Bill S.251, introduced by Senator Chittenden, aims to mandate health insurance coverage for the diagnosis and treatment of Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) and Pediatric Acute-onset Neuropsychiatric Syndrome (PANS). The bill adds a new section to Vermont's health insurance laws, specifically 8 V.S.A. 4085, which outlines definitions for PANDAS and PANS, and requires health insurance plans to cover medically necessary treatments prescribed by healthcare professionals. These treatments include antibiotics, medication therapy, mental health services, immunomodulating medicines, plasma exchange, and intravenous immunoglobulin therapy. Additionally, the bill stipulates that coverage for these conditions must align with current clinical practice guidelines and cannot impose higher cost-sharing requirements than those for other physical or mental health conditions.

The bill also addresses coding for billing and diagnosis, allowing PANDAS and PANS to be coded as autoimmune encephalitis until specific codes are established by the American Medical Association and the Centers for Medicare and Medicaid Services. Once these codes are available, PANDAS and PANS can be coded accordingly. The act is set to take effect on January 1, 2027, and will apply to all health insurance plans issued or renewed on or after that date, but no later than January 1, 2028.