Bills › 88th General Assembly
Relating to health care benefits coverage for specified pediatric autoimmune neuropsychiatric disorders
Topics:Health care
Same legislation: SF 2301
Where it is now
- Done: IntroducedJanuary 27, 2020
- Done: SubcommitteeFebruary 4, 2020
- Done: Senate committeeFebruary 18, 2020
- Skipped: Passes the SenateContinued as SF 2301
- Next: House committee
- Next: Passes the House
- Next: To the Governor
- Next: Signed into law
Became SF 2301 → Its progress continues under the new number. Go to SF 2301 What’s a funnel?
What’s in it
This bill relates to health care coverage benefits for pediatric acute-onset neuropsychiatric syndrome (PANS) and pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS). The bill defines “PANS” as a class of acute-onset obsessive compulsive or tic disorders or other behavioral changes presenting in a child that are not otherwise explained by another known neurologic or medical disorder. “PANDAS” is defined as a condition in which a streptococcal infection in a child causes the abrupt onset of clinically significant obsessions, compulsions, tics, or other neuropsychiatric symptoms or behavioral changes, or a relapsing and remitting course of symptom severity.
Read the full explanation
The bill requires a health carrier that offers individual, group, or small group contracts, policies, or plans in this state that provide for third-party payment or prepayment of health or medical expenses to offer coverage for the diagnosis and treatment of PANS and PANDAS as recommended by a health care professional for a covered person who is age or younger. The bill applies to third-party payment provider contracts, policies, or plans delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2021, by the third-party payment providers enumerated in the bill. The bill specifies the types of specialized health-related insurance which are not subject to the bill’s coverage requirements. The commissioner of insurance is required to adopt rules to administer the provisions of the bill.
Senate subcommittee
Named February 4, 2020. On February 5, 2020 it recommended amendment and passage.
Three legislators hear a bill first and recommend what the committee should do; it’s the best time to weigh in. How to take part
Fiscal note
AI summary This bill requires health insurance carriers to cover the diagnosis and treatment of PANS and PANDAS for individuals age 18 or younger. The estimated cost across all State funds ranges from approximately $65,000 to $350,000. This assumes between 13 and 14 children covered under the State of Iowa health insurance plan will require specific treatments.2
Read the fiscal note
Description
Senate File 2301 requires health insurance carriers that offer individual, group, or small group contracts, policies, or plans in the State that provide for third-party payment or prepayment of health or medical expenses to offer coverage for the diagnosis and treatment of PANS (pediatric acute-onset neuropsychiatric syndrome) and PANDAS (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections) to a covered individual who is age 18 or younger, as recommended by a health care professional. The Bill also requires the Insurance Division to adopt rules to administer the requirement for identified health insurance carriers. The Bill is effective January 1, 2021.
Background
PANS, which can be caused by infections such as influenza and varicella, and PANDAS, which is associated with streptococcal infections, may present in a neurologically severe manner that is resistant or slow to respond to forms of treatment used in mild to moderate cases. Intravenous immunoglobulin treatment (IVIG) or therapeutic plasma exchange may be clinically indicated for these severe cases.
Assumptions
- The exact prevalence of PANS and PANDAS is currently unknown; however, it is estimated that approximately 4.0% of individuals 18 years of age or younger have Obsessive-Compulsive Disorder (OCD) and that approximately 1.0% of these OCD cases are due to PANDAS/PANS. One estimate is that approximately 1 in 200 children has PANDAS/PANS.
- Approximately 13,400 children ages 18 and younger are covered under the State of Iowa health insurance plan.
- The cost of IVIG, therapeutic plasma exchange, and other associated treatments is estimated at $5,000 to $25,000 per case.
- Roughly 20.0% of PANDAS/PANS cases, per the incidence rate of associated behavioral disorders, may present in a severe manner that is unresponsive to other treatments.
Fiscal Impact
The fiscal impact of SF 2301 across all State funds ranges from approximately $65,000 to $350,000, assuming 13 to 14 children covered by the State of Iowa health insurance plan have exhausted other treatment protocols and are identified as candidates for IVIG or therapeutic plasma exchange. There is no fiscal impact to the Department of Human Services or the Medicaid program as Medicaid currently covers IVIG and therapeutic plasma exchange.
Sources
- Wellmark
- Department of Human Services
- Pediatric Autoimmune Neuropsychiatric Disorder, Insurance Coverage · February 19, 2020 · $350,000
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88th General Assembly
Picked up later
Earlier and later bills are matched by wording or an identical title.
Similar bills
- SF 165 Relating to health care benefits coverage for specified pediatric autoimmune neuropsychiat…89th General Assembly · Subcommittee recommends passageNearly identical
Matched by wording or an identical title.