State News : Arkansas

On May 1, 2025, the Chief Administrative Law Judge of the Arkansas Workers’ Compensation Commission (“AWCC” or the “Commission”) held that the federal Airline Deregulation Act (“ADA”) preempts the AWCC’s authority to regulate reimbursement rates for air ambulance services provided to injured workers. Claimant Timothy Johnson, Emp., Respondent Ark. Dept. of Corr., Emp., Respondent Public Employee Claims Div., Carrier, Intervenor Survival Flight, Inc., No. H303158 (Ark. Work. Comp. Com., May 1, 2025). The ruling reversed an Order issued by a former Administrator of the AWCC’s Medical Cost Containment Division (“MCCD”) which compelled the Arkansas Public Employee Claims Division (“PECD”) to pay an air ambulance provider, Survival Flight, nearly double the amount that PECD had initially paid Survival Flight for the air ambulance services they provided to a state employee.  

Pursuant to A.C.A. §11-9-517 and Rule 30, the MCCD was established to implement a medical cost containment program. One of the MCCD’s primary functions is to review and resolve disputes regarding bills between carriers and providers. The AWCC’s Official Fee Schedule lists the maximum allowable payment for the majority of medical services provided to treat injured workers; however, in instances where the AWCC has not specified the maximum allowable fee for a medical service, the MCCD is responsible for determining what constitutes a reasonable reimbursement rate. For administrative review of disputed bills for air ambulance services, which are not addressed in the AWCC’s Official Fee Schedule, the MCCD has historically determined reasonable ambulance rates by conducting annual surveys of the rates charged by Arkansas emergency medical services (“EMS”) providers for individual procedure codes and determining the average charged for each code which constitutes the reasonable allowable amount.

At issue in this case was Survival Flight’s bill for the air ambulance services provided to the claimant after a compensable work accident. Because PECD’s bill review company had advised PECD to only pay 3x the Medicare reimbursement rate for the air ambulance services provided rather than the $44,130.66 that Survival Flight had charged them, Survival Flight asked the MCCD to perform an administrative review of the disputed bill and to determine the reasonable payable amount for the air ambulance services they had provided. After reviewing the amounts charged for each procedure code that was listed in Survival Flight’s bill and comparing those amounts with the average amounts charged by Arkansas EMS providers for the same procedure codes, the MCCD’s Administrator ruled that it was reasonable for PECD to be required to pay an additional $22,188.17 on top of the $21,273.00  they had already paid to Survival Flight for its ambulance services. When PECD filed an appeal of the Administrator’s Order, Judge Fine carefully considered the statutory preemption language in the ADA and opinions filed by the U.S. Supreme Court and the Eighth Circuit Court of Appeals in which they repeatedly found that state laws and state causes of action which attempted to regulate or otherwise impose limitations upon prices charged by air carriers for air transportation services were preempted under the ADA  because they effectively attempted to undo federal deregulation that Congress had enacted to promote efficiency, innovation, and low prices in the airline industry. After reviewing the law and the MCCD Administrator’s Order, Judge Fine ultimately found that the authority of the AWCC and MCCD to regulate the allowable rates for air ambulance services is preempted by the Airline Deregulation Act and therefore reversed the MCCD’s Administrative Review Order that attempted to compel PECD to pay an additional $22,188.17 to Survival Flight.