe the extent to which enrolled Medicaid beneficiaries are assured continuity of care by Medicaid in the event of change of its providers, geographical area, or due to the circumstance that the RBPO becomes financially impaired to provide contracted services, substantially equivalent to the requirements in Arkansas Code § 23-76-118;

(j)

1. (1) (j)(1) An explanation of the plan by the RBPO to ensure or protect payment to contracted or participating providers of the RBPO, including subcontracted providers in the plan, for services provided should the RBPO become financially insolvent.
2. (2) (2) Such measures and protections may include access to additional capital, stop-loss insurance, business interruption insurance, etc.;

(k)

1. (1) (k)(1) A current audit report, if available, certified by an independent certified public accountant, of the applicant's financial condition, or current financial information on a statutory accounting principles (SAP) basis, attested to by an officer of the RBPO applicant.
2. (2) (2) In addition, three (3) years of financial projections, including balance sheets, income statements, and statements of cash flow must be provided.

3. (3) (3) The financial projections shall contain projected per member per month enrollment at its fiscal year end, and a concise summary of all assumptions used to generate the projections and supported by a statement of an actuarial opinion;

   1. (l) (l) A copy of the RBPO’s proposed health coverage plan or plans, contracts, arrangements, and marketing and advertising material;

      1. (m) (m) A list of the providers comprising the RBPO’s provider network, including each provider's medical designation, field of practice or specialty, licensure, or certification category, and a description of the RBPO’s procedures for determining, on an ongoing basis, that each provider is duly licensed or certified;

(p) (p) A statement or description identifying sources of additional capital resources that would be available in the event the applicant needs additional capital funding;

1. (E)

   1. (i) Provide biographical backgrounds of all proposed officers, directors, owners, and organizers, and information providing confirmation of their background and experience in the management or delivery of the services to be delivered through the RBPO.

      1. (ii) Such biographical information shall be submitted on the NAIC form, Biographical Affidavit (available upon request).
      2. (iii) Any person who has managerial involvement or control of a company that underwent any adverse state or federal administrative action shall include information about the adverse administrative action;
   2. (F) Provide a copy of the RBPO’s organizational documents, e.g., articles of incorporation, by-laws, partnership agreements, etc., including any sample contract forms or generic template contract forms between the RBPO and its participating providers;

   3. (G) Provide a written description evidencing the RBPO ownership or management satisfies the characteristics of an RBPO under Arkansas Code § 20-77-2706, which include:

      1. (i) The RBPO holds a valid certificate of authority or instrument of formation issued by the Secretary of State;
      2. (ii) The RBPO has an ownership interest of not less than fifty-one percent (51%) by participating providers;
      3. (iii) The RBPO includes within its membership:

(a) (a) One (1) or more of the following Arkansas licensed or certified direct service provider of developmental disabilities services:

1. (1) (1) Developmental day treatment clinic services (DDTCS);
2. (2) (2) Private (not state owned and operated) intermediate care facilities for individuals with intellectual or developmental disabilities (ICF/IDD);
3. (3) (3) Division of Developmental Disabilities Services waiver services;
4. (4) (4) Early intervention services (EI); or
5. (5) (5) Child health management services (CHMS);

(b) (b) One (1) or more of the following Arkansas licensed or certified direct service provider of behavioral health services:

1. (1) (1) Rehabilitation services for persons with mental illness (RSPMI) until June 30, 2018;
2. (2) (2) Outpatient behavioral health agency (OBHA);
3. (3) (3) Licensed mental health practitioner (LMHP) until June 30, 2018; or

4. (4) (4) Independently licensed practitioner (ILP);

   1. (c) (c) An Arkansas licensed hospital or hospital services organization;

      1. (d) (d) An Arkansas licensed physician practice; and

(e) (e) A pharmacist who is licensed by the Arkansas State Board of Pharmacy; and

1. (iv) The RBPO has a surety bond in the amount as required under Section 7 of the Medicaid Provider-Led Organized Care Act;

   1. (H) Provide a copy of any management or administrative contract or contracts entered into, or to be entered into, by the RBPO;
   2. (I) Confirm that the RBPO uses standardized codes, billing processes, and formats;

   3. (J)

      1. (i) Describe how the applicant has the capability to satisfactorily manage the health care coverage issued.
      2. (ii) This confirmation is to include a detailed description of the RBPO’s procedures established and implemented to ensure the maintenance of all books and records necessary to meet all reporting requirements.
      3. (iii) This requirement can be met through a third party management or administration agreement;

   4. (K)

      1. (i) Describe the RBPO’s global payment amount awarded, or, if not available, the estimated or projected global payment amount or rates.
      2. (ii) Describe the actual or projected monthly payments or monthly reimbursement amounts under the global payment to the RBPO by Medicaid.
      3. (iii) Provide a copy of all contracts between the RBPO and Medicaid related to the RBPO’s participation in the Organized Care Act Program;

   5. (L)

      1. (i) Describe the RBPO’s rates or charges to participating providers.
      2. (ii) This information shall include the basis for the calculation of the rate or charge, e.g., use of usual, customary, and reasonable rates;
   6. (M) Describe any and all stop-loss arrangements or reinsurance arrangements of the RBPO for participation in this program;
   7. (N) A copy of the basic organizational document of the RBPO, such as the articles of incorporation, articles of association, partnership agreement, trust agreement, or other applicable documents, and all amendments thereto, and a copy of the bylaws, rules, and regulations, or similar document, if any, regulating the conduct of the internal affairs of the applicant;
   8. (O) A copy of any contract made or to be made between any providers and the applicant or persons under subdivision (a)(2)(D)(ii)(m) of this section; and
   9. (P) Any other information deemed necessary by the commissioner in evaluating the application.

(b) Material changes.

1. (1) Prior to implementing any material changes in its operations or in the coverage offered by the RBPO, the RBPO must submit to the commissioner a written:

   1. (A) Description of any material modification to its plan of operation; or
   2. (B) Explanation of any material changes to the information submitted in accordance with this section.
2. (2) If the commissioner does not disapprove within sixty (60) days of filing, the modification shall be deemed approved.