Gold Card Provider Act 575 Update

Date: 03/21/25

In 2023, the Arkansas General Assembly passed Act 575, amending the 2015 Prior Authorization Transparency Act. Act 575 exempts certain healthcare providers who provide healthcare services from certain prior authorization requirements. In order to comply with the law, Arkansas Health and Wellness has developed a plan to reduce previously required prior authorizations.

This plan will be implemented on April 1, 2025, for the Marketplace product, Ambetter.  This includes both the AR Home and Federally Facilitated Marketplace members.

Beginning April 1, 2025, Ambetter will no longer require prior authorizations for the following services:

• Inpatient Services, including medical and behavioral health acute stays (excluding transplants)
• Sleep Studies
• Quantitative Urine Drug Testing
• Pain Management
• Genetic Testing and Molecular Pathology
• Neurostimulators
• Laboratory and Pathology, General Code
• Hearing Aids and Related Supplies
• Wheelchairs
• Medical Equipment and Supplies Otherwise Classified
• CPAPS and BIPAPS
• Nursing Visits
• PET Scans
• Oxygen Equipment and Supplies
• Diabetic Drugs and Supplies

To ensure members are receiving medically appropriate services, Ambetter will continue to require prior authorization for certain outpatient services and transplants in 2025. Ambetter’s “Prior Auth” tool, available on our public website, can be utilized to determine if a service requires a prior authorization. As a reminder, all services are still subject to medical necessity requirements utilizing InterQual guidelines and Arkansas Health & Wellness clinical policies. In addition, these changes are governed by Arkansas state law and the terms and conditions in your provider agreement.