Bills › 89th General Assembly
SSB 1200
Topics:Business & economy
Same legislation: SF 165
Where it is now
- Done: IntroducedJanuary 26, 2021
- Done: SubcommitteeFebruary 1, 2021
- Stopped: Senate committeeDied when the General Assembly ended
- Next: Passes the Senate
- Next: House committee
- Next: Passes the House
- Next: To the Governor
- Next: Signed into law
Died when the session ended The 2022 session adjourned on May 24, 2022, the General Assembly’s last regular session. Bills that didn’t pass both chambers died. What’s a funnel?
What’s in it
AI summary Health insurance companies in Iowa would be required to cover the diagnosis and treatment of PANS and PANDAS for children. These conditions involve sudden changes in behavior, such as tics or obsessive behaviors, following an infection or other medical cause. The new rules apply to most individual and group health plans offered in the state.1
Read the official explanation
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 bill.
Senate subcommittee
Named February 16, 2021. It hasn’t reported yet.
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 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.3
Read the fiscal note
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 · March 3, 2021 · $350,000
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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 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
Matched by wording or an identical title.