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Insurance Coverage Pediatric Neuropsychiatric Syndrome

Concerning requiring health-care coverage for pediatric acute-onset neuropsychiatric syndrome, and, in connection therewith, making an appropriation.
2024 Regular Session
Health Care & Health Insurance
Bill Summary

To the extent the coverage is not in addition to the benefits provided pursuant to the health insurance benchmark plan, the bill requires all individual and group health benefit plans to provide health insurance coverage for pediatric acute-onset neuropsychiatric syndrome (PANS) and includes pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections (PANDAS).

The coverage provided for PANS and PANDAS includes antibiotics, medication and psychological and behavioral therapies to manage neuropsychiatric symptoms, immunomodulating medicines, plasma exchange, and intravenous immunoglobulin therapy if certain conditions are met.

The mandatory coverage provision applies to large group policies and contracts issued or renewed in this state on or after January 1, 2025. For individual and small group policies and contracts issued on or after January 1, 2026, the mandatory coverage provision applies if the division of insurance in the department of regulatory agencies receives confirmation from the federal department of health and human services that the coverage requirement does not require state defrayal of any increased cost for the coverage.

(Note: Italicized words indicate new material added to the original summary; dashes through words indicate deletions from the original summary.)

(Note: This summary applies to the reengrossed version of this bill as introduced in the second house.)


Became Law


Bill Text

The effective date for bills enacted without a safety clause is August 7, 2024, if the General Assembly adjourns sine die on May 8, 2024, unless otherwise specified. Details