WHAT THIS BILL REGULATES · 6 REQUIREMENT TYPES
How Is This Bill Enforced
Verbatim statutory text on the left; plain-language analysis and a per-section checklist on the right. Numbered markers cross-link to the matching checklist row.
(1)–(6) As used in this subchapter: (1) "Artificial intelligenceArtificial intelligence"Artificial intelligence" means a machine-based system that for a given set of human-defined objectives, can make predictions, recommendations, or decisions influencing real or virtual environments;Ark. Code § 23-63-2101(1)" means a machine-based system that for a given set of human-defined objectives, can make predictions, recommendations, or decisions influencing real or virtual environments; (2) "EnrolleeEnrollee"Enrollee" means an individual who is entitled to receive healthcare services under the terms of a health benefit plan;Ark. Code § 23-63-2101(2)" means an individual who is entitled to receive healthcare services under the terms of a health benefit planHealth benefit plan"Health benefit plan" means: (i) An individual, blanket, or group plan, or a policy or contract for healthcare services offered, issued, renewed, delivered, or extended in this state by a healthcare insurer; and (ii) A health benefit program receiving state or federal appropriations from the State of Arkansas, including the Arkansas Medicaid Program and the Arkansas Health and Opportunity for Me Program or any successor program. "Health benefit plan" includes: (i) Indemnity and managed care plans; and (ii) Nonfederal governmental plans as defined in 29 U.S.C. § 1002(32), as it existed on January 1, 2025. "Health benefit plan" does not include: (i) A plan that provides only dental benefits or eye and vision care benefits; (ii) A disability income plan; (iii) A credit insurance plan; (iv) Insurance coverage issued as a supplement to liability insurance; (v) A medical payment under an automobile or homeowners insurance plan; (vi) A health benefit plan provided under Arkansas Constitution, Article 5, § 32, the Workers' Compensation Law, § 11-9-101 et seq., or the Public Employee Workers' Compensation Act, § 21-5-601 et seq.; (vii) A plan that provides only indemnity for hospital confinement; (viii) An accident-only plan; (ix) A specified disease plan; or (x) A long-term-care-only plan;Ark. Code § 23-63-2101(3); (3)(A) "Health benefit planHealth benefit plan"Health benefit plan" means: (i) An individual, blanket, or group plan, or a policy or contract for healthcare services offered, issued, renewed, delivered, or extended in this state by a healthcare insurer; and (ii) A health benefit program receiving state or federal appropriations from the State of Arkansas, including the Arkansas Medicaid Program and the Arkansas Health and Opportunity for Me Program or any successor program. "Health benefit plan" includes: (i) Indemnity and managed care plans; and (ii) Nonfederal governmental plans as defined in 29 U.S.C. § 1002(32), as it existed on January 1, 2025. "Health benefit plan" does not include: (i) A plan that provides only dental benefits or eye and vision care benefits; (ii) A disability income plan; (iii) A credit insurance plan; (iv) Insurance coverage issued as a supplement to liability insurance; (v) A medical payment under an automobile or homeowners insurance plan; (vi) A health benefit plan provided under Arkansas Constitution, Article 5, § 32, the Workers' Compensation Law, § 11-9-101 et seq., or the Public Employee Workers' Compensation Act, § 21-5-601 et seq.; (vii) A plan that provides only indemnity for hospital confinement; (viii) An accident-only plan; (ix) A specified disease plan; or (x) A long-term-care-only plan;Ark. Code § 23-63-2101(3)" means: (i) An individual, blanket, or group plan, or a policy or contract for healthcare services offered, issued, renewed, delivered, or extended in this state by a healthcare insurerHealthcare insurer"Healthcare insurer" means an insurance company, hospital and medical service corporation, or health maintenance organization that issues or delivers health benefit plans in this state and is subject to: (i) The insurance laws of this state; (ii) Section 23-75-101 et seq., pertaining to hospital and medical service corporations; or (iii) Section 23-76-101 et seq., pertaining to health maintenance organizations. "Healthcare insurer" does not include an entity that provides only dental benefits or eye and vision care benefits;Ark. Code § 23-63-2101(4); and (ii) A health benefit program receiving state or federal appropriations from the State of Arkansas, including the Arkansas Medicaid Program and the Arkansas Health and Opportunity for Me Program or any successor program. (B) "Health benefit planHealth benefit plan"Health benefit plan" means: (i) An individual, blanket, or group plan, or a policy or contract for healthcare services offered, issued, renewed, delivered, or extended in this state by a healthcare insurer; and (ii) A health benefit program receiving state or federal appropriations from the State of Arkansas, including the Arkansas Medicaid Program and the Arkansas Health and Opportunity for Me Program or any successor program. "Health benefit plan" includes: (i) Indemnity and managed care plans; and (ii) Nonfederal governmental plans as defined in 29 U.S.C. § 1002(32), as it existed on January 1, 2025. "Health benefit plan" does not include: (i) A plan that provides only dental benefits or eye and vision care benefits; (ii) A disability income plan; (iii) A credit insurance plan; (iv) Insurance coverage issued as a supplement to liability insurance; (v) A medical payment under an automobile or homeowners insurance plan; (vi) A health benefit plan provided under Arkansas Constitution, Article 5, § 32, the Workers' Compensation Law, § 11-9-101 et seq., or the Public Employee Workers' Compensation Act, § 21-5-601 et seq.; (vii) A plan that provides only indemnity for hospital confinement; (viii) An accident-only plan; (ix) A specified disease plan; or (x) A long-term-care-only plan;Ark. Code § 23-63-2101(3)" includes: (i) Indemnity and managed care plans; and (ii) Nonfederal governmental plans as defined in 29 U.S.C. § 1002(32), as it existed on January 1, 2025. (C) "Health benefit planHealth benefit plan"Health benefit plan" means: (i) An individual, blanket, or group plan, or a policy or contract for healthcare services offered, issued, renewed, delivered, or extended in this state by a healthcare insurer; and (ii) A health benefit program receiving state or federal appropriations from the State of Arkansas, including the Arkansas Medicaid Program and the Arkansas Health and Opportunity for Me Program or any successor program. "Health benefit plan" includes: (i) Indemnity and managed care plans; and (ii) Nonfederal governmental plans as defined in 29 U.S.C. § 1002(32), as it existed on January 1, 2025. "Health benefit plan" does not include: (i) A plan that provides only dental benefits or eye and vision care benefits; (ii) A disability income plan; (iii) A credit insurance plan; (iv) Insurance coverage issued as a supplement to liability insurance; (v) A medical payment under an automobile or homeowners insurance plan; (vi) A health benefit plan provided under Arkansas Constitution, Article 5, § 32, the Workers' Compensation Law, § 11-9-101 et seq., or the Public Employee Workers' Compensation Act, § 21-5-601 et seq.; (vii) A plan that provides only indemnity for hospital confinement; (viii) An accident-only plan; (ix) A specified disease plan; or (x) A long-term-care-only plan;Ark. Code § 23-63-2101(3)" does not include: (i) A plan that provides only dental benefits or eye and vision care benefits; (ii) A disability income plan; (iii) A credit insurance plan; (iv) Insurance coverage issued as a supplement to liability insurance; (v) A medical payment under an automobile or homeowners insurance plan; (vi) A health benefit planHealth benefit plan"Health benefit plan" means: (i) An individual, blanket, or group plan, or a policy or contract for healthcare services offered, issued, renewed, delivered, or extended in this state by a healthcare insurer; and (ii) A health benefit program receiving state or federal appropriations from the State of Arkansas, including the Arkansas Medicaid Program and the Arkansas Health and Opportunity for Me Program or any successor program. "Health benefit plan" includes: (i) Indemnity and managed care plans; and (ii) Nonfederal governmental plans as defined in 29 U.S.C. § 1002(32), as it existed on January 1, 2025. "Health benefit plan" does not include: (i) A plan that provides only dental benefits or eye and vision care benefits; (ii) A disability income plan; (iii) A credit insurance plan; (iv) Insurance coverage issued as a supplement to liability insurance; (v) A medical payment under an automobile or homeowners insurance plan; (vi) A health benefit plan provided under Arkansas Constitution, Article 5, § 32, the Workers' Compensation Law, § 11-9-101 et seq., or the Public Employee Workers' Compensation Act, § 21-5-601 et seq.; (vii) A plan that provides only indemnity for hospital confinement; (viii) An accident-only plan; (ix) A specified disease plan; or (x) A long-term-care-only plan;Ark. Code § 23-63-2101(3) provided under Arkansas Constitution, Article 5, § 32, the Workers' Compensation Law, § 11-9-101 et seq., or the Public Employee Workers' Compensation Act, § 21-5-601 et seq.; (vii) A plan that provides only indemnity for hospital confinement; (viii) An accident-only plan; (ix) A specified disease plan; or (x) A long-term-care-only plan; (4)(A) "Healthcare insurerHealthcare insurer"Healthcare insurer" means an insurance company, hospital and medical service corporation, or health maintenance organization that issues or delivers health benefit plans in this state and is subject to: (i) The insurance laws of this state; (ii) Section 23-75-101 et seq., pertaining to hospital and medical service corporations; or (iii) Section 23-76-101 et seq., pertaining to health maintenance organizations. "Healthcare insurer" does not include an entity that provides only dental benefits or eye and vision care benefits;Ark. Code § 23-63-2101(4)" means an insurance company, hospital and medical service corporation, or health maintenance organization that issues or delivers health benefit plansHealth benefit plan"Health benefit plan" means: (i) An individual, blanket, or group plan, or a policy or contract for healthcare services offered, issued, renewed, delivered, or extended in this state by a healthcare insurer; and (ii) A health benefit program receiving state or federal appropriations from the State of Arkansas, including the Arkansas Medicaid Program and the Arkansas Health and Opportunity for Me Program or any successor program. "Health benefit plan" includes: (i) Indemnity and managed care plans; and (ii) Nonfederal governmental plans as defined in 29 U.S.C. § 1002(32), as it existed on January 1, 2025. "Health benefit plan" does not include: (i) A plan that provides only dental benefits or eye and vision care benefits; (ii) A disability income plan; (iii) A credit insurance plan; (iv) Insurance coverage issued as a supplement to liability insurance; (v) A medical payment under an automobile or homeowners insurance plan; (vi) A health benefit plan provided under Arkansas Constitution, Article 5, § 32, the Workers' Compensation Law, § 11-9-101 et seq., or the Public Employee Workers' Compensation Act, § 21-5-601 et seq.; (vii) A plan that provides only indemnity for hospital confinement; (viii) An accident-only plan; (ix) A specified disease plan; or (x) A long-term-care-only plan;Ark. Code § 23-63-2101(3) in this state and is subject to: (i) The insurance laws of this state; (ii) Section 23-75-101 et seq., pertaining to hospital and medical service corporations; or (iii) Section 23-76-101 et seq., pertaining to health maintenance organizations. (B) "Healthcare insurerHealthcare insurer"Healthcare insurer" means an insurance company, hospital and medical service corporation, or health maintenance organization that issues or delivers health benefit plans in this state and is subject to: (i) The insurance laws of this state; (ii) Section 23-75-101 et seq., pertaining to hospital and medical service corporations; or (iii) Section 23-76-101 et seq., pertaining to health maintenance organizations. "Healthcare insurer" does not include an entity that provides only dental benefits or eye and vision care benefits;Ark. Code § 23-63-2101(4)" does not include an entity that provides only dental benefits or eye and vision care benefits; (5) "Healthcare providerHealthcare provider"Healthcare provider" means a type of provider that renders healthcare services to patients for compensation, including a doctor of medicine or another licensed healthcare professional acting within the professional's licensed scope of practice;Ark. Code § 23-63-2101(5)" means a type of provider that renders healthcare services to patients for compensation, including a doctor of medicine or another licensed healthcare professional acting within the professional's licensed scope of practice; and (6) "Managed care entityManaged care entity"Managed care entity" means an insurance company, hospital or medical service plan, healthcare provider network, physician hospital organization, health maintenance organization, healthcare service corporation, employer or employee organization, or managed care contractor.Ark. Code § 23-63-2101(6)" means an insurance company, hospital or medical service plan, healthcare providerHealthcare provider"Healthcare provider" means a type of provider that renders healthcare services to patients for compensation, including a doctor of medicine or another licensed healthcare professional acting within the professional's licensed scope of practice;Ark. Code § 23-63-2101(5) network, physician hospital organization, health maintenance organization, healthcare service corporation, employer or employee organization, or managed care contractor.
This section establishes the key terms for the subchapter. Healthcare insurer is the primary covered entity and includes insurance companies, hospital and medical service corporations, and HMOs issuing health benefit plans in Arkansas. The definition of health benefit plan is broad, covering individual, blanket, and group plans as well as state-funded programs including Arkansas Medicaid, but excludes dental-only, vision-only, disability income, credit insurance, workers' compensation, and several other categories.
(a)(1)–(2) 1 On and after January 1, 2026, a healthcare insurerHealthcare insurer"Healthcare insurer" means an insurance company, hospital and medical service corporation, or health maintenance organization that issues or delivers health benefit plans in this state and is subject to: (i) The insurance laws of this state; (ii) Section 23-75-101 et seq., pertaining to hospital and medical service corporations; or (iii) Section 23-76-101 et seq., pertaining to health maintenance organizations. "Healthcare insurer" does not include an entity that provides only dental benefits or eye and vision care benefits;Ark. Code § 23-63-2101(4) that offers, issues, renews, delivers, or extends a health benefit planHealth benefit plan"Health benefit plan" means: (i) An individual, blanket, or group plan, or a policy or contract for healthcare services offered, issued, renewed, delivered, or extended in this state by a healthcare insurer; and (ii) A health benefit program receiving state or federal appropriations from the State of Arkansas, including the Arkansas Medicaid Program and the Arkansas Health and Opportunity for Me Program or any successor program. "Health benefit plan" includes: (i) Indemnity and managed care plans; and (ii) Nonfederal governmental plans as defined in 29 U.S.C. § 1002(32), as it existed on January 1, 2025. "Health benefit plan" does not include: (i) A plan that provides only dental benefits or eye and vision care benefits; (ii) A disability income plan; (iii) A credit insurance plan; (iv) Insurance coverage issued as a supplement to liability insurance; (v) A medical payment under an automobile or homeowners insurance plan; (vi) A health benefit plan provided under Arkansas Constitution, Article 5, § 32, the Workers' Compensation Law, § 11-9-101 et seq., or the Public Employee Workers' Compensation Act, § 21-5-601 et seq.; (vii) A plan that provides only indemnity for hospital confinement; (viii) An accident-only plan; (ix) A specified disease plan; or (x) A long-term-care-only plan;Ark. Code § 23-63-2101(3) in this state shall disclose to the following through an applied model card the strengths and limitations of artificial intelligenceArtificial intelligence"Artificial intelligence" means a machine-based system that for a given set of human-defined objectives, can make predictions, recommendations, or decisions influencing real or virtual environments;Ark. Code § 23-63-2101(1)-based algorithms, including without limitation known biases, performance variability, and populations where artificial based-intelligence algorithms are more less effective, used or to be used in the healthcare insurerHealthcare insurer"Healthcare insurer" means an insurance company, hospital and medical service corporation, or health maintenance organization that issues or delivers health benefit plans in this state and is subject to: (i) The insurance laws of this state; (ii) Section 23-75-101 et seq., pertaining to hospital and medical service corporations; or (iii) Section 23-76-101 et seq., pertaining to health maintenance organizations. "Healthcare insurer" does not include an entity that provides only dental benefits or eye and vision care benefits;Ark. Code § 23-63-2101(4)'s utilization review process: (A) The Insurance Commissioner; (B) A healthcare providerHealthcare provider"Healthcare provider" means a type of provider that renders healthcare services to patients for compensation, including a doctor of medicine or another licensed healthcare professional acting within the professional's licensed scope of practice;Ark. Code § 23-63-2101(5) in the healthcare insurerHealthcare insurer"Healthcare insurer" means an insurance company, hospital and medical service corporation, or health maintenance organization that issues or delivers health benefit plans in this state and is subject to: (i) The insurance laws of this state; (ii) Section 23-75-101 et seq., pertaining to hospital and medical service corporations; or (iii) Section 23-76-101 et seq., pertaining to health maintenance organizations. "Healthcare insurer" does not include an entity that provides only dental benefits or eye and vision care benefits;Ark. Code § 23-63-2101(4)'s network; (C) An enrolleeEnrollee"Enrollee" means an individual who is entitled to receive healthcare services under the terms of a health benefit plan;Ark. Code § 23-63-2101(2); and (D) The general public on the healthcare insurerHealthcare insurer"Healthcare insurer" means an insurance company, hospital and medical service corporation, or health maintenance organization that issues or delivers health benefit plans in this state and is subject to: (i) The insurance laws of this state; (ii) Section 23-75-101 et seq., pertaining to hospital and medical service corporations; or (iii) Section 23-76-101 et seq., pertaining to health maintenance organizations. "Healthcare insurer" does not include an entity that provides only dental benefits or eye and vision care benefits;Ark. Code § 23-63-2101(4)'s publicly accessible website. (2) The disclosure under subdivision (a)(1) of this section shall include: (A) The algorithm criteria; (B) Data sets used to train the algorithm, including mitigation of any known bias; (C) The algorithm itself; (D) A description of how the algorithm is used in an applied use case; (E) The outcomes of the software or workflow in which the algorithm is used; and (F) Any results of independent third-party validation for improved transparency and trustworthiness.
(b)(1)–(4) 2 A healthcare insurerHealthcare insurer"Healthcare insurer" means an insurance company, hospital and medical service corporation, or health maintenance organization that issues or delivers health benefit plans in this state and is subject to: (i) The insurance laws of this state; (ii) Section 23-75-101 et seq., pertaining to hospital and medical service corporations; or (iii) Section 23-76-101 et seq., pertaining to health maintenance organizations. "Healthcare insurer" does not include an entity that provides only dental benefits or eye and vision care benefits;Ark. Code § 23-63-2101(4) shall ensure that: (1) An algorithm should leverage federated data-sharing models to minimize data centralization and protect enrolleeEnrollee"Enrollee" means an individual who is entitled to receive healthcare services under the terms of a health benefit plan;Ark. Code § 23-63-2101(2) privacy; (2) An algorithm is compliant with national interoperability standards, including Fast Healthcare Interoperability Resources and the United States Core Data for Interoperability; (3) EnrolleeEnrollee"Enrollee" means an individual who is entitled to receive healthcare services under the terms of a health benefit plan;Ark. Code § 23-63-2101(2) data that is used for training or validation of artificial intelligenceArtificial intelligence"Artificial intelligence" means a machine-based system that for a given set of human-defined objectives, can make predictions, recommendations, or decisions influencing real or virtual environments;Ark. Code § 23-63-2101(1) models are following privacy and security standards that align with the Trusted Exchange Framework and Common Agreement; and (4) Established mechanisms document and obtain explicit enrolleeEnrollee"Enrollee" means an individual who is entitled to receive healthcare services under the terms of a health benefit plan;Ark. Code § 23-63-2101(2) consent for using health data in artificial development and validation.
This section imposes two categories of obligations. Subsection (a) requires healthcare insurers to disclose — via an applied model card — the strengths, limitations, known biases, and performance variability of AI-based algorithms used in utilization review. The disclosure must reach the Insurance Commissioner, in-network providers, enrollees, and the general public (via the insurer's website). The required content is detailed: algorithm criteria, training data sets and bias mitigation, the algorithm itself, applied use case descriptions, workflow outcomes, and any independent third-party validation results.
Subsection (b) addresses data governance. Insurers must use federated data-sharing models to minimize centralization, comply with national interoperability standards (FHIR, USCDI), align AI training and validation data with the Trusted Exchange Framework and Common Agreement privacy standards, and establish mechanisms to obtain explicit enrollee consent for use of health data in AI development and validation. The effective date for the subsection (a) disclosure obligation is January 1, 2026.
(a) 3 If artificial intelligenceArtificial intelligence"Artificial intelligence" means a machine-based system that for a given set of human-defined objectives, can make predictions, recommendations, or decisions influencing real or virtual environments;Ark. Code § 23-63-2101(1)-based algorithms are used in the utilization review process, the artificial intelligenceArtificial intelligence"Artificial intelligence" means a machine-based system that for a given set of human-defined objectives, can make predictions, recommendations, or decisions influencing real or virtual environments;Ark. Code § 23-63-2101(1)-based algorithm recommendations shall be supported by an explanation, understandable at all literacy levels, of the rationale used by the healthcare insurerHealthcare insurer"Healthcare insurer" means an insurance company, hospital and medical service corporation, or health maintenance organization that issues or delivers health benefit plans in this state and is subject to: (i) The insurance laws of this state; (ii) Section 23-75-101 et seq., pertaining to hospital and medical service corporations; or (iii) Section 23-76-101 et seq., pertaining to health maintenance organizations. "Healthcare insurer" does not include an entity that provides only dental benefits or eye and vision care benefits;Ark. Code § 23-63-2101(4)-operated algorithm or system used in making a recommendation to deny, delay, or modify healthcare services covered under a health benefit planHealth benefit plan"Health benefit plan" means: (i) An individual, blanket, or group plan, or a policy or contract for healthcare services offered, issued, renewed, delivered, or extended in this state by a healthcare insurer; and (ii) A health benefit program receiving state or federal appropriations from the State of Arkansas, including the Arkansas Medicaid Program and the Arkansas Health and Opportunity for Me Program or any successor program. "Health benefit plan" includes: (i) Indemnity and managed care plans; and (ii) Nonfederal governmental plans as defined in 29 U.S.C. § 1002(32), as it existed on January 1, 2025. "Health benefit plan" does not include: (i) A plan that provides only dental benefits or eye and vision care benefits; (ii) A disability income plan; (iii) A credit insurance plan; (iv) Insurance coverage issued as a supplement to liability insurance; (v) A medical payment under an automobile or homeowners insurance plan; (vi) A health benefit plan provided under Arkansas Constitution, Article 5, § 32, the Workers' Compensation Law, § 11-9-101 et seq., or the Public Employee Workers' Compensation Act, § 21-5-601 et seq.; (vii) A plan that provides only indemnity for hospital confinement; (viii) An accident-only plan; (ix) A specified disease plan; or (x) A long-term-care-only plan;Ark. Code § 23-63-2101(3).
(b)(1)–(2) 4 A healthcare insurerHealthcare insurer"Healthcare insurer" means an insurance company, hospital and medical service corporation, or health maintenance organization that issues or delivers health benefit plans in this state and is subject to: (i) The insurance laws of this state; (ii) Section 23-75-101 et seq., pertaining to hospital and medical service corporations; or (iii) Section 23-76-101 et seq., pertaining to health maintenance organizations. "Healthcare insurer" does not include an entity that provides only dental benefits or eye and vision care benefits;Ark. Code § 23-63-2101(4) using an automated decision-making system shall identify and cite peer-reviewed studies assessing the automated decision-making system's accuracy measured against enrolleeEnrollee"Enrollee" means an individual who is entitled to receive healthcare services under the terms of a health benefit plan;Ark. Code § 23-63-2101(2) outcomes and the validity of automated decision-making systems. (2) The peer-reviewed studies under subdivision (b)(1) of this section shall be concordant or based on easily accessible evidence-based clinical guidelines, as opposed to proprietary healthcare insurerHealthcare insurer"Healthcare insurer" means an insurance company, hospital and medical service corporation, or health maintenance organization that issues or delivers health benefit plans in this state and is subject to: (i) The insurance laws of this state; (ii) Section 23-75-101 et seq., pertaining to hospital and medical service corporations; or (iii) Section 23-76-101 et seq., pertaining to health maintenance organizations. "Healthcare insurer" does not include an entity that provides only dental benefits or eye and vision care benefits;Ark. Code § 23-63-2101(4) criteria.
(b)(3) 5 An enrolleeEnrollee"Enrollee" means an individual who is entitled to receive healthcare services under the terms of a health benefit plan;Ark. Code § 23-63-2101(2) shall be provided a process for contesting enrolleeEnrollee"Enrollee" means an individual who is entitled to receive healthcare services under the terms of a health benefit plan;Ark. Code § 23-63-2101(2) outcomes.
This section requires that when AI-based algorithms are used in utilization review, every recommendation to deny, delay, or modify healthcare services must be accompanied by a plain-language explanation of the rationale, understandable at all literacy levels. Healthcare insurers must also identify and cite peer-reviewed studies assessing the automated decision-making system's accuracy against enrollee outcomes, and those studies must be concordant with publicly accessible evidence-based clinical guidelines rather than proprietary insurer criteria. Finally, enrollees must be provided a process for contesting outcomes — a due-process-style appeal right specific to AI-driven determinations.
(a) 6 A healthcare insurerHealthcare insurer"Healthcare insurer" means an insurance company, hospital and medical service corporation, or health maintenance organization that issues or delivers health benefit plans in this state and is subject to: (i) The insurance laws of this state; (ii) Section 23-75-101 et seq., pertaining to hospital and medical service corporations; or (iii) Section 23-76-101 et seq., pertaining to health maintenance organizations. "Healthcare insurer" does not include an entity that provides only dental benefits or eye and vision care benefits;Ark. Code § 23-63-2101(4) shall not make a decision regarding the care of enrolleesEnrollee"Enrollee" means an individual who is entitled to receive healthcare services under the terms of a health benefit plan;Ark. Code § 23-63-2101(2) based solely on the results derived from the use or application of artificial intelligenceArtificial intelligence"Artificial intelligence" means a machine-based system that for a given set of human-defined objectives, can make predictions, recommendations, or decisions influencing real or virtual environments;Ark. Code § 23-63-2101(1).
(b)(1)–(2) 7 A healthcare providerHealthcare provider"Healthcare provider" means a type of provider that renders healthcare services to patients for compensation, including a doctor of medicine or another licensed healthcare professional acting within the professional's licensed scope of practice;Ark. Code § 23-63-2101(5) who participates in a utilization review process for a healthcare insurerHealthcare insurer"Healthcare insurer" means an insurance company, hospital and medical service corporation, or health maintenance organization that issues or delivers health benefit plans in this state and is subject to: (i) The insurance laws of this state; (ii) Section 23-75-101 et seq., pertaining to hospital and medical service corporations; or (iii) Section 23-76-101 et seq., pertaining to health maintenance organizations. "Healthcare insurer" does not include an entity that provides only dental benefits or eye and vision care benefits;Ark. Code § 23-63-2101(4) that initially uses artificial intelligenceArtificial intelligence"Artificial intelligence" means a machine-based system that for a given set of human-defined objectives, can make predictions, recommendations, or decisions influencing real or virtual environments;Ark. Code § 23-63-2101(1)-based algorithms for a utilization review determination shall: (1) Ensure that a utilization review entity guarantees that an initial adverse prior authorization determination or appeal of an adverse prior authorization determination or precertification determination is reviewed by a healthcare providerHealthcare provider"Healthcare provider" means a type of provider that renders healthcare services to patients for compensation, including a doctor of medicine or another licensed healthcare professional acting within the professional's licensed scope of practice;Ark. Code § 23-63-2101(5) who: (A) Possesses a current and valid nonrestricted license to practice medicine in this state; (B) Has experience treating patients with the medical condition or disease for which the healthcare service or supply is being requested under initial prior authorization determination or appeal; (C) Is not employed by a utilization review entity, is not under contract with a utilization review entity other than to participate in one (1) or more of the utilization review entity's healthcare providerHealthcare provider"Healthcare provider" means a type of provider that renders healthcare services to patients for compensation, including a doctor of medicine or another licensed healthcare professional acting within the professional's licensed scope of practice;Ark. Code § 23-63-2101(5) networks or to perform reviews of appeals, and does not otherwise have a financial interest in the outcome of the appeal; (D) Has not been directly involved in making the adverse determination; and (E)(i) Has considered known clinical aspects of the healthcare service under review, including without limitation: (a) A review of pertinent medical records provided to the utilization review entity by the enrolleeEnrollee"Enrollee" means an individual who is entitled to receive healthcare services under the terms of a health benefit plan;Ark. Code § 23-63-2101(2)'s healthcare providerHealthcare provider"Healthcare provider" means a type of provider that renders healthcare services to patients for compensation, including a doctor of medicine or another licensed healthcare professional acting within the professional's licensed scope of practice;Ark. Code § 23-63-2101(5); (b) Relevant records provided to the utilization review entity by a healthcare facility; and (c) Medical literature provided to the utilization review entity by the healthcare providerHealthcare provider"Healthcare provider" means a type of provider that renders healthcare services to patients for compensation, including a doctor of medicine or another licensed healthcare professional acting within the professional's licensed scope of practice;Ark. Code § 23-63-2101(5). (ii) If the decision is an adverse determination, the healthcare providerHealthcare provider"Healthcare provider" means a type of provider that renders healthcare services to patients for compensation, including a doctor of medicine or another licensed healthcare professional acting within the professional's licensed scope of practice;Ark. Code § 23-63-2101(5) shall complete and sign the denial notice, providing the required information described under this subdivision (b)(1); and (2) Open and document the review of the individual clinical records or data before the individualized documented decision of a denial.
(c) 8 The healthcare insurerHealthcare insurer"Healthcare insurer" means an insurance company, hospital and medical service corporation, or health maintenance organization that issues or delivers health benefit plans in this state and is subject to: (i) The insurance laws of this state; (ii) Section 23-75-101 et seq., pertaining to hospital and medical service corporations; or (iii) Section 23-76-101 et seq., pertaining to health maintenance organizations. "Healthcare insurer" does not include an entity that provides only dental benefits or eye and vision care benefits;Ark. Code § 23-63-2101(4) shall submit to the Insurance Commissioner, in the form and manner as the commissioner may require, data on the amount of time a human reviewer spends examining an adverse organizational determination before signing off on each denial under subsection (b) of this section.
(d) 6 An artificial intelligenceArtificial intelligence"Artificial intelligence" means a machine-based system that for a given set of human-defined objectives, can make predictions, recommendations, or decisions influencing real or virtual environments;Ark. Code § 23-63-2101(1)-based algorithm shall not be the sole basis of a decision to deny, delay, or modify healthcare services based in whole or in part on medical necessity.
(e) 9 An adverse determination of medical necessity shall be made only by a healthcare providerHealthcare provider"Healthcare provider" means a type of provider that renders healthcare services to patients for compensation, including a doctor of medicine or another licensed healthcare professional acting within the professional's licensed scope of practice;Ark. Code § 23-63-2101(5) or a licensed healthcare professional competent to evaluate the specific clinical issues involved in the healthcare services requested by the healthcare providerHealthcare provider"Healthcare provider" means a type of provider that renders healthcare services to patients for compensation, including a doctor of medicine or another licensed healthcare professional acting within the professional's licensed scope of practice;Ark. Code § 23-63-2101(5) as required under subdivision (b)(1) of this section, by reviewing and considering the requesting healthcare providerHealthcare provider"Healthcare provider" means a type of provider that renders healthcare services to patients for compensation, including a doctor of medicine or another licensed healthcare professional acting within the professional's licensed scope of practice;Ark. Code § 23-63-2101(5)'s recommendation, the enrolleeEnrollee"Enrollee" means an individual who is entitled to receive healthcare services under the terms of a health benefit plan;Ark. Code § 23-63-2101(2)'s medical or other clinical history, as applicable, and individual clinical circumstances.
(f) 10 A healthcare insurerHealthcare insurer"Healthcare insurer" means an insurance company, hospital and medical service corporation, or health maintenance organization that issues or delivers health benefit plans in this state and is subject to: (i) The insurance laws of this state; (ii) Section 23-75-101 et seq., pertaining to hospital and medical service corporations; or (iii) Section 23-76-101 et seq., pertaining to health maintenance organizations. "Healthcare insurer" does not include an entity that provides only dental benefits or eye and vision care benefits;Ark. Code § 23-63-2101(4) that uses clinical supervision of artificial intelligenceArtificial intelligence"Artificial intelligence" means a machine-based system that for a given set of human-defined objectives, can make predictions, recommendations, or decisions influencing real or virtual environments;Ark. Code § 23-63-2101(1) under this section shall provide ongoing education and certification, if applicable, for a clinician reviewing artificial intelligenceArtificial intelligence"Artificial intelligence" means a machine-based system that for a given set of human-defined objectives, can make predictions, recommendations, or decisions influencing real or virtual environments;Ark. Code § 23-63-2101(1) determinations to ensure the clinician's ability to critically assess artificial intelligenceArtificial intelligence"Artificial intelligence" means a machine-based system that for a given set of human-defined objectives, can make predictions, recommendations, or decisions influencing real or virtual environments;Ark. Code § 23-63-2101(1) outputs.
This is the bill's central human-oversight section. Subsection (a) flatly prohibits healthcare insurers from making care decisions based solely on AI results. Subsection (d) reiterates that an AI-based algorithm may not be the sole basis for denying, delaying, or modifying healthcare services based on medical necessity. Subsection (b) sets detailed requirements for the clinical reviewer of adverse prior authorization determinations: the reviewer must be a licensed, non-restricted physician with relevant clinical experience, must be independent of the utilization review entity, must not have been involved in the initial adverse determination, and must review individual clinical records including medical records, facility records, and medical literature before signing the denial notice. Subsection (e) requires that adverse medical-necessity determinations be made only by a qualified clinical professional who reviews the treating provider's recommendation and the enrollee's individual clinical history. Subsection (c) requires submission of human-review time data to the Insurance Commissioner. Subsection (f) requires ongoing clinician education and certification for those reviewing AI outputs.
(a)–(b) The Insurance Commissioner may audit at any time a healthcare insurerHealthcare insurer"Healthcare insurer" means an insurance company, hospital and medical service corporation, or health maintenance organization that issues or delivers health benefit plans in this state and is subject to: (i) The insurance laws of this state; (ii) Section 23-75-101 et seq., pertaining to hospital and medical service corporations; or (iii) Section 23-76-101 et seq., pertaining to health maintenance organizations. "Healthcare insurer" does not include an entity that provides only dental benefits or eye and vision care benefits;Ark. Code § 23-63-2101(4)'s automated utilization management system. (b) The commissioner may contract with a third-party entity to perform an audit under subsection (a) of this section.
(c)(1) 11 A healthcare insurerHealthcare insurer"Healthcare insurer" means an insurance company, hospital and medical service corporation, or health maintenance organization that issues or delivers health benefit plans in this state and is subject to: (i) The insurance laws of this state; (ii) Section 23-75-101 et seq., pertaining to hospital and medical service corporations; or (iii) Section 23-76-101 et seq., pertaining to health maintenance organizations. "Healthcare insurer" does not include an entity that provides only dental benefits or eye and vision care benefits;Ark. Code § 23-63-2101(4) that uses an automated decision-making system shall: (1) Engage in a regular system audit to ensure use of the automated decision-making system is not increasing overall or disparate claims denials or coverage limitations or otherwise decreasing access to care;
(c)(2) 12 Publish statistics regarding the automated decision-making systems' approval, denial, and appeal rates on the payor's website or another publicly available website in a readily accessible format with enrolleeEnrollee"Enrollee" means an individual who is entitled to receive healthcare services under the terms of a health benefit plan;Ark. Code § 23-63-2101(2) population demographics to report and contextualize equity implications of automated decisions.
This section creates two tracks of audit oversight. First, the Insurance Commissioner has standing authority to audit any healthcare insurer's automated utilization management system at any time, with the option to contract with third-party auditors. Second, healthcare insurers using automated decision-making systems must themselves conduct regular internal audits to ensure the system is not increasing overall or disparate claims denials, coverage limitations, or otherwise decreasing access to care. Insurers must also publicly publish statistics on the system's approval, denial, and appeal rates broken out by enrollee population demographics to contextualize equity implications.
(a)(1)–(2) 13 A healthcare insurerHealthcare insurer"Healthcare insurer" means an insurance company, hospital and medical service corporation, or health maintenance organization that issues or delivers health benefit plans in this state and is subject to: (i) The insurance laws of this state; (ii) Section 23-75-101 et seq., pertaining to hospital and medical service corporations; or (iii) Section 23-76-101 et seq., pertaining to health maintenance organizations. "Healthcare insurer" does not include an entity that provides only dental benefits or eye and vision care benefits;Ark. Code § 23-63-2101(4) shall: (1) Reference publicly accessible internal coverage criteria that are based on current evidence in widely used treatment guidelines or clinical literature; or (2) Use artificial intelligenceArtificial intelligence"Artificial intelligence" means a machine-based system that for a given set of human-defined objectives, can make predictions, recommendations, or decisions influencing real or virtual environments;Ark. Code § 23-63-2101(1)-based algorithms solely to implement internal coverage criteria that have been made public and adopted in compliance with this subchapter.
(b)(1)–(2) 14 A healthcare insurerHealthcare insurer"Healthcare insurer" means an insurance company, hospital and medical service corporation, or health maintenance organization that issues or delivers health benefit plans in this state and is subject to: (i) The insurance laws of this state; (ii) Section 23-75-101 et seq., pertaining to hospital and medical service corporations; or (iii) Section 23-76-101 et seq., pertaining to health maintenance organizations. "Healthcare insurer" does not include an entity that provides only dental benefits or eye and vision care benefits;Ark. Code § 23-63-2101(4) shall not use artificial intelligenceArtificial intelligence"Artificial intelligence" means a machine-based system that for a given set of human-defined objectives, can make predictions, recommendations, or decisions influencing real or virtual environments;Ark. Code § 23-63-2101(1)-based algorithms that: (1) Rely on any information not in compliance with this section; or (2) Independently change or create coverage criteria.
This section constrains how insurers may use AI algorithms relative to their coverage criteria. Insurers must either reference publicly accessible internal coverage criteria based on current evidence in widely used treatment guidelines or clinical literature, or use AI algorithms solely to implement criteria that have been made public and adopted in compliance with the subchapter. AI algorithms may not rely on information not in compliance with these requirements and may not independently change or create coverage criteria — preventing insurers from using AI to shift coverage boundaries beyond what their published criteria authorize.
(a)(1)–(2) 15 A healthcare insurerHealthcare insurer"Healthcare insurer" means an insurance company, hospital and medical service corporation, or health maintenance organization that issues or delivers health benefit plans in this state and is subject to: (i) The insurance laws of this state; (ii) Section 23-75-101 et seq., pertaining to hospital and medical service corporations; or (iii) Section 23-76-101 et seq., pertaining to health maintenance organizations. "Healthcare insurer" does not include an entity that provides only dental benefits or eye and vision care benefits;Ark. Code § 23-63-2101(4) shall establish an ongoing, biannual quality assurance testing process that meets requirements established by rule by the Insurance Commissioner that specify defined parameters on safety and efficacy of an artificial intelligenceArtificial intelligence"Artificial intelligence" means a machine-based system that for a given set of human-defined objectives, can make predictions, recommendations, or decisions influencing real or virtual environments;Ark. Code § 23-63-2101(1)-based algorithm. (2) The requirements under subdivision (a)(1) of this section shall meet standardized benchmarks or definitions achieved by consensus-building at a national level.
(b) 16 A healthcare insurerHealthcare insurer"Healthcare insurer" means an insurance company, hospital and medical service corporation, or health maintenance organization that issues or delivers health benefit plans in this state and is subject to: (i) The insurance laws of this state; (ii) Section 23-75-101 et seq., pertaining to hospital and medical service corporations; or (iii) Section 23-76-101 et seq., pertaining to health maintenance organizations. "Healthcare insurer" does not include an entity that provides only dental benefits or eye and vision care benefits;Ark. Code § 23-63-2101(4) shall ensure that the artificial intelligenceArtificial intelligence"Artificial intelligence" means a machine-based system that for a given set of human-defined objectives, can make predictions, recommendations, or decisions influencing real or virtual environments;Ark. Code § 23-63-2101(1)-based algorithms used in the quality assurance testing process under subsection (a) of this section are consistent with state and federal antidiscrimination laws and meet certain parameters of safety and fairness.
(c)–(d) 17 A healthcare insurerHealthcare insurer"Healthcare insurer" means an insurance company, hospital and medical service corporation, or health maintenance organization that issues or delivers health benefit plans in this state and is subject to: (i) The insurance laws of this state; (ii) Section 23-75-101 et seq., pertaining to hospital and medical service corporations; or (iii) Section 23-76-101 et seq., pertaining to health maintenance organizations. "Healthcare insurer" does not include an entity that provides only dental benefits or eye and vision care benefits;Ark. Code § 23-63-2101(4) shall submit the results of the quality assurance testing under subsection (a) of this section to the commissioner at the time and in the form and manner as the commissioner may specify, but not less frequently than semiannually. (d) The results submitted under subsection (c) of this section shall be published on a public website within thirty (30) days of the submission of the results to the commissioner.
(e)(1)–(2) 15 Any quality assurance testing shall include: (1) Validation for generalizability as well as mechanisms to support local site testing, where necessary, and on-site monitoring applicability for artificial intelligenceArtificial intelligence"Artificial intelligence" means a machine-based system that for a given set of human-defined objectives, can make predictions, recommendations, or decisions influencing real or virtual environments;Ark. Code § 23-63-2101(1) solutions to ensure safety, robustness, adaptability, and fairness; and (2) Testing based on the risk level of the model's intended use, with higher-risk applications requiring more rigorous evaluation and monitoring.
(f)(1)–(2) 15 A healthcare insurerHealthcare insurer"Healthcare insurer" means an insurance company, hospital and medical service corporation, or health maintenance organization that issues or delivers health benefit plans in this state and is subject to: (i) The insurance laws of this state; (ii) Section 23-75-101 et seq., pertaining to hospital and medical service corporations; or (iii) Section 23-76-101 et seq., pertaining to health maintenance organizations. "Healthcare insurer" does not include an entity that provides only dental benefits or eye and vision care benefits;Ark. Code § 23-63-2101(4) shall build capabilities for generating and curating real-world evidence to ensure artificial intelligenceArtificial intelligence"Artificial intelligence" means a machine-based system that for a given set of human-defined objectives, can make predictions, recommendations, or decisions influencing real or virtual environments;Ark. Code § 23-63-2101(1)-based algorithms are tested for the highest standards for safety, accuracy, and reliability to identify potential risks. (2) All artificial intelligenceArtificial intelligence"Artificial intelligence" means a machine-based system that for a given set of human-defined objectives, can make predictions, recommendations, or decisions influencing real or virtual environments;Ark. Code § 23-63-2101(1) solutions shall undergo benchmarking against standardized metrics approved by the commissioner, including without limitation safety, efficacy, and reliability in representative enrolleeEnrollee"Enrollee" means an individual who is entitled to receive healthcare services under the terms of a health benefit plan;Ark. Code § 23-63-2101(2) populations from Arkansas.
(g)(1)–(4) 15 Quality assurance testing datasets under this section shall: (1) Be multi-institutional and representative of Arkansas's demographic makeup; (2) Explain data provenance and origin; (3) Contain relevant characteristics pertaining to the artificial intelligenceArtificial intelligence"Artificial intelligence" means a machine-based system that for a given set of human-defined objectives, can make predictions, recommendations, or decisions influencing real or virtual environments;Ark. Code § 23-63-2101(1) being used; and (4) Be updated regularly to ensure the highest quality data is used at all times.
(h) The commissioner shall allocate resources to federally qualified health centers, critical access hospitals, and rural clinics in this state to enable participation in quality assurance testing.
This section imposes a comprehensive biannual quality assurance testing regime. Healthcare insurers must establish an ongoing QA process meeting Insurance Commissioner-specified safety and efficacy parameters, aligned with nationally standardized benchmarks. Algorithms must be tested for consistency with antidiscrimination laws and safety and fairness parameters. Test results must be submitted to the Commissioner at least semiannually and published on a public website within 30 days. QA testing must include validation for generalizability, local site testing, on-site monitoring, and risk-level-based evaluation rigor. Insurers must build capabilities for generating real-world evidence and benchmark all AI solutions against commissioner-approved metrics in representative Arkansas enrollee populations. Testing datasets must be multi-institutional, representative of Arkansas demographics, explain data provenance, and be regularly updated. The Commissioner must allocate resources to FQHCs, critical access hospitals, and rural clinics to enable their participation.
(a)–(b) Except as provided in subsection (b) of this section, this subchapter applies to a healthcare insurerHealthcare insurer"Healthcare insurer" means an insurance company, hospital and medical service corporation, or health maintenance organization that issues or delivers health benefit plans in this state and is subject to: (i) The insurance laws of this state; (ii) Section 23-75-101 et seq., pertaining to hospital and medical service corporations; or (iii) Section 23-76-101 et seq., pertaining to health maintenance organizations. "Healthcare insurer" does not include an entity that provides only dental benefits or eye and vision care benefits;Ark. Code § 23-63-2101(4) offering a health benefit planHealth benefit plan"Health benefit plan" means: (i) An individual, blanket, or group plan, or a policy or contract for healthcare services offered, issued, renewed, delivered, or extended in this state by a healthcare insurer; and (ii) A health benefit program receiving state or federal appropriations from the State of Arkansas, including the Arkansas Medicaid Program and the Arkansas Health and Opportunity for Me Program or any successor program. "Health benefit plan" includes: (i) Indemnity and managed care plans; and (ii) Nonfederal governmental plans as defined in 29 U.S.C. § 1002(32), as it existed on January 1, 2025. "Health benefit plan" does not include: (i) A plan that provides only dental benefits or eye and vision care benefits; (ii) A disability income plan; (iii) A credit insurance plan; (iv) Insurance coverage issued as a supplement to liability insurance; (v) A medical payment under an automobile or homeowners insurance plan; (vi) A health benefit plan provided under Arkansas Constitution, Article 5, § 32, the Workers' Compensation Law, § 11-9-101 et seq., or the Public Employee Workers' Compensation Act, § 21-5-601 et seq.; (vii) A plan that provides only indemnity for hospital confinement; (viii) An accident-only plan; (ix) A specified disease plan; or (x) A long-term-care-only plan;Ark. Code § 23-63-2101(3) in this state. (b) This subchapter does not apply to a managed care entityManaged care entity"Managed care entity" means an insurance company, hospital or medical service plan, healthcare provider network, physician hospital organization, health maintenance organization, healthcare service corporation, employer or employee organization, or managed care contractor.Ark. Code § 23-63-2101(6) or healthcare service contractor that is: (1) Majority-owned or controlled by a nonprofit hospital, hospital system, or managed care entityManaged care entity"Managed care entity" means an insurance company, hospital or medical service plan, healthcare provider network, physician hospital organization, health maintenance organization, healthcare service corporation, employer or employee organization, or managed care contractor.Ark. Code § 23-63-2101(6); or (2) A nonprofit legal entity under 26 U.S.C. § 501(c) that provides a majority of covered professional services in a specific geographic area through employed healthcare providersHealthcare provider"Healthcare provider" means a type of provider that renders healthcare services to patients for compensation, including a doctor of medicine or another licensed healthcare professional acting within the professional's licensed scope of practice;Ark. Code § 23-63-2101(5) or a single contracted medical group.
This section defines the subchapter's scope. It applies to all healthcare insurers offering health benefit plans in Arkansas, with two carve-outs: the subchapter does not apply to managed care entities or healthcare service contractors that are (1) majority-owned or controlled by a nonprofit hospital, hospital system, or managed care entity, or (2) nonprofit 501(c) entities that provide a majority of covered professional services in a specific geographic area through employed providers or a single contracted medical group.
(1)–(4) If the Insurance Commissioner determines that a healthcare insurerHealthcare insurer"Healthcare insurer" means an insurance company, hospital and medical service corporation, or health maintenance organization that issues or delivers health benefit plans in this state and is subject to: (i) The insurance laws of this state; (ii) Section 23-75-101 et seq., pertaining to hospital and medical service corporations; or (iii) Section 23-76-101 et seq., pertaining to health maintenance organizations. "Healthcare insurer" does not include an entity that provides only dental benefits or eye and vision care benefits;Ark. Code § 23-63-2101(4) is not in compliance with this subchapter, the commissioner may impose: (1) A penalty, including without limitation: (A) A civil money penalty of not more than twenty-five thousand dollars ($25,000) for each determination of noncompliance; (B) A civil money penalty of not more than ten thousand dollars ($10,000) for each week beginning on and after the date on which a civil money penalty under subdivision (a)(1)(A) of this section is imposed by the commissioner during which the deficiency that is the basis of a determination of noncompliance exists; and (C) Suspension of enrollment of individuals in health benefit plansHealth benefit plan"Health benefit plan" means: (i) An individual, blanket, or group plan, or a policy or contract for healthcare services offered, issued, renewed, delivered, or extended in this state by a healthcare insurer; and (ii) A health benefit program receiving state or federal appropriations from the State of Arkansas, including the Arkansas Medicaid Program and the Arkansas Health and Opportunity for Me Program or any successor program. "Health benefit plan" includes: (i) Indemnity and managed care plans; and (ii) Nonfederal governmental plans as defined in 29 U.S.C. § 1002(32), as it existed on January 1, 2025. "Health benefit plan" does not include: (i) A plan that provides only dental benefits or eye and vision care benefits; (ii) A disability income plan; (iii) A credit insurance plan; (iv) Insurance coverage issued as a supplement to liability insurance; (v) A medical payment under an automobile or homeowners insurance plan; (vi) A health benefit plan provided under Arkansas Constitution, Article 5, § 32, the Workers' Compensation Law, § 11-9-101 et seq., or the Public Employee Workers' Compensation Act, § 21-5-601 et seq.; (vii) A plan that provides only indemnity for hospital confinement; (viii) An accident-only plan; (ix) A specified disease plan; or (x) A long-term-care-only plan;Ark. Code § 23-63-2101(3) offered by the healthcare insurerHealthcare insurer"Healthcare insurer" means an insurance company, hospital and medical service corporation, or health maintenance organization that issues or delivers health benefit plans in this state and is subject to: (i) The insurance laws of this state; (ii) Section 23-75-101 et seq., pertaining to hospital and medical service corporations; or (iii) Section 23-76-101 et seq., pertaining to health maintenance organizations. "Healthcare insurer" does not include an entity that provides only dental benefits or eye and vision care benefits;Ark. Code § 23-63-2101(4) on and after the date the commissioner notifies the healthcare insurer of a determination of noncompliance and until the commissioner is satisfied that the basis for the determination has been corrected and is not likely to recur; (2) Administrative fees, including a fee charged or allocated for collection activities conducted by the commissioner that will be passed on to a health benefit planHealth benefit plan"Health benefit plan" means: (i) An individual, blanket, or group plan, or a policy or contract for healthcare services offered, issued, renewed, delivered, or extended in this state by a healthcare insurer; and (ii) A health benefit program receiving state or federal appropriations from the State of Arkansas, including the Arkansas Medicaid Program and the Arkansas Health and Opportunity for Me Program or any successor program. "Health benefit plan" includes: (i) Indemnity and managed care plans; and (ii) Nonfederal governmental plans as defined in 29 U.S.C. § 1002(32), as it existed on January 1, 2025. "Health benefit plan" does not include: (i) A plan that provides only dental benefits or eye and vision care benefits; (ii) A disability income plan; (iii) A credit insurance plan; (iv) Insurance coverage issued as a supplement to liability insurance; (v) A medical payment under an automobile or homeowners insurance plan; (vi) A health benefit plan provided under Arkansas Constitution, Article 5, § 32, the Workers' Compensation Law, § 11-9-101 et seq., or the Public Employee Workers' Compensation Act, § 21-5-601 et seq.; (vii) A plan that provides only indemnity for hospital confinement; (viii) An accident-only plan; (ix) A specified disease plan; or (x) A long-term-care-only plan;Ark. Code § 23-63-2101(3) on a pro-rata basis and added to a civil money penalty under subdivision (a)(1) of this section collected from the health benefit planHealth benefit plan"Health benefit plan" means: (i) An individual, blanket, or group plan, or a policy or contract for healthcare services offered, issued, renewed, delivered, or extended in this state by a healthcare insurer; and (ii) A health benefit program receiving state or federal appropriations from the State of Arkansas, including the Arkansas Medicaid Program and the Arkansas Health and Opportunity for Me Program or any successor program. "Health benefit plan" includes: (i) Indemnity and managed care plans; and (ii) Nonfederal governmental plans as defined in 29 U.S.C. § 1002(32), as it existed on January 1, 2025. "Health benefit plan" does not include: (i) A plan that provides only dental benefits or eye and vision care benefits; (ii) A disability income plan; (iii) A credit insurance plan; (iv) Insurance coverage issued as a supplement to liability insurance; (v) A medical payment under an automobile or homeowners insurance plan; (vi) A health benefit plan provided under Arkansas Constitution, Article 5, § 32, the Workers' Compensation Law, § 11-9-101 et seq., or the Public Employee Workers' Compensation Act, § 21-5-601 et seq.; (vii) A plan that provides only indemnity for hospital confinement; (viii) An accident-only plan; (ix) A specified disease plan; or (x) A long-term-care-only plan;Ark. Code § 23-63-2101(3); (3) If the commissioner determines that a healthcare providerHealthcare provider"Healthcare provider" means a type of provider that renders healthcare services to patients for compensation, including a doctor of medicine or another licensed healthcare professional acting within the professional's licensed scope of practice;Ark. Code § 23-63-2101(5) or enrolleeEnrollee"Enrollee" means an individual who is entitled to receive healthcare services under the terms of a health benefit plan;Ark. Code § 23-63-2101(2) was adversely affected by the noncompliance of the healthcare insurerHealthcare insurer"Healthcare insurer" means an insurance company, hospital and medical service corporation, or health maintenance organization that issues or delivers health benefit plans in this state and is subject to: (i) The insurance laws of this state; (ii) Section 23-75-101 et seq., pertaining to hospital and medical service corporations; or (iii) Section 23-76-101 et seq., pertaining to health maintenance organizations. "Healthcare insurer" does not include an entity that provides only dental benefits or eye and vision care benefits;Ark. Code § 23-63-2101(4), an amount necessary to compensate the healthcare providerHealthcare provider"Healthcare provider" means a type of provider that renders healthcare services to patients for compensation, including a doctor of medicine or another licensed healthcare professional acting within the professional's licensed scope of practice;Ark. Code § 23-63-2101(5) or enrolleeEnrollee"Enrollee" means an individual who is entitled to receive healthcare services under the terms of a health benefit plan;Ark. Code § 23-63-2101(2) for the harm attributable to the noncompliance that is not otherwise compensated and may require the healthcare insurerHealthcare insurer"Healthcare insurer" means an insurance company, hospital and medical service corporation, or health maintenance organization that issues or delivers health benefit plans in this state and is subject to: (i) The insurance laws of this state; (ii) Section 23-75-101 et seq., pertaining to hospital and medical service corporations; or (iii) Section 23-76-101 et seq., pertaining to health maintenance organizations. "Healthcare insurer" does not include an entity that provides only dental benefits or eye and vision care benefits;Ark. Code § 23-63-2101(4) to pay the amount, including appropriate interest, to the healthcare providerHealthcare provider"Healthcare provider" means a type of provider that renders healthcare services to patients for compensation, including a doctor of medicine or another licensed healthcare professional acting within the professional's licensed scope of practice;Ark. Code § 23-63-2101(5) or enrolleeEnrollee"Enrollee" means an individual who is entitled to receive healthcare services under the terms of a health benefit plan;Ark. Code § 23-63-2101(2) in addition to any other penalties under this section; or (4) Any other remedy available to the commissioner under state law.
This section gives the Insurance Commissioner a graduated enforcement toolkit. Upon a determination of noncompliance, the Commissioner may impose civil money penalties up to $25,000 per violation, with an additional $10,000 per week of continuing noncompliance. The Commissioner may also suspend enrollment in health benefit plans offered by the noncompliant insurer, impose administrative collection fees, and require compensatory payments (including interest) to adversely affected providers or enrollees. The Commissioner may also deploy any other remedy available under state law.
(a)–(b) Except as provided in subsection (b) of this section, a writing or other agreement shall not contain a provision that constitutes a waiver, modification, or nullification of a requirement or remedy under this subchapter. (b) This section does not prohibit a writing or other agreement that grants to a healthcare providerHealthcare provider"Healthcare provider" means a type of provider that renders healthcare services to patients for compensation, including a doctor of medicine or another licensed healthcare professional acting within the professional's licensed scope of practice;Ark. Code § 23-63-2101(5) more protection or remedy than contained in this subchapter or a waiver given in settlement of a dispute or action.
This section makes the subchapter's protections non-waivable — no contract or agreement may waive, modify, or nullify any requirement or remedy. The sole exception is that agreements granting healthcare providers greater protections than the subchapter or waivers given in settlement of disputes are permitted.
(a)–(d) The Attorney General may bring a civil action in an appropriate court for declaratory or injunctive relief as is necessary to carry out this subchapter. (b) A person who is aggrieved by a violation of this subchapter may provide written notice of the violation to the Insurance Commissioner. (c) If the violation of this subchapter is not corrected within ninety (90) days after receipt of a notice under subsection (b) of this section, the aggrieved person may bring a civil action in an appropriate court for declaratory or injunctive relief with respect to the violation. (d) In a civil action under this section, the court may allow the prevailing party, other than the state, reasonable attorney's fees, including litigation expenses, and costs.
This section creates dual enforcement paths beyond the Commissioner's administrative authority. The Attorney General may bring a civil action for declaratory or injunctive relief. Any person aggrieved by a violation may provide written notice to the Insurance Commissioner, and if the violation is not corrected within 90 days, the aggrieved person may bring a civil action for declaratory or injunctive relief. The prevailing party (other than the state) may recover reasonable attorney's fees, litigation expenses, and costs. Notably, private plaintiffs are limited to equitable relief — no statutory or compensatory damages are available through the private right of action.
(1)–(2) The Insurance Commissioner may: (1) Collaborate with academic institutions and healthcare organizations to establish training programs for ethical artificial intelligenceArtificial intelligence"Artificial intelligence" means a machine-based system that for a given set of human-defined objectives, can make predictions, recommendations, or decisions influencing real or virtual environments;Ark. Code § 23-63-2101(1) deployment; and (2) Fund public-private partnerships to create education initiatives for a healthcare providerHealthcare provider"Healthcare provider" means a type of provider that renders healthcare services to patients for compensation, including a doctor of medicine or another licensed healthcare professional acting within the professional's licensed scope of practice;Ark. Code § 23-63-2101(5) to use artificial intelligenceArtificial intelligence"Artificial intelligence" means a machine-based system that for a given set of human-defined objectives, can make predictions, recommendations, or decisions influencing real or virtual environments;Ark. Code § 23-63-2101(1) tools.
This section grants the Insurance Commissioner discretionary authority — not a mandate on insurers — to collaborate with academic institutions and healthcare organizations to establish training programs for ethical AI deployment, and to fund public-private partnerships for provider AI education. Because it imposes no obligation on healthcare insurers, it creates no compliance duty.
(1)–(5) The Insurance Commissioner shall promulgate rules to: (1) Strengthen oversight and enforcement of existing rules to ensure health benefit planHealth benefit plan"Health benefit plan" means: (i) An individual, blanket, or group plan, or a policy or contract for healthcare services offered, issued, renewed, delivered, or extended in this state by a healthcare insurer; and (ii) A health benefit program receiving state or federal appropriations from the State of Arkansas, including the Arkansas Medicaid Program and the Arkansas Health and Opportunity for Me Program or any successor program. "Health benefit plan" includes: (i) Indemnity and managed care plans; and (ii) Nonfederal governmental plans as defined in 29 U.S.C. § 1002(32), as it existed on January 1, 2025. "Health benefit plan" does not include: (i) A plan that provides only dental benefits or eye and vision care benefits; (ii) A disability income plan; (iii) A credit insurance plan; (iv) Insurance coverage issued as a supplement to liability insurance; (v) A medical payment under an automobile or homeowners insurance plan; (vi) A health benefit plan provided under Arkansas Constitution, Article 5, § 32, the Workers' Compensation Law, § 11-9-101 et seq., or the Public Employee Workers' Compensation Act, § 21-5-601 et seq.; (vii) A plan that provides only indemnity for hospital confinement; (viii) An accident-only plan; (ix) A specified disease plan; or (x) A long-term-care-only plan;Ark. Code § 23-63-2101(3) compliance with applicable legal and contractual requirements for coverage and appeals; (2) Ensure compliance with quality and performance standards; (3) Ensure that health benefit planHealth benefit plan"Health benefit plan" means: (i) An individual, blanket, or group plan, or a policy or contract for healthcare services offered, issued, renewed, delivered, or extended in this state by a healthcare insurer; and (ii) A health benefit program receiving state or federal appropriations from the State of Arkansas, including the Arkansas Medicaid Program and the Arkansas Health and Opportunity for Me Program or any successor program. "Health benefit plan" includes: (i) Indemnity and managed care plans; and (ii) Nonfederal governmental plans as defined in 29 U.S.C. § 1002(32), as it existed on January 1, 2025. "Health benefit plan" does not include: (i) A plan that provides only dental benefits or eye and vision care benefits; (ii) A disability income plan; (iii) A credit insurance plan; (iv) Insurance coverage issued as a supplement to liability insurance; (v) A medical payment under an automobile or homeowners insurance plan; (vi) A health benefit plan provided under Arkansas Constitution, Article 5, § 32, the Workers' Compensation Law, § 11-9-101 et seq., or the Public Employee Workers' Compensation Act, § 21-5-601 et seq.; (vii) A plan that provides only indemnity for hospital confinement; (viii) An accident-only plan; (ix) A specified disease plan; or (x) A long-term-care-only plan;Ark. Code § 23-63-2101(3) compliance with this subchapter is not eroded by using artificial intelligenceArtificial intelligence"Artificial intelligence" means a machine-based system that for a given set of human-defined objectives, can make predictions, recommendations, or decisions influencing real or virtual environments;Ark. Code § 23-63-2101(1) tools, including auto-denial software; (4) Include continuous post-deployment monitoring of artificial intelligenceArtificial intelligence"Artificial intelligence" means a machine-based system that for a given set of human-defined objectives, can make predictions, recommendations, or decisions influencing real or virtual environments;Ark. Code § 23-63-2101(1) to ensure models maintain efficacy and safety; and (5) Establish a process for biannual reporting and public disclosure of quality assurance outcomes.
This section directs the Insurance Commissioner to promulgate implementing rules covering five areas: strengthening oversight and enforcement of existing compliance requirements, ensuring quality and performance standards compliance, ensuring AI tools do not erode subchapter compliance (including auto-denial software), requiring continuous post-deployment AI monitoring for efficacy and safety, and establishing biannual reporting and public disclosure of quality assurance outcomes. This is a rulemaking directive to the Commissioner rather than a direct obligation on insurers, though the resulting rules will generate obligations.