The bill introduced by Representative Daniels aims to amend section 3902.50 and enact new sections 5.22108, 3902.65, and 5164.094 of the Revised Code to ensure that health plan issuers and the Medicaid program provide coverage for treatments and services related to Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) and Pediatric Acute-onset Neuropsychiatric Syndrome (PANS). Notably, the bill designates October 9th as "PANDAS and PANS Awareness Day" and outlines specific coverage requirements for diagnostic evaluations, immunomodulatory therapies, antimicrobial treatments, and therapeutic care, while prohibiting cost-sharing requirements that are less favorable than those for other medical benefits.

Additionally, the bill stipulates that coverage for PANDAS and PANS shall not be subject to step therapy protocols or prior authorization requirements, nor contingent upon the severity of a patient's symptoms or immunodeficiency status. If the state is required to cover any costs associated with this coverage under federal law, the requirements of the bill would become inoperative. The existing section 3902.50 of the Revised Code is also repealed as part of this legislative update.

Statutes affected:
As Introduced: 3902.50