Proyectos de ley › 88.ª Asamblea General
Relating to health care benefits coverage for specified pediatric autoimmune neuropsychiatric disorders
Presentado por el comité Human Resources del Senado
Temas:Health careInsurance
La misma legislación: SF 2084
Dónde está ahora
- Hecho: Presentado27 de enero de 2020
- Hecho: Subcomité4 de febrero de 2020
- Hecho: Comité del Senado18 de febrero de 2020
- Hecho: Lo aprueba el Senado10 de marzo de 202047–0
- Hecho: Comité de la Cámara3 de junio de 2020
- Se detuvo: Lo aprueba la CámaraMurió al terminar la Asamblea General
- Sigue: A gobernador(a)
- Sigue: Firmado como ley
Murió al terminar la sesión La sesión de 2020 terminó el 14 de junio de 2020, la última sesión ordinaria de la Asamblea General. Los proyectos que no pasaron por ambas cámaras murieron. ¿Qué es el embudo (funnel)?
Qué contiene
Resumen con IA Health insurance companies in Iowa would be required to cover the diagnosis and treatment of certain sudden behavioral and neurological conditions in children. These conditions, known as PANS and PANDAS, involve sudden changes in behavior or tics caused by medical issues. This rule applies to most individual and group health plans offered in the state. (Todavía no está traducido al español.)1
Lea la explicación oficial (en inglés)
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. 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.
House subcommittee
Named March 11, 2020. On March 16, 2020 it recommended 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
Nota fiscal
Cost: up to $350,000 Compare con otros proyectos
Resumen con IA 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. (en inglés)3
Lea la nota fiscal (en inglés)
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 · 19 de febrero de 2020 · $350,000
Lo que cambia del Código de Iowa (Iowa Code)
Crea§514C.35
Cabildeo
1 a favor · 3 en contra · 22 indecisos · Quiénes →
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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.