This bill aims to amend the Code of West Virginia by introducing new sections that mandate coverage for the treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome. Specifically, it requires that health insurance plans, including those under the Public Employees Insurance Act (PEIA), Medicaid, and other health insurance providers, provide coverage for intravenous immunoglobulin therapy for these conditions. However, coverage will only be granted if the insured's physician obtains prior authorization, demonstrating that all other treatment options have been exhausted.

The new provisions will take effect for plans issued or renewed after specific dates, including July 1, 2026, for PEIA and January 1, 2026, for Medicaid and other insurance plans. The bill emphasizes the importance of ensuring that patients have access to necessary treatments while also establishing a protocol for prior authorization to manage the use of these therapies effectively.

Statutes affected:
Introduced Version: 5-16-7h, 9-5-32, 33-15-4y, 33-16-3ii, 33-24-7z, 33-25-8w, 33-25A-8z
Committee Substitute: 5-16-7h, 9-5-34, 33-15-4y, 33-16-3ii, 33-24-7z, 33-25-8w, 33-25A-8z