Proyectos de ley › 89.ª Asamblea General
Relating to health care benefits coverage for specified pediatric autoimmune neuropsychiatric disorders
Temas:Health careInsurance
La misma legislación: SSB 1200
Dónde está ahora
- Hecho: Presentado26 de enero de 2021
- Hecho: Subcomité1 de febrero de 2021
- Se detuvo: Comité del SenadoMurió al terminar la Asamblea General
- Sigue: Lo aprueba el Senado
- Sigue: Comité de la Cámara
- Sigue: Lo aprueba la Cámara
- Sigue: A gobernador(a)
- Sigue: Firmado como ley
Murió al terminar la sesión La sesión de 2022 terminó el 24 de mayo de 2022, 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, 2022, 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 1, 2021. On February 11, 2021 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
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 aged 18 or younger. The estimated cost across all State funds is approximately $65,000 to $350,000, assuming 13 to 14 children covered under the State of Iowa health insurance plan require specific treatments. There is no fiscal impact to the Department of Human Services or the Medicaid program. (en inglés)3
Lea la nota fiscal (en inglés)
Description
Senate File 165 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, 2022.
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 cost of SF 165 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 · 3 de marzo de 2021 · $350,000
Lo que cambia del Código de Iowa (Iowa Code)
Crea§514C.36
Cabildeo
3 a favor · 4 en contra · 12 indecisos · Quiénes →
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Study bill
89th General Assembly
Earlier and later bills are matched by wording or an identical title.
Tried before
This idea has been filed in an earlier General Assembly. None became law, though one got through a chamber.
- SF 2084 Relating to health care benefits coverage for specified pediatric autoimmune neuropsychiat…88th General Assembly · Renumbered as SF 2301 · same titleCleared committee
- SF 2301 Relating to health care benefits coverage for specified pediatric autoimmune neuropsychiat…88th General Assembly · Passed Senate · same titlePassed a chamber
Matched by wording or an identical title.