The bill amends the General Laws to require health insurance coverage for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) and pediatric acute onset neuropsychiatric syndrome (PANS) in Rhode Island. Starting January 1, 2023, all group health insurance contracts, hospital, or medical expense insurance policies, plans, or group policies delivered, issued for delivery, or renewed in the state must cover treatment for PANDAS and PANS, including intravenous immunoglobulin therapy. The conditions are to be coded as autoimmune encephalitis until specific codes are created. The coverage is limited to services within Rhode Island unless pre-authorization establishes that the necessary services are not available in-state from a network provider.

The bill also requires health insurance carriers to collect and report data on the costs and savings of adding this coverage to the office of the health insurance commissioner. A cost-benefit analysis is due by January 1, 2025, to assess if the coverage results in net savings. The original sunset clause, which would have ended the mandate on December 31, 2025, has been deleted, indicating the provisions are intended to continue indefinitely. The act will take effect upon passage.

Statutes affected:
2076: 27-18-90, 27-19-82, 27-20-78, 27-41-95