StrickenHall languageof wouldthe beHouse deletedof fromRepresentatives and93rd underlinedGeneral languageAssembly would- beRegular addedSession, to2021 presentAmendment law.Form ______________________________________________________________________ Subtitle of Senate Bill No.

State639 ofTO ArkansasAUTHORIZE AsOFF-LABEL Engrossed:USE OF DRUG TREATMENTS TO TREAT PATIENTS DIAGNOSED WITH PEDIATRIC ACUTE-ONSET NEUROPSYCHIATRIC SYNDROME AND PEDIATRIC AUTOIMMUNE NEUROPSYCHIATRIC DISORDERS ASSOCIATED WITH STREPTOCOCCAL INFECTION.

S4/15/21______________________________________________________________________ H4/21/21Amendment 93rdNo. General Assembly A Bill Regular Session, 2021 SENATE BILL 639 5 By:

Senator1 K.to Senate Bill 639 Amend Senate Bill No.

Hammer639 By:as engrossed S4/15/21 (version:

Representative04/15/2021 Cloud01:46:18 8PM): For An Act To Be Entitled AN ACT TO AUTHORIZE OFF-LABEL USE OF DRUG TREATMENTS TO TREAT PATIENTS DIAGNOSED WITH PEDIATRIC ACUTE- ONSET NEUROPSYCHIATRIC SYNDROME AND PEDIATRIC AUTOIMMUNE NEUROPSYCHIATRIC DISORDERS ASSOCIATED WITH STREPTOCOCCAL INFECTION;

ANDPage FOR4, OTHERdelete PURPOSES.line 1, and substitute the following:

Subtitle"requirements TOand AUTHORIZEany OFF-LABELstandard USEprior OFauthorization DRUGreview TREATMENTSof TOa TREAThealthcare PATIENTSinsurer DIAGNOSEDor WITHa PEDIATRIChealth ACUTE-ONSETbenefit NEUROPSYCHIATRICplan; SYNDROME AND PEDIATRIC AUTOIMMUNE NEUROPSYCHIATRIC DISORDERS ASSOCIATED WITH STREPTOCOCCAL INFECTION.

BEand" IT*.ANS461* ENACTEDBy: BY THE GENERAL ASSEMBLY OF THE STATE OF ARKANSAS:

SECTIONRepresentative 1.Cloud_______________________________________________________________________________ ANS/ANS - 04-20-2021 08:33:12 _________________________ ANS461 Chief Clerk

Arkansas Code Title 23, Chapter 79, Subchapter 19, is amended to add an additional section to read as follows:

23-79-1903.

Off-label use of drug treatment to treat pediatric acute- onset neuropsychiatric syndrome and pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection — Legislative findings — Definitions.

(a) The General Assembly finds that:

(1) Pediatric acute-onset neuropsychiatric syndrome, also known as "PANS", is a clinically defined disorder characterized by the sudden onset of obsessive-compulsive symptoms or eating restrictions, accompanied by two *ANS396* 04-21-2021 10:48:25 ANS396 As Engrossed:

S4/15/21 H4/21/21 SB639 (2) or more symptoms of acute behavioral deterioration or motor and sensory changes, or both;

(2) Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection, also known as "PANDAS", is a term used to describe a subset of symptoms affecting children and adolescents within the broader PANS classification;

(3) Other states may require coverage for off-label use of drug treatments to treat pediatric acute-onset neuropsychiatric syndrome and pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection;

and (4) Arkansas does not require coverage for off-label use of drug treatments to treat patients who are diagnosed with pediatric acute-onset neuropsychiatric syndrome and pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections.

(b) As used in this section:

(1)(A) “Health benefit plan” means an individual, blanket, or any group plan, policy, or contract for healthcare services issued, renewed, or extended in this state by a healthcare insurer, health maintenance organization, hospital medical service corporation, or self-insured governmental or church plan in this state.

(B) “Health benefit plan” includes:

(i) A plan offered by a risk-based provider organization as established under the Medicaid Provider-Led Organized Care Act, § 20-77-2701 et seq.;

(ii) Indemnity and managed care plans;

and (iii) Plans providing health benefits to state and public school employees under § 21-5-401 et seq.

(C) “Health benefit plan” does not include:

(i) A plan that provides only dental benefits or eye and vision care benefits;

(ii) A disability income plan;

(iii) A credit insurance plan;

(iv) Insurance coverage issued as a supplement to liability insurance;

(v) Medical payments under an automobile or homeowners' insurance plan;

04-21-2021 10:48:25 ANS396 As Engrossed:

S4/15/21 H4/21/21 SB639 (vi) A health benefit plan provided 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.;

(vii) A plan that provides only indemnity for hospital confinement;

(viii) An accident-only plan;

or (ix) A specified disease plan;

and (2)(A) "Healthcare insurer" means any insurance company, hospital and medical service corporation, or health maintenance organization that issues or delivers health benefit plans in this state and is subject to any of the following laws:

(i) The insurance laws of this state;

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

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