AR| Arkansas has adopted rules implementing the Vision Care Plan Act of 2015 (23 CAR Part 142), applying to insurers, vision benefit managers, vision care plans, vision care discount plans, and participating vision care providers, except for plans exempt from state regulation under federal law. The rules restrict contractual and reimbursement practices involving noncovered services and materials, provider supply choices, covered-service and covered-material reimbursement, and post-payment recoupment where a provider relied in good faith on eligibility verification. The notice provided does not state an effective date, so insurers should confirm the final rule’s effective date in the applicable Arkansas administrative-rule filing and ensure their operational and contractual compliance is in place by that date.
Key Points
- Revise eligibility and recoupment controls: When a provider customarily verifies eligibility, reasonably relies on that verification in good faith, and furnishes covered services or materials, do not withhold or recoup payment later solely because the enrollee is determined ineligible for the date of service.
- Update participating-provider agreements: Do not set provider fees for noncovered services or materials, avoid characterizing minimally reimbursed items as “covered” to evade that prohibition, and do not restrict providers’ optical-lab or supplier choices.
- Validate reimbursement practices: For covered services, pay at least the applicable current-year, nonfacility, locality-specific Medicare Physician Fee Schedule amount; for covered materials, ensure reimbursement is not nominal or de minimis.