Relating to health insurance coverage for specified pediatric autoimmune neuropsychiatric disorders and postinfectious autoimmune encephalopathy

This bill relates to health insurance coverage for pediatric acute-onset neuropsychiatric syndrome (PANS), pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS), and postinfectious autoimmune encephalopathy. The bill defines “PANS” as a clinically defined disorder characterized by the sudden onset of obsessive-compulsive symptoms or eating restrictions accompanied by two or more symptoms of either one or both of acute behavioral deterioration and motor and sensory changes. “PANDAS” is defined as a term used to describe a subset of children and adolescents within the broader PANS classification. 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, PANDAS, and postinfectious autoimmune encephalopathy as recommended by a covered person’s health care professional as medically necessary and that is consistent with the standard of medical care and protocols established in collaboration with the national institute of mental health, the children’s postinfectious autoimmune encephalopathy center of excellence, and the PANDAS physicians network. Treatment may include but is not limited to antibiotics, drugs and behavioral therapies to manage neuropsychiatric symptoms, plasma exchange, and immunoglobulin. Additional requirements concerning the coverage are detailed in the bill. The bill shall not be construed to prohibit a health carrier from requesting treatment notes, and anticipated treatment duration outcome information, from a covered person’s health care professional. 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, 2026, 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.