§ 23-99-203 - Definitions. - Arkansas Statutes

23-99-203. Definitions.

(a) (1) "Copayment" means a type of cost sharing whereby insured or covered persons pay a specified predetermined amount per unit of service or percentage of health care costs with their health care insurer paying the remainder of the charge.

(2) The copayment is incurred at the time the service is rendered.

(3) The copayment may be a fixed or variable amount.

(b) "Gatekeeper system" means a system of administration used by any health benefit plan in which a primary care provider furnishes basic patient care and coordinates diagnostic testing, indicated treatment, and specialty referral for persons covered by the health benefit plan.

(c) "Health benefit plan" means any entity or program that provides reimbursement, including capitation, for health care services, except and excluding any entity or program that provides reimbursement and benefits pursuant to Arkansas Constitution, Amendment 26, Acts 1993, No. 796, or the Public Employee Workers' Compensation Act, 21-5-601 et seq., and rules, regulations, and schedules adopted thereunder.

(d) "Health care provider" means those individuals or entities licensed by the State of Arkansas to provide health care services, limited to the following:

(1) Advanced practice nurses;

(2) Athletic trainers;

(3) Audiologists;

(4) Certified orthotists;

(5) Chiropractors;

(6) Community mental health centers or clinics;

(7) Dentists;

(8) Home health care;

(9) Hospice care;

(10) Hospital-based services;

(11) Hospitals;

(12) Licensed ambulatory surgery centers;

(13) Licensed certified social workers;

(14) Licensed dieticians;

(15) Licensed professional counselors;

(16) Licensed psychological examiners;

(17) Long-term care facilities;

(18) Occupational therapists;

(19) Optometrists;

(20) Pharmacists;

(21) Physical therapists;

(22) Physicians and surgeons (M.D. and D.O.);

(23) Podiatrists;

(24) Prosthetists;

(25) Psychologists;

(26) Respiratory therapists;

(27) Rural health clinics; and

(28) Speech pathologists.

(e) "Health care services" means services and products provided by a health care provider within the scope of the provider's license.

(f) "Health care insurer" means any entity, including, but not limited to:

(1) Insurance companies;

(2) Hospital and medical service corporations;

(3) Health maintenance organizations;

(4) Preferred provider organizations;

(5) Physician hospital organizations;

(6) Third party administrators; and

(7) Prescription benefit management companies,

authorized to administer, offer, or provide health benefit plans.