Payment for services rendered by physical therapists, occupational therapists, and speech-language pathologists

1. Law
2. Arkansas Code
3. Public Utilities and Regulated Industries
4. Insurance
5. Insurance Policies Generally
6. General Provisions
7. Payment for services rendered by physical therapists, occupational therapists, and speech-language pathologists

1. (a) As used in this section:

   1. (1)

      1. (A) “Health benefit plan” means any group or blanket plan, policy, or contract for healthcare services issued or delivered in this state by healthcare insurers, including indemnity and managed care plans and the plans providing health benefits to state and public school employees under § 21-5-401 et seq., but excluding individual major medical plans and plans providing healthcare services under Arkansas Constitution, Article 5, § 32, the Workers' Compensation Law, § 11-9-101 et seq., and the Public Employee Workers' Compensation Act, § 21-5-601 et seq.

      2. (B) “Health benefit plan” does not include an accident-only, specified disease, hospital indemnity, Medicare supplement, long-term care, disability income, or other limited benefit health insurance policy;

   2. (2) “Healthcare insurer” means any insurance company, hospital and medical service corporation, or health maintenance organization issuing or delivering health benefit plans in this state and subject to any of the following laws:

      1. (A) The insurance laws of this state;

      2. (B) Section 23-75-101 et seq., pertaining to hospital and medical service corporations; and

      3. (C) Section 23-76-101 et seq., pertaining to health maintenance organizations;

   3. (3) “Licensed physical therapist, occupational therapist, or speech-language pathologist” means:

      1. (A) A physical therapist licensed under §§ 17-93-101 — 17-93-312;

      2. (B) An occupational therapist licensed under the Arkansas Occupational Therapy Practice Act, § 17-88-101 et seq.; and

      3. (C) A speech-language pathologist licensed under §§ 17-100-102 — 17-100-308; and

   4. (4) “Licensed primary care physician or osteopath” means a primary care physician and an osteopath licensed under §§ 17-80-101 — 17-95-505.

2. (b) An insurer shall not impose a copayment, coinsurance, or an office visit deductible amount or a combination of a copayment, coinsurance, or an office visit deductible amount charged to the insured for services rendered for a date of service by a licensed physical therapist, occupational therapist, or speech-language pathologist that is greater than the copayment, coinsurance, or office visit deductible amount charged to the insured for an office visit for the service of a licensed primary care physician or osteopath.

3. (c) An insurer shall state in its health benefit plan:

   1. (1) The availability of physical therapy, occupational therapy, or speech-language pathologist coverage under its plan; and

   2. (2) All related limitations, conditions, and exclusions.

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