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Arkansas Senate Bill SB181

Arkansas 2023 Regular Session

Arkansas Senate Bill SB181 Compare Versions

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11 Stricken language would be deleted from and underlined language would be added to present law.
2-Act 876 of the Regular Session
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54 State of Arkansas As Engrossed: S4/3/23 H4/5/23 1
65 94th General Assembly A Bill 2
76 Regular Session, 2023 SENATE BILL 181 3
87 4
98 By: Senator K. Hammer 5
109 By: Representative Warren 6
1110 7
1211 For An Act To Be Entitled 8
1312 AN ACT TO MANDATE CO VERAGE FOR USE OF IN TRAVENOUS 9
1413 IMMUNOGLOBULIN TO TR EAT PEDIATRIC ACUTE-ONSET 10
1514 NEUROPSYCHIATRIC SYN DROME OR PEDIATRIC A UTOIMMUNE 11
1615 NEUROPSYCHIATRIC DIS ORDERS ASSOCIATED WI TH 12
1716 STREPTOCOCCAL INFECT ION; TO DECLARE AN E MERGENCY; AND 13
1817 FOR OTHER PURPOSES. 14
1918 15
2019 16
2120 Subtitle 17
2221 TO MANDATE COVERAGE FOR USE OF 18
2322 INTRAVENOUS IMMUNOGLOBULIN TO TREAT 19
2423 CERTAIN PEDIATRIC DISORDERS CAUSED BY 20
2524 INFECTIONS; AND TO DECLARE AN EMERGENCY. 21
2625 22
2726 23
2827 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF ARKANSAS: 24
2928 25
3029 SECTION 1. Effective January 1, 2024, Arkansas Code § 23 -79-1903 is 26
3130 repealed. 27
3231 23-79-1903. Arkansas PANS/PANDAS Advisory Council — Creation — 28
3332 Membership — Duties. 29
3433 (a) There is created the Arkansas PANS/PANDAS Advisory Council to 30
3534 consist of the following members: 31
3635 (1) Two (2) members of the House of Representatives appointed by 32
3736 the Speaker of the House of Representatives; 33
3837 (2) Two (2) members of the Senate appointed by the President Pro 34
3938 Tempore of the Senate; 35
4039 (3) One (1) member who is a medical professional with two (2) 36 As Engrossed: S4/3/23 H4/5/23 SB181
4140
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4342
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4544 years of professional experience working with PANS/PANDAS patients, appointed 1
4645 by the Governor; 2
4746 (4) One (1) member who is a medical professional with two (2) 3
4847 years of professional experience working with PANS/PANDAS patients, appointed 4
4948 by the council; 5
5049 (5) The Secretary of the Department of Health or his or her 6
5150 designee, serving as an ex officio nonvoting member; 7
5251 (6) The Insurance Commissioner or his or her designee, serving 8
5352 as an ex officio nonvoting member; 9
5453 (7) Three (3) members appointed by the Governor who are employed 10
5554 by a public school district, one (1) member to be a public school nurse, one 11
5655 (1) member to be a public school counselor, and one (1) member to be a public 12
5756 school teacher; 13
5857 (8) One (1) member who is designated by the Arkansas Hospital 14
5958 Association, Inc.; 15
6059 (9) One (1) member who is designated by the Arkansas State Board 16
6160 of Nursing; 17
6261 (10) One (1) member who is designated by the Arkansas 18
6362 Pharmacist's Association; 19
6463 (11) One (1) member who is designated by the American Academy of 20
6564 Allergy, Asthma, and Immunology; 21
6665 (12) Two (2) members who are parents, appointed by the Governor; 22
6766 and 23
6867 (13) One (1) member who is designated by the Arkansas Medical, 24
6968 Dental, and Pharmaceutical Association, Inc. 25
7069 (b)(1) Upon appointment to the council, the initial members shall draw 26
7170 lots to determine the length of their terms. 27
7271 (2) Appointments shall be for a term of four (4) years. 28
7372 (3) Vacancies on the council shall be filled in the same manner 29
7473 as provided for the initial appointment. 30
7574 (4) The new appointee shall serve for the remainder of the 31
7675 unexpired term. 32
7776 (c) Members shall serve at the pleasure of the organizations they 33
7877 represent or of the Governor, as indicated. 34
7978 (d)(1) The President Pro Tempore of the Senate shall appoint the Chair 35
8079 of the Arkansas PANS/PANDAS Advisory Council who shall be one (1) of the 36 As Engrossed: S4/3/23 H4/5/23 SB181
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8584 legislative members of the council. 1
8685 (2) The Speaker of the House of Representatives shall appoint 2
8786 the Vice Chair of the Arkansas PANS/PANDAS Advisory Council who shall be one 3
8887 (1) of the legislative members of the council. 4
8988 (e)(1) A majority of the membership shall constitute a quorum. 5
9089 (2) A majority vote of those members present shall be required 6
9190 for any action of the council. 7
9291 (f)(1) The council shall meet as often as is deemed necessary by the 8
9392 chair. 9
9493 (2) The council shall meet at the State Capitol Building in 10
9594 Little Rock, Arkansas. 11
9695 (g) Legislators shall be paid per diem and mileage as authorized by 12
9796 law for attendance at meetings of interim committees of the General Assembly. 13
9897 (h)(1) The council shall receive staff support from the Bureau of 14
9998 Legislative Research. 15
10099 (2) The council shall receive assistance from the Children's 16
101100 Postinfectious Autoimmune Encephalopathy Center of Excellence at the 17
102101 University of Arizona Steele Children's Research Center with the preparation 18
103102 of any reports required by this subchapter. 19
104103 (i) The council may: 20
105104 (1) Make recommendations designed to improve and increase 21
106105 knowledge and develop mechanisms to increase clinical awareness and treatment 22
107106 throughout the state for pediatric acute-onset neuropsychiatric syndrome, 23
108107 also known as “PANS”, and pediatric autoimmune neuropsychiatric disorders 24
109108 associated with streptococcal infections, also known as “PANDAS”, especially 25
110109 for healthcare professionals; 26
111110 (2) Operate along with the interdisciplinary panel on 27
112111 PANS/PANDAS at the University of Arkansas for Medical Sciences to determine 28
113112 quarterly information, including case statistics, outcome measures, and other 29
114113 relevant information; 30
115114 (3) Make recommendations concerning standard practice guidelines 31
116115 for the diagnosis and treatment of PANS/PANDAS for adult and pediatric 32
117116 patients who have been diagnosed with PANS/PANDAS; 33
118117 (4) Provide outreach to educators and parents; 34
119118 (5) Develop a network of volunteer experts on PANS/PANDAS to 35
120119 serve as resources within this state; and 36 As Engrossed: S4/3/23 H4/5/23 SB181
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124123
125124 (6) Consider any related topics associated with the council's 1
126125 charge. 2
127126 (j)(1) The council shall report to the Senate Committee on Insurance 3
128127 and Commerce, the House Committee on Insurance and Commerce, the Senate 4
129128 Committee on Public Health, Welfare, and Labor, and the House Committee on 5
130129 Public Health, Welfare, and Labor, as requested. 6
131130 (2) The report described in subdivision (j)(1) of this section 7
132131 shall be submitted to the Legislative Council for final review. 8
133132 9
134133 SECTION 2. Arkansas Code § 23 -79-1904 is repealed. 10
135134 23-79-1904. Sunset. 11
136135 This subchapter shall expire on December 31, 2023, unless extended by 12
137136 the General Assembly. 13
138137 14
139138 SECTION 3. Arkansas Code § 23 -79-1905 is amended to read as follows: 15
140139 23-79-1905. Off-label use and coverage of drug treatment to treat 16
141140 pediatric acute-onset neuropsychiatric syndrome and pediatric autoimmune 17
142141 neuropsychiatric disorders associated with streptococcal infection — 18
143142 Legislative findings — Definitions. 19
144143 (a) The General Assembly finds that: 20
145144 (1) Pediatric acute -onset neuropsychiatric syndrome, also known 21
146145 as “PANS”, is a clinically defined disorder characterized by the sudden onset 22
147146 of obsessive-compulsive symptoms or eating restrictions, accom panied by two 23
148147 (2) or more symptoms of acute behavioral deterioration or motor and sensory 24
149148 changes, or both; 25
150149 (2) Pediatric autoimmune neuropsychiatric disorders associated 26
151150 with streptococcal infection, also known as “PANDAS”, is a term used to 27
152151 describe a subset of symptoms affecting children and adolescents within the 28
153152 broader PANS classification; 29
154153 (3) Other states may require coverage for off -label use of drug 30
155154 treatments to treat pediatric acute -onset neuropsychiatric syndrome and 31
156155 pediatric autoimmune n europsychiatric disorders associated with streptococcal 32
157156 infection; and 33
158157 (4) Arkansas does not require coverage for off -label use of drug 34
159158 treatments to treat patients who are diagnosed with pediatric acute -onset 35
160159 neuropsychiatric syndrome and pediatric aut oimmune neuropsychiatric disorders 36 As Engrossed: S4/3/23 H4/5/23 SB181
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165164 associated with streptococcal infections. 1
166165 (b) As used in this section: 2
167166 (1)(A) “Health benefit plan” means an individual, blanket, or 3
168167 any group plan, policy, or contract for healthcare services issued, renewed, 4
169168 or extended in this state by a healthcare insurer, health maintenance 5
170169 organization, hospital medical service corporation, or self -insured 6
171170 governmental or church plan in this state. 7
172171 (B) “Health benefit plan” includes: 8
173172 (i) A plan offered by a risk -based provider 9
174173 organization as established under the Medicaid Provider -Led Organized Care 10
175174 Act, § 20-77-2701 et seq.; 11
176175 (ii) Indemnity and managed care plans; and 12
177176 (iii) Plans providing health benefits to state and 13
178177 public school employees under § 21 -5-401 et seq. 14
179178 (C) “Health benefit plan” does not include: 15
180179 (i) A plan that provides only dental benefits or eye 16
181180 and vision care benefits; 17
182181 (ii) A disability income plan; 18
183182 (iii) A credit insurance plan; 19
184183 (iv) Insurance coverage issued as a s upplement to 20
185184 liability insurance; 21
186185 (v) Medical payments under an automobile or 22
187186 homeowners insurance plan; 23
188187 (vi) A health benefit plan provided under Arkansas 24
189188 Constitution, Article 5, § 32, the Workers' Compensation Law, § 11 -9-101 et 25
190189 seq., and the Public Employee Workers' Compensation Act, § 21 -5-601 et seq.; 26
191190 (vii) A plan that provides only indemnity for 27
192191 hospital confinement; 28
193192 (viii) An accident-only plan; or 29
194193 (ix) A specified disease plan; and 30
195194 (2)(A) “Healthcare insurer” means any i nsurance company, 31
196195 hospital and medical service corporation, or health maintenance organization 32
197196 that issues or delivers health benefit plans in this state and is subject to 33
198197 any of the following laws: 34
199198 (i) The insurance laws of this state; 35
200199 (ii) Section 23-75-101 et seq., pertaining to 36 As Engrossed: S4/3/23 H4/5/23 SB181
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205204 hospital and medical service corporations; 1
206205 (iii) Section 23-76-101 et seq., pertaining to 2
207206 health maintenance organizations; or 3
208207 (iv) A risk-based provider organization established 4
209208 under the Medicaid Provider -Led Organized Care Act, § 20 -77-2701 et seq. 5
210209 (B) “Healthcare insurer” does not include an entity that 6
211210 provides only dental benefits or eye and vision care benefits. 7
212211 (c)(1) A Except as provided in subsection (f) of this section, a 8
213212 health benefit plan th at is offered, issued, or renewed in this state, 9
214213 including a plan offered by a risk -based provider organization established 10
215214 under the Medicaid Provider -Led Organized Care Act, § 20 -77-2701 et seq., 11
216215 shall provide coverage for off -label use of intravenous im munoglobulin, also 12
217216 known as “IVIG”, to treat individuals diagnosed with pediatric acute -onset 13
218217 neuropsychiatric syndrome or pediatric autoimmune neuropsychiatric disorders 14
219218 associated with streptococcal infection, or both, on or after January 1, 15
220219 2022, under a patient-specific treatment plan established by the Childhood 16
221220 Post-infectious Autoimmune Encephalopathy Clinic established by the 17
222221 University of Arkansas for Medical Sciences in collaboration with Arkansas 18
223222 Children's Hospital consistent with established pr otocols and rules to be 19
224223 developed by the Insurance Commissioner, in consultation with the Childhood 20
225224 Post-infectious Autoimmune Encephalopathy Center of Excellence. 21
226225 (2) Rules to implement this subdivision have to be promulgated 22
227226 by August 31, 2023. 23
228227 (d) The coverage for off-label use of drug treatment to treat 24
229228 pediatric acute-onset neuropsychiatric syndrome and pediatric autoimmune 25
230229 neuropsychiatric disorders associated with streptococcal infection under this 26
231230 section: 27
232231 (1) May be subject to policy d eductions or copayment 28
233232 requirements and any standard prior authorization review of a healthcare 29
234233 insurer or a health benefit plan; and 30
235234 (2) Does not diminish or limit benefits otherwise allowable 31
236235 under a health benefit plan. 32
237236 (e) The Insurance Commission er shall develop and promulgate rules for 33
238237 the implementation and administration of this section. 34
239238 (f)(1)(A) A health benefit plan that is offered, issued, or renewed in 35
240239 this state shall provide coverage for the use of intravenous immunoglobulin 36 As Engrossed: S4/3/23 H4/5/23 SB181
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245244 to treat individuals diagnosed with pediatric acute-onset neuropsychiatric 1
246245 syndrome or pediatric autoimmune neuropsychiatric disorders associated with 2
247246 streptococcal infection, or both, on or after January 1, 2024, if the 3
248247 pediatric patient's primary care physician, in consultation with an Arkansas 4
249248 licensed pediatric psychiatrist and an Arkansas licensed physician who 5
250249 practices in at least one (1) pediatric subspecialty, including a 6
251250 neurologist, rheumatologist, or infectious disease physician who has treated 7
252251 the pediatric patient determines and agrees that the treatment is necessary 8
253252 and follows a patient-specific treatment plan. 9
254253 (B) A primary care physician may continue to consult with 10
255254 the Childhood Post-infectious Autoimmune Encephalopathy Center of Excellence. 11
256255 (C) The appeal process for a denial of coverage or adverse 12
257256 determination under this subdivision (f)(1): 13
258257 (i) Shall align with the normal appeal process of 14
259258 any other type of denial under the health benefit plan; and 15
260259 (ii) Applies to all health benefit plans. 16
261260 (2) Upon approval by the United States Food and Drug 17
262261 Administration of the use of intravenous immunoglobulin to treat individuals 18
263262 diagnosed with pediatric acute-onset neuropsychiatric syndrome or pediatric 19
264263 autoimmune neuropsychiatric disorders associated with streptococcal 20
265264 infection, or both, the Insurance Commissioner, with consultation and upon 21
266265 approval of the Arkansas State Medical Board and the Arkansas State Board of 22
267266 Pharmacy, shall adopt by rule a written statewide protocol that provides 23
268267 clarification that the consultation required under subdivision (f)(1) of this 24
269268 section and the patient-specific treatment plan required under subsection (c) 25
270269 of this section are no longer required for coverage under a health benefit 26
271270 plan. 27
272271 (g) A primary care physician who prescribes intravenous immunoglobulin 28
273272 to treat individuals diagnosed with pediatric acute-onset neuropsychiatric 29
274273 syndrome or pediatric autoimmune neuropsychiatric disorders associated with 30
275274 streptococcal infection, or both, shall report the data to the Childhood 31
276275 Post-infectious Autoimmune Encephalopathy Center of Excellence. 32
277276 33
278277 SECTION 4. EMERGENCY CLAUSE. It is found and determined by the 34
279278 General Assembly of the State of Arkansas that certain children in this state 35
280279 who are diagnosed with pediatric acute-onset neuropsychiatric syndrome or 36 As Engrossed: S4/3/23 H4/5/23 SB181
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285284 pediatric autoimmune neuropsychiatric disorders associated with streptococcal 1
286285 infection, or both, are receiving limited treatment options; that requiring 2
287286 healthcare insurers to provide coverage of intravenous immunoglobulin, also 3
288287 known as “IVIG”, to treat individuals diagnosed with pediatric acute-onset 4
289288 neuropsychiatric syndrome or pediatric autoimmune neuropsychiatric disorders 5
290289 associated with streptococcal infection, or both, could alleviate some 6
291290 symptoms; and that this act is immediately necessary to ensure that children 7
292291 receive the greatest chance to be healthy and live productive lives. 8
293292 Therefore, an emergency is declared to exist, and this act being immediately 9
294293 necessary for the preservation of the public peace, health, and safety shall 10
295294 become effective on: 11
296295 (1) The date of its approval by the Governor; 12
297296 (2) If the bill is neither approved nor vetoed by the Governor, 13
298297 the expiration of the period of time during which the Governor may veto th e 14
299298 bill; or 15
300299 (3) If the bill is vetoed by the Governor and the veto is 16
301300 overridden, the date the last house overrides the veto. 17
302301 18
303302 SECTION 5. TEMPORARY LANGUAGE. DO NOT CODIFY. Rules. 19
304303 (a) The Insurance Commissioner, in consultation with the Staff of the 20
305304 Childhood Post-infectious Autoimmune Encephalopathy Center of Excellence, 21
306305 shall promulgate rules necessary to implement Section 3 of this act. 22
307306 (b)(1) When adopting the initial rules to implement this act, the 23
308307 final rule shall be filed with the Secretary of State for adoption under § 24
309308 25-15-204(f): 25
310309 (A) On or before August 31, 2023; or 26
311310 (B) If approval under § 10-3-309 has not occurred by 27
312311 August 31, 2023, as soon as practicable after approval under § 10-3-309. 28
313312 (2) The commissioner shall file the proposed rule with the 29
314313 Legislative Council under § 10-3-309(c) sufficiently in advance of August 31, 30
315314 2023, so that the Legislative Council may consider the rule for approval 31
316315 before August 31, 2023. 32
317316 33
318317 /s/K. Hammer 34
319-APPROVED: 4/13/23 35
318+ 35
320319 36