Business Days and Hours in the Prior Authorization Transparency Act

Hugh McDonald SECRETARY OF COMMERCE AID ARKANSAS INSURANCI InPARTNENT * * BULLETIN # 20-2023 DATE: NOVEMBER 28, 2023 Alan McClain COMMISSIONER, ARKANSAS INSURANCE DEPARTMENT TO: ALL HEALTH INSURERS, HEALTH MAINTENANCE ORGANIZATIONS & HOSPITAL SERVICE CORPORATIONS RE: BUSINESS DAYS AND HOURS IN THE PRIOR AUTHORIZATION TRANSPARENCY ACT The Arkansas Insurance Commissioner ("Commissioner") issues the following guidance pertaining to the Prior Authorization Transparency Act, codified at Ark. Code Ann. §§ 23-99-1101 et seq (hereafter, the "Prior Authorization Act"). This guidance addresses what constitutes a business day and business hours under the Prior Authorization Act. Please see Ark. Code Ann. § 23-99-1105 and § 23-99-1106. The term, "business day," is not defined in the Prior Authorization Act. For nonurgent healthcare services, a health insurer, or utilization review entity ("URE"), most notify the subscriber within two (2) business days of obtaining all necessary information to make the authorization or adverse determination. For urgent or expedited cases, the time period for providing such notices is within one (1) business day after receiving all information needed to complete the review of the requested urgent healthcare service. A failure of the health insurer or URE to provide this notice in time is severe. Under Ark. Code Ann. § 23-99-1116(a), "if a healthcare insurer or utilization review entity fails to comply with this subchapter, the requested healthcare services shall be deemed authorized or approved." Therefore, given such consequences, there is a need to define with specificity the meaning of what constitutes a "business day" under the Prior Authorization Act. For purposes of the Prior Authorization Act, the Commissioner will define "business day" similarly to other definitions in the Arkansas code to mean Monday through Friday, except for an official state or federal holiday. Please see. Ark. Code Ann. §§ 23-48-103(e), 26-37-202(g)(1), and 26-37-310(j). In terms of the business hours during a business day, the Commissioner will follow the meaning of business hours from Black's Law Dictionary to mean: "those hours of the day during which, in a given community, commercial, banking, professional, public, or other kinds of business are ordinarily carried on. This phrase is declared to mean not the time during which a principal requires an employee's services, but the business hours of the community generally." Therefore, for purposes of the meaning of "business hours" in the Prior Authorization Act, the Commissioner interprets these hours to be 8:00 A.M to 5 P.M, central standard time. Arkansas Department of Commerce Arkansas Insurance Department 1 Commerce Way, Suite 102 ' Little Rock, AR 72202 INSURANCE.ARKANSAS.GOV For any questions related to this Bulletin, please contact Booth Rand, General Counsel, at 501-371-2820 or email insurance.legal@arkansas.gov. I 1/ 2-1 IL3 ALAN MCCLAIN DATE ARKANSAS INSURANCE COMMISSIONER 2