2019 Arkansas Code
Title 23 - Public Utilities and Regulated Industries
Subtitle 3 - Insurance
Chapter 99 - Healthcare Providers
Subchapter 9 - Limitation on Financial Penalties in Alternative Payment Systems
§ 23-99-902. Definitions
- As used in this subchapter:
(1) “Alternative payment system” means a payment methodology used by a healthcare payor that includes a risk-sharing or gain-sharing component for a healthcare provider that participates in a plan, program, or network offered by the healthcare payor;
(2) “Gain-sharing payment” means an increase in a payment or additional payments made by a healthcare payor to a healthcare provider as a result of the achievement of identified benchmarks, including without limitation that patient care costs fall below cost thresholds of any form;
(3)
(A) “Healthcare payor” means an entity that reimburses a physician for the delivery of healthcare services that are covered by a plan administered, issued, or delivered by the entity.
(B) “Healthcare payor” does not include a provider-based network or system that utilizes risk-sharing including an accountable care organization or a clinically integrated network;
(4) “Healthcare provider” means any type of provider that renders healthcare services to patients for compensation, including:
(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, including a hospital, ambulatory surgery center, or other type of facility licensed in this state to provide healthcare services; and
(5)
(A) “Risk-sharing payment” means a reduction in a payment to or refund of a payment already made to a healthcare provider as a result of failure to achieve identified benchmarks, including without limitation that patient care costs exceed cost thresholds of any form.
(B) “Risk-sharing payment” includes the alternative payment method by gift card, credit card, or other type of electronic payment or virtual credit card as payment if the healthcare provider is given clear instructions about how to select an alternative payment method that does not result in the healthcare provider's being charged a service fee to process.
