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) and Medicaid, 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 provisions will apply to plans issued or renewed after specified dates in 2026.

The bill adds seven new sections across various chapters of the West Virginia Code, including provisions for both public and private health insurance plans. Each section emphasizes the requirement for prior authorization for coverage of the specified treatments, ensuring that physicians must show that alternative treatments have been attempted before intravenous immunoglobulin therapy can be approved. This legislative change is intended to enhance access to necessary medical care for affected pediatric patients while establishing a framework for insurance providers to follow.

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