SB83

Senate Bill 83 mandates that health benefit plans in Arkansas provide coverage for breast reconstruction surgeries, including various modalities, procedural variations, and treatments for complications arising from mastectomies or breast tissue loss. The bill requires healthcare insurers to implement a prior authorization process for these procedures. If an insurer lacks a participating provider capable of performing a necessary surgery, the bill mandates the approval of a single-case agreement with an out-of-network provider. It establishes specific reimbursement rate formulas for out-of-network providers based on the 80th percentile of regional charges in a non-affiliated benchmarking database. Furthermore, the legislation imposes penalties on insurers for failing to reimburse providers at the required rates, including a provision requiring payment of three times the difference between the initial underpayment and the required rate. The bill prohibits health plans from denying eligibility to enrollees to avoid these mandates and states that the provisions cannot be waived by contract. It applies to most health insurance plans, including those covering state and public school employees and state-funded programs like Medicaid.