The bill amends the General Laws to ensure that, starting January 1, 2023, all group health insurance contracts and policies in Rhode Island must provide coverage for the treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) and pediatric acute onset neuropsychiatric syndrome (PANS). This includes coverage for intravenous immunoglobulin therapy. For billing purposes, these conditions will be coded as autoimmune encephalitis until specific codes are established by the American Medical Association and the Centers for Medicare and Medicaid Services. The bill also mandates that coverage for these services is primarily applicable within Rhode Island, with provisions for out-of-state services if in-network options are unavailable.

Additionally, the bill requires health insurance carriers to collect and report data on the costs and savings associated with this coverage to the office of the health insurance commissioner. A cost-benefit analysis is to be submitted to the general assembly by January 1, 2025, to evaluate the financial impact of the coverage. Notably, the bill removes a previously included sunset clause that would have repealed the coverage requirement on December 31, 2025, indicating a commitment to maintaining these health benefits indefinitely.

Statutes affected:
5625: 27-18-90, 27-19-82, 27-20-78, 27-41-95