Application of Arkansas Prior Authorization Law to Non-Physician Healthcare Providers

Hugh McDonald \ SECRETARY OF COMMERCE AID /111001.111101.1“.• * * July 7, 2023 BULLETIN NO. 12-2023 TO: Alan McClain INSURANCE COMMISSIONER, ARKANSAS INSURANCE DEPARTMENT ALL LICENSED DOMESTIC INSURERS, DOMESTIC HEALTH MAINTENANCE ORGANIZATIONS (HMOs), DOMESTIC HOSPITAL AND MEDICAL SERVICE CORPORATIONS, DOMESTIC TITLE INSURERS, AND OTHER DOMESTIC INSURING ENTITIES REPORTING TO THE INSURANCE COMMISSIONER, INSURER TRADE ASSOCIATIONS, NATIONAL ASSOCIATION OF INSURANCE COMMISSIONERS, AND OTHER INTERESTED PARTIES FROM: ARKANSAS INSURANCE DEPARTMENT SUBJECT: APPLICATION OF ARKANSAS PRIOR AUTHORIZATION LAW TO NON-PHYSICIAN HEALTHCARE PROVIDERS The Arkansas Insurance Department ("AID") is responding to an inquiry of whether the Arkansas Prior Authorization Act (Ark. Code Ann. § 23-99-1101 et seq), including subsequent 2023 amendments, applies to physical therapists, occupational therapists, and speech pathologists. The answer to this inquiry is, yes, if acting within the scope of their license for that profession. The Act and its provisions apply to many healthcare providers who are not physicians. The relevant provisions in the Act referring to the healthcare providers entitled to protections of the Act are codified in Ark. Code Ann. § 23-99-1103(a)(9), and this provision defines these providers in the following matter: (9) "Healthcare provider" means: (A) A doctor of medicine, a doctor of osteopathy, or another licensed healthcare professional acting within the professional's licensed scope of practice; or (B) A healthcare facility licensed in the state where the facility is located to provide healthcare services; (10) (A) "Healthcare service" means a healthcare procedure, treatment, or service provided by a healthcare provider. (B) "Healthcare service" includes the provision of pharmaceutical products or services or durable medical equipment; It is clear from the above provisions that licensed physical therapists, occupational therapists and speech pathologists qualify as healthcare providers under the Prior Authorization law, if they are acting "within the professional's licensed scope of practice." The Arkansas Insurance Commissioner ("Commissioner") does not intend to write a bulletin for every healthcare provider profession but refers interested persons to the definitions above and advises that it interprets such provisions to apply to any healthcare provider acting within their licensed scope of practice. Arkansas Department of Commerce Arkansas Insurance Department 1 Commerce Way, Suite 102 • Little Rock, AR 72202 INSURANCE.ARKANSAS.GOV If you have any questions related to this Bulletin, please contact Booth Rand, General Counsel at AID, at 501- 371-2827. ALAN McCLAIN INSURANCE COMMISSIONER STATE OF ARKANSAS -7- "7-.1a3.3 DATE