23 CAR § 151-102 – Coverage requirement review

(a) Pursuant to Arkansas Code § 23-79-1905(c), a health benefit plan that is offered, issued, provided, or renewed in this state shall provide coverage for off-label use of intravenous immunoglobin (IVIG) to treat individuals diagnosed with pediatric acute-onset neuropsychiatric syndrome and pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection, or both, on or after January 1, 2022, under a patient-specific treatment plan consistent with protocols set forth in Appendix A of this part established in consultation with the Childhood Postinfectious Autoimmune Encephalopathy Center of Excellence.
(b)
1. (1) Pursuant to Arkansas Code § 23-79-1905(f) a health benefit plan that is offered, issued, or renewed in this state shall provide coverage for the use of intravenous immunoglobulin to treat individuals diagnosed with pediatric acute-onset neuropsychiatric syndrome or pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection, or both, on or after January 1, 2024, if the pediatric patient's primary care physician, in consultation with an Arkansas-licensed pediatric psychiatrist and an Arkansas-licensed physician who practices in at least one (1) pediatric subspecialty, including a neurologist, rheumatologist, or infectious disease physician, who has treated the pediatric patient determines and agrees that the treatment is necessary and follows a patient-specific treatment plan.
2. (2) A primary care physician may continue to consult with the Center of Excellence, and the appeal process for a denial of coverage or adverse determination under this section shall:
  1. (A) Align with the normal appeal process of any other type of denial under the health benefit plan; and
  2. (B) Apply to all plans.
(c) Coverage for off-label use of IVIG and associated drug treatment as set forth in this section above may be subject to policy deductions or copayment requirements of a healthcare insurer or health benefit plan, and such coverage for benefits shall not be diminished or limited as otherwise allowable under a health benefit plan.